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The Science of Human PerfectionHow Genes Became the Heart of American Medicine$

Nathaniel Comfort

Print publication date: 2012

Print ISBN-13: 9780300169911

Published to Yale Scholarship Online: October 2013

DOI: 10.12987/yale/9780300169911.001.0001

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The Heredity Clinics

The Heredity Clinics

(p.97) 4 The Heredity Clinics
The Science of Human Perfection

Nathaniel Comfort

Yale University Press

Abstract and Keywords

This chapter discusses the creation of the heredity clinic. When the Eugenics Record Office (ERO) shut down the associates of the former ERO superintendent Harry Laughlin established the Heredity clinics in 1939, as a new and hybrid kind of eugenics institute. Heredity clinics started out as eugenics record offices, with affiliations to medical schools and teaching hospitals. These clinics show how interconnected the twin goals of relief of suffering and human improvement could be.

Keywords:   eugenics, hereditary clinics, Harry Laughlin, Eugenics Record Office, human improvement

SOMETIME IN 1937, HARRY LAUGHLIN, the superintendent of the Eugenics Record Office, had a seizure while driving down Main Street in Cold Spring Harbor. He suffered from epilepsy, which had ever been on the eugenicists' list of dysgenic mental conditions. By his own definition, in other words, Laughlin himself was unfit. He survived the accident but was badly shaken. His institute was also a bit wobbly. After Charles Davenport retired in 1934, Albert Blakeslee, the new Cold Spring Harbor director, had launched a review of the ERO, assembling a committee that included Columbia's L. C. Dunn and the Harvard anthropologist Earnest Hooton. They found the record collection to be nearly useless for the study of human genetics, the Eugenical News to be an unscientific embarrassment, and the office itself an anachronism. Laughlin's response to this upbraiding included accepting an honorary doctorate from the University of Heidelberg the following year—tantamount to the Nazi seal of approval. In 1938 Laughlin's ally John C. Merriam retired as president of the Carnegie Institution. His replacement, the MIT physicist Vannevar Bush, wasted little time in diagnosing the disease and recommending therapy. The necessary surgery was performed and, on the last day of 1939, the ERO shut its doors.1

The demise of the ERO makes a convenient tombstone for the eugenics movement. It and Laughlin have come to symbolize what had gone wrong with Eugenics. Yet in the late thirties Laughlin had begun to push eugenics toward more medical applications—a direction often seen as the antidote to (p.98) the discredited social, behavioral eugenics of which he himself is the emblem. He sounded out the constitutionalist George Draper about adding a genetics component to his Constitutional Clinic. He petitioned the Rockefeller Foundation and the Carnegie Institution of Washington. And he approached New York philanthropists such as Wickliffe Draper and Frederick Osborn about establishing a medical genetics clinic, perhaps at a medical school such as Johns Hopkins, perhaps adjacent to the Eugenics Record Office at Cold Spring Harbor. But no hospital would join forces with him, and Cold Spring Harbor had no medical accreditation. Laughlin never got his clinic. Nevertheless, he sensed that strengthening the medical aspects of eugenics would have been good reputation hygiene.2

He was not the only one. Before the dust had fully settled at the ERO, some of Laughlin's acquaintances created a new, hybrid kind of eugenics institute: the heredity clinic. Heredity clinics were conceived as eugenics record offices attached to medical schools and teaching hospitals. Established on the eve of America's entry into the Second World War, they struggled in their first years. But though they were small in staff and few in number, the heredity clinics represented exactly the sort of integration of eugenics and medicine that Macklin, Allan, and Snyder had been campaigning so hard for since the late 1920s. And small wonder, because they—in particular, Snyder and Allan—were architects of the new hybrid institution. Although their pedigree is unquestionably eugenic, the heredity clinics established the core methods, built the institutional structures, and founded the professional community that we associate with “modern” (noneugenic) medical genetics. In short, they show how interwoven were the twin goals of relief of suffering and human improvement.

The North American human genetics community in the late 1930s was small indeed. Most trained geneticists had fled human genetics for more tractable experimental organisms such as mice or fruit flies. Yet a few geneticists maintained an interest in humans on the side. The mouse geneticist C. C. Little had been interested in human genetics and eugenics since the teens; he often attempted to relate the mouse work to humans, in particular to cancer. At the University of Michigan, Lee Raymond Dice did behavioral (p.99) genetics in mice and population studies in humans. At Wisconsin, the zoologist Michael Guyer dabbled in human genetics. In between reporting baroque and brilliant experiments on fruit flies, Hermann Joseph Muller, one of the founders of classical genetics, wrote dire treatises on the accretion of silent lethal mutations in the human gene pool. His bleak, socially conscious genetics rubbed off on his students H. Bentley Glass, Clarence “Pete” Oliver, and, later, Elof Axel Carlson, all of whom went on to write about human genetics and eugenics.3 Many of these zoologically trained researchers found themselves pulled by their interest in human heredity into the medical sphere.

There were also a few dedicated students of human heredity, mainly with backgrounds in the health and human sciences. Madge Macklin, of course, continued her studies on heredity and disease at the University of Western Ontario. In Charlotte, North Carolina, William Allan was still studying the “defectives” of Appalachia. The biometrician Raymond Pearl, himself increasingly marginalized as a loose cannon, continued his work on eugenics and human biology at the Johns Hopkins School of Public Health and Hygiene, even while savaging the Eugenics movement in speeches and in print. At the University of Chicago, the psychologist H. H. Newman's 1937 book with F. N. Freeman and K. J. Holzinger defined the modern methods of twin research. The Harvard anthropologist Earnest Hooton, though mainly interested in questions of race, regularly consorted with health professionals in conferences and symposia. In 1936 Franz Kallmann, a German émigré, had established a human genetics department at New York Psychiatric Hospital in New York City.4

But the most prominent figure in American human genetics in the thirties was Laurence Snyder of Ohio State. Through his work on blood groups, Snyder united the worlds of medical heredity and populational human genetics. Although his contributions to statistical population genetics paled in comparison to those of Wright or J. B. S. Haldane, Snyder was well liked and energetic, and a natural teacher, networker, and administrator. He was passionate about medicalizing human genetics. He became a hub in an emerging network of North American medical genetics. Frederick Osborn, who took the torch of American eugenics from Charles Davenport, called him a “first-class, second-rate man.”5

(p.100) Osborn himself was decidedly first-class. Born into a distinguished and wealthy New York family, he had a gentle patrician bearing accentuated by his six-foot-eight-inch frame. He had instant eugenic credentials: he was a nephew of Henry Fairfield Osborn, a founder of the Galton Society, the elite anthropological eugenics club that still convened at the American Museum of Natural History in New York. Henry Fairfield Osborn's son Fairfield Osborn was a conservationist and the head of the New York Zoological Society. The cousins Fairfield and Frederick collaborated on population problems, although Frederick was also interested in medicine. In 1928 Frederick Osborn retired from business and began to soak himself in eugenics, learning its philosophy at his uncle's knee. He joined and soon became an officer in all of the New York–area eugenics societies: the Galton Society, the Eugenics Research Association, the American Eugenics Society—he was the leading voice in the AES until the 1970s. He was on the board of the Carnegie Corporation and the Carnegie Institution of Washington, and he was part of the network of New York finance and philanthropy. Using these contacts, Osborn set about reorganizing American human genetics and eugenics. He sought to ensure eugenic progress, curb population growth, and promote biomedical research—while keeping his own reputation clean of unsavory associations. Where Snyder was the social hub that connected a disparate and far-flung group of workers interested in human heredity, Osborn was an idea and a money man. He reconceived American eugenics, adroitly reading the increasingly medical direction it was taking, and became the conduit through which the money would flow to support it. Working both independently and together, Snyder and Osborn established the first heredity clinics, reconfigured American human genetics, and established a newly medical eugenic agenda.

Morale was low among eugenics activists in the early thirties. Despite increasing medical interest in the subject, membership in the American Eugenics Society declined through the first half of the decade. Osborn later noted that much of this attrition occurred among the ranks of prominent and wealthy citizens who had contributed much to the vigor, visibility, and zeal of the society in the 1920s—and who had done much to cheapen its reputation among scientists. No doubt the Depression was a major cause of the decay. But the scientific membership fell away as well. Only (p.101) seventy-three people had attended the Third International Congress of Eugenics in New York in 1932.6

Yet by the time Osborn took the reins, eugenics was experiencing something of a revival. The cultural terroir was becoming more suitable for eugenically minded programs. Since Buck v. Bell, many American states had passed new sterilization laws designed to withstand constitutional challenge. The number of sterilizations performed increased steadily through the decade, more than doubling from 16,066 in 1932 to 33,035 in 1939. In Michigan in 1935, the state Academy of Arts, Science, and Letters called for the creation of a Family Research Bureau, to “study the causes of criminality and of mental defects and diseases, and if possible discover effective means for preventing and curing such conditions.” Support for birth control also grew steadily. In 1936 Margaret Sanger successfully challenged the classification of birth control materials as “obscene” under the Comstock Laws; the next year, North Carolina passed the nation's first law explicitly permitting state agencies to distribute contraceptives and contraceptive information. The motivation behind the push for relaxed birth control regulation included factors having nothing to do with eugenics, particularly women's demand for the right to regulate their own reproduction and family size. Through such measures, sterilization and birth control became increasingly entwined; by the 1960s voluntary sterilization would become one of the most popular methods of birth control. Such changes made the cultural soil more hospitable to the eugenic seed.7

