The Black Stork: Eugenics and the Death of "Defective" Babies in American Medicine and Motion Pictures Since 1915.

In 1915, a physician's public announcement that he had withheld lifesaving treatment from a seriously malformed newborn prompted an outburst of press coverage and commentary from individuals across the American spectrum of political and social beliefs. The same physician, Harry Haiselden of Chicago, went on to write and star in a film, The Black Stork, which argued the eugenic desirability of withholding treatment from "defective" newborns. Haiselden's actions joined eugenics and euthanasia into a single issue which elicited powerful reactions at a moment when progressive era hopes that objective science might produce a consensus on social questions were beginning to falter.

Martin Pernick's superb analysis of these events falls into two parts. In the first half of the book, he dissects opinions on the issue of how to treat abnormal newborns that appeared in the extensive newspaper coverage of Haiselden's actions. In the second half, he analyzes the film The Black Stork and draws on history of film making and film distribution in the 1920s to show how the crystallization of film genres in this period resulted in the elimination of provocative or disturbing medical material from mass release commercial films.

Pernick surveyed a geographically and editorially diverse set of newspapers, as well as elite publications like medical journals, and, from the coverage of Haiselden's actions, culled every instance he could find of individuals' expressions of opinion on the issue of how to treat abnormal newborns. In analyzing this opinion, Pemick insists on the importance of going beyond scientists' evolving technical understanding of genetics and considering popular conceptions of heredity. In the late nineteenth century, he notes, even most scientists did not believe heredity and environment were mutually exclusive. More importantly, though the rediscovery of Mendel's work in 1900 and Thomas Hunt Morgan's work on the genetics of the fruit fly prompted scientists to distinguish heredity more sharply from environmental influence, in public discourse heredity continued to be seen as a putative cause for virtually all human traits and behaviors. Thus, reactions to Haiselden reflected people's attitudes toward the broadest social problems of the day, including poverty, immigration, infectious disease, alcoholism, and sexual norms, as well as whether they thought eugenic measures might prove effective in rectifying them.

From these sources Pernick develops his reading of the complex ways that profession, class, gender, and religious and political affiliation correlated with stances on whether treatment should ever, or sometimes, be withheld from newborns, or whether positive steps should be taken to end the life of some infants. While he is careful not to claim that newspaper coverage equals public opinion, he argues that what appeared in the mass media created the framework within which most people thought about eugenics and euthanasia. The results include some startling individual views; for example, Helen Keller supported Haiselden's stance, though she stated that only mental, rather than physical, incapacity should be grounds for withholding treatment.

More significantly, Pernick's analysis reveals the seeds of dissolution of the one article of faith that united progressives across the fluid pre-World-War-I political spectrum: that objectivity, working through science, could produce correct solutions for value-laden social problems. For example, specialist groups' articulation of their distinct interests undermined professional consensus. Obstetricians were more likely than general practitioners to oppose withholding treatment because of their ongoing struggle with midwives over who should control childbirth. Obstetricians staked out the professional high ground in part by accusing midwives of colluding in infanticide and therefore they tended to embrace an ethos of saving all babies.

Among those identified with the Democratic party, Catholics uniformly opposed withholding treatment from any infant while non-Catholics were likely to favor withholding treatment from some infants. In a period when male medical experts were gaining power to pronounce on issues of family and child-rearing, eugenicists and feminists remained divided among themselves on the role of women, lay or professional, in making life-and-death decisions. In probing such fault lines, Pernick demonstrates that eugenics was not a set of ideas embraced by most commentators of the age, but a vocabulary of concepts within which people framed their views on the meanings of disability, human potential, social engineering, and a wide range of related issues.

The second half of Pernick's book draws on film history (and more newspaper analysis) to argue that an emerging aesthetic censorship shaped how issues like eugenics were presented to the American public in the mass media. The film The Black Stork was released in 1916, following ten years of enthusiasm among physicians and public health workers regarding the potential of instructional films to instill healthy behaviors and attitudes in the populace. The controversy provoked by The Black Stork deepened the growing ambivalence of medical professionals regarding the fitness of mass-audience films as a medium for discussing complex and potentially disturbing medical issues.

