Pox (12 page)

For Walter Wyman, the request from Governor Bradley was enough. On March 16, Wyman wired J. M. Mathews and told him the Marine-Hospital Service was prepared to “furnish medical officers, attendants, guards, inspectors, and attend to vaccination and disinfection.” The local authorities would still be expected to “care for poor not sick” and to furnish the pesthouse with food “so far as possible.” Wyman did not want to open up a massive federal relief effort in Middlesboro. It was J. N. McCormack who wired back to accept Wyman's offer, so long as the Service intended to “aid and co-operate under our regulations.” Wyman agreed to this face-saving language. But he added a condition of his own: “All expenditures . . . must be supervised and accounted for by our own officer.” A reasonable condition, to be sure. But also a brisk slap in the Kentuckian's face.
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All of these niceties did not disguise the new political reality in Middlesboro. As the
Lexington Morning Herald
reported, “Uncle Sam is in charge of small-pox now.”
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T
here was one recent precedent for a federal takeover of a local small-pox epidemic. On January 8, 1898, two months prior to Wertenbaker's arrival in Middlesboro, another Marine-Hospital Service surgeon named George M. Magruder had taken control of the smallpox epidemic in Birmingham and Jefferson County, Alabama. This was the same epidemic the miner named Scott thought he had left behind as he made his way north to the Mingo Mines. Built on a swampy valley floor, the manufacturing and mining boomtown with its highly transient population was a public health disaster waiting to happen—and never waiting very long. The area had weathered one epidemic after another since its founding in 1871, including serious bouts of Asian cholera in 1873 and typhoid in 1881. Alabama laws, enacted during the 1870s, established a state board of health and authorized the creation of county health departments. But at the moment smallpox broke out, not a single full-time county health organization existed in the entire state.
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Smallpox had been raging since July 1897 in Jefferson County, an area of a thousand square miles and 110,000 people. Half of the residents lived in Birmingham, the rest in mining camps, small towns, and manufacturing settlements outside the city. By the time Magruder arrived on the scene, more than 400 cases of smallpox had been reported in the area, with 15 deaths. As it would be in Middlesboro, the disease was confined almost exclusively to the African American population. The
Atlanta Constitution
assured its readers, “There is no danger of a spread of the disease among the white people.”
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So far the disease had proved exceptionally mild, but also exceptionally expensive. The city and county governments spent the huge sum of $30,000 fighting the epidemic. They set up quarantine camps, enforced vaccination, and furnished 75,000 tubes and points of free vaccine. City officials strictly enforced vaccination: at least seven people were arrested in the first weeks of the epidemic for refusing to be vaccinated. But outside Birmingham, enforcement was spottier, and by December 1897, more than twenty towns and camps reported smallpox. In January, the local authorities called on the Marine-Hospital Service for aid. Surgeon General Wyman extended to Birmingham and Jefferson County the same offer he would later make to Middlesboro: the U.S. government would take general control of the quarantine camps, provide free vaccine, and organize a corps of men to inspect and vaccinate the population. But the city and county must “bear all other expenses.” The local authorities readily accepted.
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From his headquarters in Birmingham, Magruder organized a corps of thirty inspectors, recruiting local physicians and medical students. He assigned each to a territory within the city, in which they inspected all homes and their occupants. Magruder advised the inspectors to extend courtesy to everyone—the “refined and rough, reasonable and unreasonable, crank and sage.” But under no circumstances would the Service honor certificates of vaccination. “In all large towns,” he explained, one could find “some physicians who will give false certificates for a small fee.” Magruder's instructions show his awareness of the urban tradition of resistance to compulsory vaccination, abetted by local doctors who were supposed to be the front line of public health. He told his inspectors to check every person's arm for a fresh vaccine scar—the only real proof of a successful recent vaccination. The inspectors were to make a thorough search of every room they visited, “especially in negro quarters,” looking for concealed people with smallpox. Ambulance wagons carried the sick to one of the quarantine camps. All suspects found living in a house with a smallpox sufferer were vaccinated at once and sent to the detention camp to be kept under watch for sixteen days. At the camps, Magruder introduced an innovation of which he was particularly proud. He surrounded each camp with a high fence of barbed wire. Thirty feet inside of this line he marked out a “dead line,” beyond which no “patient” was allowed to tread. At night the entire area was illuminated with gasoline torches, “enabling a small number of guards to effectually prevent the escape of convalescents.” Even with the doctors moving to and fro, to the detainees the federal quarantine facilities must have invited comparisons to Alabama's notorious convict labor camps.
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The mining camps outside of the city posed a special problem. Magruder believed the disease was spread chiefly by itinerant African American coal miners, who avoided vaccination whenever they could. Since they lived in unincorporated camps, none of the local compulsory vaccination ordinances applied to them. When superintendents of mining companies tried to enforce vaccination, “the men would leave in such numbers as to cause serious embarrassment from lack of laborers.” The men just picked up and moved to another camp where vaccination was not enforced. As a consequence, those mining superintendents who had tried compulsory vaccination on their premises gave up the effort.
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Magruder had an idea. He called together the owners and superintendents of the mining companies. These men ran mines and furnaces that employed thousands of workers, including many with families. Magruder persuaded the company men to cooperate—with each other and the federal government. They posted notices at their mines and furnaces, stating that no one would be allowed to work who refused to have himself and his family vaccinated. The notices listed all the area companies that had entered into the agreement. Once employers tightened control over their workforce, Magruder reported, the phenomenon of vaccination-induced walkouts “almost entirely ceased.” The surgeon's plan merged government and private authority in an ingenious solution to a seemingly intractable problem of industrial management and public health. Magruder's account makes one wonder if the cooperative agreement he engineered among the employers might have laid the foundation for future agreements to control the organization and conditions of labor in their industries.
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Other southern communities watched the Marine-Hospital Service's work in Jefferson County with great interest. In short order, the mayor of nearby Talladega, Alabama, where smallpox had spread in the cotton mills, asked the Service to step in there, too. During the three months after the Marine-Hospital Service took over at Birmingham, the Service's corps of inspectors had paid more than 41,000 visits to private residences, many of them the poorly constructed houses and cabins of African American workers and their families, where they had found a great many concealed cases. The corps had vaccinated nearly 39,000 people. The Service had treated 352 patients in its three quarantine camps, with only nine deaths. Among the 225 patients at the Birmingham Quarantine Hospital, all but six were African American; more than two thirds were male; nearly half were in their twenties; and nearly half had never been vaccinated .
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By March 10 (the very date that Representative Colson asked Surgeon General Wyman to intervene at Middlesboro), George Magruder announced that the epidemics in Birmingham, Jefferson County, and Talladega had ceased—at least “for the present.” Magruder had no illusions about the permanency of his achievement in Alabama. Barbed wire, gas torches, armed guards, and men with lancets could only accomplish so much in this industrial frontier, where “large numbers of the unvaccinated persons are daily coming in.” And there were several towns and mining camps where the inspectors had met with such intense local opposition that Magruder had withdrawn them, leaving behind large unvaccinated communities. As he prepared to pull up stakes from Birmingham, Magruder had to concede that despite all his efforts, and the support he had received from employers and citizens' groups in Birmingham, there were still enough unvaccinated people in the area to “keep the disease alive for some time.” He was right. In 1899 alone, 9,150 cases of smallpox were reported in the state of Alabama. Significantly, 5,265 of those cases were white—a number roughly proportional to the percentage of whites in the state population. In Alabama as elsewhere, the early promise of a special dispensation for whites did not last.
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O
n March 17, C. P. Wertenbaker officially took over smallpox control at Middlesboro, Kentucky. He set up his headquarters, complete with a telephone, in a suite of offices in the business district. He hired five inspectors and twenty-five guards outfitted with Springfield rifles. He had four physicians on his medical staff, including Dr. Blair from Bell County, who would head up the inspector corps. A crew of nurses, cooks, attendants, and ambulance drivers rounded out the operation. Wertenbaker kept the mountain city under strict quarantine. Armed men guarded the public roads and the train depot, allowing no one to enter or leave the city without a pass signed by Wertenbaker. Within a week, one local newspaper reported, the federal surgeon had the smallpox control operation “running smooth as oil.”
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For all of the similarities between the Jefferson County, Alabama, and Middlesboro, Kentucky, epidemics, the crisis Wertenbaker inherited from A. T. McCormack was far less intractable. The field of action was small by comparison—ten square miles against one thousand, a population of 3,500 against 110,000. And the Middlesboro population had been forcibly contained; unlike Jefferson County, which had laborers coming and going throughout the epidemic, Middlesboro had been under armed quarantine for weeks. Thanks to the efforts already made by local authorities and the state, the vast majority of the population had been vaccinated. In fact, if one believed everything printed in the state reports and the local newspapers, the total number of vaccinated people
exceeded
the actual population of Middlesboro.

