Museum of Fine Arts, Boston

‘Because She Was Susceptible’; aquatint by Francisco Goya from Los Caprichos, 1797–1799

There are currently at least 2.3 million people detained and confined in the United States and its territories. Many thousands are held without having committed a crime, including nearly 11,000 children locked away for “technical violations” or “status offenses” such as running away or skipping school. And since at least 1978, the number of women and girls removed from society and locked up for extended periods of time has been growing at more than double the rate of men and boys.

According to The Trials of Nina McCall: Sex, Surveillance, and the Decades-Long Government Plan to Imprison “Promiscuous” Women, a new book by the law student Scott Stern, a shocking number of American girls and women were also locked up beginning in the 1910s as part of the now completely forgotten “American Plan,” a governmental effort to combat venereal disease. Stern happened upon this unnerving piece of history largely by accident when he was an undergraduate poking around the stacks of the Yale libraries. His curiosity piqued, he spent almost a decade digging into archival collections, visiting decaying rural towns, and interviewing people in their living rooms, trying to understand what this program was and what its human cost might have been.

Stern’s research not only uncovered many details about this nationwide attempt to control women suspected of spreading syphilis and gonorrhea, but also rescued from obscurity the story of an eighteen-year-old girl named Nina McCall, who experienced the program firsthand. For those of us who decry today’s internationally unparalleled carceral crisis and wonder how we ended up here, Stern’s beautifully written account of the American Plan and the life of Nina McCall offers some needed but uncomfortable answers.

Attempts to control the spread of disease have nearly all originated in moments of economic or social crisis, and virtually all of them have targeted society’s most vulnerable members. At the turn of the century, when antibiotics had yet to be discovered, syphilis and gonorrhea were rampant in American cities. Notably, concern among reformers and government officials over venereal diseases (as sexually transmitted infections—STIs—were called at the time) was fueled by a more general rise in white anxiety over changing ethnic and racial demographics across the nation: 14.5 million people immigrated to the US between 1900 and 1920, and half a million African-Americans moved to northern cities from the South during World War I.

Efforts to slow these diseases often took the form of targeting women, particularly black and brown women, for persecution—some white middle-class reformers rallied around the criminalization of prostitution. Others pushed for the legalization and accessibility of contraceptives. The Comstock laws, in place since the 1870s, effectively outlawed the circulation and in some cases the use of contraceptives, including condoms, in part to discourage extramarital sex. When Margaret Sanger opened the first family planning clinic in New York in 1916, she was arrested and imprisoned on obscenity charges.

Governmental and reformer concern with venereal diseases escalated dramatically upon America’s entry into World War I, when the sexual health of soldiers became a military priority. Many thousands were infected as they socialized in cities where they were stationed before heading to the front, which resulted in the dismissal of over 10,000 men and countless lost hours of work. Recasting venereal disease as a national security issue led to the creation in the late 1910s of several laws that came to be known as the American Plan. Their enforcement was initially paid for by the National Security and Defense Fund; in 1918 Congress passed the Chamberlain-Kahn Act, which allocated $1 million to the project and established the Interdepartmental Social Hygiene Board to oversee its implementation.

What began as a local effort to reduce prostitution around military bases quickly expanded. Federal agents divided the nation into ten districts within which paid supervisors and field representatives were “to investigate the presence of alcohol, prostitution, and general female promiscuity in a given area.” Should investigators discover women they considered likely to have an STI, they had the legal authority to examine them, quarantine them indefinitely, and subject them to medical treatments that were thought to be a “magic bullet” but were known to be extremely painful and carry terrible side effects. At the time, Stern writes, “no effective treatment existed for syphilis or gonorrhea.” This practice “went on for decades”—well after the supposed need to protect soldiers in both World War I and World War II passed—and incredibly, “the age listed for a first ‘offense’ or ‘delinquency’ was often as low as seven.”

Reformers with their sights on eradicating prostitution were the ones originally most keen to promote the work of the American Plan, but in time numerous other governmental agencies were equally eager to underwrite the effort after it lost federal funding in 1922. By 1918 the plan was operating in forty-one states, in no small part because legislators across the country had been handed a preworded “model law” regarding how best to control STIs. Among other things, this law stipulated that the spread of venereal diseases was “to be declared unlawful,” that such infections must be “reported by name, not merely number,” and that those deemed infected must be quarantined because “their habits are a menace to others.” These people were prohibited from seeking “private treatment” (from, say, a drugstore) and were also prohibited from asking any other authority to issue them “certificates of freedom from venereal diseases.” These model laws remained in place, largely unchanged, in every state, establishing a legal precedent for detaining and quarantining citizens during any outbreak of disease—most recently Ebola and the Zika virus.


