3 The Involvement of Nurses in the Eugenics Program in Alberta, 1920–1940

Diana Mansell

The opening decades of the twentieth century were years in which the Canadian government actively recruited immigrants from the United Kingdom, Europe, and the United States to assist in the settlement of western Canada. The immigration waves that followed contained large numbers of non-English-speaking people of eastern European heritage.¹ As these numbers increased, the white Anglo-Saxon Protestant minority feared a “multiplication of the inferior.”² Indeed, during the first half of the twentieth century, Canadians felt threatened by the rising numbers of what were considered “unfit” and “inferior” citizens, on whom they blamed a wide variety of social problems such as divorce, alcoholism, and economic instability.³ To that end, according to public health researchers Kowalewski and Mayne, “the mentally ill, new immigrants, and social deviants were very often considered unfit.”⁴ Alberta’s solution was the passage of the Sexual Sterilization Act in 1928 and the creation of the Alberta Eugenics Board (regarding the more detailed social and political context, see also chapters 1 and 4). The act remained law until 1972 and its repercussions continued into the 1990s, when the Progressive Conservative government of Ralph Klein (1942–2013) was taken to court by many victims of sterilization.⁵ The act was supported by many prominent first-wave feminists, including Nellie McClung (1873–1951) and Emily Murphy (1868–1933). Nurses too supported the act and the philosophical ideology on which the need for sterilization was based: “on available means for racial improvement,” as was prominently pointed out by the Toronto-based psychiatrist Clarence B. Farrar (1874–1970) in his 1931 editorial in the Canadian Journal of Public Health.⁶

The historical argument made in this chapter is that nurses, with their concerns for the overcrowding and overburdening situation and working context in hospitals and mental institutions of the time, were especially drawn to contemporary eugenic ideals that seemed to offer an easy way out of the often-unbearable care and administrative situations in those hospitals and asylums. The chapter will explore the role nurses played in promoting eugenics in Alberta through referrals to the AEB and the promotion of birth control material in public and institutional advertisement and prevention campaigns. It includes contributions made by public health nurses since much of their work was devoted to the socialization of new immigrants to Canada. Class, gender, and ethnicity are central themes to this discussion because the majority of individuals who were sterilized were unemployed female immigrants from eastern Europe.⁷ The 1920s to the 1940s represent a time in nursing history when a nurse’s duty to care was complicated by the attitudes and values of the society in which she existed. Patricia Dantonio highlights the importance of revisiting nursing history:

History matters to nursing . . . more today now that issues of health care policy and practice, so central to the mission of the profession, have re-engaged the public agenda. . . . [However,] there seems to be only one familiar history to which nurses turn as they consider their place in this process. This history has often been written from the stance of educators deeply concerned about the inability of the profession to control the many different educational routes to nursing practice. Its sources have been a long list of twentieth century reports on the status and future of nursing education.⁸

THE LEILANI MUIR LAW CASE

In the 1990s, a high-profile court case in Alberta drew attention to the topic of eugenics and the controversial issues that surrounded it. In the case of Muir v. Alberta, a fifty-one-year-old woman was awarded $740,000, to be paid by the Alberta government, for having been sexually sterilized while wrongfully confined to a provincially run mental institution.⁹ In her ruling on January 26, 1996, Madam Justice Joanne Veit stated, “The circumstances of Ms. Muir’s sterilization were so high-handed and so contemptuous and so little respected Ms. Muir’s human dignity that the community’s and the court’s sense of decency is offended.”¹⁰ At fourteen years of age, Leilani Muir (1944–2016) had been classified as a “mental defective” following an IQ test that rated her as subnormal. On January 19, 1959, she was sterilized without her knowledge.¹¹ This procedure was done in accordance with the Sexual Sterilization Act. The provincial act, which became law on March 21, 1928, and was finally repealed in 1972, directed the Lieutenant Governor in Council to appoint a board that would include two medical practitioners. This board became known as the Alberta Eugenics Board (AEB). It was established to examine all patients residing in Alberta mental hospitals for the purposes of sterilization prior to their discharge. In this way, according to the AEB, “the danger of procreation with its attendant risk of multiplication of the evil by transmission of the disability to progeny” would be eliminated.¹²

