According to the conventional understanding of the Constitution’s Tenth Amendment, police power—the right to interfere with individual liberty and property rights in order to serve the public welfare—was reserved chiefly to the states. During the constitutional firestorm of Reconstruction, the U.S. Supreme Court had breathed new life into that old understanding, almost as if the Civil War and the Fourteenth Amendment had left the federal system unaltered. The immediate losers in the Court’s jurisprudence were African Americans, whose civil rights Congress proved increasingly powerless (and unwilling) to protect. But the decisions reverberated in other areas as well. In the Slaughter-House Cases (1873), the Court’s majority reinvigorated the long-standing constitutional position that gave the state and local governments primary and, as far as the federal courts were concerned, well-nigh unlimited authority to restrain liberty and property in the name of the public health.16
In practice, the boundaries of local, state, and federal power frequently blurred. From time to time Wertenbaker did encounter smallpox in his work for the Service. On assignment in Chicago, he served as the federal sanitary inspector at the World’s Columbian Exposition of 1893. With Asiatic cholera spreading across Europe and visitors and performers arriving in Chicago from all corners of the globe, American officials braced themselves for an outbreak at the Exposition. Instead, smallpox struck the White City that summer and spread across the real-life Second City during the fall and winter, taking hold in the West Side tenement sweatshops and killing more than a thousand people. Wertenbaker assisted overwhelmed city health officials by searching for concealed cases on the hundreds of boats that had taken up winter quarters along the icy Chicago River. He surely heard about, if he did not witness for himself, the small riots that broke out as city vaccinators worked their way through the tenements. State Factory Inspector Florence Kelley, a Hull House social settlement veteran who knew the West Side well, would never forget “the feeling against vaccination in the tenements.” One young surgeon on the vaccination squad had been “disabled for life” when an agitated tailor shattered his elbow with a bullet.17
If Wertenbaker ever doubted the effectiveness of vaccination, as some physicians did, his work in Chicago and elsewhere gave him reason to believe. Vaccination as practiced in much of the United States during the 1890s was an unpleasant and risky medical procedure. Even under the best of circumstances newly vaccinated people often felt ill and achy for days. But in the vast majority of people, vaccination worked. As chief of the Service’s Delaware Breakwater Station in August 1896, Wertenbaker inspected the steamship Earnwell, just in from Colón, Panama. Three men on board had broken out with pox. Two of them had undergone vaccination before their voyage; they experienced mild attacks. The first mate had evidently escaped vaccination, and he suffered terribly from a severe confluent case. Wertenbaker could do little more than watch the seaman die from a preventable disease.18
In January 1898, Wertenbaker took command of the Marine-Hospital Service station at Wilmington, North Carolina, his first southern assignment in seven years. A bustling port located thirty miles up the Cape Fear River from the Atlantic Ocean, Wilmington was the state’s largest city. Roughly half of the city’s 21,000 inhabitants were African American. Most black residents worked in manual and domestic labor, but Wilmington had a sizable African American middle class of skilled tradesmen, physicians, lawyers, and—ever since a fusion campaign of Republicans and Populists won control of the government in 1894—several municipal officials. Wertenbaker arrived in the city at a moment of rising political tension. In the course of 1898, white Democrats would become increasingly well organized and violent in their determination to seize control of the government and bring an end to “Negro domination.”19
As a white southern Democrat himself, Wertenbaker must have had an opinion about these developments, but he did not express it in writing. The Virginian took Jim Crow for granted. He chose to continue the station’s practice of maintaining separate “white” and “colored” hospital wards. Apart from a white steward, the entire staff was black. Wertenbaker introduced a new level of discipline at the station, including weekly inspections, for which the surgeon turned out in his full dress uniform, sword and all. Wertenbaker moved into the station officer’s residence, on the first floor of the two-story main hospital building, with his wife, Alice Girardeau Wertenbaker, who descended from a prominent South Carolina family, and their infant daughter, Alicia. Alice would make a respectable household for the young family, and she and little Alicia toured the coastal area in the Service’s “station wagon,” a horse-drawn affair operated by a black driver in livery. Charles Wertenbaker himself never had a chance to settle in.20
During Wertenbaker’s two and a half years at Wilmington, his telegraphic orders from Surgeon General Wyman sent him, over rail lines and dirt roads, to disease-stricken locales in Virginia, North Carolina, South Carolina, Georgia, Alabama, Kentucky, and Tennessee. Wertenbaker called this phase of his long career in the Service “my smallpox work.” And if, at times, that work seemed as cursed as smallpox itself, he could take some satisfaction in the fact that no one did it better.
