The Women She Left Behind

Early in 1938, a woman named Addie Odear in Lexington, Kentucky, wrote Eleanor Roosevelt a letter. Appealing to the first lady’s “graciousness and kindness,” she asked for advice “as to the proper way to proceed in a matter which is very close to my heart.” Two days after the letter arrived, a staff member in Roosevelt’s office considered the writer’s request: she worked at an institution that needed money to establish facilities to treat young women infected with syphilis, a prevalent and often asymptomatic sexually transmitted infection. The “fight against syphilis,” she wrote, “is the Lord’s work.”

Odear sat on the board of the Kentucky branch of the Florence Crittenton Mission, which ran dozens of residential institutions for women and girls across the United States. The Crittenton Homes, which operated from the 1890s until well into the twentieth century—some were still open in the 1980s—were lauded for compassionately “uplifting” unwed mothers and sex workers. The Crittenton name, gushed one account from the 1930s, “is synonymous with mercy and love and help for unfortunate girls in their most tragic hour.”

Over the last two decades, a number of the roughly 1.5 million former inmates have, with journalists and scholars, revealed that the homes were in fact sites of abuse where pregnant women were coerced into surrendering their children to adoption. Less well known is that many of the Crittenton homes also incarcerated women convicted or merely suspected of committing vaguely defined “morals” offenses, such as waywardness or vagrancy, as well as women considered likely to spread venereal diseases—namely syphilis or gonorrhea. Hence Addie Odear’s request: she wanted funds for “quarantine facilities,” she wrote, to which “syphilitic” young women could be committed, ostensibly voluntarily. Many such “voluntary” facilities, however, had long been used to incarcerate women that police and public health authorities merely suspected of having syphilis or gonorrhea—and a great many more would follow suit in the years to come.

Six days after Odear’s letter arrived at her office, Roosevelt forwarded it to Thomas Parran Jr., the US surgeon general, along with a note: “Is there any way in which these people could be helped?” Parran replied to the first lady that Odear’s letter “impresses me with the very great need for additional Federal assistance in dealing with the urgent problem which confronts the Florence Crittentone [sic] Home”—that is, “syphilitic” young women.

“You may recall that I talked with you last year concerning my hope that Federal assistance for venereal disease control could be provided,” he continued. He attached copies of several bills that, if passed, “would make possible a real national attack upon the venereal diseases.” Parran added a handwritten postscript indicating that Henry Morgenthau Jr., then the treasury secretary, “expects to discuss this with the President today.” The first lady “appreciated” the information, her secretary later replied to Parran. “She asks if you will please keep Miss Odear’s plea in mind if the proposed legislation is passed.”

The legislation did pass later in 1938, without a single dissenting vote in Congress. The Venereal Diseases Control Act provided state health officers with tens of millions of dollars to “control” the spread of STIs—through education, treatment clinics, premarital testing, and more punitive measures. In the following years, aided in no small part by these funds, officials across the country intensified longstanding practices of detaining, incarcerating, and forcibly medicating thousands of women suspected of having such infections. To differentiate it from the earlier French and English “plans” to control STIs and prostitution (the former compelled sex workers to register with the state and the latter subjected them to regular police supervision), this program became known at the time as the American Plan.¹

It is not clear if, in the late 1930s, Odear or Roosevelt knew about the abuse occurring inside Crittenton homes and similar facilities, and neither could have predicted how fast the program of incarceration would accelerate as the US mobilized for World War II. Yet Roosevelt, for her part, would soon come to understand more about it. Her correspondence with Parran concerning Odear is among several documents in her archival papers associating her with the American Plan. Her involvement was always peripheral, often mediated by Parran, and no deeper than that of many other reformers of her time. And yet these items in her papers—never before cited, so far as I’m aware—are worth scrutinizing, not in spite of their incidental quality but because of it. Precisely because it was so casual, so seamlessly woven into the rest of her activism, her connection to the Plan shows how easily reform efforts led by the powerful can curdle into something coercive. The point of studying it is not to disparage Roosevelt or diminish her achievements in civil or human rights but to understand the contradictions of the well-meaning, elite-led social reform she championed, which allowed the well-off to determine what was best for the marginalized—even when the “best” public health methods of the day entailed the incarceration of tens of thousands of poor women.   