The Muir case raised a number of socio-legal and health-care-related questions. To what extent is a current government accountable for consequences of previous social policy going back as far as 1928? Furthermore, as one newspaper editor noted, “It is worth considering the parallels between eugenics, a faith in human engineering that at one time was embraced by reputedly progressive thinkers of the right and left and the new science of genetic engineering.”¹³ For nursing, however, a group that is always associated with health and health-care issues, the questions are different. Past nursing activities are often viewed through the lens of “caring.”¹⁴ In what way was caring manifested as nurses assessed and referred individuals for sterilization and assisted in the actual operative procedure? In the Muir case, for example, the nurse was not entirely honest when she told Leilani that she was only going to have her appendix removed.¹⁵ On the surface, this might appear to contradict her duty of care, but “caring” was perceived quite differently during past decades than it is understood today.¹⁶ The point is that nursing did not develop in isolation but participated in, and became very involved with, the lives of all Canadians. As a result, much of the profession’s development was in response to the needs of Canadian society often identified by individuals and groups external to nursing. This chapter, therefore, examines the role of women in the eugenics movement and raises questions regarding the role of nurses in that movement.¹⁷

Eugenicist ideas emerged out of nineteenth-century notions developed by British polymath Charles Darwin (1809–82) and became very popular in the United States through Herbert Spencer (1820–1903), a Social Darwinist.¹⁸ Sir Francis Galton (1822–1911), a cousin of Charles Darwin, took these theories further, becoming known as the founder of eugenics. According to Galton,

Eugenics is the science which deals with all influences that improve the inborn qualities of a race; also with those that develop them to the utmost advantage. The improvement of the inborn qualities, or stock, of some one human population. . . . All creatures would agree that it was better to be healthy than sick, vigorous than weak, well-fitted than ill-fitted for their part in life.¹⁹

NURSING BETWEEN CARE AND COMPASSION

The international climate into which these ideas parachuted was receptive because evolution suggested that the race was moving forward and there existed a possibility of improving the race through selective breeding.²⁰ The Canadian milieu for the reception of these ideas was fertile. This was due in part to the large influx of eastern and southern European immigrants between 1896 and World War I. Their numbers added to the anxiety of Canada’s middle-class reformers, who considered themselves to be from sound Anglo-Saxon stock and were highly conscious of the warnings about the degeneration of the race.²¹ The emerging view of the new immigrants was linked to notions of social purity by those moral reformers who favoured a “whiter” skin colour. It was thought that the darker the skin, the lower the race and, as a result, the lesser the ability to control sexual desires.²² According to Kowalewski and Mayne, for example, physicians were among the main proponents of eugenics and their increasing authority in society led to a widespread belief in the power of science to solve social problems.²³ Additionally, the social problems and public discourses in Alberta and its neighbouring province Saskatchewan were similar, while nurses and nursing teachers frequently moved from Alberta to Saskatchewan and vice versa. This was particularly the case in the 1930s, when their similar challenging experiences of the Great Depression and the Western Dust Bowl necessitated personal exchanges and interprovincial mobility of nursing and warden staff. Indeed, the argument was made “that only professionals educated in scientific biological thought could possibly cope with the complex problems facing a society on the brink of degeneration.”²⁴ Physicians then convinced the Canadian public that social problems were medical issues, thus reflecting the beginning of a trend toward medicalization and an easy opportunity to increase the power of the medical profession.²⁵