He established himself as the Service’s foremost smallpox expert in the field, known to governors, mayors, and state and local health officials as a master diagnostician of the new “mild type” of smallpox, and a man with a proven strategy for stamping out the disease. Such was Wertenbaker’s stature in the field that he received temporary appointments to the staffs of the governors of Virginia, Georgia, and Nebraska. In 1899, Wertenbaker sent Wyman a long memo entitled “Plan of Organization for the Suppression of Smallpox.” The surgeon general published it as a supplement to the Service’s “Précis upon the Diagnosis and Treatment of Smallpox.” If the “Précis” presented the latest scientific knowledge of the disease, the “Plan” offered a comprehensive strategy—part medical intervention, part military operation—for suppressing local outbreaks. The highest demand for both pamphlets came from the southern states, and though the tactics Wertenbaker outlined should have worked just as well anywhere, they were distinctly the product of his own experience fighting smallpox in southern cities, towns, plantations, and work camps.21
Wertenbaker had been on the job at Wilmington for only a few days when North Carolina’s first reported case of mild type smallpox arrived in the city. On January 12, 1898, a local physician informed Mayor S. P. Wright that Stephen Johnson, an African American brakeman who worked the Atlantic Coast Line between Wilmington and Florence, South Carolina, had contracted smallpox. City health officials hung a yellow quarantine placard outside the Johnson home on Hanover Street and quarantined three neighboring houses, vaccinating all the residents. Mayor Wright posted two policemen on the block to prevent residents from leaving. Wertenbaker had no jurisdiction in the matter. But he offered his assistance to the local government, ordered a hundred points of vaccine, and told Wyman he would vaccinate “all persons applying.” During the next three weeks, Wertenbaker watched Wilmington turn into a battleground over public health.22
On the first day of the outbreak, Wertenbaker accompanied Dr. William D. McMillan, the city superintendent of health, as he searched for a suitable site to establish a pesthouse. McMillan planned to remove Johnson from his thickly settled neighborhood as soon as possible. The doctors chose a three-room house on Meares Street, amid the sandy lots in the far southeastern section of the city. The place seemed ideal. It occupied a block by itself, the nearest house being three hundred yards away, and the caretaker said his tenant would be happy to move out so he could rent it to the city. But the area was not as deserted as it looked. Unlike Johnson’s neighborhood, inhabited almost exclusively by African Americans, the blocks around the Meares Street house were overwhelmingly white. When the Wilmington Messenger announced the opening of the pesthouse, twenty or thirty armed white men assembled at the property, warning that they “meant business” if an ambulance wagon showed up carrying Stephen Johnson. Under pressu
re from his neighbors, the tenant decided to stay put.23
Dr. McMillan reset his sights on the northeastern corner of the city. He found a house on Nixon Street, located between the railroad tracks and one of Wilmington’s largest African American sections. The house had recently served as a barracks for a gang of convict laborers employed grading a link line for the Wilmington and New Bern Railroad. As soon as African American neighbors got wind of McMillan’s plan, they did just what the white residents of Meares Street had done. They formed a mob. But theirs was larger. Three hundred men, women, and children turned out at the property when Mayor Wright and Dr. McMillan paid it a visit. The crowd threatened to burn the house if the authorities brought Johnson there. That evening, Nixon Street teemed with men carrying pistols, shotguns, and, as one policeman commented, “some old time war muskets with muzzles big enough for rats to run into.” According to one witness, the many women in the crowd were even “more vehement” than the men. White men joined the crowd and “took a hand in the defiance.” Men and women blocked every avenue to the house; a hundred men stood guard along the railroad tracks to prevent the authorities from delivering Johnson by that route. No ambulance or train carrying Johnson materialized that night. But the crowd burned the house to the ground anyway. A smaller two-room house stood on the same property. The next day, a rumor spread that officials planned to move Johnson there. That evening a crowd set the second house on fire.24
