Pox
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Health officials met with resistance to every form of action they took. African Americans were said to be particularly quick to hide sick relatives and friends from health inspectors and the police, but whites did it, too. Shotgun quarantines on the public roads proved to be a weak defense against rural folk who knew their way through the woods. “We had just as well undertake to quarantine against red foxes and jack rabbits,” said one Kentucky health official. Pesthouses that had been hastily built were just as swiftly torched or torn asunder by crowds of people, white and black, who refused to let their neighborhoods be turned into smallpox dumping grounds. “We were totally unprepared to take care of a contagious disease,” recalled Dr. J. M. Manning, superintendent of health of Durham, North Carolina. Dr. Manning rode with the mayor across Durham, looking for a suitable place to pitch an isolation tent, but they were “met with shot-guns” wherever they stopped. Where officials did manage to establish pesthouses, they had to find a way to keep people in them. Even with armed guards and gasoline torches, most pesthouses and detention camps could not hold people who had the will and energy (as patients with mild smallpox often did) to escape. Local newspapers that a generation earlier had published notices of runaway slaves now ran stories about African American pesthouse fugitives who had broken loose from their confinement and fled into the night.34
No public health measure inspired more ill will than compulsory vaccination. Some of the opposition came from the top of the political order—from state lawmakers, who almost everywhere maintained that if compulsory vaccination were to exist at all it must be by local mandate. Even in the midst of the regional epidemic, efforts to enact uniform statewide vaccination legislation failed in several states, including Alabama (despite strong support from the medical profession), Florida (where rural representatives killed a bill favored by their urban colleagues), and North Carolina (where a bill drafted by the state board of health was “treated with absolute contempt”). Even in those few states that did enact new vaccination laws—such as Mississippi, a yellow fever state with an exceptionally well-funded board of health—lawmakers merely authorized local governments to compel vaccination and impose penalties. Compulsory vaccination of public schoolchildren could be attempted under state legislation or local authority, but in a region with almost no compulsory school attendance laws, such measures had limited reach. As Secretary Richard H. Lewis of the North Carolina Board of Health commented, “One practical difficulty on educational lines now is to get the children to go to school at all.”35
In the absence of state statutes, during smallpox epidemics local governments often ordered vaccination under their own general police powers, performing their legal duty to protect their populations from immediate danger. The orders usually resembled the one issued by the Wilmington aldermen: they required everyone in the community to show proof of a recent successful vaccination. The penalties ranged dramatically—with fines from $5 to $100, jail terms from ten to forty days. Some judges ordered violators to work on the public roads. In one North Carolina town, a man who refused to be vaccinated and threatened to spread smallpox among his “political enemies” had “three buggy whips worn out on him.” By contrast, some state and local measures created exemptions for specific classes of people. The city of Nashville made exceptions for people aged seventy or over, for women more than five months pregnant, and for individuals who, “in the opinion of the vaccinating physicians, are too ill to submit to the procedure.” Wertenbaker took a dim view of such exemptions. Only two classes of people should be allowed to neglect this duty, he wrote in his “Plan”: those who have had smallpox already and “those who are dead.”36
Local or not, compulsory vaccination orders engendered strife. Much the same drama played out across the South, from High Point, North Carolina—where Wertenbaker arrived to find that the furniture factory employees had “closed their houses, and gone into the country to avoid being vaccinated”—to Sherman Heights, Tennessee, where a crowd of citizens drove off county vaccinators with stones, curtain poles, and guns. Some people loudly protested the measures as violations of their personal liberty. Others tried to shrug off the health officers’ authority. The health officer of Russell County, Alabama, complained bitterly to a Service surgeon that when he tried to enforce vaccination without the aid of police “the negroes laughed at him.”37
In carrying out a policy that frequently targeted blacks, officials did not hesitate to use physical force. The sort of actions that Wertenbaker had heard about in Middlesboro (where African Americans were handcuffed and vaccinated at gunpoint) were echoed in official actions elsewhere. The phrase “equal protection of the laws” had little meaning in southern public health. Authorities in smallpox-ridden Thomson, Georgia, made sure that “all the colored population that could be caught were vaccinated” before they pressed the issue with whites. When they met “bitter opposition on the part of the white element,” the authorities decided to ask for an “outside opinion” before “forcing the matter.” They appealed for the aid of a Service surgeon. Racist pride was probably enough to stop white Thomson officials from asking Uncle Sam to help them handle “their” colored people.38
Beleaguered southern health officials had a concise explanation for popular resistance to their authority: the people were “ignorant.” After the rebellious citizens of Laurel County, Kentucky, caused the local health board to withdraw its vaccination order, one officer sent a plea to Secretary J. N. McCormack: “you alone know how much unjust, unreasonable and criminal censure these ignorant people are heaping upon us.” Other health officials pointed out that the common people had no monopoly on ignorance. Physicians, judges, and county officials were clueless, too. When the opposition came from white farmers or mountain people, some officials inclined toward more charitable, if no less condescending, theories. “Our people are unaccustomed to the restraints and duties incident to the proper management of them according to the principles of modern hygiene,” Secretary Lewis of the North Carolina board gently explained. Meanwhile, African Americans who pushed back against white health authority were disparaged as not just “ignorant” but “criminally careless.”39
As the southern smallpox epidemic wore on, Wertenbaker and some of his state and local peers developed a set of deeper explanations for why both smallpox and popular antipathy to public health authority had gotten so out of hand. Knowledge remained the crucial piece in these explanatory schemes. But Wertenbaker and others realized that a community’s understanding of disease depended on something more personal than a public health circular or a family doctor’s advice. Medical beliefs rested upon shared experience and memory. On this score, smallpox posed a special problem.