At the same time, psychiatrists Charles Kirk Clarke (1857–1924) and Clarence Hincks (1889–1964) founded the Canadian National Committee for Mental Hygiene (CNCMH) in 1918.²⁶ The committee encouraged a public health movement predicated on assessing the severity of mental health problems across Canada.²⁷ As historian Erika Dyck notes, these Canadian reformers “believed that there was a strong correlation between mental abnormalities, or levels of intelligence, and criminal or, immoral behaviour, and likened these categories to a social disease or epidemic that threatened to infect mainstream society.”²⁸ In Alberta, psychiatrists, superintendents, and mental hygiene practitioners conducted a survey and concluded that it would be ideal to reject the insane and mentally deficient because they were more threatening than any other group. And further, “immigrants have contributed more than their fair share to the insane and feeble-minded population, and to other undesirable groups.”²⁹

Another factor that contributed to Canadian receptivity of eugenic ideas was that the control of reproduction in segregated asylums for those classified as “feeble-minded” was being criticized as expensive and inefficient.³⁰ Although these ideas received much attention in eastern Canada, the western provinces provided a more hospitable climate for the growth of hereditarian doctrines.³¹ In western Canada the language of eugenics focused on foreign weeds in the gardens of Alberta, a reflection of an economy based on agrarian activities. The topic of immigration posed questions that fused the “elements of class, race, and intelligence, using ‘foreigner’ as convenient shorthand for undesirable.” According to Dyck, “at the heart of eugenics programs . . . lay a desire to exert power and surveillance over families that did not suit the national regional plan.”³² The plan would have been to focus on the growth of the white Anglo-Saxon Protestant population, and this was further endorsed by that demographic, which was strongly represented in the farming community. The United Farmers of Alberta (UFA) was formed as a political entity and entered the political arena in 1917. Its main areas of concern were public health and social ethics. At the UFA’s annual convention in 1918, its members asserted that “the insane and feeble-minded constitute a source for a large proportion of the paupers, criminals and prostitutes in Alberta.”³³ Given the timing, the UFA decided to take this opportunity “to build a new, healthier post-war society . . . through prohibition, health care, eugenics, social welfare, and progressive taxation.”³⁴ Along with the United Farm Women of Alberta (UFWA) the UFA endorsed “eugenic solutions to keep Canada racially virile,” thus providing fertile ground in this western province.³⁵

In 1921, the UFA formed the provincial government in Alberta. The UFWA carried a significant amount of influence with the UFA, as had been reflected in the fact that both organizations supported suffrage for women, which resulted in women obtaining the provincial franchise in 1916.³⁶ The suffragists were Anglo-Saxon, Protestant, and middle-class and shared the anxieties and expectations of this group; they also viewed social problems through glasses tinted with values shaped by this allegiance.³⁷ According to Dyck, these early feminist reformers in the UFWA “linked poverty and reproduction even more explicitly with feeble-mindedness, and eugenics became a significant part of their campaign in Alberta, embracing the ethos of eugenics as a progressive approach to improving the province’s families.”³⁸ In 1924, Irene Parlby (1868–1965), as the acting UFWA president, noted in a speech the grave concerns surrounding mental deficiency and prostitution “and the urgent need for the public to consider its role in assuaging the calamitous effects of prostitution, illegitimacy, drunkenness, and criminality in society.”³⁹ According to Parlby, “the main problem . . . remained the high birth rate among people in the defective category, for which she recommended regulation of marriage, segregation of all defectives, and sterilization.”⁴⁰ Further defence of their domestic turf involved the prevention of entry by immigrants. The UFWA asserted that immigrants “were over-represented by the feeble-minded, the epileptic, the idiotic, the tubercular, the dumb, the blind, the illiterate, the criminal, and the anarchistic.”⁴¹ Eugenic principles would bring about the betterment of the state through scientific breeding—a notion not unfamiliar to the farming community.⁴² Their ideology has been labelled “maternal feminism” in that they demanded the vote so that they could more adequately defend their homes and children.

