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In 1923, Boston City Hospital chose Dr. William Mayo, already famous for the work of his Minnesota clinic, to speak at the inauguration of a new laboratory. Mayo’s thoughts on hospital administration, published in the Boston Medical and Surgical Journal (which would be renamed the New England Journal of Medicine in 1928), highlighted the common anxieties of his profession and went far beyond the anodyne comments that were usual on such occasions.1 Mayo amplified the phobias and fed the moral panic stemming from the eugenic thought of that time, saying that municipal hospitals were swamped by the poor, as cities were besieged by criminals and the country threatened with demise by waves of defective immigrants. While Congress debated increased restriction on immigration, Mayo traced poverty to “constitutional inferiority and mental instability,” declaring both “to a large extent hereditary.”

Mayo said one goal of public hospitals should be to “reduce the number of people whom it must care for at the expense of the taxpayer.” A robust sterilization program and limits on immigration of the “defective” would serve that goal...