Outside the urban centers and port cities such as Charleston and New Orleans, most communities had not seen smallpox in a generation. People old enough to remember the Civil War recalled the epidemics that had raged in both armies. C. C. Wertenbaker probably told his son about the pox that burned through the Army of Northern Virginia during the Maryland campaign. Union and Confederate soldiers wrote in their diaries and letters of the wonders and horrors of arm-to-arm vaccination: the common practice of inoculating men with pus taken from another soldier’s vaccination sore or, worse, from an actual smallpox lesion. Some troops expressed gratitude for the protection their vaccinations afforded, while many more recounted stories of terrible fevers, poisoned arms, amputations, and death. During the battle of Chancellorsville in May 1863, five thousand Confederate soldiers were deemed unfit for duty after being vaccinated with material taken from the arm of a soldier who, as luck would have it, had syphilis.40
The civilian population did not have it much better. “Colonel” A. W. Shaffer of North Carolina recalled the desperate measures taken by local communities when vaccine ran out. “Everything having the semblance of a scab or pus passed for vaccine; anything with two hands and a blade or point, for a vaccinator; and every filthy sore at the point of abrasion, for a successful vaccination.” So
shocking had been the side effects that Shaffer blamed them for the outpouring of antivaccination sentiment in his state some thirty-five years later. “No wonder that the memory of that harvest of vile diseases still burns in the hearts and perverts the brains of the fathers and mothers of this later generation!”41
If Shaffer was right, the horrors of wartime vaccination burned more brightly in the memories of the people than did smallpox itself. Many places had not seen a single case since the war’s end. Like other rural Southerners, the people of Monroe County, Kentucky, had come to think of smallpox, in the words of a local physician, as “a disease confined to cities . . . a disease to be read about in the newspapers.” North Carolinians could boast of the “blessed fact that epidemics of infectious disease of any magnitude have been extremely rare in our State.” But the downside of this “wonderful immunity” was that in the Tar Heel State, as in more plague-prone areas of the South, a generation had come of age with no clear memory of how the symptoms of smallpox compared with those of the common childhood eruptive diseases such as chicken pox or measles. It did not seem to matter how much publicity heralded the spread of smallpox across the region. Each new outbreak seemed to catch the infected community by total surprise, like the unexpected return of some obnoxious but long-forgotten relation.42
Southern physicians suffered from the same memory deficit. “Many physicians have never seen a case of smallpox, and are unfamiliar with the methods necessary for its suppression,” Wertenbaker wrote in May 1898 after visiting Columbia, South Carolina—which was, after all, a state capital, not a one-horse town. Old-timers in the profession remembered small-pox all too well: Dr. M. H. Young recalled treating hundreds of cases during his service as a surgeon in the Fourth Kentucky Volunteer Infantry during the war. But a generation of younger men had entered the field who had never laid a compress on a smallpox-rubbled face, never inhaled the sickening odor of an infected person’s room, or, for that matter, never received much college instruction on the subject.43
Vaccination, meanwhile, had fallen by the wayside. The procedure, though simple, took time and care to perform correctly, and it normally garnered the physician a nominal fee. In the decades since the war, the once standard practice of arm-to-arm vaccination had been largely abandoned in favor of bovine vaccine, cowpox or vaccinia lymph harvested from cows and dried onto ivory points. The shift from so-called humanized virus to bovine points was hailed by most scientific authorities as a great innovation that reduced the transmission of human diseases, such as syphilis. But for a small-town physician, the changing technology imposed a new burden. If he chose to offer vaccination as part of his regular practice, he had to keep a stock of fresh vaccine on hand. In the absence of either much risk of smallpox, or much reward for performing the procedure, many physicians decided vaccination was not worth the bother. The practice had become, in the words of Secretary McCormack, “one of the ‘lost arts’ to the majority of country physicians.” To laypeople, it became an exotic and dodgy procedure, best left alone.44
And so, when the disease returned in the late 1890s, Southerners in general—and African Americans and poor whites in particular—were caught almost uniformly unprotected. Service surgeon Joseph J. Kinyoun, a North Carolina native and the first director of the National Hygienic Laboratory, warned that “Small-pox is more of a menace to the Southern people than to the northern people,” because in the South vaccination was “practiced but little, and only in places of large population.” In North Carolina, scarcely 10 percent of the population had ever been vaccinated. In Georgia, a Service surgeon placed vaccination levels closer to 25 percent, but that was after smallpox had been back for a few years. At the outset of the Middlesboro epidemic in the winter of 1898, Kentucky officials estimated that “only” two thirds of the state’s residents had ever undergone the procedure. But as local reports came in from across the state, the officials had to revise that figure. Two thirds of Kentuckians had never taken the vaccine. Among African Americans, vaccination status varied with age. Many of the older former slaves had been vaccinated; their masters’ self-interest, if not their vaunted paternalism, had seen to that. But the overwhelming majority of younger blacks, raised in an era of almost total neglect from the white-dominated medical profession, had never been inoculated.45
In his travels, C. P. Wertenbaker learned that ignorance, like knowledge, was a product of history. Medical knowledge—in both its popular and professional forms—still depended upon firsthand experience with illness. As far as smallpox was concerned, the wellspring of experience had (blessedly) dried up in the decades after the Civil War.