Also in 1936, in New York the wealthy financier Wickliffe Draper consulted with Laughlin, Osborn, and others in creating a philanthropic structure for the support of eugenic causes of all sorts, but especially those related to race and preventing miscegenation. One component of this fund was to have been a “marriage clinic,” from which people could seek advice—mainly about race and disease—in regard to potential mates and to childbirth, although this quasi-medical aspect was eventually dropped as the group crystallized as the Pioneer Fund. In Minnesota in 1937, the eccentric physician Charles Fremont Dight died, leaving a modest endowment to the University of Minnesota for the creation of a new eugenics institute. California's environmentally oriented, family-based eugenics network was thriving, with Paul Popenoe's marriage clinic in Los Angeles; Samuel J. (p.102) Holmes up in Berkeley and highly active in the AES; and the eccentric, zealous, and pro-Nazi retired banker C. M. Goethe in Sacramento financing eugenics efforts in myriad ways. In the late thirties, then, there was a widespread sense of optimism and rebirth among the movement's leaders, with ambitious plans and money available to fund them. By the time the writing was on the wall for the Cold Spring Harbor Eugenics Record Office, the eugenics leaders could take its decline as an opportunity for restructuring.8

Through the quirks of personal connections, the first focus of that restructuring was central North Carolina. Both Osborn and the North Carolina physician-eugenicist William Allan were on the board of the Eugenics Research Association, the research and publicity arm of the Eugenics Record Office. When the AES was created in the 1920s, Irving Fisher and Charles Davenport had defined it as primarily an educational and propaganda institution, with the ERA serving as the movement's research arm. The ERA held an annual meeting and published Eugenical News, ten or so scattershot pages chocked with research updates on the biochemistry of sperm or the material nature of the gene, clinical and public health studies on incidence of disease, legal news on marriage legislation, and utopian mini-rants about our eugenic future. When it became clear that the ERO would be shut down, Osborn seized the opening as an opportunity to realign the axes of American eugenics.

Following a 1936 ERA meeting in New York, Allan approached Osborn with a scheme: “What is in my mind is this; someone ought to start a eugenics office as part of a county health department somewhere, and this seems a good place to do it.” It was a genteel southerner's plea for financial help. As a physician in private practice, Allan had been unsuccessful at obtaining support from either the foundations or the public health agencies. He suggested that Osborn relocate from Manhattan to Charlotte to set up the clinic—a naïve idea, if he intended it literally, but canny if this was the desired effect: Osborn demurred on moving to North Carolina, of course, but said he would very much like to visit and receive a eugenic tour of the region. That visit, followed by many further conversations and much correspondence, resulted in Osborn's brokering a series of agreements among (p.103) Allan, the Carnegie Corporation, and the new Bowman Gray School of Medicine of Wake Forest University, which resulted first in substantial funding of Allan's eugenics research and later in attaching Allan and his small team to an academic medical school, leading to the founding of the first department of medical genetics in the country. At the end of his career, Osborn proudly listed the Wake Forest program as one of the fruits of his efforts and as an indicator of the new direction in eugenics that he had spearheaded.9

Stimulated by Allan's perspective, Osborn reconceived the division of labor within the movement. The “old” eugenics had moved along the common axes of the Progressive era—race, ethnicity, and social class. Now, at the tail end of the Great Depression, Osborn and Allan discussed realigning those axes. “The groove I move in is a very narrow one,” Allan wrote to Osborn in 1937, “in which I constantly encounter those who have inherited physical or mental disaster (blind, deaf, crippled, etc.), and these derelicts constitute such a serious problem that I perhaps over emphasize the genetic end and think too little of the lack of good environment.” Osborn took the point. “I am in an area of declining births, where the loss of good genes has us all worried. You are in a high birthrate area, where the constant increase of bad genes is a cause not only of anxiety but of daily observation and distress.”10

In short, Osborn and Allan saw positive eugenics as urban and social, negative eugenics as rural and medical. From his New York offices, Osborn himself planned to lead the AES in a mixture of eugenics education and social programs in welfare and public health designed to increase the frequencies of the “best” genes in all sectors of society. Given recent excesses in the name of negative eugenics, it is understandable that eugenic enhancement seemed gentle, social, friendly. The other, less politically palatable side of eugenics—elimination of the unfit—would be handed over to trusted, soothing doctors. We have seen that negative eugenics had been going medical for several years. Osborn's genius was recognizing that trend, encouraging it, and pairing it with a seemingly benign new approach to positive eugenics, or enhancement. “We don't for a moment mean to imply a neglect of negative eugenics,” Osborn insisted. But negative eugenics needed a friendly, trusted face. Osborn understood that physicians had both (p.104) the tools and the moral capital to carry out a program of negative eugenics. As he wrote in his 1940 book Preface to Eugenics, negative eugenics was “the concern of the medical profession and public health authorities. Their complexity requires that they be in professional hands, and it is unlikely that the public will accept advice from any other source.” The new negative eugenics, then, would focus on health rather than sociality. Disease would now be the prime target, although that included “feeblemindedness” and other mental conditions on the traditional eugenics agenda. The umbrella of health has always been capacious and flexible; few old eugenic targets needed to be dropped, although some had to be renamed.11

In Osborn's scheme, the husk of the Eugenics Research Association was the perfect receptacle for a new, medically oriented organization for negative eugenics. The first step in reorganizing the ERA was the election of Laurence Snyder to the presidency in 1937. He succeeded C. M. Goethe, who epitomized the old eugenic guard. Snyder was the perfect transitional figure: his Harvard Ph.D. in genetics gave him scientific credibility; he considered Davenport one of his primary mentors; and he was a pioneer in the introduction of genetics into medical schools. The next year, Osborn wrote to Allan about reorganizing the ERA along medical lines. It would need a new name, something bland like the Association for Research in Hereditary Factors, perhaps, “because the word ‘eugenics’ has so many connotations which are confusing to many medical men.” Notwithstanding that “confusion”—clearly a euphemism for misguided opposition—over the word, Osborn was convinced that doctors were natural eugenicists. Echoing Davenport in 1912, he told Allan that negative eugenics “should be increasingly a science in the hands of the medical profession for application.” With negative eugenics under the impeccable stewardship of America's trusted physicians, Osborn was free to return to Galton's original concept of a primarily positive eugenics driven by education and incentive, with coercion necessary only in extreme cases of incapacitation or pigheadedness.12

Allan could not have agreed more; he had written as much in recent articles such as “Medicine's Need of Eugenics” (1936) and “The Relationship of Eugenics to Public Health” (1937). The conquest of infectious disease, he wrote, required bacteriologists who would eliminate pathogens from water and milk supplies, immunize the populace, quarantine sick individuals, and (p.105) control animal and insect vectors. In contrast, to discover and control hereditary disease was simple: it required “nothing more elaborate than a family record office in the county health department.” Osborn gave Allan that family record office.13

In 1938 the Carnegie Corporation (on whose board Osborn sat as well) initiated a new funding program. Allan leapt at the chance. “A $3,000 grant-in-aid,” he told Osborn, “would give me a chance to put out a field worker to survey this territory in a systematic manner, instead of depending on my finding odd moments to dash off and bring home samples.” Since Davenport's day, fieldworkers had been unskilled but trainable researchers, almost all women, who collected but did not analyze data. Allan got more than he asked for. Osborn introduced him to Charles Dollard, assistant to the president of the Carnegie Corporation. The Carnegie would provide the funds, but Dollard and Osborn thought Allan needed the collaboration of a fully trained geneticist. This move was probably a tacit acknowledgment of Allan's limited genetic training—something Allan admitted, though he tended to portray it as a strength. Further, the plan would bring new men into human genetics. Allan was a good mentor—rugged, warm, appealing—and a practical geneticist, a eugenicist, full of craft knowledge. Osborn understood both Allan's merits and his deficiencies as a medical-genetic pioneer.14

Osborn and Dollard often consulted Leslie C. Dunn, a highly respected Drosophila geneticist uptown at Columbia University, on genetic matters. They hoped Dunn would be able to suggest someone with knowledge and reputation strong enough to withstand scrutiny from skeptics. Allan was agreeable to the plan, though he cautioned that for fieldwork, temperament was as important as technical knowledge. “If you and Professor Dunn picked a man with your gift of friendliness it would be smooth sailing,” he told Osborn. “But a man with Laughlin's shyness and inhibitions, for instance, would be mistaken for one of General Sherman's stragglers and strung up.” Allan naturally suggested his old collaborator Laurence Snyder as his genetics adviser, citing Davenport's opinion that Snyder was the leading human-geneticist in the country. Osborn delicately yet firmly rejected the nomination. He himself liked Snyder, he said. However, “the opinion of the geneticists themselves,” unfortunately, “does not apparently (p.106) place Snyder in the top flight in which such men as Sewall Wright of Chicago and L. C. Dunn of Columbia are leaders. It is my impression that the geneticists think of Snyder a little the way they do about Davenport, though to a much less degree, and are inclined to think of work on human heredity as being the kind of work done by men like Davenport and Snyder, with some rather indefinable derogatory implication.” He continued, diplomatically, “Now, I think that's a rotten attitude on their part, but I gather there is just enough justification for it to make it hard to combat directly.” A renewed effort in medical genetics and negative eugenics needed to be above reproach scientifically. Dunn suggested his former student Paul R. David, a geneticist then at Lafayette College in Pennsylvania's Lehigh Valley. Although Allan admitted that “the name startled me a little”—Jews? In North Carolina?—Dollard reassured him that David was from “these parts” and was a “first class fellow.” Allan agreed to take him on.15

North Carolina was an ideal test ground for medicalized negative eugenics. The state had long been in the vanguard of hereditary and sexual public health policy. It had had a sterilization law on the books since 1929. And when the Supreme Court struck down the federal proscription against distributing contraceptives in 1936, North Carolina was the first state to pass a law specifically allowing it. Immediately, the soap powder heir Clarence J. Gamble established a program to disseminate condoms and his contraceptive foaming powder to rural North Carolinians.16 Osborn was already interested in population problems at this time and doubtless had been following these events with interest. Probably no state in the Union had conditions more favorable to his vision of a medically mediated negative eugenics.