Although it is obvious from these drastic guidelines that the political and legal architects of the American Plan had little regard for civil liberties, what it actually meant to endure the effects of the plan was murky even to Stern until he came across the case of Nina McCall, who died in 1957. He was struck by her story in part because she did not come from a major American city known for “immoral” or “seedy” living, such as San Francisco or Chicago. Nina lived in a small town in central Michigan, a sign of how deeply into the nation the American Plan reached. Most importantly, she decided to sue those who subjected her to confinement and treatment, leaving behind a paper trail of her testimony. “In all these ways,” Stern writes, “Nina made for an ideal protagonist.”

Ideal perhaps, but Nina McCall was not necessarily representative. Stern’s research indicated clearly to him that the plan “disproportionately affected nonwhite women.” Not only was Nina white, but there were also black women who had the audacity to file lawsuits, such as Bettie May James from Texas, whom he perhaps could have profiled. But what elite reformers and medical professionals did to this unremarkable white girl from the middle of nowhere—neither an immigrant from New York City nor a black woman from the South—underscores one of Stern’s central points: that under the plan, to be poor and female, even if you were white, was to be perpetually vulnerable to criminalization, confinement, and control. Scores of interviews with women detained under the American Plan in Kansas, for example, make clear just how little evidence could constitute “reasonable suspicion” of an STI:

One woman, for instance, was arrested and examined for defending a friend from the police…. One woman owed rent to a former sheriff…; another was arrested after changing jobs, when her former boss vengefully reported her to the health officer. One woman was arrested after her car broke down…. One woman was forcibly examined after just being on a date with a man who was drinking.

Stern combed through newspapers, court and marriage records, local histories, and almanacs to reconstruct McCall’s story. His narrative allows readers to share her mother’s anxiety as she tried to raise a daughter on her own with few resources, Nina’s shame and fear when she was accused of having gonorrhea and hauled off to a detention center despite having insisted that she had never “been with a man,” and her anguish when her efforts to seek justice were thwarted.

When Nina was eighteen years old, she crossed paths with a woman who had been hired to seek out potentially STI-infected women and bring them to a local physician, Thomas Carney, for mandatory vaginal examination. Although St. Louis, Michigan, was a remote town, it was on a railway line that carried soldiers to various military installations on their way to the European front. When Ida Peck knocked on Nina McCall’s door and told her mother to bring her to Dr. Carney’s office for an examination immediately, a terrified Nina complied. Within hours she had been given a rough and painful gynecological exam, diagnosed with gonorrhea, and informed that she now had two choices: she could either have a placard affixed to the door of her home warning the public that she was diseased and quarantined, or she could check into a local hospital where she would have to stay until she was fully cured. Despite her fervent insistence that it simply wasn’t possible for her to be infected, Nina chose detention over the prospect of bringing shame on her mother’s house.

Nina spent nearly three months in captivity in a bleak fortress known as the Bay City Detention Hospital. Treatment for syphilis and gonorrhea at the time involved painful injections of mercury that, in Stern’s words,

caused, among other things, throbbing pain, kidney damage, inflammation or ulceration of the mouth, and terrible skin rashes….It could [also] stunt growth, affect the memory and basic mental functioning, bring about deafness or blindness, and result in death.

Despite these side effects, detainees were also forced to labor in their facilities; women like Nina scrubbed floors, washed laundry, and sewed bedclothes and uniforms. Her treatment by state officials, while shockingly cruel, was far from the worst reported case; women accused of breaking the rules in a reformatory in New York


were handcuffed with their hands behind their backs and fastened to the cell grating by another pair of handcuffs attached to those on their wrists so that, in some cases, their toes, or the balls of their feet, only touched the floor; and while suspended, their faces were dipped into pails of water until subdued.

Having been confined for gonorrhea, Nina was then told she had syphilis. The toxic treatments she endured, including mercury injections and the application of various deadly silver protein compounds to her vagina, caused her so much pain that she “couldn’t hardly move” the arm in which she received injections. As she later put it, “I suffered with my mouth; my teeth got sore and loose, they were so loose that they could bend them anyplace. They had never been that way before.” In time her hair began to fall out as well.

After three months, Nina was finally allowed to go home. But by then she was considered an outcast in her hometown, unable to find a job or a husband. Worse, Ida Peck and Dr. Carney continued to hound Nina after her release from Bay City. She was required, according to Peck, to continue to undergo treatment (the dreaded mercury injections) even though she had been released. According to Carney, they hadn’t been giving her the right kind of mercury, and she needed a new regimen. Should she refuse to comply, Nina was told, she would be locked up again.

She dutifully reported for treatments at Dr. Carney’s office. Once again, her body began to ache, and just as “the lameness would begin to fade, Nina would have to go back to Carney’s for another injection.” Almost a year after being released from Bay City, however, Nina decided to sue Dr. Carney, Peck, and Mary Corrigan, a particularly cruel matron at the detention hospital. The defendants, her lawyers maintained, had

schemed, connived and confederated together among themselves and with divers other persons both in official positions and without the shadow and shield of office…[and] commanded this Plaintiff to submit her body to an examination…whereupon this Plaintiff refused to so submit herself, and that while said Plaintiff was in such condition of fear, restraint and duress, and without her lawful consent or the lawful consent of any person in her behalf…she suffered great humiliation and disgrace, and a sense of degradation which has continued to this present day.