Initiated in the late 1910s at the urging of federal and state officials determined to protect the young soldiers massing for World War I from the “scourges” of prostitution and venereal disease, the American Plan was part of a broader crusade known as the “social hygiene” movement, which sought to wield public health techniques to address the social causes of syphilis and sex work. Many social hygienists (such as the prominent New York physician Prince A. Morrow) believed that venereal disease and promiscuity were, in effect, a matter of heredity. While merely “silly” or “untrained” women could be reformed, the thinking went, a significant proportion of sex workers were congenitally “feebleminded,” in the language of the time. “Virtually half of the country’s prostitutes are mentally deficient,” the military psychologist Paul A. Mertz wrote in the Journal of the American Medical Association in 1919. Feeblemindedness in women, in turn, was thought to manifest in prostitution or other forms of deviancy.

This sort of thinking grew out of eugenics, which held that some people are genetically endowed with superior intelligence or ethics while others are cursed by poor genes with stupidity, indolence, or criminality. In the first half of the twentieth century, this was a popular social theory, and eugenicists (especially those in the US) maintained that the human race could be “improved” through selective breeding, accomplished by “positive” programs such as family planning and marriage counseling as well as “negative” programs such as institutionalization. 

Many social hygienists were prominent promoters of the program of “eugenic” sterilization—most notably Paul Popenoe, author of the first major eugenics textbook, who, as a federal agent in the late 1910s, pushed officials in Texas, New Mexico, and Arizona to incarcerate as many women with STIs as they could, Black and Hispanic women above all. Across the country, administrators of the American Plan subjected incarcerated women to intelligence tests to determine feeblemindedness. A memorandum, sent in 1917 from the federal government to every state governor, demanded such testing, to be followed by “the commitment to institutions of non-diseased prostitutes for industrial training and for the commitment of all feeble-minded prostitutes to custodial care.”

The eugenicists wrought extraordinary harm, especially against women of color, poor women, and immigrants. Well over 60,000 people were sterilized in the United States between the 1890s and 1970s under laws “aimed primarily at the female habitual moral offender,” as the historian Barbara Meil Hobson has written.² Few records survive, but that number clearly included some women incarcerated under the American Plan. Incarceration itself, for that matter, was a way to prevent women from having sex or reproducing. Thousands were caged under these initiatives from the 1910s through the 1950s (and, in a few places, several years longer). Local police, federal agents, military personnel, and public health officials scrutinized the streets, especially near military bases and in major cities, for women they thought looked promiscuous. Any woman “reasonably suspected” of having an STI could be forcibly examined, usually by a male physician; those who tested positive could be locked, without due process, in a detention hospital, reformatory, or local jail for treatment and so-called moral rehabilitation.

The American Plan was not hidden; politicians spoke about it before roaring crowds, justifying it as helping the downtrodden. The Plan’s architects—and especially its female administrators, who were part of the first generation of female college graduates to obtain federal employment—believed that it was in the best interest of poor women to be institutionalized, for inside such institutions they could receive vocational training, Christian proselytization, and compulsory medical treatment.

A small number of the educated elite, many of them Quakers or Christian Scientists, opposed the American Plan. One female physician, missionary, and egalitarian Christian thinker, Katharine Bushnell, deplored in a 1918 letter the “pretended discovery that ‘about half’ the prostitutes are feeble-minded, and must be confined—not temporarily, but for the rest of their lives.” Such critiques failed to win over many policymakers, however, and elite opposition was confined mainly to letters and pamphlets; eventually several female federal administrators also resigned in protest.

By contrast, the American Plan’s most relentless adversaries were its victims. Thousands of women and girls incarcerated under the Plan and other morals laws escaped from behind bars, set their sites of captivity on fire, assaulted their guards, sued their captors, engaged in hunger strikes, and spoke out. “Goddamn these doctors,” wrote one sex worker who, after testing positive for an STI in the 1930s, was sterilized against her will.