The authorities decided to let Stephen Johnson recover or die in his own home. (He survived.) A few days later Wilmington officials discovered a second man with smallpox, an African American stevedore named James Harge. Determined to remove him from his home, they settled on a remote site three miles from the city.25
The Wilmington board of aldermen did not rush to order vaccination in the city. They debated the question for nearly two weeks. Several aldermen, including A. J. Walker, one of the body’s African American members, opposed the idea. Finally, on January 24, the board adopted an order requiring all residents to show proof of recent vaccination. Violators were subject to a $5 fine or ten days in jail. (Mayor Wright had called for stiffer penalties.) The mayor appointed five city vaccinators, including two African American physicians who were assigned to the black neighborhoods.26
On January 27, some five hundred citizens of Wilmington, including about fifty African American men, assembled at city hall to protest the vaccination ordinance. They carried a protest document that had been drawn up earlier that day outside of J. T. Smith’s store on Front and Castle streets. The men took their stand as breadwinners, acting, as their petition announced, “[o]n behalf of ourselves, our wives and our children, and the thousands of our citizens and their families, who provide their livelihood by manual labor.” Two cases of smallpox did not justify a measure that threatened the arms and livelihoods of Wilmington’s wage earners. “[C]ompulsory vaccination will inflict an unnecessary hardship,” the petition said, “especially upon the poor who have to labor for their living.” The petitioners vowed to “resist to the uttermost with all our influence and manhood the enforcement of this iniquitous law.” The group’s leaders included an African American doctor named Bill Moore, who claimed that the document represented “the sentiment of two-thirds of the people of Wilmington.” According to the Wilmington Messenger, the physician’s statement was “greeted with applause by white and black.” In an impressive display of biracial local democracy, the committee appointed a jury-sized delegation of six white men and six black men. Together they presented the petition to the mayor and board of aldermen.27
The aldermen did not rescind the ordinance. They did not have to. The city vaccinators met with such widespread resistance in Wilmington’s neighborhoods and workplaces that the board of health suspended the entire campaign just a few days after it had begun. All of the vaccinators had found the work dispiriting. The city’s strategy of sending black doctors into African American neighborhoods had not overcome the residents’ concerns about vaccination. One African American woman drove a black physician from her doorstep with an axe. An African American man brandished a gun to defend his threshold from a city vaccinator and two policemen, all of them black. White vaccinators hadn’t fared much better in white working-class neighborhoods. As the city hall protest had shown, compulsory vaccination was perceived as dangerous and unjust by many people, regardless of race.28
By the time the city vaccinators ceased their unfinished work, Johnson and Harge had begun to recover. No further smallpox cases had come to light.
The Wilmington smallpox skirmishes of 1898 would be overshadowed in the city’s memory by the bloody race riots that came just ten months later during the November elections. The riots left more than ten blacks dead in the streets of Wilmington, caused thousands to leave the city, and put Democrats in control of the city government. Soon after that tragic episode, the North Carolina Board of Health issued its annual report. Citing the Wilmington smallpox outbreak as a cautionary tale, the board lamented that the city government’s efforts to stamp out the disease had been “so violently resisted by the negroes as to cause the abandonment of the attempt.” Absent from the report was any mention of the white and black pesthouse mobs, or the biracial coalition of Wilmington men, some five hundred strong, who had together taken a stand at city hall as workingmen and breadwinners opposed to compulsory vaccination.29
For C. P. Wertenbaker, the pesthouse fires and antivaccination protests marked the beginning of an education in the contentious politics of southern smallpox control. Wherever Wertenbaker went, he saw smallpox engender intense conflict between “the public health” as a political ideal and “the public” as a fractious social reality. The public health implied a unity of purpose and interests—within the medical profession, between physicians and the state, and between state and society—that Wertenbaker rarely encountered. Instead, he found governments that wouldn’t govern and citizens who wouldn’t let them when they tried.