The film's story line pairs the experiences of two couples - Claude and Anne, who marry in spite of Claude's susceptibility to an inherited disease and against their doctor's advice, and Miriam and Tom, who refrain from marriage because of Miriam's fear she has inherited epilepsy. Confirming her doctor's fears, Anne gives birth to a sickly, malformed child. The eugenically minded Dr. Dickey, played by Haiselden, refuses to treat the infant and displays examples of defective children in his efforts to dissuade the couple from seeking lifesaving care elsewhere. Anne then receives a vision of the life her son would live if saved: enduring social ostracism as a child, falling into crime and poverty as an adult, and finally going insane and killing the doctor who saved him. Anne makes the difficult choice to withhold treatment, and the infant's soul is released from his imperfect body. Miriam, in contrast, learns that her fears of epilepsy are groundless; it was a step-parent who had the condition. She and Tom marry and she gives birth to a plump, healthy baby.

As Pernick shows, this film was remarkable for the way it combined its dour eugenic message with the typical melodrama of the subplot in which (eugenic) virtue is rewarded with love, marriage and healthy offspring. Tracing changes in the film as successive versions were released between 1916 and 1927, and discussing the evolution of film genres and film distribution systems in the 1920s and 1930s, Pernick notes important shifts in the kinds of issues that commercial films were likely to treat. Various factors militated against a durable trend in commercial film as a vehicle for medical ideas and information. Haiselden drew at least as much criticism for his publicity-seeking as for his views in favor of eugenics and euthanasia. Arguments over who was best qualified to make life-or-death decisions regarding children had implications for how or even whether such issues should be portrayed in public media. Some commentators believed overly explicit portrayals of illness and deformity could be harmful to viewers, especially to women.

Pernick argues that reaction to The Black Stork played a significant role in the process whereby such medical images and issues faded from commercial films. Physicians and film critics alike objected to the film's depiction of misshapen bodies and difficult medical choices. Although early films had capitalized on a public appetite for the bizarre and the spectacular, by the 1920s film critics and producers and civic leaders had agreed that too-explicit portrayal of medical themes in films violated desirable aesthetic standards. Commercial films became vehicles for entertainment only.

Although versions of The Black Stork continued to be shown in some venues until about 1942, Halselden and the issue of infant euthanasia faded quickly from public consciousness after the burst of publicity of 1915. Pernick carries the story to 1945 with a survey of other American and German films treating eugenic themes and a careful discussion of whether and how films like The Black Stork might have influenced Nazi policies of euthanasia and mass killing.

When infant euthanasia resurfaced in public dialogue in the form of Baby Doe cases in the 1970s, Pernick notes, media coverage betrayed a complete lack of historical memory on the issue. Debates about physician-assisted suicide and coverage of the Human Genome Project have once again brought the meanings of heredity and the worthiness of individual lives to the foreground of public consciousness. Pernick (and others he cites) recognize important differences in how these issues are treated today - indeed, our current conceptions regarding the ethics surrounding death or the potentials inherent in genetic technologies are virtually defined as contrasting with pre-Nuremberg standards regarding protection of individual rights. Pernick stresses, however, that there are more, and more important, continuities than are usually recognized. He warns that exaggerated faith in startling research advances and renewed hopes that science can provide uncontentious answers to questions regarding the quality of individual lives are as dangerous now as in the progressive era. Such misplaced faith in objectivity, he urges, "delegitimat[es] the kinds of political and ethical scrutiny that alone can enable a culture to debate and evaluate these value judgments intelligently." (p. 175-6) Such a warning is especially pertinent in a period of public retreat from social explanations for social problems. This is an excellent book whose appeal should extend to general readers interested in film and the public role of science, as well as to historians of medicine and film and to social and cultural historians.

Caroline Jean Acker Carnegie Mellon University