Historians have fought bitterly over how to interpret the fact that many of the twentieth century’s most influential and progressive social movements included strains of eugenicist thinking. There were strong and enduring ties between the eugenics movement and the labor movement, the child welfare movement, and the social welfare movement. Eugenics was embraced and promoted by university presidents, US presidents, Supreme Court justices, journalists, novelists, physicians, social reformers, and nearly every major religious denomination in the country. This was equally true of the American Plan. As I have written elsewhere, many seemingly progressive individuals and organizations of the early twentieth century expressed some degree of support for the Plan, including Roger Baldwin, Earl Warren, Fiorello La Guardia, the American Civil Liberties Union, the American Medical Association, the American Bar Association, the Girl Scouts, and even at least one prominent Quaker, Martha P. Falconer.

To modern readers such links may seem surprising, and in recent decades scholars have done considerable work to contextualize them. Eugenics provided a convenient legitimizing vocabulary for anti-immigrant prejudice in the early twentieth century, allowing many to cast their bigotry in the idiom of science. In a period characterized by high rates of poverty, illiteracy, disease, and alcoholism, eugenics also gave some powerful people a way to explain this suffering without acknowledging how much of it was due to the economic system in which they had prospered. The effect was to shift the blame for social ills onto the marginalized. “Does eugenics mean less sympathy for the unfortunate?” asked a 1926 publication of the American Eugenics Society. “It means a much better understanding of them, and a more concerted attempt to alleviate their suffering, by seeing to it that everything possible is done to have fewer hereditary defectives.”

The link between the eugenics movement and the birth control movement has been particularly controversial. “All too often,” the historian Alexandra Minna Stern lamented in her book Eugenic Nation, the complex debates over the legacy of eugenics and the figures who embraced it “are distilled into a thumbnail sketch of the hot-button figure of Margaret Sanger.”³ Scholars (including Dorothy Roberts and Angela Davis) have analyzed Sanger’s decades-long affiliation with eugenics proponents and organizations and her voluminous anti-Black, anti-immigrant, and pro-sterilization writings. Others (such as Ellen Chesler) have argued that she was personally more skeptical of genetic determinism, and that the birth control movement’s association with eugenics was less a passionate embrace and more a strategic political alliance. Still others—often conservative and religious antiabortion advocates—have seized on Sanger’s ties to racists and eugenicists in an attempt to delegitimize the struggles for reproductive freedom and justice in our own time, often with the goal of defunding Planned Parenthood, the organization Sanger helped create. Even Clarence Thomas has attempted to yoke modern reproductive rights to Sanger’s eugenic legacy.  

The American Plan was a notably popular expression of eugenicist thought. One national poll from 1937, from George Gallup’s new firm, found that a majority of Americans believed that STI treatment “should be obligatory.” As one interviewee said, “I’m in favor of any steps at all that would help control the disease. Nothing the government could do would be too drastic.”

Eleanor Roosevelt is generally remembered, for good reason, as a paragon of human rights, and women’s rights in particular. From her lobbying for anti-lynching legislation and vocal criticism of segregation in the 1930s and 1940s to her work chairing the United Nations Commission on Human Rights and drafting the Universal Declaration of Human Rights in the 1940s and 1950s, she consistently used her position to push for social change. Raising awareness about worthy causes, connecting the voiceless with those in power, and promoting her preferred policies seemed to her natural parts of her role as first lady, which she expanded far beyond its traditional strictures of hostess-in-chief.

Sometimes these priorities put her at odds with her husband. In the words of Eleanor’s latest biographer, David Michaelis, Franklin Roosevelt believed “that the development of the Japanese cranium” could explain certain “‘racial characteristics’—nefariousness, for example, and trickiness, and ruthlessness.” According to Michaelis, that belief informed the president’s program of Japanese internment, which “shocked” Eleanor. “Incarceration of Japanese Americans…put a lasting wedge between them as Eleanor’s primary role in Franklin’s wartime presidency became that of a self-appointed agitator.”

