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This book project describes how concerns about disability and pathology are constitutive elements of American adoption and have helped shape its history. I argue that the concepts of disability and pathology in adoption function as cultural signifiers reflecting American anxieties about who is fit to rear children in general and about the suitability of raising non-biological children in particular. This work links American disability history and adoption history by uncovering the ways in which the notion of disability (whether physical, cognitive, or mental) in children and adults has functioned historically within an arena that is simultaneously very public and intensely private: the building of family. The first book to focus on historical issues of disability and pathology in the making of the American adoptive family, my project represents a significant contribution to scholarly and public debates about evolving ideas of familial "fitness," parenting, and "desirability."