On a winter morning in an asylum built to resemble a palace, a panel of men sat at a table in a small second-floor office and opened a folder containing a patient’s name. The doctors held no scalpel. They held something quieter and more permanent: the power to decide whether that person would ever have a child. For decades, the people of Cherokee, Iowa, took quiet pride in the enormous hospital on the hill above their town.
But behind its dairy barns and dining halls, the institution was quietly deciding something no hospital should ever have the power to decide alone. By the 1890s, Iowa had a problem it could no longer ignore. Its three existing asylums at Mount Pleasant, Independence, and Clarinda were full past capacity. The state needed a fourth hospital, and lawmakers agreed.
What they did not agree on was exactly where. Towns across the region saw opportunity: construction contracts, hundreds of steady jobs, and a stop worth making on the railroad line. Cherokee, a farming town on the Little Sioux River, launched an active and relentless campaign to win the legislature’s favor. Tom McCulla, editor of the local Cherokee Times, served as chief lobbyist in Des Moines.
Wyman Miller, a farmer who represented the district in the General Assembly, carried the fight from inside the chamber. The contest dragged on through 14 separate ballots before the legislature finally settled on Cherokee. The legislature appropriated $12,000 to purchase the site, a modest sum reflecting how little anyone understood what they were about to build. What followed was six and a half years of stops and starts: foundations poured and then left waiting, a building standing half-finished and empty on the hillside while lawmakers argued session after session over funding.
It took a new General Assembly and a theatrical piece of persuasion to move the project forward. In March 1900, a special train pulled into Cherokee carrying 91 legislators, their wives, board members, and other observers—231 people in all—to walk through the vast unfinished shell. Barely a month later, the Assembly approved $360,000 to finish the work. By 1901, construction was alive with activity.
Crews built the heating plant, underground tunnels, boilers, and electric light plant. They laid hardwood floors and waterproof tile. Woodworkers set oak trim throughout. The mechanical systems alone represented an engineering effort most Iowa towns of the era never attempted.
The hospital stretched 980 feet in length and 600 feet across, with 550 rooms, 23 dining rooms, 30 bathing rooms, and a smokestack rising 192 feet into the Iowa sky. It had cost roughly $1 million and did not resemble a hospital so much as a fortress or a small, self-governing town. The guiding philosophy behind every state institution built in this era was simple: make it pay for itself. Cherokee built an agricultural operation around that philosophy that would have rivaled many small towns.
The original site covered 840 acres, later expanded to more than a thousand, and virtually every acre was farmed. In 1902, the hospital purchased 35 dairy cows to start a herd that would become one of the finest registered Holstein herds in the country. At its height, the herd numbered 180 cows, supplying milk, butter, cream, ice cream, and cottage cheese to the institution’s kitchens. When the dairy closed in 1966, breeders traveled from across the country to bid on its bloodlines.
The truck gardens yielded staggering volumes: over 118,000 pounds of cabbage, nearly 60,000 pounds of carrots, and thousands of pounds each of asparagus, beans, celery, sweet corn, and cucumbers. The farm raised its own hay, corn, oats, and broom corn. At its peak, the barns held 23 horses and mules, 135 head of cattle, 840 hogs, 239 sheep, and 2,000 chickens. The daily labor was performed by the patients themselves.
Hospital policy held that a patient capable of work ought to be working, on the theory that labor kept a person tethered to reality and improved both body and mind. Whatever the merits of that theory, Cherokee’s remarkable self-sufficiency was built on the uncompensated labor of the very people it had been built to treat. By the mid-1930s, the arrangement had run for more than three decades, feeding thousands of patients and generating a genuine operating profit for the state almost every year. But farming methods grew steadily more mechanized, labor grew more expensive, and by the mid-1960s state officials questioned whether a mental hospital needed to be a working farm at all.
The equipment was sold at auction in late 1965, and almost all the land followed the next year. In the summer of 1907, an 18-year-old woman named Elsie Cavy stepped off a train in Cherokee carrying two heavy suitcases and walked alone to the state hospital for a job interview. Superintendent Volding hired her as an attendant on the female wards. Shifts began at 6:00 in the morning and ran until 7:30 at night, 13 hours a day, six and a half days a week for $30 a month plus room and board.
