- The Science of Human Perfection: How Genes Became the Heart of American Medicine by Nathaniel Comfort
eugenics, medical genetics, heredity clinic
The history of medical genetics has long been narrated as a story of the unfortunate entanglement of human genetics with the morally dubious practices and scandals of eugenics from which it finally freed itself. Such a master narrative—which often refers to a legitimizing “medical turn” in the middle of the century after World War II—is deeply mistaken, argues Nathaniel Comfort. Eugenics was never “overcome,” as if it were some sort of “contaminant” that could finally be left in the dustbin of history, and at no time “did medical genetics break suddenly with its eugenic past.” Rather than assume a clear shift from “a focus on human improvement to one on relief of suffering,” Comfort argues that we have always been eugenical: “human improvement and the relief of suffering [are] the two goals of all eugenics—and all medical genetics.” The Science of Human Perfection offers a powerful revisionist account that highlights the key role played by an ever-present “eugenic impulse” in the emergence of medical genetics, which identifies how such an impulse remains an important and insidious feature of biomedicine even today. According to Comfort, “the promises of genetic medicine are the promises of eugenics.”
Comfort takes a generally chronological approach to his subject matter, and combines a close eye for telling detail with an irresistible desire for the resonant turn of phrase. (Bateson’s Defence is described early on as “at once dirty-laundry personal and test-tube elegant,” while Lederberg’s skills are later described as insufficient to distinguish “a combine from a cow pie.”) The book’s early chapters explore how public hygiene, a Progressive-Era eugenics-inspired idea, came to be understood ultimately “as a form of preventive medicine.” As this putatively Mendelian conception of public health took hold, hereditary disease came to be framed as a public health concern like that of any other infectious disease. Using Comfort’s terms, “genes were like germs,” and sterilization was accordingly an appropriate tool for dealing with “a genetic Typhoid Mary.” But this emerging characterization of “pathological heredity” also enabled physicians, long concerned with the more constitutional dimensions of disease, to transform eugenics in other ways. Rather than “drive eugenics out of the study of human heredity,” Comfort notes, “eugenics was the means by which genetics went medical.” As eugenical attention to the fate of the population was increasingly complemented with [End Page 685] medical concern for the situation and fate of the individual, the “unfit” outcast was increasingly recharacterized as a “patient.” Medical ideas about the prevention of hereditary and other disease were thus not easily separable from larger eugenical concerns.
Comfort’s study of the mid-century rise of the “heredity clinic” out of the demise of the Eugenics Record Office highlights the complex interrelationship between medicine and eugenics well. Such “new hybrid institutions,” essentially “eugenics record offices attached to medical schools and teaching hospitals,” had “unquestionably eugenic” roots even as they also fruitfully sought to unite the medical relief of suffering with the goal of human improvement. Heredity clinics—Comfort examines three, one each in North Carolina, Michigan, and Minnesota—helped to establish “the core methods, built the institutional structures, and founded the professional community” of medical genetics. While the focus of such institutions was always on the individual patient, at least at first, “their clinical gaze invariably extended to the family, future descendants, and the population.” Medical genetics thus did not somehow escape, overcome, or reform eugenics; rather, heredity clinics were simply “the next logical step in the medicalization of negative eugenics.”
By the end of World War II, Comfort argues, increasing acknowledgment of the danger of radiation-induced genetic damage brought human medical genetics to public attention, and transformed old eugenical arguments about degeneration into new concerns that seemed to require ever-greater mastery of human heredity. As the field of medical...