During the 1920s, “disease prevention and health promotion took on a major role in the health care services provided by the federal and Alberta provincial governments.” Included in this was the importance of early detection of disability and disease, thus resulting in the need for “periodic health examinations, medical inspection of schools, and the promotion of prenatal care.”⁴³ Furthermore, at that time, only 50 percent of women calling themselves nurses were registered with the professional association, the Alberta Association of Registered Nurses (AARN). Indeed, these women were operating quite autonomously in their nursing practice.⁴⁴ In 1923, the Calgary Graduate Nurses Association influenced a change in policy by recommending that “patients in the country needed the services of the most highly skilled nurses as well as those living in the city.”⁴⁵ This notion would lead to the creation of the District Nursing Services.⁴⁶ At this time, the nursing service ideal was based on Christian values rooted in church attendance.⁴⁷ Yet, the District Nursing Services happened as a direct result of political activism by organized women’s groups, especially the UFWA, not the Alberta Association of Registered Nurses.

It should also be noted that during the 1920s, licensure with the professional association was not pursued by graduate nurses in Alberta. Furthermore, the AARN was not involved in any “political activism relating to health care issues” and although the association “did little overtly to impede creation of the District Nursing Service, it similarly offered no concrete support.”⁴⁸ Indeed, the AARN did not see any value in “allying themselves with other organized women’s groups,” because their goals were different.⁴⁹ This view was accepted among nursing associations on both provincial and national levels. As the University of Alberta’s nurse historian Sharon Richardson has pointed out, the “creation of the Alberta District Nursing Service became the exclusive result of extensive and persistent political activism by organized women’s groups, especially the UFWA,” and not of influence by organized nursing or graduate nurses.⁵⁰ Indeed, early Alberta nurse leaders divorced themselves and members of their nursing organizations from health-care issues such as rural and homesteading women’s need for reproductive health care.⁵¹

PUBLIC HEALTH PERSPECTIVES

The Canadian government built a railway across Canada to link the East and the West and, in 1872, passed the Dominion Land Act, which provided “free homesteads to settlers locating in the west.” The first homesteaders were primarily “English-speaking and [of] Anglo-Saxon origin.”⁵² Once this influx of settlers tapered off, large campaigns were launched to entice eastern Europeans—targeted because the government believed the land in the Canadian West was similar to that of eastern Europe and thus these peasants would be suited to Prairie farms. As a result, between 1901 and 1931 the population of Alberta increased from 73,033 to 732,605, resulting in a dramatic change in the ethnic composition of the province; the Prairies had become a “mosaic of distinct ethnic and linguistic communities.”⁵³ This immigration impacted nursing and the provision of health care. Alberta developed public health-care services in 1918 through its new Department of Public Health, because—as a Public Health report noted—“at this period in our history, a great many deaths among the infant population, especially among our immigrants, were never reported; burials being made in the back yard.”⁵⁴ This was probably the underlying reason for the employment of nurses: to investigate these deaths and to educate people as to what might be done to prevent them.⁵⁵ In Manitoba, public health nurses were meant to detect “symptoms of disease and physical defects, unreported communicable diseases, unreported births, malpractice in midwifery, and unsanitary conditions, especially detrimental to the welfare of mothers and children.”⁵⁶ These tasks would have been the same for public health nurses across the Prairies, in Saskatchewan and Alberta, as well.