Most employees lived inside the institution, and the doors were locked promptly at 10:00 each night. Superintendent Volding ran the hospital with strictness that extended well past the wards and into employees’ private lives. He did not approve of unmarried female staff going downtown or keeping company with young men from the community. Within that isolation, the hospital built something resembling an ordinary community life.
There was a hospital band made up of both employees and patients. Baseball was taken seriously, with games that occasionally ended in fist fights. Employees staged amateur plays. There was a canteen and a combined post office and library.
Becoming an attendant required two full years of training in the physical and mental care of patients, with coursework in anatomy, nursing, and mental disorders taught by the hospital’s own staff physicians. The population climbed almost as fast as the newspapers could report it. Barely two months after opening, enrollment had passed 200. By January 1903, it stood at 587 patients, plus another 64 men in the inebriate department.
By 1905, barely three years after opening, hospital officials were already reporting overcrowding. Cherokee was an institution absorbing more people than it had ever been built to hold. The superintendents who ran Cherokee held a kind of power with almost no real precedent outside institutions like this one. A superintendent decided who was admitted and who was released.
He decided which patients worked the farm and which were kept on locked wards. He set policy for an entire self-contained population that had in most cases no meaningful legal ability to challenge his judgment. The case of a patient named Jonathan Pennington, confined at Cherokee in the early 1900s, shows just how narrow that path could be. When Pennington’s friends came to believe he no longer belonged inside the hospital’s walls, officials disagreed, and there was no internal appeal process.
Their only option was to hire an attorney and petition a judge directly for a writ of habeas corpus. Most families never got even that far. And beginning in 1911, the very men who ran Cherokee and its sister hospitals were handed a new and extraordinary duty: to examine patients and determine whether their mental or physical condition made them unfit to have children. The decision did not rest with a court, with the patients’ families, or in any meaningful sense with the patients themselves.
It rested with the superintendent, his surgical staff, and a state parole board. Iowa passed its first sterilization law on July 4, 1911, becoming the ninth state in the country to put such a statute on its books. The law authorized the directors of the state’s mental institutions and members of the parole board to decide whether a patient was likely to pass on what the era’s doctors broadly classified as hereditary defect, insanity, or criminal tendency. If the answer was yes, the patient could be sterilized without consent.
That first law was quickly challenged and repealed. A second version in 1913 was struck down by a federal court as unconstitutional. Iowa’s legislature responded not by abandoning the practice but by rewriting it, and in 1915 passed a third law requiring written consent of the patient or a close relative. In practice, historians have found that this so-called consent was often anything but voluntary.
Patients hoping for release were frequently told that agreeing to sterilization was the price of walking back out the front doors. For someone facing the choice between an operation and indefinite institutionalization, it was barely a choice at all. The practice expanded dramatically in 1929 when the state created a formal board of eugenics. Its membership was drawn directly from the leadership of Iowa’s institutional system, including the superintendent of each of the four state hospitals for the insane at Cherokee, Clarinda, Independence, and Mount Pleasant.
The very men who ran the hospitals were now sitting in judgment over which of their own patients should be sterilized. Over the nearly five decades the board operated, close to 1,900 Iowans were sterilized under its authority. More than two out of every three of them were women. Sterilizations in Iowa actually climbed after World War II, driven in part by a group called the Human Betterment League, which framed the procedure not as punishment but as a modern, compassionate form of family planning.
The single busiest year on record came in 1949, when 165 Iowans were sterilized in 12 months alone. The movement did not go unopposed. Iowa’s Women’s Christian Temperance Union funded research to challenge the eugenic premise, and members of the Catholic Church spoke out forcefully enough to see a number of proposed cases dismissed. Much of the intellectual scaffolding behind the movement traced back to a single Iowa native.
Harry Laughlin became superintendent of the Eugenics Record Office in New York and one of the most influential eugenicists in the country. His model legislation helped shape sterilization laws not just in Iowa but across the nation. In one of the era’s stranger footnotes, Laughlin himself would later learn that he suffered from epilepsy, one of the very conditions his own philosophy held should disqualify a person from having children. Iowa did not finally dissolve its board of eugenics until 1977.