Wertenbaker's inspectors, under the charge of Dr. Blair, set out immediately into the streets and neighborhoods of Middlesboro. Wertenbaker divided the city into five districts, assigning one inspector to each to make a house-to-house canvass. A local newspaper boasted awkwardly that the Service's inspection showed that “outside of small-pox this is the healthiest town on the globe.” They examined everyone, vaccinating the few unscarred people they found. Anyone who refused the vaccination order was promptly turned over to the city authorities, who gave the violator the option of being vaccinated or taken to jail. As Wertenbaker reported to Wyman, it was something of a moot question, because if the uncooperative person chose jail, “they are vaccinated as soon as they enter, under a law requiring all inmates of jails to be vaccinated.” The violence of compulsory vaccination at gunpoint in the Over the Rhine district had given way to something different, more orderly but still highly coercive.
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Wertenbaker took steps to separate the smallpox patients from the smallpox suspects. He turned a row of twelve houses near the old Brown's Row pesthouse, where patients and suspects had been confined, into a detention camp for suspects. He placed the camp under the charge of Dr. W. N. Shoemaker of Birmingham, who had become acquainted with Service methods from the epidemic there, and a staff of attendants and guards. For a smallpox hospital, Wertenbaker rented the old Biggerstaff boardinghouse, a two-story building on the city's western outskirts, and fitted it out with beds and supplies. Someone christened it the South Boston Hospital, after the nearby South Boston Iron Works, once a major supplier of cannons and armaments to the U.S. government. Wertenbaker's men moved the ninetyone people who had been languishing in the Brown's Row pesthouse into the hospital and placed them under the charge of Dr. W. C. Duke, a physician from Memphis who had been trained in Service work. It was a simple facility, but Duke had the assistance of nurses and attendants, and no patient would go hungry for lack of provisions.

In all smallpox epidemics, good nursing care—including the provision of such basic human needs as warmth, proper food, water, and clean sheets—had a major influence on mortality rates. A poorly run or ill-provisioned pesthouse (and many turn-of-the-century pesthouses were both) could be far worse for a patient's chances of recovery than care at home with family, which is one reason why so many families hid their sick from the health authorities. During the Service's operation at Middlesboro, the hospital treated 103 patients. About three quarters of them were African American, and the males outnumbered the females 64 to 39. The patients' ages provided a very rough measure of the vaccination status of the general population before the epidemic. All but six of them were under forty. Dr. Duke's staff treated twenty-two children under ten years old, including seven younger than a year. All of the patients in the hospital, including the infants, survived. Even in an epidemic of mild smallpox, that was no small achievement.
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