During Roosevelt’s years in the White House, hundreds of people across the country wrote her directly, including about matters of public health. In 1939, for instance, a man from New York sent her a letter to say that he had been rejected from medical school and request her intercession; in 1940 a Philadelphia man wrote her describing a plan for “socialized medicine.” The powers of the first lady were limited, but Roosevelt often took it upon herself to forward these missives to the appropriate officials. Both of those men were passed along to Parran.

Parran had been associated with the Roosevelts for several years. Born in 1892, he joined the Public Health Service as a young physician and dedicated the better part of his professional life to governmental health efforts—notably the fight to treat syphilis and gonorrhea. In 1918 he pushed towns in Alabama, where he was stationed, to detain and forcibly treat young women suspected of having either infection. His attention returned to that state over a decade later, when he oversaw the now-infamous Tuskegee study, in which the government denied medical care to hundreds of poor, Black Alabamans with syphilis. In 1930 he joined the administration of New York Governor Franklin Roosevelt as state health commissioner, in which capacity he promoted sex education and public STI clinics while giving speeches extolling the benefits of “compulsory treatment or quarantine” for “socially irresponsible” patients.

Eleanor, too, was invested in the cause of containing the spread of STIs. In 1924, as the chair of the first women’s committee to present proposals for the Democratic Party platform, she and her fellow members pushed for including “sex education and venereal disease prevention.” She was an ally of the American Social Hygiene Association, one of the loudest organizations pushing for aggressive government measures to combat STIs, and especially laws to incarcerate their carriers. (She would eventually raise so much money for the ASHA that the organization would consider giving her its highest award.) By the 1930s, this mutual interest had drawn Parran and Eleanor closer together.

As it became increasingly likely that the country would enter World War II, the first lady and the surgeon general began exchanging letters detailing their shared belief that more should be done to preemptively combat the venereal scourge afflicting the military. In the spring of 1940, at Parran’s suggestion, Eleanor hosted a White House screening of Dr. Ehrlich’s Magic Bullet, a controversial film lionizing Paul Ehrlich, the German scientist who tried to discover a cure for syphilis. (His “cure” was moderately effective yet so poisonous that few patients could tolerate its yearslong administration.) A month after the screening, Eleanor delivered a speech about the film, for which Parran provided her with research, to a gathering of congressional wives.

A year later a memo landed on the first lady’s desk detailing the apparent rise of syphilis and gonorrhea among soldiers and sailors. “We feel,” it read, “that there is very little being done to combat the venereal menace in the District of Columbia.” The memo concluded that “infected registrants should be forced to take treatment.” Eleanor took it to Franklin, who, she later wrote to Parran, felt “very strongly” that its suggestions be adequately funded. For his part, Parran was confident that such measures would soon be realized under the city’s “quarantine laws.” Later that year, with the president incensed over the surgeon general’s impertinently public calls for more extreme measures against STIs (Parran had even cowritten a book attacking the secretaries of war and the navy for not cracking down on sex work with sufficient zeal), Parran appealed to Eleanor for support. He claimed not to be “asking you to intervene, now or later,” but asked that she consider publicizing the extremity of the situation. “It is time,” read the literature Parran passed along to the first lady, for municipalities across the country “to give some thought to the prevention of infection as well as the treatment of the infected person.”

The US entered the war days after Parran sent his plea. In the name of protecting the troops, the federal government renewed its campaign against women suspected of selling sex or having STIs; over the course of the war, officials incarcerated tens of thousands of women without due process. One of Parran’s employees raised concerns about “the ‘prostitute prison camp’ aspect” of the detention facilities, and another official, Charles P. Taft II—second-in-command in the wartime Federal Security Agency (FSA), the son of the former president, and the brother of a US senator—lamented “the lack so far of rehabilitation and efforts at employment for the girls who come out of the hospitals.” But the campaign carried on.