Allan considered his eugenics work akin to that of a hereditary public health officer. With Carnegie support, in 1939 he opened the Family Record Office in Charlotte. He soon formed an advisory board for the FRO that included the state public health officer and the deans of medicine at the three North Carolina medical schools: Duke, the University of North Carolina, and Wake Forest. In March 1940 Allan visited all of them, to feel them out on the possibility of getting an academic program in medical genetics started.17

He found Dean Coy C. Carpenter at Wake Forest the most receptive. Wake Forest medicine was in a state of fertile upheaval. Carpenter was overseeing (p.107) the conversion of its two-year medical school into a full four-year program; simultaneously, the medical school was moving across the state, from the Raleigh area to Winston-Salem, thanks to a bequest from the tobacco magnate Bowman Gray, head of R. J. Reynolds. The bequest funded only the establishment of the new school—it provided no endowment. Carpenter had a lot of freedom but no money. When Allan discussed implementing a novel program in medical genetics with outside funding, Carpenter listened eagerly.18

Allan was sixty years old and his health was weak. If Carpenter was going to get a permanent program in medical genetics, he would need a successor for Allan. He suggested that if Allan could obtain additional Carnegie funding to support a bright young resident to serve as second in command, he would create a new department of medical genetics when the new school opened in Winston-Salem. Allan would gain a university appointment, a protégé, and a genetic consultant; Carpenter would have a progressive, promising, and best of all completely funded new program in medical genetics to help his new school make a splash; and Dollard and the Carnegie would be bringing new men into human genetics while supporting a quiet program in eugenics in a medical school, where it would be infused with the sanitary odor of carbolic acid.

Claude Nash Herndon, Carpenter's pick for Allan's junior associate, was twenty-two, born and bred in North Carolina, with a bachelor's from Duke and an M.D. from Jefferson Medical College in Philadelphia. He had a genial southern manner, polite and deferential, but he had an earthy side that came out in his private correspondence. In September 1940 Carpenter sent him to spend a week in the field with Allan to see how he liked the work. “After four days of pretty strenuous field trips,” Allan told Carpenter afterward, “Dr. Herndon tells me he likes the outlook in genetics and wants to tackle the job.” Herndon went on to be one of the leaders of the “new” human genetics of the nineteen fifties and sixties.19

Research was necessary but not sufficient; any comprehensive program in human heredity also had to reach students. “All the deans” of the North Carolina medical schools, Allan wrote to Osborn, “want some genetics taught in their schools.” Chances are it was Allan who convinced them. Instructors in medical genetics were hard to find, however. Allan knew of (p.108) just one: Snyder. Whatever Snyder's reputation as a scientist, he was unquestionably the most qualified instructor of medical genetics in the country. Since 1933 he had been teaching the nation's only required course in genetics in a medical school. Allan invited him to give it, in triplicate, to North Carolina's medical students. In 1941, on Carnegie funding, he spent a mild southern winter commuting between Raleigh-Durham and Wake Forest, offering a series of lectures based on his Ohio State course. Duke University Press published the results almost immediately.20

In between lectures, Snyder consulted with Allan, Osborn, Dollard, and Carpenter as they hammered out the details of the new program in medical genetics at Bowman Gray. It would be called the Department of Medical Genetics, although administratively it would reside within the larger Department of Medicine—thus it was more like a division in many medical schools. It would open in the fall of 1941, with the new medical school. Allan and Herndon would continue their research. The hospital affiliation would provide a reputable outlet for clinical services and eugenic advice. And the medical school would provide a forum for teaching genetics to medical students. The program was designed from the bottom up as an integration of genetics into Allan's clinical research program of eliminating serious hereditary disease from families. Consultation with the geneticist Paul David would inject needed genetic theory into their work.

The only weak spot in the plan was Herndon's lack of training in formal genetics. At first, it was thought he might spend a year or so with L. C. Dunn at Columbia, but then a fortuitous new opportunity arose. In July 1941 Allan received a letter from Charles Cotterman, a student of Snyder's now in Ann Arbor, Michigan, where he was working in the Laboratory of Vertebrate Biology under director Lee R. Dice. Cotterman had written to ask whether Allan had a medical man with an interest in genetics who might be looking for a job and some training. It must have seemed providential.

Lee Raymond Dice came to medical genetics from a background in zoology and the West Coast conservationist style of eugenics. Born in Georgia in 1877 (he was, he believed, named after Robert E. Lee), Dice was raised in rural Washington State. He went to Stanford, where he studied evolution (p.109) with David Starr Jordan and Vernon Kellogg. He then went to Berkeley for graduate school, where he worked with the eugenicist and ecologist Samuel J. Holmes. He served as a deputy fur warden for the Alaska Fisheries Service, did fieldwork in eastern Montana, and caught rats in Washington, D.C., for the U.S. Biological Survey. Following military service in the First World War and brief stints at several universities and colleges, in 1919 Dice was offered a position in zoology and the curatorship of mammals in the Museum of Zoology at the University of Michigan in Ann Arbor. He never left. In 1925 C. C. Little became president of the university. He soon established a Laboratory of Mammalian Genetics and put Dice in charge. By the thirties Dice had begun a research program in eugenics and human genetics. In 1937 he responded to a call put out by the state's Academy of Arts, Sciences, and Letters for Michigan to create its own Eugenics Record Office. Michigan already had a tradition of eugenics and human genetics—Battle Creek was an hour to the northwest, and Victor C. Vaughan made his home in Ann Arbor. It was a natural fit.21

Dice needed staff for this new effort, and he himself was not trained as a geneticist. Laurence Snyder again provided the link. His student Charles Cotterman was among the brightest, most original, and most eccentric individuals in genetics, arguably “the last universal mind in biology,” in the words of his obituarist and former colleague John Opitz.22 For all his brilliance, though, Cotterman had a stormy relationship with publishing. His dissertation, “A Calculus for Statistico-Genetics,” has been called the “most famous unpublished paper in the history of human genetics.” He had hoped to finish in 1939, but in late 1940 he was still working on it, even as he was getting settled into his first faculty position.23

In late fall 1940 Dice formulated a plan for a “department of human heredity” that would expand his and Cotterman's work in human heredity and operate in “close association with the Medical School,” including privileges in the University Hospital. The problem was, both Dice and Cotterman were Ph.D.s and thus could not get access to the medical records they needed for data. Neither had an interest in any particular medical conditions; what they wanted was reliable data on human traits. Dice had connections in medical departments: Harold Falls in ophthalmology and George Moore and Byron Hughes in the orthodontics clinic. But his proposed (p.110)

The Heredity Clinics

4.1 Lee Raymond Dice, founder of the Michigan Heredity Clinic. Courtesy of Bentley Library, University of Michigan

heredity clinic needed a medical man on staff. Beyond that, Dice was developing a commitment to medical genetics as a hybrid of science and medicine that required formal training in both fields. Over the coming years, he sponsored or encouraged a great deal of cross-pollination between scientific genetics and academic medicine, one of the key themes of medical genetics.24

By sending Herndon to Michigan, Allan could gain the needed training in genetics for Wake Forest and simultaneously expand the nascent field by helping to set up a second program in medical genetics. F. P. Keppel, at the (p.111) Carnegie Corporation, was willing to release Herndon to go to Michigan. “We are interested in what you are doing at Michigan,” he assured Dice, “and if releasing Herndon will help the cause which we are all in one way or another promoting, the Corporation is glad to cooperate.” Herndon packed his bags and arrived in Ann Arbor at the end of August.25

In the fall of 1941, as it was becoming increasingly obvious that the United States would not be able to stay out of the war, American human genetics was similarly in a state of ferment. The Bowman Gray School of Medicine opened in September, just as Herndon left for Ann Arbor. When he arrived, he found himself near the heart of a burgeoning center of North American activity in human genetics. Snyder was just a few hours away in Columbus. And, as Herndon informed Allan, the University of Minnesota had just formally opened the Dight Institute of Human Genetics. Like the Michigan Heredity Clinic, the Dight Institute operated out of the Department of Zoology but maintained close contact with the medical school. It was directed by Clarence “Pete” Oliver, Drosophila geneticist and student of H. J. Muller from Texas. The three institutes, born as nonidentical triplets, shared both the bonds and the rivalry of any siblings. The Dight, however, was the odd brother out. Whether it was Pete Oliver's personality or simply the lack of personal connections with men like Snyder and Osborn, the Dight was never as close to either the Bowman Gray department or the Michigan Heredity Clinic as the latter two were to each other. All three, however, shared the sense that hybridization with medicine was the route to success. “Oliver told Cotterman that one of his main objects was to arouse interest in genetics among the medical people,” Herndon wrote Allan in September. As we shall see, their visions of what the fusion of genetics and medicine ought to look like often clashed. The making of the first medical genetic institutions was the result of the efforts of men whose ideologies were rooted in clinical medicine, theoretical genetics, and eugenics, respectively, negotiating with one another to form a new, medically oriented kind of Eugenics Record Office.26