The Department of Public Health’s report of 1921 was particularly concerned with the living habits of eastern Europeans that were viewed as “disgusting” and a threat to the health of the “whole province.” It was suggested that inspectors along with public health nurses investigate these immigrants’ homes and “force sanitary conditions upon these people.”⁵⁷ The problem of mentally defective immigrants raised alarms for the Department of Public Health as well. In 1924, the minister, George Hoadley (1867–1955), brought his concerns to Premier Herbert Greenfield (1869–1949), noting that medical examinations at point of entry were at that time only cursory.⁵⁸ Hoadley argued that “this practice had resulted in a large number of foreign-born individuals residing in the Provincial Hospital for the Insane. Canadians, for example, represented 49 percent of the provincial population and 27 percent of patients in the asylum, while immigrants from the British Isles, Europe, and the United States, although they represented 17, 14, and 18 percent of Alberta’s population, respectively, were a disproportionately higher 25, 24, and 22 percent of asylum patients.”⁵⁹

The UFWA moved in concert with the UFA.⁶⁰ Parlby was the first president of the UFWA and the first female cabinet minister in Alberta in the newly elected UFA government. In 1921, however, she was succeeded by Marian Sears (b. 1862?), who was particularly interested in hygiene, birth control, sterilization of the mentally unfit, and sterilization legislation.⁶¹ In 1928, UFWA members fully supported the Sexual Sterilization Act.⁶² Their goal was the protection of their community or, as Emily Murphy (who was then the first female magistrate in the British Empire) said, “to prevent these deviants from plucking the plum and the cream from the upper crust.”⁶³ In 1929, the UFWA immigration convener made a plea for the maintenance of “superior British stock” in Canada, a country for “virile races.”⁶⁴ She then moved that “we urge our Canadian government to regulate the flow of migrants to Canada so that in no year would the number from other countries exceed [those] of British birth.”⁶⁵ Society in general feared that alcoholism, epilepsy, social dependency, delinquency, borderline intelligence, congenital syphilis, physical weakness, and criminal behaviour might be transmitted from parent to child.⁶⁶ As noted by sociologist Jana Grekul, the provincial director of mental health and the superintendents of the province’s mental institutions concluded that “sterilization is the only rational procedure for dealing with mental defectives who were unduly prolific both within and without marriage and bring into the world children double handicapped by both heritage and early environment.”⁶⁷

As the influence of psychiatry and medicine grew, it was believed that their “scientific” proof allowed for the promotion of the link between feeble-mindedness and social problems, the solution to which was to be found in “involuntary sterilization” and “racial betterment through the weeding out of undesirable strains.”⁶⁸ The AEB first appeared in the Department of Public Health’s annual reports in 1932. A profile emerged of those individuals who were referred to the board. As legal scholar Timothy Christian concluded from his research,

They tended to be female rather than male, young and inexperienced rather than mature, not employed and dependent rather than self-supporting, employed in low status rather than prestigious jobs, residents of small towns rather than cities, members of ethnic minorities rather than the dominant ethnic group, single rather than married, and had been defined as sexual deviants. In addition, those persons dealt with by the Eugenics Board had been branded with the most socially debilitating label of all—a psychiatric diagnosis.⁶⁹

Most cases approved for sterilization were those in which a patient was diagnosed as mentally defective. However, psychotic, “manic-depressive” (today’s notion would be bipolar disorder), and schizophrenic patients represented 42.7 percent of cases and the bulk of the remaining individuals approved for sterilization. Further, by 1929, the UFA was looking to enlarge the community of health-care professionals to include physicians and public health nurses in order to identify potential candidates for sterilization who had not been admitted to an institution.⁷⁰