Nina lost the case, but won her appeal. It would take more than one young woman in one small town to bring down the American Plan, and while Nina’s attempts to do so are worth recounting in detail, the horror of the plan was on a larger scale. This decades-long initiative to “reform” poor women in the name of protecting the public was made possible by the strong support of well-respected female reformers like Jessie Binford, by the substantial funding of John D. Rockefeller Jr. and other well-known philanthropists, by the aggressive enforcement of J. Edgar Hoover, and by the deep conviction of jurists such as Earl Warren that the American Plan was necessary for national security. Peck, Carney, and Corrigan were small cogs in a large and well-oiled machine.

Stern is entirely right to concentrate on the underappreciated damage that the plan did to poor women across the country. The program, he shows, was never really about venereal disease—it was an effort to clean up the streets and police the behavior of women. He recounts how local law enforcement used the American Plan to “commit girls between the ages of ten and seventeen” for “frequent[ing] saloons,” or “lounging upon the public streets,” or “attend[ing] any public dance, skating rink or show” without a parent’s permission, but never boys. This was not a response merely to more blacks, immigrants, and women moving to America’s cities. Once relocated these people needed, and demanded, decent housing, jobs, wages, and, most threatening of all, greater equality. This method of maintaining the racial and economic status quo in the face of demographic and political disruption declined with the widespread availability of penicillin in the 1940s, but others took its place; Stern considers the marginalization of HIV/AIDS patients in the 1980s as an “intellectual, legislative, and judicial successor” to the American Plan.

When we see the American Plan not in isolation, but rather as a part of a long history—from slavery in the 1800s to mass incarceration in the 2000s—Stern’s book is not merely the story of one women’s fight against injustice. His research exposes both the insidious ways in which calls for “public safety” soon come to justify the curtailment of rights, and the extent to which today’s most destructive carceral apparatus has its basis in fear on the part of the powerful. Race, class, and gender profiling inform which citizens today are policed and imprisoned. The same factors determined who was surveilled and locked away under the American Plan. Women who worked as prostitutes and waitresses were seen as a serious threat to the public in 1918. Then, as now, immigrants, people of color, and the poor were deemed the primary threats to “public safety.” In 2018, suspicious white bystanders call the police on black men sitting in coffee shops, black women renting Airbnbs, Native American teens on college tours, and Latinos simply taking a walk in their own neighborhood.

Stern’s account of the myriad ways in which Nina’s incarceration affected her life after she went free will also seem familiar. Her imprisonment marked her as permanently unemployable, much as formerly incarcerated people are continuously monitored and harassed now. In Nina’s time women could end up back in a place like Bay City merely, in Stern’s words, for “marrying without the reformatory’s permission, disregarding curfew, disobeying their parents, running away from home, wearing makeup or seductive clothing, [and] casually dating men.” Today it could be for offenses as unavoidable or minor as failing to get a job, having a cell phone, possessing alcohol, or being unable to pay fines.

Just as the American Plan managed to stay operational and secure funding “even though the war was now over” and even well into the age of penicillin, today’s repressive laws, sentencing, and prisons persist even now that crime rates have reached historic lows. Powerful lobbying organizations, most notably the American Legislative Exchange Council (ALEC), still push for the passage of model laws to exploit marginalized citizens as prison labor.

The good news, Stern notes, is that once they became aware of the American Plan’s myriad abuses, many of the women who for years had championed its enforcement began to call for major reforms. The reformer Ann Webster came to lament having worked “in about thirty states for the government, with delinquents” and was “ashamed to admit” that she had “been party to a procedure which deprived persons of their rights…in the name of their welfare.” Recently, more than a few prosecutors, such as Larry Krasner in Philadelphia, and police, such as those affiliated with Law Enforcement Action Partnership and Law Enforcement Against Prohibition, have also begun to reckon with the damage done by their zealous enforcement of the War on Drugs, which comes down hardest on poor and nonwhite people. They too now seek ways to atone by trying to roll back the worst of its laws.

McCall’s willingness to take her tormentors to court mattered; the countless stories Stern has compiled of resistance to the American Plan by ordinary people suggest that these women’s self-advocacy, and the evolving conscience of women within various organizations, also contributed powerfully to its diminishing enforcement. And yet the laws of the American Plan continued to justify the arrest of “promiscuous” women and sex workers into the 1970s, decades after the discovery of penicillin and the development of sulfa drugs made venereal diseases easily curable. Perhaps Stern’s most important point is that the American Plan matters because it “is not ancient history. [It] helped create the infrastructure and rationale for an explosion of the female prison population that continues to this day.”