The clinically trained Herndon was unimpressed by academic genetics in Ann Arbor. Cotterman had a Galtonian turn of mind—statistical, (p.112) populational. He could not have cared less which traits he studied, so long as they could be analyzed clearly. Medical patients were simply a good source of material for genetic analysis. Herndon, in contrast, wanted to treat real diseases and prevent suffering. At the end of his first month in Michigan, he wrote to Allan, “I certainly wish I could get these folks to listen to some real practical genetics and get them interested in things that are really serious. They are about to drive me dippy with such things as anomalies of the eyebrows and minor defects of the teeth.” Allan chuckled at Herndon's letter and replied, “We'll ruin the academic outlook someday I hope.” Tensions notwithstanding, Herndon got to work. By the end of November he had helped Dice and Cotterman get their clinic open, and he

The Heredity Clinics

4.2 Claude Nash Herndon, holder of the chair in Medical Genetics at Wake Forest School of Medicine, endowed by the eugenic philanthropist Wickliffe Draper. Courtesy of Wake Forest School of Medicine

(p.113) sent Allan an announcement flyer, adding sourly at the bottom a paraphrase of Sextus Empiricus's Against Professors: “The mills of the Gaels grind slowly. It has taken me this long to get this far.”27

Two weeks later, the Japanese struck Pearl Harbor. Before Christmas, American medical schools were instructed to shift to an accelerated, four-quarters-per-year program, to increase the flow of much-needed physicians into the military. The three new programs in human genetics—and the entire fledgling enterprise of the Bowman Gray School of Medicine—were destabilized as soon as they began.

One almost immediate effect of the war was to spring Herndon from Michigan. Deeply dissatisfied, over the Christmas holiday he apparently had a heart-to-heart with Allan about returning to Winston-Salem. Herndon wrote him a short note on New Year's Eve, saying, “Dear Dr. Allan, You win. I'm going back to Michigan. But I am still of the opinion that if that is genetics I would rather be practicing medicine in the backwoods.” The following February, however, Coy Carpenter did a bait and switch. He first obtained Herndon's release from Michigan on grounds of military service, then secured a deferral on the grounds that he was essential teaching staff at Bowman Gray. In the result, Herndon's “permanent” position in Ann Arbor lasted just six months. By April 1942 he was back in Winston-Salem, teaching in the medical school and doing the fieldwork that he loved. Allan and Herndon were tickled.28

The two units tried the reciprocal exchange as well. Dice lost both Harold Falls and Charlie Cotterman to the war effort, but in late 1943 Cotterman secured a transfer to Bowman Gray Medical School, where he enrolled as a first-year medical student in January 1944. Cotterman fared no better in medical school than Herndon had in the laboratory. Writing from Winston-Salem to the Heredity Clinic secretary Nedra Kuntz, he captured in two words the experimentalist's boredom with the medical curriculum: “Right now (7:00) I must be running along to a ‘Clinical Pathological Conference.’ Ho hum.” He lasted only a year, saved in 1945 by another transfer and then the end of the war. The hybridization of science and medicine was fraught with tensions of personality, culture, and intellectual style.29

At Ann Arbor, Dice could not hold on to his staff and could not replace them: the military sucked the universities almost dry. And he badly needed (p.114) more funding to support the various research efforts of his Laboratory of Vertebrate Biology: the Heredity Clinic, his behavioral genetics project with the dormouse Peromyscus, and various ecological projects. He drummed up business with promotional articles about the Heredity Clinic in local papers—“U. of M. Heredity Clinic Seeks to Improve Human Breed”—and even McCall's magazine. He also sought a replacement for Herndon. He wanted badly to find someone with both an M.D. and a Ph.D. in genetics. One possibility was Ray Anderson, a student of Pete Oliver's who came to Ann Arbor to do an internship in pediatrics. He cooperated with the Heredity Clinic, but then he too was called into service, and when he came back to the States he returned to Minneapolis to work at the Dight. The Dight Institute itself, with independent funding and a staff of only two, did not have a high enough profile to be greatly affected, although it too weathered a crisis just after the war. In 1946 Pete Oliver left abruptly for a post at the University of Texas, Austin, rendering the Dight dormant for more than a year while it searched for a new director. Sheldon C. Reed, a geneticist who, like Snyder, had trained under William C. Castle at Harvard, took over in 1947 and ran the Institute until 1975. Reed's views on eugenics, medical genetics, and genetic counseling were complex. He is considered the founder of the field of genetic counseling; he coined the term in 1947, in order to distinguish it from previous eugenic practice. Yet he saw heredity clinics such as the Dight as the most effective way to bring about eugenic improvement. In short, Reed, like his compatriots, was an unabashed but complex eugenicist who saw medicalization and patient autonomy as critical for the fulfillment of eugenics' promise.30

Finally, one must note that during the war, Charles Davenport died quietly, on February 18, 1944, a victim of environment and temperament. The old marine biologist was an avid supporter of the local whaling museum. Overworking himself while cleaning a rare beached whale, he caught and succumbed to pneumonia. The official announcement from Cold Spring Harbor made no mention of eugenics or the ERO, even though just two years earlier, Laboratory director Milislav Demerec had tried to reopen it, even palpating H. J. Muller and a young James Neel for the post. The ERO was high and dry.31

(p.115) The groups at Ann Arbor and Winston-Salem managed to eke out some research during the war years. Allan and Herndon continued their field studies, funded at first almost entirely by the Carnegie Corporation. Their main project was a survey of hereditary disease in the counties of the Great Smoky Mountains to the west, particularly Watauga County. These mountain counties were a “gold mine in heredity,” Allan wrote. It was homogeneous, “a country without negroes, tenant farmers, or shifting mill population.” It was reproductively isolated, with little immigration in or out since about 1810. “Practically everybody,” Allan claimed, descended from the post-Revolutionary pioneers and so could trace their lineage back four to six generations. They often found relatively complete genealogies recorded in the pages of family Bibles. And there were, he wrote, “unbelievably high rates of in-breeding.” This meant that many rare recessive diseases appeared at relatively enormous frequencies, compared with the population at large, and further, “that the carriers of recessive or hidden pathological traits can be traced back to the pioneers who brought these traits into that region, hence the possible carriers of such traits will be confined to the direct descendants of such pioneers.” He told Snyder, “It seems to me the greatest natural experiment in inbreeding since the Children of Israel crossed the Red Sea and had to marry their cousins for the next forty years.” Twenty years later, the Johns Hopkins medical geneticist Victor McKusick would find an even greater natural experiment in inbreeding among the Amish.32

Allan, Herndon, and Florence Dudley—Allan's secretary, whom he trained into an effective and enthusiastic fieldworker—surveyed these populations for a variety of hereditary conditions. Allan's pet diseases were deafness and blindness—including several forms of cataracts and retinitis pigmentosa, a reliable Mendelian recessive—as well as such crippling diseases as muscular dystrophy and peroneal atrophy. He made a study of albinism and in fact was happy to track down almost any disease on which they could get a strong lead. Allan's dream project was begun near the end of his life and was carried on by Herndon after Allan's death. It was a survey of the entirety of Watauga County for every hereditary disease they could document. He had been planning such a study for years, but in December 1941 (p.116) he proposed it concretely to Osborn, and the Carnegie agreed to fund it.33

It was shoe-leather genetics. Allan, Dudley, or Herndon would typically go out into the field for one to several weeks at a time, setting up a base at a local hotel. Allan's favorite for the Watauga Survey was the Daniel Boone Hotel, in Boone, North Carolina. From there, they would make forays into local communities. Often they would contact a local doctor or clergyman and inquire about hereditary diseases. The people could be harder to find than the records. Bad leads, bad roads, bad weather, and wartime shortages all hampered their efforts. “Things have been moving slowly here since my last report, due to several causes,” Herndon wrote at the end of a long day. “First, the bottom fell out of the clouds around here this past week, and this county has been practically under water. My other difficulties are poor diagnoses and worse addresses.” Gasoline rationing forced very careful itineraries, which were often foiled by an itinerant study population. “So far my luck on this trip has been pretty poor,” Herndon reported. “I was in Durham Saturday, and spent most of the day trying to trace a colored girl that seemed to think it was cheaper to move than to pay rent. Finally found her though.” Despite Allan's cheerful description, Herndon seemed to think the Negroes that were there pretty shiftless.34

Once Allan, Herndon, or Dudley found a subject, they administered a medical examination and took a family history interview. They recorded all data on forms obtained from Cold Spring Harbor. Along with trait and pedigree information, they collected folk theories of heredity. “I think I more than met my match this morning,” Herndon wrote.

