As a doctor, Annie Alexander had the training and dedication to heal thousands of individuals over her 42 years as Charlotte's - and the South's - female physician. As an educated citizen, she devoted thought and effort to treating the causes of illness. She spoke and wrote on subjects like nutrition and sanitation in order to empower people to make choices that would bring about healthy lives for themselves and their families.

Like many others in the field of public health in the 20th century, Dr. Alexander was drawn to the theory of eugenics, the idea that the regulation of reproduction would improve the "stock" of the human race. Like other physicians, she knew the damage that alcohol and other drugs could do to families. She saw the susceptibility to addiction as a congenital weakness, one that should be purged from society.

"The highest racial standards cannot be expected if drunkards and dopists, weak-minded persons and those who are physical wrecks continue to perpetuate their imperfections for generations to come."  (1) [2] The year in which she spoke was the peak of a half dozen years of interest in the topic, judging from the frequency of the word "Eugenics" in the Observer's headlines, and Dr. Annie Alexander's name was associated with it only once. Dr. Annie's life's work speaks of her compassion for her patients, and eugenics was considered a theraupeutic treatment to a social problem. 

At the time Dr. Annie and other physicians wrote in praise of the therapeutic eugenics, the United States was still an agrarian society. Large numbers of the population were illiterate and had little access to healthcare whether it was medical or physical.   Across the nation, local Health Departments were overrun with clients who were ill-equipped to live independent lives, and their families lacked the means to provide for them. There were no government safety nets and local and state government could barely afford to maintain the facilities that literally warehoused individuals without any hope of release.

Originally in North Carolina, sterilization surgeries were performed on those in institutions and prisons. Unfortunately, in the late 1920s, the state of North Carolina  gave social workers permission to request the procedure be performed on young people in homes, considered "unwholesome" or who did poorly in school.  Tragically, the practice went beyond its original scope and did not officially end until 1974.