Pox (13 page)

Given the strong contemporary belief that smallpox could be spread by contaminated objects, or fomites, a critical component of any state-of-the-art smallpox eradication effort was disinfection. Wertenbaker's Disinfecting Division, under Acting Assistant Surgeon Ira W. Porter and his crew, traveled the city equipped with two large autoclaves for sterilizing objects, another disinfecting apparatus for burning sulfur, and a third for hosing rooms down with bichloride. In all, the division disinfected nearly one hundred houses. All clothing and bedding was destroyed. Houses too ramshackle to be disinfected were burned.
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From the date the Service took over, only seven new cases developed in Middlesboro. Each day the Smallpox Hospital released more recovered patients. First they underwent a regimen of baths, while hospital staff washed their clothes in bichloride of mercury. The last smallpox case surfaced on April 6. Wertenbaker had returned to Wilmington the previous day, leaving the cleanup operation in Middlesboro in the hands of a Service officer named Hill Hastings. By April 14, only two cases of smallpox remained in Middlesboro. Hastings had them transferred to the Bell County pesthouse. (It was the very least Bell County could do.) On April 15, on Surgeon General Wyman's orders, Hastings and his men broke up the Marine-Hospital Service's camp at Middlesboro. Five months after it began, the Middlesboro epidemic finally came to an end.
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F
or J. N. and A. T. McCormack of the Kentucky Board of Health, the Middlesboro epidemic had been a disaster—a disaster that threatened to overtake the entire state, one ill-governed community at a time. Political fecklessness and pound-foolishness had allowed Kentucky's first encounter with mild type smallpox to spiral out of control. On March 25, Secretary McCormack issued a state bulletin, warning that the Middlesboro epidemic would be repeated everywhere if local authorities did not take its two main lessons to heart.