I went to see two sisters who are albinos, and listened to a two hour lecture on astrology and got about 15 minutes-worth of pedigree. As soon as they found out what I was up to I couldn't get a word in edgewise. It seems they know exactly what causes albinism and all other kinds of hereditary diseases, and they proceeded to tell me. I gathered that albinos occur when Saturn is exactly 8 degrees from something or other under the signs of Pisces and something else…. They are certain that we are wasting our time gathering pedigrees when all we need is a good book on astrology.35

Jabbing at their geneticist-consultant, Paul David, he added, “It all sounds rather complicated to me, so I recommend you send Dr. David up to talk to (p.117) them.” In Herndon's mind, his and Allan's style of “real practical genetics” was rigorous and tough-minded; Paul David's theoretical population genetics was only a step away from fortune-telling.

Practical genetics had a natural-history quality. Allan, Herndon, and Dudley collected diseases the way an ornithologist collects birds. “On the Wildcat Road of the Stony Fork this afternoon, I found a nice trait of deafmutism,” Dudley wrote from the field. Once they had a good trait, they worked out the pedigrees, identifying the affected and the carriers and trying to pinpoint the “pioneer” who introduced the trait. “The retinitis [pigmentosa] pedigree is exactly what we want,” Allan wrote in 1942, “as I think we should be able to tag everybody since the pioneer with the correct probability of carrying the trait.” Allan attended family reunions, interviewing as many of the attendees as would talk to him. Winning their trust was critical, and Allan drew upon his considerable charm and social skills, gathering jokes and stories he knew people would enjoy. He told Herndon, “I have accumulated a couple of church stories to use on the Baptists.” Sometimes he drew the pedigrees on-site and in real time, taping large rolls of butcher paper around the outside of a church and filling in the chart as people told him their stories. With the pedigree method, medicine merged into anthropology: beyond simply identifying the hereditary pattern, Allan and Herndon sought to identify the original person in whom a condition occurred. Allan was familiar with standard population-genetic methods for identifying carriers of a trait (heterozygotes), but he needed to know which individuals were carriers. “The technique of determining the number of heterozygotes by taking the square root of the number in the sample studied does not identify anybody,” he wrote to Snyder in 1942. “So we have just taken these rare recessive traits, like gyrate atrophy of the choroid, and chased them back to the pioneer that brought them in here.” The direct descendants of that pioneer were possible heterozygotes; analyzing the phenotypes of their offspring could reveal their genotype. “And these folks are all known to us by name, age, sex and location, and the chances of their heterozygosity are usually not hard to determine.” Population genetics would have given Allan an accurate estimate of the carriers in a population, but no indication of whether a given individual was a carrier or not.36

(p.118) Knowing the individual carriers, he said, enabled them to give eugenic advice. “This gives us a small number that may need birth control information, should they have already married their cousins. This frees the rest of the county from any fear of carrying the trait.” This was practical genetics, what Allan called simply the family history method. All the geneticists' fancy statistics did not tell you why this person has this disease. His was a down-home, high-touch genetics: “I judge this problem calls for a much more intimate acquaintance with our population rather than any further refinement of methodology,” he complained once to Paul David. He was more diplomatic to his friend Laurence Snyder, admitting, “As far as you real geneticists being too theoretical goes, there wouldn't be any science of genetics today if you fellows had not worked your gray matter pretty hard.” However, theory needed to be worn lightly, in his view. “Every now and then the suit you men cut out doesn't exactly fit everywhere,” he continued, “and I tinker a little on some of the tight spots.”37

Allan and Herndon also attempted to find linkage, to correlate genetic diseases with known human genes, of which there were fewer than a dozen in the 1940s. If someone had x, what was they chance he would also develop y? What genes were inherited together? One of their best tools was Snyder's PTC test, which they always tried to administer when taking a history. Sometimes, getting people to take the test proved challenging. The rumor spread that the bitter strips had a different purpose. “Word got around in the back country that they were sneaking around and sterilizing” people with the PTC strips, reminisced Allan's daughter, Elizabeth Berger, in a taped conversation with Herndon. In her analysis of the North Carolina Eugenics Board, Johanna Schoen found that some poor rural North Carolina women actively sought sterilization. With the public health nurse Lena Hillard traversing Watauga County at the same time, distributing contraceptive sponges and foaming powder, it is easy to understand how the people might have thought the PTC strip a new birth-control technique—or even a means of sterilization. “And the people didn't want to take it,” Berger recalled. “At least some of them didn't.” Herndon agreed, adding that Allan “suddenly noticed that, when he'd go to a farm house, that the ladies were always willing to take it and the men lit out for the barns.”38

(p.119) Allan and Herndon were not sterilizing people out in the countryside, but the hillfolk were not wrong about the researchers' larger intent. The purpose of the fieldwork was simultaneously medical and eugenic. In a letter to Paul David, sent from the field in 1942, Allan described these twin aims. “What I'm trying to do in Watauga,” he wrote, “consists of an effort to solve the riddle of the frequency and distribution of rare recessive pathological genes.” But the next sentence described his “primary purpose”: “cutting down the supply of defective children.” Just as important as the men lighting out for the barns, however, is the observation of the women lining up to take what they think is a new form of birth control. While some women were clearly coerced or tricked into receiving contraception or sterilization, others took birth control eagerly. Allan, and to an even greater extent Herndon, operated in a world without sharp moral boundaries. Providing a welcome service graded insensibly into providing a needed service, which graded into providing education, into providing advice, into persuasion, into coercion. When is intransigence an expression of autonomy, and when a symptom of a desperate need for medical care? Public health eugenics involved a complex physio-moral calculus, which Herndon executed paternalistically and often chauvinistically, but with humanitarian intent.39

A fourth project, in addition to surveys of crippling diseases and blindness and the Watauga County survey, was billed explicitly as a “eugenics project” in Forsyth County, of which Winston-Salem is the county seat. Reporting on the year's activity to the Carnegie Corporation for the year 1943–44, Herndon wrote that the project, begun in September 1943, was aimed at “the eugenic improvement of the population of Forsyth County.” It consisted of a “gradual, but systematic effort to eliminate certain genetically unfit strains from the local population.” A principal technique, of course, was sterilization. About thirty sterilizations had been performed, Herndon wrote. Eugenic sterilization in North Carolina was treated as an aspect of public health. The reasons for sterilization were many, and the impetus might come from doctors, the state, or the woman in question herself. “Feeble-mindedness” continued to be a common official reason for sterilization. The North Carolina Eugenics Board records document horrific examples of women and even girls as young as ten being “diagnosed” as feebleminded and sterilized against their or their family's wishes. Allan (p.120) himself appears not to have thought much of feeblemindedness as a genetic trait. In one of his chatty field reports to Herndon in 1942, he wrote, “The feeble-minded child I will try to get a look at, but I am a little shy about this trait as I don't know how much of a factor heredity is.” He preferred traits with clearer hereditary patterns. “Good old retinitis pigmentosa,” he continued, “we can go to town on, since it is 100 percent hereditary.” This was exactly the kind of solid footing on which Frederick Osborn had been hoping to place negative eugenics. Allan felt confident exercising his authority as a doctor to eliminate unfit strains of Tarheel humanity, but he tried to be careful that the traits he selected against were both medically and genetically well defined. The germ theory of genes gave better medicine.40

Allan died, suddenly but not unexpectedly, on April 24, 1943. Herndon began working in the hospital's outpatient department, both as a form of service and for much-needed income—for several years this paid his entire salary. It left little time or energy for research, and Herndon did much less fieldwork. Increasingly, he drew on “clinical material”—patients—he encountered in the outpatient department and through referrals for his research. When he found a new and interesting case, he would take the patient's pedigree and then often go out into the field to try to track down family members, who might be examined at home or, if it was convenient, brought in to the clinic and examined there. This was very much the style of the medical genetics clinics that sprung up in the 1950s and 1960s. Thus Herndon's shift from old-style eugenics surveys to clinical genetics was quick and smooth, a simple decision prompted by a death and a war.

The final dimension of the Wake Forest team's work was education and propaganda. Allan gave numerous talks and lectures to public groups. He and Herndon gave “talks on negative eugenics” at civic clubs, medical societies, and other organizations. Herndon and Florence Dudley brought poster exhibits to medical and public health meetings and made it a point to network with anyone likely to be sympathetic to their positions on birth control and sterilization. Herndon would talk to almost anyone. From a conference in St. Louis, he wrote home to Florence Dudley, “Three Catholic sisters came up to see the exhibit, so I suddenly developed urgent business elsewhere. I had no intention of arguing birth control with three nuns—I (p.121) know when I'm licked. I'll let you tackle those folks.” Allan seems to have done little if any formal teaching, but as Herndon assumed leadership of the medical genetics department he incorporated as much genetics as he could into the medical curriculum. In the first trimester of the 1942–43 school year, he reported, he gave talks to the Bowman Gray Medical Society and the neurology clinic, and lecture courses in pathology, neurology, embryology, and medicine. In 1943–44 he offered a formal course, meeting once a week for twenty-four weeks, to the third-and fourth-year students. In addition, he introduced the third-year students to the “family-history method.” He had them take pedigrees on all patients assigned to them on the medical wards. He found the rates of adoption of the method and the quality of the results variable, but on the whole he was pleased to be shaping the course of instruction, ensuring that physicians emerging from the Bowman Gray school would have at least a significant exposure to medical genetics.41