Any epidemic of smallpox would have caught most southern communities off guard. But the epidemiological profile of these end-of-the-century epidemics made them particularly difficult to manage. Smallpox struck African Americans first. And the disease took an exceptionally mild form. These two facts shaped how the scientific claims and political demands of public health officials would be received by the South’s many publics.
Addressing a white Mississippi audience in the early twentieth century, Booker T. Washington told his listeners, as he so often did, that “the destiny of the southern white race” was “largely dependent on the Negro.” The eminent African American educator drew upon recent history to make his point. “You can’t have smallpox in the Negro’s home and nowhere else,” he said. “You need to see that the cabin is clean or disease will invade the mansion. Disease draws no colour line.”46
Several years earlier, C. P. Wertenbaker stood outside a grocery store in Richland, Georgia, a whistle-stop town of nine hundred souls not far from the Alabama border. As people came and went from the store, a crowd of children, white and black, loafed outside. One African American boy caught Wertenbaker’s eye. Judging by the scabs on his face, Wertenbaker figured the boy to be in the convalescent stage of smallpox known in the medical literature as “desquamation.” Smallpox experts considered desquamation, when the scabs crumbled and fell from the face and body, to be the most contagious phase of the disease. The boy, Wertenbaker recalled, was “scattering infection everywhere he went.” No one paid the boy any mind.47
It was never easy to get rural people to take mild smallpox seriously, but when the disease appeared to infect “none but negroes” the task proved far more difficult. Federal, state, and local health officials, reporting from points across the South, uniformly identified the African American population as the reservoir for this disease. Newspapers, too, traced local outbreaks to particular African American individuals, families, or settlements. Even after the disease made its appearance among whites, the great majority of reported cases were in black people. In Tennessee and North Carolina, African Americans accounted for three quarters of all reported cases, far exceeding their proportion in the population. In particular locales, officials recorded far greater disparities. In Greenwood, Mississippi, a town of three thousand inhabitants where blacks outnumbered whites by a narrow margin, more than five hundred people contracted smallpox in the winter of 1900; just twenty-three of them were white.48
Wertenbaker observed that many white Southerners, including some physicians, called mild smallpox “nigger itch” and claimed that whites could not catch it. Often, the first whites to contract the disease aroused contempt. When a group of young white men in Stanford, Kentucky, broke out with the “itch,” their neighbors had a ready explanation: the boys had made “indiscreet visits” to the “Deep Well Woods,” an African American settlement on the outskirts of town. The first white patients identified in health board reports were usually marginal figures such as tramps, half-witted women, and promiscuous girls—fixtures of the era’s eugenics-inspired literature on southern “white trash.” That some rural whites covered their faces before allowing health board photographers to take their pictures attests to the shame they felt at being caught with this “loathsome negro disease.”49
Southern health officials admitted that a large percentage of smallpox cases went
unreported in their states. How, then, could they speak with such certainty about the racial origins of these epidemics? Those in a position to produce official accounts of epidemics have often blamed their occurrence on subordinate social groups. But this is not to say that all such narratives are works of pure fiction. To dismiss the official accounts out of hand—or to read them only as elite ideology—is to forgo all hope of recovering the social experience of disease. The wonderfully idiosyncratic epistolary form that public health reports took in this era inspires at least some confidence in their contents. State reports consisted mainly of letters and telegrams, peppered with chatty detail, sent in by local health officers. Even assuming broad agreement regarding matters of race and class, it would have taken a racial conspiracy of an implausible scale to make all of these reports tell a common story of the epidemic’s prevalence among African Americans and poor whites, if there were not some basis for this in fact. With an infectious disease such as smallpox, which spread most easily among people without regular access to medical care and who lived in close proximity to one another, the poorest members of society were exceptionally vulnerable. Inadequate nutrition made poor people susceptible to all sorts of diseases. Public health officials made a revealing leap, however, when they concluded from such epidemiological facts that “irresponsible negroes” (or “ignorant” whites) were morally culpable for the spread of smallpox.50