Since women were viewed as more promiscuous than men and as having a greater potential for evil than men, cumulative totals for female sterilization were much higher than those for men. This was in spite of the fact that from 1934 until 1943, the number of men recommended for sterilization annually outnumbered women. In 1934, 132 men were recommended for sterilization and 46 operations were performed: in the same year, 82 women were recommended and 59 were sterilized.⁷¹ Given the fact that a vasectomy is much simpler to perform than a salpingectomy (removal of a Fallopian tube), this situation can also be seen to reflect both the domination of men within the AEB and the low social status held by women.⁷² Nurses joined virtually all Canadians in working toward the maintenance and preservation of a white Anglo-Saxon Canada. Since all aspects of nursing are closely connected to hygiene, it is not surprising to learn that nurses were also concerned with “mental hygiene,” “social hygiene,” and mental illness. To this end, articles published in the Canadian Nurse addressed the sexual attitudes of nurses.⁷³ It was generally agreed that sex was at the root of a great number of the ills from which the world was suffering—ills that nurses also combated. One such “ill” was masturbation, which was closely linked to insanity and criminal or anti-social behaviour.⁷⁴ The language of eugenics also appeared in articles in the Canadian Nurse that discussed the type of young woman that should be accepted into training schools. The ease with which nurses made use of the vocabulary of eugenics reflects the interactivity of nursing with society at the time.⁷⁵ Similar rhetoric appeared in the pages of the Canadian Public Health Journal, a journal in which both nurses and physicians expressed their views.⁷⁶ Health-care workers seemed to agree that sterilization provided a path to racial improvement.⁷⁷

Support for this idea is particularly exemplified in the role played by the public health nurse, who was very much involved with “public hygiene” in that she often worked with children and thus had the opportunity to identify those commonly referred to as “idiot” or “feeble-minded.” The appearance of these children in a family was usually attributed to a history of insanity, poor environment, or poor hygiene on the part of the mother.⁷⁸ The services of a public health nurse might also be viewed as a “Canadianizing” influence on the eastern Europeans. Health education and prevention of disease in this population contributed to the perceptions that the nurse acted as an agent of socialization and surveillance, owing to the frequency of the visits. As one public health nurse wrote, “I have tried everything as perfectly as possible under the circumstances, and also to explain to them just why we think our way better than theirs.”⁷⁹ The preferred way for a new Canadian to arrive in Canada was “in a cradle in a Canadian home.”⁸⁰ These views were in keeping with mainstream Canadian society. The support that nurses gave eugenics mirrors the assent of Canadian society in general and demonstrates the integral role of nursing in these social developments. It also reveals their prejudices and the kind of attitudes they would have had toward the people they were trying to help.

In Alberta, public health nurses and the UFWA were closely connected. As early as 1916, the UFWA initiated investigations into the need for public health nurses, rural hospitals, and health units. The organization’s efforts were rewarded when the Department of Public Health was established in 1919. This, in turn, led to the creation of a system of public health nurses, municipal hospitals, and travelling clinics throughout Alberta. Nurses collaborated with the Women’s Institute, the Red Cross Society, and the UFWA to ensure that hospital care and nursing care were available to all Albertans.⁸¹ By 1935, nurses staffed the twenty-two hospitals operating under the Municipal Hospitals Act. In addition to offering their services within these institutions, nurses provided professional help when called upon by the communities in which they lived. Throughout Alberta, nurses who were married were on call and often performed public health nursing functions in their homes. Nursing had become an essential service and the status of those women involved in delivering the service had been further enhanced by the approval in 1923 of a degree program that would lead to a bachelor of science in nursing at the University of Alberta.⁸²

PUBLIC HEALTH NURSES AND THE ALBERTA EUGENICS PROGRAM

Public health nurses worked diligently to maintain the standards of public health set by the dominant group.⁸³ These standards were fuelled in part by eugenic ideology as well as by fiscal restraint. As Jean Field of Kinuso, Alberta, member of the AEB, noted in her address to the eighteenth annual convention of the UFWA in 1932,

I am convinced that the Eugenic Sterilization Act brought into being a new phase of health work, which will be of great benefit to the future of our citizenship in Alberta. . . . It is not a cure all. . . . But it is one of many sane and practical and humane methods which must be adopted in all effort to relieve in a slight degree, the appalling problem of the mentally incompetent, and the result to our future citizenry of the unimpeded transmission of mental defects to progeny. Also, when we consider that, out of every hundred dollars spent in this Province in public health, eighty dollars is spent in mental health, one must consider this question in its economic aspects as well.⁸⁴