Medical genetics at Wake Forest in the 1940s, then, was cast in the mold of Allan's genetic public health. It offered intellectual challenges different from conventional public health, but the essential methods and view of disease were the same: it was a germ-theory-of-genes approach. As Herndon took the reins, the operation moved into the clinic, but it retained its original epidemiological flavor. The focus was always first on the disease, then on the heredity. They never asked, “How does this gene work?” but always, “How is this disease inherited?” What made their work stand out from other efforts in preventive medicine or public health was that, although they always began with the individual patient, their clinical gaze invariably extended to the family, future descendants, and the population. They drew no sharp line between advising an educated woman about the chances of her having a baby with peroneal atrophy or cataracts and sterilizing the defectives of Forsyth County. Reflecting this public health orientation, in 1947 the Department of Medical Genetics moved from Internal Medicine to Preventive Medicine. “The primary aim of medical genetics is the prevention of disease,” Herndon wrote in his annual report to the Carnegie Corporation that year. Herndon agreed with Macklin, who agreed with Davenport: prevention of disease in an individual was good; prevention in a family was better; and elimination of the disease was the ideal.42

(p.122) If Allan's program at Wake Forest was a species of public health and preventive medicine, Dice's at Michigan was a type of human biology. Through the 1940s Dice built a diverse program of research that spanned clinical medicine, anthropology, psychology, and ecology, all of it geared toward understanding the basis of all human traits, not just the pathologies. It was, in this sense, quite close to Raymond Pearl's Constitutional Clinic and much closer to Davenport's broad eugenics program than to Allan's narrower one, although Dice attended to the environment far more than Davenport ever did. All of these research efforts, however, shared a commitment to understanding the fundamentals of human heredity with an eye toward human improvement.

The boundaries between vertebrate zoology and medical genetics at Michigan were fluid. In 1942 Dice was promoted to full professor, and the Laboratory of Mammalian Genetics combined with the Heredity Clinic to form the Laboratory of Vertebrate Biology. Although the Heredity Clinic became the largest and most productive branch of Dice's group, ecological and anthropological projects continued to play a role in LVB activities. Members of the group collaborated in different combinations, depending on the project. Heredity Clinic activities included receiving referrals from other medical departments, operating an outpatient clinic, and whatever research was being done by Heredity Clinic staff and associates (members of other medical departments with courtesy appointments in the HC).

Dice had broad, eclectic research interests. He maintained a large colony of Peromyscus mice and used them in a variety of studies, both genetic and ecological. He developed a strain with hereditary epilepsy; in 1945 he sent a supply of them to the pharmaceutical company Glaxo for use in testing antiepilepsy drugs, and the study continued to be funded, largely by the National Institute of Mental Health, well into the 1950s. He also carried out a study of the effects of radiation on mice, in collaboration with Earl Green, at the Roscoe B. Jackson Memorial Laboratory in Bar Harbor, Maine, and funded by the Atomic Energy Commission. His zoological training made it easy and obvious to carry out mouse studies with the aim of human application. Not until the 1960s did this approach catch on widely among human-geneticists. (p.123)

The Heredity Clinics

4.3 The building that became the Michigan Heredity Clinic. Courtesy Bentley Library, University of Michigan

At the same time, he kept his ecological roots, pursuing, for example, studies of geographic variation in wild Peromyscus.43

Even before the Heredity Clinic officially opened, Dice and Cotterman began collaborating with medical faculty on clinical case studies. In addition to the connections with the orthodontists George Moore and Byron Hughes and the ophthalmologist Harold Falls, Dice and Cotterman cultivated contacts in neurology, medicine, and other departments in the School of Medicine as well as mental hospitals and other institutions outside the university. In 1944 they listed referrals from twelve different sources. When unusual cases came in to these clinics, Dice or, more often, Cotterman would be contacted and they would collaborate to describe the condition and the pattern of heredity. Falls was one of their favorite collaborators. Cotterman and he published a paper on the genetics of ectopia lentis, a displacement of the lens related to Marfan syndrome. Another paper described a surprising hereditary pattern in the Marcus Gunn (p.124) phenomenon, an abnormal contraction of the pupil used as a sign of optic nerve damage. Moore and Hughes alerted Cotterman when they found any patients with what looked like hereditary dental anomalies. Cotterman published articles, usually with other clinicians, on a wide array of such traits—among them developmental anomalies, heredity of gout, and “status Bonnevie-Ullrich,” which a decade hence would be understood to be a sex-chromosome deficiency known as Turner syndrome. Such were the types of studies that led Herndon to deride the early Heredity Clinic research as “anomalies of the eyebrows and minor defects of the teeth.”44

The Heredity Clinic offered no treatment other than counseling. Early publications reflected a harshly eugenic outlook that took the reproduction of individuals with genetic “defects” as the equivalent of tubercular scoundrels spitting in the water supply. In their ectopia lentis paper, for example, Cotterman and Falls stated, “A kindred of this character frequently becomes a burden to county and welfare funds. This family is no exception.” The last line of the paper read, “Eugenic advice is of importance to both the unaffected and the affected members of a kindred exhibiting this dominant pathologic inheritance.” In later years, Falls's eugenic judgments softened; by the mid-fifties, he often included sensitivity to the patient's needs and wants as an important determiner of the kind of advice the genetic counselor should give.45

Patients admitted to the Heredity Clinic underwent an exhaustive battery of tests and interviews. An eighty-page manual from 1946 documents them, as well as codifying procedure for every clinical and administrative aspect of the Heredity Clinic, down to boilerplate for form letters and specifications for the color and weight of paper to use for different purposes. Typically, someone visiting the Heredity Clinic presented either a medical complaint known or presumed to be hereditary or some other trait of potential genetic interest. This individual was called the “propositus,” the term for an individual through whom a family comes medically to light. Considerable care seems to have been taken to secure informed consent as well as permission to interview and examine family members—consent and permission are listed on multiple forms and instructions. The staff used a variety of forms, but among them were “family record” forms, a type of form used also at Wake Forest and a direct descendant of those used at the Eugenics Record (p.125) Office at Cold Spring Harbor. The origin of such records, of course, was Francis Galton's anthropological survey back in 1889.46

A typical patient work-up by the Heredity Clinic staff involved an updated, medicalized Galtonian biometry. Their parsing of the body relied heavily on a semipopular book published in 1942 called Family Treasures. Billed as being directed primarily at amateurs, it was a sort of field guide to the human body, a taxonomy grouped by body part, heavily illustrated with more or less clinical photographs and accompanied by a narrative and descriptive, rather than analytical, text. The staff recorded a battery of test results, including assessments of mental acuity and musical talent, as well as a wide range of anthropometric measurements. They recognized ten different shades of skin color, including four shades of brown but no black. They recorded reflexes, tongue protrusion, “mental condition,” “habits,” speech, memory, attentiveness, and visual, auditory, and olfactory abilities. In short, they were interested in the same range of traits as Charles Davenport had been, but their measures were less laden with value judgments and stereotypes.47

Less laden, but not unladen. “Yellow brown” skin was described as “the usual oriental type,” thus simultaneously appealing to folk knowledge about race and lumping people of Asian descent with those of African descent. Subjectivity crept everywhere into the measurements. A submedium depression of the nasion (the point where the frontal and two nasal bones converge) should be recorded, the manual specified, when “a little more than a trace but not the customary depression” was observed. A “+++” forehead slope was defined as having “an exaggerated posterior slope, giving a ‘rat face’ appearance.” Obesity ranged from none, to slightly plump, to average for a person over thirty “or a comparable amount in a younger person,” to a “fat individual.” Subjectivity in itself is not necessarily insidious, of course, and naturalists have ever sought to partition graded characters into sharply defined categories. It is a necessary procedure whenever one tries to classify objects—to put people, in this case, into bins according to type. Nevertheless, in the murky world where human biology met medicine, the method had inherent moral hazards.48

These examination procedures show vividly a key difference between the Michigan Heredity Clinic and the Bowman Gray Department of Medical (p.126) Genetics. In contrast to Allan and Herndon's emphasis on pathology, Dice was equally interested in positive human characters and defects. He developed a colorimeter to measure eye color and the tint of the skin, an experiment reminiscent of Francis Galton's eclectic studies of talent and character. He bought a piano in order to test sense of pitch. In the tradition of human genetics and eugenics, by 1941 more than thirty years long, Dice's catholic approach, involving medicine, biometry, psychophysics, and other disciplines, was more mainstream than Allan's and Herndon's more narrowly clinical approach. The zoologist in him was always interested in measuring normalcy at least as much as dissecting pathology.49 After the war, Dice began to win larger grants to undertake longer-term studies. In 1949 he drafted a proposal for a study of hereditary abilities. Again recalling Galton, Dice's study involved gathering pairs of twins and giving each a battery of psychological and behavioral tests, taking anthropomorphic measurements, and also taking blood for biochemical tests. The experimental question was exploratory rather than hypothetical: the goal was simply an “attempt to discover which … abilities are hereditary” and to search for correlations between mental abilities and biochemical or physical traits.”50

But if the experimental design of the hereditary abilities study was simplistic, it was founded on a strikingly Garrodian axiom. “A fundamental tenet of the science of genetics,” Dice began in his proposal, “is that most if not all of the spectrum of genetically controlled variations finds its ultimate explanation in terms of biochemical alterations.” It seems to be an extension of George Beadle and Edward Tatum's “one gene, one enzyme” hypothesis, articulated just a few years before, to all of human heredity. Dice obtained a $90,000, three-year grant from the McGregor Fund, a Detroit philanthropy organized in 1925 “to relieve the misfortunes and promote the well-being of mankind.” In a 1951 note to C. M. Goethe, one of the enduring patrons of eugenics research and a great admirer of Dice, he described the Hereditary Abilities Study as “part of our general program to measure as precisely as possible the trend of heredity in human populations.” At the Michigan Heredity Clinic, Galtonian measurement and population thinking coexisted peacefully with Garrodian biochemical individuality.51

It was axiomatic to Dice, as a mammalogist and ecologist, that population principles should apply equally to mice and men. For example, one of the (p.127) main projects of his group in the 1950s was the Assortative Mating Study. Assortative mating is a basic concept of population genetics that describes the degree to which animals prefer to mate with animals either similar (positive) or dissimilar (negative) to themselves. In nature, positive assortative mating can lead to sympatric speciation: one species splitting into two within a defined geographic area. Thus the implied question in studying assortative mating in humans is: To what extent are marriage choices among urban people leading to the creation of genetically distinct populations? Race is certainly one variable in urban populations, but age, socioeconomic status, education, profession, personal taste, and other variables also enter in.