On June 9, 1943, the first lady spoke at a conference on “Women’s Role in Social Protection” at the Washington, D.C. headquarters of the Social Security Administration. Taft and a number of other senior federal officials (many affiliated with the FSA, which had organized the conference) gathered there alongside representatives from many of the nation’s most important women’s organizations, such as the Young Women’s Christian Association (YWCA), General Federation of Women’s Clubs, National Council of Catholic Women, National Council of Jewish Women, American Association of University Women, and American Medical Women’s Association, to talk about locking up the poor and infected.

The first speakers, including Taft, were not coy about the ongoing efforts at incarceration. They spoke at length about “quarantine hospitals” and “rapid treatment centers for the women who are picked up by the police.” Following them, Roosevelt focused on what we might now call the social determinants of health. The “real roots” of venereal disease, she declared, “lie in the fact that we do not face our community conditions. Wherever you find poverty and dirt, lack of opportunity, and lack of education, you are going to find venereal disease. It just can’t be helped. What we are facing is the need for a better organization of community services in every community.” It was, taken alone, a thoroughly unobjectionable speech.

Though the minutes of this meeting survive in the National Archives, they do not reveal the close collaboration between Roosevelt and the officials who spoke before her, who hoped to use the first lady’s attendance to legitimize their cause and secure “the full support of women.” According to letters in Roosevelt’s papers, once she agreed to attend, the officials then worked around her calendar to pick a date for the conference; she even allowed them to suggest the subject of her speech. To help her prepare, they passed along pieces of literature, each representative of the harms of their approach. “Venereal Disease, Prostitution and War: A Sound Legislative Program for the Control of Venereal Disease and the Repression of Prostitution Founded Upon Experience” catalogued the laws enabling the government’s “war” against the venereal scourge, including statutes enabling compulsory examination and quarantine. “Preliminary Report: Social Protection Study: Girls and Women Apprehended by Police in San Antonio, Texas, for Prostitution and Allied Offenses” studied fifty women and girls, some as young as fourteen, “apprehended by the police” on morals charges, of whom thirty-seven were being compulsorily treated for STIs. It was (like many other federal reports from this time) rife with eugenic language, including the detail that two of the women were “mentally incompetent,” while another was “very low-grade.” “Techniques for Repressing Unorganized Prostitution” detailed law enforcement protocols that included the incarceration of infected women but not infected men.

At the end of the meeting, the women present unanimously adopted more punitive resolutions. They endorsed “a nationwide program to prevent and control venereal disease” as an “imperative war necessity and an indispensable part of a continuous welfare program.” More specifically they called for the “quarantine of infected persons who refuse to take voluntary treatment of venereal disease” and the “strict enforcement of all laws, ordinances, and regulations that pertain to prostitution activities,” as well as the “social rehabilitation where possible, of infected persons in need of redirection.” It is not clear whether Roosevelt herself voted.

All of this shows that by 1943, if not earlier, Roosevelt knew in great detail about the ongoing federal program to incarcerate thousands of women and participated in a conference meant to build public support for it. “I was happy to be able to help,” she wrote afterward. An apparently sincere desire to prevent the spread of STIs led her to embrace a program constructed on eugenic assumptions about the people who spread them. She undoubtedly had information about the harms of the American Plan, but she may not have recognized those harms for what they were. The history of elite reform projects is full of such failures.

At least one incarcerated woman did write to Roosevelt directly. Mamie LaPlant, a member of the Blackfeet Nation, sent a handwritten plea in late 1943, which Mikaela Gerwin located in the archival papers of the Bureau of Indian Affairs six years ago, when Gerwin was a senior at Princeton. LaPlant explained that she had been detained by Montana police on suspicion of having an STI, examined by a health officer, and ultimately incarcerated for treatment. “Please help me out,” she wrote the first lady. A member of Roosevelt’s staff forwarded LaPlant’s letter to a Public Health Service physician, asking him to “take whatever action you deem advisable.” He passed the letter on to an Indian Service agent, who wrote back to LaPlant that he had no authority to help her, as she had been “committed for necessary treatment under the state quarantine laws.”