Cherokee had been overcrowded almost since the day it opened. The population finally crested in December 1945, when 1,729 patients were crowded into a building complex never designed to hold nearly that many people. Beds were pushed into every available hall and corner. It was against this backdrop that Cherokee faced one of the deadliest weeks in its history.
In July 1936, in the middle of a brutal, record-breaking heat wave that scorched the entire Midwest, Cherokee recorded 16 patient deaths in a single month. Ten of those deaths were directly attributable to the heat. Fifteen of the 16 who died were 50 years of age or older. The worst single day came on a Tuesday, when four patients died within hours of one another.
The first heat-related death had come on July 5, and deaths were recorded on nearly every day of that terrible stretch. Surviving hospital death records tell the story in clinical, unadorned language: heat exhaustion paired with malnutrition, bronchopneumonia, and cerebral hemorrhage. Doctors told reporters that hospital staff were doing everything possible to relieve the patients’ suffering. But a building constructed in the age of coal-fired boilers and steam heat had few real defenses against a heat wave of that severity, especially when it was already operating far beyond its intended capacity.
The 1936 heat wave did not force any dramatic change in how Iowa ran its state hospitals, but it marked an early visible sign of a deeper truth. In the years just ahead, Cherokee’s doctors would turn to a new and radical procedure sweeping through American psychiatry: the lobotomy. By the middle of the 20th century, American psychiatry had almost nothing that could reliably calm a violent or severely psychotic patient. Into that vacuum stepped a neurologist named Walter Freeman, who had renamed a Portuguese brain surgery and brought it to the United States in 1936.
A decade later, Freeman developed a version that required no surgeon, no operating theater, and no anesthesia beyond a jolt of electroshock therapy strong enough to render a patient briefly unconscious. He called it a transorbital lobotomy. By 1950, Freeman began traveling from state hospital to state hospital, demonstrating the technique and performing dozens of operations himself in a single visit. In a single two-week stretch in July 1952, working for a state-sponsored program in West Virginia that newspapers nicknamed “Operation Icepick,” Freeman performed 228 transorbital lobotomies, charging as little as $25 a procedure and often operating without a surgical mask or gloves.
Cherokee State Hospital was one of the institutions he came to. Patients selected for the operation were rarely consulted in any meaningful way, and their families were often informed only after a decision had already been made by hospital staff. Results at Cherokee were fatal: patients died on the operating table during procedures performed at the hospital, one of them during an operation in which Freeman allowed himself to be distracted while a photograph was being taken. Many patients who survived were left permanently blunted, stripped of the emotional range that had once made them who they were.
The practice did not last. The arrival of the first genuinely effective psychiatric medications in the middle of that decade finally gave doctors an alternative that did not require opening a patient’s skull or eye socket. The change arrived not through scandal or investigation, but through a small brown pill. In the 1950s, pharmaceutical researchers introduced the first genuinely effective antipsychotic medications, drugs that could calm hallucinations, ease agitation, and stabilize mood in ways no earlier treatment had ever reliably managed.
Social workers began actively searching for placements back in patients’ own communities. Through the 1960s, that shift accelerated, driven by a broader national push toward community-based mental health care. The census that had once strained every ward began to fall. The farm could not survive that shift.
Its equipment was sold at auction in late 1965, and nearly all the land went with it the following year. Kenny Cottage, the tuberculosis ward built in 1914, closed permanently in 1971 and was torn down that same year, the only patient building in the hospital’s history ever to be demolished. In 1977, the state of Iowa finally abolished its board of eugenics. The Cherokee State Hospital, now named Cherokee Mental Health Institute, is still open today, still standing on the same hill west of town.
The campus has shrunk to 208 acres. The dairy herd, truck gardens, hog houses, and granaries are gone, replaced by a modern psychiatric facility treating a comparatively small number of adults and adolescents for acute care. What remains constant is harder to see than any building: the reminder that an institution built with the best intentions of its era can also become a place where enormous, largely unchecked power settles into the hands of a small number of people. The same concentration of authority in a superintendent’s office that made the farm’s self-sufficiency possible also made it possible for that office to decide whether the people in its care would ever be allowed to have children of their own.
Those two facts sat inside the same walls for the better part of a century. It took 14 ballots in the Iowa legislature to decide that Cherokee should exist at all. It took only a handful of men to decide who inside it would ever be allowed to raise a family of their own.