The project was funded by an “anonymous donor” who gave $100,000 over five years—a huge amount for the day. It was Wickliffe Draper. The principal investigators for the study were Dice and James Spuhler, an anthropologist on the staff. Taking the city of Ann Arbor as a type of natural community, they asked, What is the size of the mating isolate—the group of individuals who interbreed? What is the frequency with which members of the community marry into families with economic and social backgrounds similar to their own? What are the similarities between mates in physical features, mental characteristics, states of health? And finally, what are the effects of these choices on the future structure of the community?52

The method was straight out of Galton's Natural Inheritance. They would randomly sample the population of Ann Arbor. Each person selected would undergo a wide variety of biometric and psychological measurements—physical traits, such as height, weight, hair color, and so forth, as well as mental traits including IQ, musical ability, and other aptitudes. And each would be extensively interviewed about occupation, income, habits, and of course mating choices. The researchers would then perform statistical analyses to discover correlations among the traits in order to determine whether people who possessed a given trait were more likely to marry someone who shared it. In 1951 the United Press wire service picked up the story of a huge amount of money for research on human mating preferences. The story's lead ran: “The University of Michigan announced the donation of $100,000 to explore the ‘decisive question’ whether gentlemen actually prefer blondes.” The project, the reporter stated, would attempt to discover “why (p.128) certain types of men and women are attracted to each other.” A woman in Germany, skeptical of such a deterministic approach to human mate choice, clipped the story and sent it to Dice, penning sardonically beneath it, “Because they love each other!”53

Cover one eye when looking at the heredity clinics and you think you are looking at an old-fashioned eugenics office. Cover the other, and you see something very like a medical genetics clinic of the “modern” period. Stereoscopically, the images blend, gaining texture and depth. Their founders saw them as the next logical step in the medicalization of negative eugenics. Both Lee Dice and William Allan had strong ties to the Progressive-era eugenicists, and both men explicitly modeled their institutions on the Cold Spring Harbor Eugenics Record Office. Davenport and Laughlin may have been ignominious by the 1940s, but among those interested in human health, eugenics remained a noble, intelligent, compassionate goal. At the same time, the heredity clinics' directors and staff were central in the professionalization of human genetics, beginning with the formation of a professional society in the late forties. They are the direct ancestors of the divisions and departments of medical genetics of the nineteen fifties and sixties, founded by sundry “pioneers” and “father” figures, celebrated in internal histories of the field. They helped ensure that when human genetics became a profession, its practitioners would work in medical schools.

The heredity clinics crystallized the idea that negative eugenics was a medical procedure. Frederick Osborn did not invent this distinction—since the late 1920s, negative eugenics had been increasingly a medical practice—but he was instrumental in institutionalizing it. In the trusted environment of a hospital, concern with immigration and marriage laws gave way to eugenic advice, often dispensed by a physician, and medical sterilization. Once, the unfit were outcasts; now they were patients. No one would have denied the social associations of these unfortunates—that they were the inbred poor of Appalachia, or the descendants of Africans with sickle cell anemia. But the justification for eliminating a tainted human “strain” was now medical, not sociological. Allan's family history method (p.129) brought negative eugenics from a population level of analysis to the level of the individual. One no longer had to rely on crude techniques such as marriage or immigration restriction to eliminate hereditary disease; one could operate at the level of keeping this person from having a baby with a given disease.

The heredity clinic workers saw no conflict between Garrodian concern for the individual and Galtonian concern for the population. Prevention of suffering is prevention of suffering, whether now or in the future. But the urgency of racial improvement was waning. The commitment remained but the zeal had ebbed, pushed back as much by the physician's concern for the patient as by technical or theoretical advances in genetics. Gone were the statistically naïve predictions of huge changes in gene frequencies in a few generations; these researchers had a sense of how long it would take to achieve meaningful change. Many medical geneticists and eugenicists of the late 1930s were becoming more philosophical. So long as the genetic material remained enigmatic and so long as direct intervention in human heredity remained ethically off-limits, they would have to be patient.54

Patient, however, does not mean inert. Although the heredity clinic workers understood the limitations of their knowledge, they pressed forward avidly in building and growing their profession. At the end of the war, the optimism about human genetics in the early 1940s would blossom, when the world gained a stunning new sense of the urgency of stemming human genetic deterioration.


(1.) Allen, “Eugenics Record Office,” 250–54.

(2.) Wilson, “Pedigree Charts.”

(3.) Oliver headed up one of the heredity clinics described in this chapter. Glass published extensively on human problems; see chapter 6. Carlson, Muller's last student, has had a second career as a historian of genetics and eugenics. See, for example, Genes, Radiation, and Society and The Unfit.

(4.) Newman, Freeman, and Holzinger, Twins; Gershon, “Historical Context”; Rainer, “Franz Kallmann's Views on Eugenics”; Kolb and Roizin, First Psychiatric Institute; Mildenberger, “On the Track of ‘Scientific Pursuit.’”

(5.) Charles Dollard interview with Frederick Osborn, February 6, 1939, f. 11, “Allan, William,” III.A.1 A–B, box 1, Carnegie Corporation of New York Records, Rare Book and Manuscript Library, Columbia University Libraries, New York.

(6.) Osborn, “History of the American Eugenics Society,” 118.

(7.) Rising sterilizations: Reilly, Surgical Solution, chapter 6 and p. 97, table 4. Family Research Bureau: “36th and 37th Annual Reports of the Michigan Academy of Science, Arts and Letters 1935, pp. 1–113,” typescript, f. Institute of Human Biology—Heredity Clinic—History (Timeline and Correspondence), box 1, Department of Human Genetics Papers, Bentley Historical Library, University of Michigan (hereafter DHG). Sterilization and birth control: Kluchin, Fit to Be Tied, chapter 1; Schoen, “Fighting for Child Health,” 90.

(8.) Pioneer Fund: Tucker, Funding of Scientific Racism, chapter 2. Wilson, “Pedigree Charts as Tools,” 183. On Goethe, see Stern, Eugenic Nation, chapter 4.

(9.) “What is in my mind”: Allan to Osborn, June 18, 1936, box N 307-1, f. 1936–1939, William Allan Papers, Coy C. Carpenter Library, Wake Forest University (hereafter Allan Papers); Osborn demurred: Osborn to Allan, July 14, 1936, box N 307–1, f. 1936–1939, Allan Papers. Wake Forest a proud achievement: Osborn, “History of the American Eugenics Society,” 120–21.

(10.) Allan to Osborn, June 21, 1937; Osborn to Allan, July 6, 1937, f. 1936–1939, box N307-1, Allan Papers.

(11.) Osborn to Allan, July 6. 1937, f. 1936–1939, box N307-1, Allan Papers; Osborn, Preface to Eugenics, 29.

(12.) Osborn to Allan, April 21, 1938, f. 1936–1939, box N307-1, Allan Papers. Both Barry Mehler, “History of the American Eugenics Society,” 120–27, and William H. Tucker, Funding of Scientific Racism, 50, have noted Osborn's support for negative eugenics and complicated his reputation as a moderate. Neither, however, explored the history of the heredity clinics that Osborn helped instigate.

(13.) Allan, “Relationship of Eugenics to Public Health,” 74.

(14.) Allan to Osborn, December 5, 1938; Osborn to Allan, January 27, 1939, f. 1936–1939, box N307-1, Allan Papers.

(15.) Allan to Osborn, January 24, 1939; Osborn to Allan, February 16, 1939; Allan to Osborn February 22, 1939, f. 1936–1939, box N307–1, Allan Papers.

(16.) Schoen, Choice and Coercion, 32–38.

(17.) Allan to Osborn March 8, 1940, f. F121, “Allan, William,” subject file, WFU.

(18.) Meads, Bowman Gray School of Medicine, and North Carolina Baptist Hospital, Miracle on Hawthorne Hill.

(19.) [Anonymous], “Herndon”; Allan to Carpenter, September 20, 1940, f. F121, “Allan, William,” subject file, WFU.

(20.) Allan to Osborn, March 20, 1940, f. 1940, box N307-1, Allan Papers; Snyder, Medical Genetics.