Farm women and public health nurses were not alone in their support of these views. The citizens of Alberta strongly supported the sexual sterilization activities approved by the AEB.⁸⁵ One fascinating example of this closer interaction between groups of farm women and public health nurses occurred in 1937, when the Wesley United Church in Calgary established the Family Planning Association, to educate women to have “children by choice—not by chance.” To this end, the Family Planning Association hired a Kaufman nurse.⁸⁶ Alvin Ratz Kaufman (1885–1979) already had one nurse in Alberta when Ann Hammill (d. 2007?) accepted the position to assist in the promotion of birth control material for the Family Planning Association.⁸⁷ Hammill was paid $19.95 per month plus an additional $1.00 for every application for birth control that she sent to the Parents’ Information Bureau at 410 King Street West in Kitchener, Ontario. The application incorporated a brief medical history of the client, a description of the client’s home conditions, and information relevant to birth control devices. Information was available in English, Polish, Ukrainian, or French and all supplies were free of charge. Hammill cooperated with the AEB and described the board as “very helpful.”⁸⁸ All of the “abnormal” cases were referred to the board; for Hammill, “abnormal” meant families in which one or two children out of five or six had a physical deformity.⁸⁹

This nurse was committed to her work. Indeed, in her opinion, given the economic climate of the 1930s, the government could not bear the cost of the many children who eventually became wards of the state. Hammill herself recounted one case in which she felt she had “picked the wrong one to sterilize”:

We had one or two women here in town whom I am sure were responsible for turning over 15 to 20 babies to the Relief Department here. Every year they would present another one. . . . After having about 12 children, we finally caught up with the family and suggested possible sterilization and we picked the wrong one to be sterilized—we sterilized the husband. So, she turned up again a few years following this and when Mrs. W came into the clinic at City Hall, she called me and she said: “I have a baby in east Calgary left with a babysitter and the mother has not come back for the baby and I recognize the features and I know where [it] belongs.” Do you suppose you could possibly get a hold of this patient and maybe it’s not too late to have her done. So we finally did have her sterilized. But this was over a period of years. These babies were taken over and became government wards. . . . This is why Commissioner X said that we had saved them so much money.⁹⁰

Those individuals referred to the AEB by nurses such as Hammill were seldom from the dominant class, with whom nurses shared concerns regarding the burden that unwanted children placed upon both the poor and the state. The goal of these socially conservative women was to control the health and well-being of women, children, and the families in the community where the poor, as a group, constituted a socially disruptive force.⁹¹

The direct role that nurses in Alberta played in the eugenics movement with its focus on questions concerning procreation by individuals with mental disorders involved the assessment, referral, operating room assistance, and post-operative care. Anecdotal evidence suggests that on an individual basis, some nurses refused to participate, but this was usually rooted in a deep religious conviction. In particular, at the Alberta Hospital, Edmonton, student nurses in their psychiatric nursing training refused to assist in the operating room during a sterilization procedure. Most nurses, however, recognized it as law.⁹² In 1937, the Social Credit government wanted to reassure voters about their fiscal credibility, and to demonstrate this, they “removed the Board’s need to obtain consent in cases where the client was deemed mentally defective.”⁹³ The revised act included the following:

If, upon examination of any mentally defective person, the Board is unanimously of the opinion that the exercise of the power of procreation would result in the transmission to such person’s progeny of any mental disability or deficiency, or that the exercise of the power of procreation by any such mentally defective person involves the risk of mental injury either to such person or to his progeny, the Board may direct, in writing, such surgical operation for the sex sterilization of such mentally defective person as may be specified in the written direction.⁹⁴

