Item
Bibliographic Resource

1924 Sterilization Form

Title of the Document
1924 Sterilization Form
One Line Summary
This consent form contains the requirements to be sterilized in the 1920s. This specific document was used for inmates, however, the qualifications to be sterilized can be applied to the general public. Ultimately, this document highlights the weight of “low IQ” in eugenics, as the options are “insane, idiotic, imbecile, feebleminded, and epileptic”.
Author
Virginia State Hospital Board
Date Created
1924
Location
Virginia
Type of Document
Legal Document
Transcription
Hospital Form No. 111

VIRGINIA:
BEFORE THE STATE HOSPITAL AT

________________________________
(Institution)

In re
_______________________ Register No. ___________________ } Order for sexual sterilization

Upon the petition of ____________________________________________________________

Superintendent of ______________________________________________________________

and upon consideration of the evidence introduced at the hearing of this matter, the board finds the said inmate is

{Insane
Idiotic
Imbecile and by the laws of heredity is the probable parent of potentially
Feeble-minded
Epileptic}

inadequate offsprings likewise afflicted; that said inmate may be sexually sterilized without detriment to his or her general health, and that the welfare of the inmate and of society will be promoted by such sterilization.

Therefore, it appearing that all proper parties have been duly served with proper notice of these proceedings, and have been heard and given the opportunity to be heard, it is ordered that

__________________________________{ perform/ have performed
(superintendent)

by Dr. ______________________, on the said inmate the operation of {vasectomy/salpingectomy}
after not less than (30) days from the date hereof.

______________________________
(Designated Master of the Board)

Dated ____________________________
Provenance
“Virginia Eugenics Consent Form, 1924,” University of Virginia Eugenics Exhibit, University of Virginia, box 2: folder 9.

Part of 1924 Sterilization Form