(21.) Evans, “Lee Raymond Dice.” “A Proposed Laboratory for the Study of Human Heredity in Michigan,” Michigan Academy of Arts, Science, and Letters Annual Report, 1937, 84–87, f. Reprints, box 6, Dice Papers.

(22.) Opitz, “Obituary: Charles W. Cotterman,” 149.

(23.) Crow and Denniston, “In Memory of Charles W. Cotterman,” 903.

(24.) “Report to Dean Yoakum on Research Grant R-108 (L. R. Dice) 1940–1941,” f. Inst of Hum Biol—Corresp and Administrative Material—1941–1942, box 1, DHG. Allan to Snyder, July 12, 1941, f. 1941, box N307-1, Allan Papers.

(25.) “Interested in what you are doing”: Keppel to Dice, August 1, 1941, f. IHB 1946, Dice Papers. Herndon arrived in August: Herndon to Allan, August 20, 1941, f. 1941, box N307-1, Allan Papers.

(26.) Herndon to Allan, September 17, 1941, f. 1941, box N307-1, Allan Papers. I concentrate here on the Wake Forest and Michigan programs; for more on the Dight Institute, see Stern, Telling Genes.

(27.) “Drive me dippy”: Herndon to Allan, October 30. 1941, f. 1941; “Ruin the academic outlook”: Allan to Herndon, November 11, 1941, f. 1941, box N307-1, Allan Papers. Flyer dated December 1, 1941, f. 1941, box N307-1, Allan Papers; “To the Staff of the University Hospital,” f. Institute of Human Biology—Heredity Clinic—History (timeline and correspondence), box 1, DHG. The original quotation reads, “The mills of God grind slowly, but they grind exceedingly small”—An apt characterization of the fine-grained genetic style of Cotterman, although why Herndon referred to the Michigan group as Gaelic is obscure.

(28.) Herndon to Allan, December 31, 1941, f. 1941; Herndon to Allan, March 16, 1942, f. 1942–1 Jan–May, box N307-1, Allan Papers.

(29.) “Report of Department of Medical Genetics May 1, 1943 to May 1, 1944,” f. Carnegie Corporation, box 7, Allan Papers; Cotterman to Kuntz, October 2, 1944, f. Inst of Hum Biol—Corresp and Administrative Material—1943–1944, box 1, DHG.

(30.) Dice's publicity efforts: Paul M. Chandler, “U. of M. Heredity Clinic Seeks to Improve Human Breed,” Flint Journal, August 14, 1943; “Heredity Clinic at U. of M. Aims to Better Human Race,” Pontiac Press, August 14, 1943, both in f. Inst of Hum Biol—Corresp and Administrative Material—1943–1944, box 1, DHG; Postle and Postle, “Whose Little Girl Are You?” The Postles consulted Dice through their writing, including sending him drafts of the article, initially titled, “Human heredity clinic,” f. 1947–1948, Bbx 1, DHG. Anderson as possible replacement for Herndon: Dice to Roy [sic: Ray] C. Anderson, April 5, 1945, Anderson to Dice, July 26, 1945, f. IHB—Corresp. and Admin. Material 1945, box 1, DHG. Reed, “Reactivation of the Dight Institute,” 1; Resta, “Historical Perspective: Sheldon Reed and 50 years of genetic counseling,” 375. On Reed, see: Stern, Telling Genes; Resta, “Historical Perspective”; Resta and Paul, “Historical Aspects of Medical Genetics.”

(31.) Department of Human Genetics Collection, f. Inst of Hum Biol—Corresp and Administrative Material—1941–1942, box 1, Bentley Library, University of (p.257) Michigan. Muller was apparently being considered by Michigan as well. Neel, too, weighed the advantages of Michigan vs. Cold Spring Harbor and decided he needed the medical environment of the Heredity Clinic; Neel, Physician to the Gene Pool, 24–25.

(32.) “Gold mine in heredity”: Allan to Paul David, November 10, 1941, f. 1941, box N307-1, Allan Papers. “Review of the Year's Activity, July 1941–July 1942,” f. 1942–2 Jun–Dec, box N307-1, Allan papers. “Greatest natural experiment”: Allan to Snyder, July 5, 1942, f. 1942-2 Jun–Dec, box N307-1, Allan Papers.

(33.) Allan to Osborn, December 1, 1941, f. 1941, box N307-1, Allan Papers.

(34.) Herndon to Allan, April 7, 1941, f. 1941, box N307-1, Allan Papers.

(35.) Herndon to Allan, July 25, 1941, f. 1941, box N307-1, Allan Papers.

(36.) Dudley to Herndon, May 14, 1942, f. 1942-1 (Jan.–May); Allan to Herndon, April 22, 1942, f. 1942-1 (Jan.–May); Allan to Snyder, December 12, 1942, f. 1942-2, box N307-1, Allan Papers.

(37.) Allan to Snyder, December 12, 1942, f. 1942-2; Allan to Paul David, November 10, 1941, f. 1941; Allan to Snyder, December 2, 1942, f. 1942-2 Jun–Dec, box N307-1, Allan Papers.

(38.) Herndon 16; Schoen, Choice and Coercion, 98–102.

(39.) Allan to Paul David, July 17 1942, f. 1942-2, box N307-1, Allan Papers.

(40.) “Report of Department of Medical Genetics, May 1, 1943 to May 1, 1944,” f. Carnegie Corporation, box 7, Allan Papers; Schoen, Choice and Coercion, 30–43, chapter 2; Allan to Herndon, April 22, 1942, postscript April 25, f. 1942–1, box N307-1, Allan Papers.

(41.) Herndon to Florence Dudley, November 3, 1942; Herndon to Allan, September 22, 1942, f. 1942-2 Jun–Dec., box N307-1; “Report of Department of Medical Genetics May 1, 1943, to May 1, 1944,” f. Carnegie Corporation, box 7, Allan Papers.

(42.) “Report of Department of Medical Genetics May 1, 1946, to May 1, 1947,” f. Carnegie Corporation, box 7, Allan Papers.

(43.) Dice to Raymond W. Waggoner, Neuropsychiatric Institute, University of Michigan, April 27, 1945, f. IHB—Corresp. and Admin. Material 1945; NIH research grant application, f. Institute of Human Biology—Correspondence and administrative materials—1954, box 1, DHG; “Current Research Projects of LVB Staff, Aug. 1946,” f. Laboratory of Vertebrate Biology Meeting Minutes, 1945–1952, box 5, Dice Papers.

(44.) Referrals: Untitled document, July 8, 1944, f. Institute of Human Biology—Correspondence and Administrative Material—1943–1944, box 1, DHG. Cotterman, “Status Bonnevie-Ullrich”; Cotterman, Falls, and Neel, “Some Hereditary Diseases”; Smyth, Cotterman, and Freyberg, “Genetics of Gout and Hyperuricaemia”; Smyth, Cotterman, and Freyberg, “Genetics of Gout and Hyperuricaemia: An Analysis”; Cotterman and Falls, “Unilateral Developmental Anomalies in Sisters”; Falls, Kruse, and Cotterman, “Three Cases of Marcus Gunn Phenomenon.”

(45.) Reed, “Short History of Genetic Counseling”; Falls and Cotterman, “Genetic Studies on Ectopia Lentis,” 11. On Reed, see Resta, “Historical Perspective”; Stern, Telling Genes. The small Harold Falls collection—just one box—at the Bentley Library, University of Michigan, contains a good set of Falls's reprints.

(46.) “Procedures Manual, 1946,” f. Institute of Human Biology Procedures Manual, 1946, box 1, DHG.

(47.) Whitney, Family Treasures.

(48.) “Anthropometric measurements,” “General neurological examination,” and “Physical Examination, sheet E-1,” f. Institute of Human Biology Procedures Manual, 1946, box 1, DHG.

(49.) For example, in 1945 Dice wrote to Harvard's Clark Heath, “It is our aim, as it seems to be yours, to find as many ways as possible for accurately measuring the human organism. We also are particularly interested in ‘normal health and mentality,’ though most of the cases we receive deal with physical or mental defects and illnesses” (Dice to Heath, October 9, 1945, f. IHB—Corresp. and Admin. Material 1945, box 1, DHG).

(50.) “Anthropometric measurements,” “General neurological examination,” and “Physical Examination, sheet E-1,” f. Institute of Human Biology Procedures Manual, 1946, box 1, DHG.

(51.) www.mcgregorfund.org, last viewed September 11, 2011. Dice to Goethe, November 8, 1951, f. Goethe, C. M., box 2, Dice Papers.

(52.) Minutes of Staff Meeting, Inst. Human Biology, July 27, 1951, f. Corresp. and Admin. Material—1951, box 1, DHG; James P. Adams to Mr. Wickliffe Draper, April 25, 1950, Regents Exhibit; Wickliffe Draper to the President of the University of Michigan, April 18, 1950, Regents Exhibit, Bentley Historical Library, University of Michigan. Thanks to Alex Stern for this insight and detective work. She recounts these events in Stern, Telling Genes, chapter 2.

(53.) Der Tagesspiegel, August 19, 1951, f. Ka–Kk, box 3, Dice Papers. For a description of the AMS, see “Institute of Human Biology, 1951–52,” f. Correspondence and Administrative Materials, 1951, box 1, DHG.

(54.) Paul, “Did Eugenics Rest on an Elementary Mistake?”