This shift in the consent process coincided with a growing silence around the subject of eugenics in medical journals and the press, so that by the end of World War II, the surgeries had increased but reporting on them had disappeared completely (compare with tables A1 to A4 in the appendix).⁹⁵ This would suggest that other problems were taking up the attention of society, with the returning soldiers and the postwar relief to which people turned following the trauma of war. In December 1940, psychologist John M. MacEachran (1872–1947), then chair of the AEB, reported that a total of 801 males and 774 females had been presented and passed for sterilization but “only” 277 males and 450 females had actually been sterilized during the first twelve years of the existence of the eugenics program in the province (see also chapter 1).⁹⁶ Given the aims of the Sexual Sterilization Act, these numbers suggest that some success was obtained. In fact, by the time the act was repealed, 2,835 women and men had been sterilized.⁹⁷ What does this tell us about nurses and their participation in these sterilizations? Nursing historian Hilde Steppe viewed the support that nurses in Germany gave to the National Socialist Party during the 1930s and 1940s as the darkest chapter in the history of her profession.⁹⁸ She attributed the willingness of those nurses to participate in National Socialist policy to what she describes as the four pillars on which secular nursing in Germany was based: humility, sacrifice, selflessness, and obedience.⁹⁹ National Socialist nurses followed orders and experienced an internalized sense of obligation that moved one nurse to state, “I was personally of the opinion that if the doctor prescribed it and the law prescribed it, then it must be right.”¹⁰⁰ A similar explanation can be applied to nurses in Alberta between 1920 and 1940. Tradition dictated that a “good” nurse was an “obedient” nurse. Indeed, one school of nursing in Alberta made the following demands:

All pupils are required to be honest, truthful, trustworthy, punctual, orderly, neat and obedient. In a word, they are expected to keep in mind the importance of their position and to evince at all times the self-denial, good temper and gentleness so essential to successful service.¹⁰¹

Not surprisingly, this school is credited with making a significant contribution to nursing in Alberta, particularly through the provision of matrons in hospitals throughout the province.¹⁰² Ultimately, sterilization decisions were medically driven and the rationale was understood to be for the protection of, and in the best interests of, the patients.

DISCUSSION

As this chapter has sought to demonstrate, predominantly those nurses in Alberta—who were organized in the Provincial Nursing Association of Alberta—supported the notion that society was protecting these patients, especially female patients, from exploitation, unwanted pregnancies, and the burden of childrearing by applying both positive and negative forms of eugenics measures.¹⁰³ As I have argued here, nurses were working obediently in a medical culture—at the time led largely by white, male, Anglo-Saxon Protestant physicians, scientists, and administrators—that was pro-eugenics, despite likely personal reservations about the program. In particular, the nurses were, by job description and function, peripheral to the matter of eugenics as a medico-legal matter. In this way, the caring demonstrated by these nurses is similar to that discussed by Thomas Olson in that the nurses handled, managed, and controlled individuals in order to maintain a society that adhered to the wishes of the dominant group, of which they were a part.¹⁰⁴ As Dyck has previously determined,

The history of reproductive politics is complicated through the swirl of debates surrounding sterilization, contraception, and abortion, loud voices have often been raised to condemn seekers of such choices for their carelessness and irresponsibility. Carelessness has been framed in terms of personal hygiene, proximity to mainstream values . . . and intelligence or ability. Irresponsibility has been used to justify intervening in people’s lives, sometimes coercion, and in the case of eugenics, to curb their fertility.¹⁰⁵

These conclusions also hold for my own argument here regarding the involvement of nurses in the centralized eugenics program in Alberta between 1920 and 1940.

Finally, however, there is no evidence to suggest that the Provincial Nursing Association attempted to influence social policy on any level, one way or the other.¹⁰⁶ This was not a time when the topic of human rights was on the social agenda of provincial or national politics; therefore, there is little reason to suspect that the attitudes of nurses differed from those held by the society within which they functioned. In terms of eugenics in Alberta, this chapter has stressed that nurses clearly represented the thinking of Canadian society at large. If opposition to the eugenics movement existed among nurses, failure to articulate it or act upon it might he attributed to “I see and I am silent,” the motto chosen for the first school of nursing in Canada.¹⁰⁷