The first lesson was legal: under Kentucky laws, the expense of smallpox control had to be quickly met by the affected counties and cities. The price of inaction in Middlesboro amounted to thousands of dollars in government funds, “very many thousands in loss of business,” and the sheer “mortification of clamoring for outside aid.” In the future, McCormack said, the state board would not hesitate to order a quarantine against cities and counties that failed to do their duties.
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The second lesson was racial: Kentucky communities could no longer ignore the spread of smallpox among African Americans. “The exemption of the white race” from the new smallpox was coming to an end. In a chilling statement, McCormack advised that “visiting and strange negroes be hunted, vaccinated, and kept under observation.” As the Kentucky epidemic spread, McCormack redoubled his efforts to control the movement of African Americans. At the October 1898 meeting of the board, he warned that the unrestricted travel of unvaccinated colored persons constituted “a menace to the health and lives of the people of this state.” The secretary proposed a resolution, which the board swiftly adopted. The new regulation made it unlawful for any person exposed to smallpox—and any African American,
period
—“to leave Cincinnati, Louisville, Memphis, Evansville, or any other point or place where small-pox now or may hereafter prevail,” for any point in Kentucky by train, steamboat, or other conveyance without a certificate of vaccination issued by a public health officer. A vaccination certificate had become a kind of internal passport, required of all blacks, as well as those whites who had actually been exposed to smallpox, for travel into, or within, the state of Kentucky. The most basic freedom of all—freedom to move—which African Americans had exercised in extraordinary numbers in the late nineteenth-century South, redefining the national map in the process, was now made dependent upon their vaccination status.
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In the aftermath of the local outbreak that launched a four-year-long epidemic in the state of Kentucky, costing county and municipal governments more than $300,000, the officials of Middlesboro and Bell County seemed no more inclined than before to assume the legal obligations that came with local autonomy. Dr. Samuel Blair of the Bell County Board of Health sued the county to recover payment for his services at Middlesboro. A local jury ruled in his favor, and he received a judgment of $250. But Bell County appealed. The county suggested that because two members of its own board of health (Drs. Robertson and Curd) were taxpayers in Middlesboro, they had “fraudulently acted with the intention to charge the county and relieve the city from the burden.” An appellate court ruled in favor of the county, declaring that a city of Middlesboro's size was not only empowered to fight contagious disease but also liable for the costs.
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Remarkably, in all of the paper left behind during this five-month episode, there is not a single word of any effort by local officials to seek relief from the men of capital who had created Middlesboro and still owned its coal and its future. An ocean away, the American Association, Inc., did not lift a hand to aid the citizens of Middlesboro during their hour of need. Some Middlesboro citizens, though, seemed able to find a joke in everything. When reports reached the mountain city that a smallpox epidemic of more than five hundred cases had struck Middlesborough, England, one local newspaper asked if the disease had been carried there by “a negro from Kentucky.”
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Back in Washington, Surgeon General Wyman saw the events in Middlesboro as a cautionary tale. The epidemic had cost the federal government a great deal of effort and $3,500 in cash. In his 1898 annual report, Wyman issued a terse statement titled “Principles Governing the Extension of Aid to Local Authorities in the Matter of Smallpox.” The surgeon general railed against the shortsightedness of local and state officials who, he believed, had allowed smallpox to rage out of control in Kentucky and elsewhere in the southern states. The spread of smallpox, Wyman thundered, “is so easily prevented under proper management that it is a disgrace to the sanitary authorities of any State, municipality, or locality whenever this disease is permitted to get beyond their control.”
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Henceforward, Wyman declared, the role of the Marine-Hospital Service in local smallpox control would be strictly limited, in keeping with the constitutional principles of American federalism. Local governments were the first line of defense against epidemic disease, supported, when things got out of control, by state institutions. The Marine-Hospital Service's surgeons in the field, Wyman explained, would not lightly assume responsibilities that were so clearly local. They would merely furnish “expert assistance” to local and state authorities, settling differences of opinion about whether a particular infectious disease was smallpox. The surgeons would also offer “advice” regarding smallpox suppression. But the Service would take full control of an epidemic only when doing so was “necessary to prevent the spread from one State to another.” Monetary aid would be withheld “except under the most urgent circumstances.”
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Stern language. Given the nature of the southern outbreaks, however, the surgeon general surely understood that his “Principles” enabled the exercise of federal power as much as they restrained it. The spread of “mild type” smallpox placed an elite corps of federal officers—the medical men of the U.S. Marine-Hospital Service—in the almost unheard-of position of exercising police power in local communities. For the right to name a local outbreak of “Elephant itch” or “Cuban itch” a bona fide epidemic of small-pox was the very act that set the machinery of disease control in motion. Once that happened, the federal “advisor” who diagnosed the disease was well placed to take charge of operations on the ground. And when did smallpox ever respect national borders or state lines? As smallpox made its way across the southern states at the end of the nineteenth century, with little regard for political boundaries or man-made laws, the hundreds of urgent requests from local communities for federal assistance would put the old constitutional principles to the test. All of which is how C. P. Wertenbaker and the medical men of the U.S. Marine-Hospital Service became the vanguard of federal power in the American South.