He witnessed this conflict in Wilmington in January 1898. He saw it that February in Charlotte, where white cotton mill workers, fearing vaccine poisoning, refused to comply with the city government’s vaccination order. He saw it again in March in Middlesboro, Kentucky, where local officials rebelled against their own legal duties as keepers of the public health. When Wertenbaker returned to Wilmington in April, Wyman forwarded to him a letter that J. W. Babcock of the Columbia, South Carolina, Board of Health had sent to Senator Benjamin R. (“Pitchfork Ben”) Tillman. As smallpox raged in the capital city, the board had ordered a general vaccination. “My private opinion,” Babcock told the senator, “is that we shall not get much cooperation from the white people, and none at all from the negroes.” Babcock asked Tillman to secure “the services of a competent officer of the Marine-Hospital Service, who would come here to advise and act with the Board in stamping out the disease.” Dispatched to Columbia, Wertenbaker reported that he found “much the same condition of affairs” as he had “in so many other places.” There was so much difference of opinion about the disease among doctors and so much concern about vaccination among the working people that health officials had “great difficulty in inducing the people to take necessary precautions.”30
Wertenbaker’s experiences in the field would make him into an advocate for reform in the field of public health administration. He pushed for better, safer vaccines. He promoted official candor and public education as the best remedies for the pervasive “prejudice” against vaccination. And though Wertenbaker never discarded the racial beliefs of his time and place, he would, in an era of overwhelming white indifference to African American health, call for the government to mobilize rural blacks to organize their own fight against infectious disease. Ultimately, Wertenbaker’s smallpox sorties led him to conclude that there was only one way to stamp out infectious disease in the South—by increasing the scale and scope of federal police power.31
If late nineteenth-century American jurists were certain about anything it was th
is: the states could take any action necessary to protect their citizens from the “present danger” of a deadly infectious disease. Since the dawn of the republic, state and local governments had wielded powers both plenary and plentiful to defend the people from outbreaks of smallpox, yellow fever, cholera, and other pestilences. Individual liberty and property rights melted away before the state’s power—indeed its inherent legal duty—to defend the population from peril. Under the broad authority of the police power, state and local governments confined suspected disease carriers against their will, established armed quarantines on land and at sea, seized private homes for smallpox pesthouses, removed infected persons by force from their homes, and enacted, in the approving words of the U.S. Supreme Court, “health laws of every description.” Considering the case of a merchant from Burlington, North Carolina, who had refused to submit to his town’s vaccination during the epidemic winter of 1899, Justice Walter McKenzie Clark of the state supreme court drew a ready analogy between public health and the sovereign’s power of self-defense. “[I]t is every day common sense,” he said, “that if a people can draft or conscript its citizens to defend its borders from invasion, it can protect itself from the deadly pestilence that walketh by noonday, by such measures as medical science has found most efficacious for that purpose.” Like war, it seemed, epidemic disease was the health of the state.32
But in the cities, towns, and rural hamlets that C. P. Wertenbaker visited across the South, convalescent people with infectious smallpox scabs on their faces and limbs moved freely about the streets, ran country stores, and went to work in the fields and mills. Meanwhile, local physicians engaged each other in front porch debates about the nature and provenance of this mysterious eruptive disease. When alarmed public health officials called for strong measures, local government agents often hesitated to act, not wanting to interfere with business or upset the electorate. When officials finally did act, as Wertenbaker wrote in a report to Surgeon General Wyman, time and again the people “revolted.”33
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