Though he never went to war, C. P. Wertenbaker lived his entire life in uniform. As a boy, he donned the outsized epaulets and tasseled shako cap of the Warrenton Rifles, a company of the Virginia Volunteers that was legendary in Charlie Wertenbaker's world for its stand at Fairfax Court House on June 1, 1861. (The Rifles' commander, Captain John Q. Marr, lost his life that day, the first Confederate officer to fall in the Civil War.) While a medical student at the University of Virginia, and during his half-dozen years as a practicing physician, Wertenbaker turned out for militia duty in the resplendent garb and sergeant's insignia of the Volunteers' Third Infantry. At twenty-eight, he put on yet another uniform, the one he would wear with honor for the rest of his career. The simple navy-blue field suit of a commissioned officer in the U.S. Marine-Hospital Service, meant to suggest military-issue without quite being military-issue, consisted of dress pants and a fly-front coat, the only adornments a pair of gold Service insignia—a fouled anchor and caduceus—on the coat's upright collar. For ceremonial occasions, he sported the Service's full dress uniform, a double-breasted suit with two rows of big brass buttons, golden epaulets, white gloves, and, at his side, a sword etched with the Great Seal of the United States of America. It was this national uniform, rather than the state regalia of his younger self, in which Wertenbaker would one day choose to be buried.
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But the most memorable outfit Wertenbaker ever wore, and the one most truly his own, was the one he contrived for his southern “smallpox work” in the late 1890s. Before he stepped, uninvited and unannounced, across the threshold of a sharecropper's cabin or a mill worker's wood-framed house, he pulled on a pair of crisp, sterile overalls and a coat that reeked of formalin disinfectant. He wound cloth around the top of his head, looking like a soldier with a head wound. And over his mouth and nose he tied a respirator that he fashioned from a yard of cheesecloth and a piece of thick cotton. It was not until Wertenbaker completed his inspection—after he had posed his last question, examined the last squirming child, and scraped his lancet against the very last arm—that the subjects of his attentions finally got a good look at him. Their eyes followed the U.S. government man as he stepped outside, doffed his cap and respirator, and set them aflame.
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T
he road that carried C. P. Wertenbaker from his privileged childhood on Virginia's upper Piedmont Plateau to the humblest homes of laborers in the Deep South ran through Richmond, New York, Norfolk, Galveston, Chicago, Washington, and a great many points in between. The Marine-Hospital Service surgeon had at least one thing in common with the railroad workers, rivermen, agricultural laborers, miners, drummers, minstrel performers, and machine tenders who ferried smallpox across the South in their bodies and on their clothes: he never stayed put for long. For many laborers in the end-of-the-century South, the ability to pick up and go was the only form of mobility their lives offered. To aging former slaves and their children, freedom of movement was a cherished right, one exercised, sometimes, for the sake of exercising it, to demonstrate to an exploitative boss or landlord that their bodies and labor could not, in fact, be owned. For the Service surgeon, member of an elite cadre of some two hundred mobile federal medical men, transience was part of the job description.
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And, as Wertenbaker would learn, it was more than that. The surgeons' readiness to move, the very portability of their federal medical expertise, made them a force for the integration and bureaucratic standardization of public health in the United States. Wertenbaker and his colleagues were the vanguard of a modern, national public health system. That such a system would not reach fruition in their lifetimes does not diminish the significance of their work.

C. P. Wertenbaker as a young surgeon with the U.S. Marine-Hospital Service in 1888.
COURTESY OF THE ALBERT AND SHIRLEY SMALL SPECIAL COLLECTIONS LIBRARY AT THE UNIVERSITY OF VIRGINIA

 

A half century before the establishment of the federal Communicable Disease Center (now the Centers for Disease Control and Prevention) in Atlanta in 1946, public health was still an explicitly coercive form of social regulation, or “police power.” As one early twentieth-century authority observed, “The famous Roosevelt doctrine to ‘speak softly, but carry a big stick' is particularly applicable to public health work.” For the most part, local and state governments still wielded that authority, or neglected to, with little interference from Washington. But the mobility of the Service surgeons—premised upon the fact that smallpox and other infectious diseases did not respect borders—enabled the U.S. government to deploy scientific expertise and project an extraordinary measure of national authority across a vast region, a far-flung nation, and into new colonial possessions in the Caribbean and the Pacific. For a growing number of people across America and many other parts of the world, a medical man in a navy suit was the first representative of the U.S. government they ever encountered. In 1891, Congress had assigned the Service a new role as sentinels at the nation's borders and overseas ports, to ensure that immigrants did not carry foreign diseases onto American soil. Though virtually forgotten today, the intervention of Service officers like Wertenbaker at the scenes of local outbreaks—often deep in the American interior—may have been just as important as border control to the long process by which the U.S. government learned to govern its territory and people like a modern nation-state.
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