Pox (19 page)

Some of the most dramatic clashes between health authorities and lay officials took place in crowded courtrooms, the center stage of local political life at the turn of the century. When the modern expertise of medical science collided with the old-fashioned legal authority of judges and juries, the law won. Having given up on persuading local physicians that the “ketching disease” troubling Jackson County was really smallpox, Inspector Smock made his case to the county court. The state health official delivered a two-hour speech. As a reporter from Louisville described the scene, things seemed to be going well for Smock until a preacher stood up and addressed the assembly. “The Lord has sent this affliction upon us, and the Lord will take it away in His own good time,” he said. At that point the county attorney, an elected official in a room full of voters, declared that there was no proof that smallpox existed in the community and he was opposed to any measure that would cost the taxpayers their hard-earned dollars. In a remarkable gesture to rural democracy, the judge decided to take a vote of all those present, asking the courtroom crowd to decide whether the disease was smallpox. “[T]o a man they voted that small-pox did not exist,” the journalist reported, “notwithstanding the fact that two men with distinct pustules on their faces were in the crowd.”
⁷⁰

 

 

L
ike Inspector Smock, C. P. Wertenbaker learned that to fight smallpox in a southern community he had to make his case in the court of public opinion. The politics of smallpox control was a politics of knowledge, as well as interests. Local government officials had many motives for requesting the aid of a Service surgeon. As in Middlesboro, some hoped to persuade “Uncle Sam” to pick up the tab for an epidemic they had allowed to spin out of control. After that debacle, though, Surgeon General Wyman had made clear that the Service would be supplying only expertise, not largesse. More opinions would seem the last thing needed in these local communities, where health officers had run into so much trouble trying to arouse public concern.

But to his surprise, Wertenbaker often found that by the time he arrived in a place, the people were ready to listen to a surgeon from the U.S. Marine-Hospital Service. Evidently, southern suspicion of federal authority had its limits. For Wertenbaker found that the quarreling parties in a community—the “kicking doctors,” the health officers, the county officials, and the public—seemed prepared to consider the diagnosis and recommendations of an agent of the U.S. government. Perhaps the Service's years of yellow fever work had left a legacy of trust in the region. Maybe the Service's reputation for medical expertise preceded it. Though local relationships generally mattered a great deal in these communities, it worked to Wertenbaker's benefit that he had neither personal ties to these places nor private interests at stake. Sometimes he arrived to find that the quarreling parties had agreed in advance to accept the federal surgeon's “diagnosis and advice.” In any case, he always came prepared to persuade.
⁷¹

And to perform. There was a theatrical, even scripted, quality to Wertenbaker's appearances in southern cities, county seats, and small towns. In an age of Chautauqua assemblies, traveling circus shows, and political debates in the open air, Wertenbaker's impending arrival was heralded in advance in the local newspapers and by word of mouth. The public seemed hungry for information about smallpox and vaccination—or at least eager for a good show. The medical man gave it to them.
⁷²

The show began the moment he stepped off a train, packet, or wagon. Greeted by the local health officers and officials, he asked them to take him directly to see the smallpox suspects. Before making his inspection, he put on his smallpox outfit—the overalls, head wrap, and respirator. Typically, the men, women, and children he examined had already been diagnosed with chicken pox or “elephant itch” or something else. It rarely took Wertenbaker long to make his own diagnosis, and it was usually smallpox.
⁷³

Wertenbaker would then call a public meeting. At first he held his meetings in county courthouses, but the audiences soon grew too large and he moved with them into the public square or streets. The crowds sometimes numbered a thousand people or more. Entire communities turned out for the show: farmers and factory workers, businessmen and representatives of local women's clubs, parents and schoolchildren, whites and blacks. Wertenbaker announced to the audience that smallpox existed in their midst and, be it ever so mild, it could kill. He instructed the people in the clinical features of smallpox, explaining how mild type smallpox differed from chicken pox, measles, and other common diseases.
⁷⁴

Next he would explain the importance of vaccination, and how it worked. And that's when folks got edgy. Wertenbaker's audiences always included many people who were strongly opposed to vaccination. It was during these moments, as he stood in his Service blues preaching the virtues of vaccination to workingmen in overalls and women in homemade dresses, that Wertenbaker would listen to their complaints and their fears. He came to appreciate the extent to which antivaccination sentiment grew from reasonable fears of the procedure. Whether he was speaking in Charlotte or Columbia, Danville or Lumpkin, the surgeon heard the same objection from mill workers, farmers, and other manual laborers: vaccination caused “sore arms,” and that interfered with business.
⁷⁵

This common fear of a vaccine-disabled arm was at least as old as the Civil War epidemics. “I have been in the habit of preaching vaccination for the last thirty or forty years,” one North Carolina physician said in 1898. “I never saw a fiddler vaccinated in my life.” The bad batches of “dry point” vaccine flooding the South in 1898 and 1899 turned a lot of people into fiddlers.
⁷⁶

Even under the safest conditions—an aseptic procedure, using vaccine free of harmful bacteria—smallpox vaccination typically caused some constitutional disturbance, a fever, and a painful inflammation at the site of the vaccination. That's how a physician knew the vaccine had taken: it “set up a fire.” But mass vaccinations during epidemics rarely afforded the safest conditions, and the results of the dry points caused physicians and health officers to voice concern.
⁷⁷

In an era when almost everyone earned their living with their hands—farming the land, working wood, laying track, mining coal, tanning hides, rolling tobacco—the prospect of losing a few weeks' wages to a “sore arm” brought on by tainted vaccine was reason enough to dodge the lancet. The belief that this new mild smallpox (if it actually was smallpox) was unlikely do serious harm only strengthened the perceived risk of vaccination. Secretary Lewis of the North Carolina Board of Health noted that opposition to vaccination seemed to be strongest among cotton mill workers. Although he favored compulsory vaccination, Lewis acknowledged the workers' “natural reluctance” to lose the use of their hands. No system of social insurance existed in the 1890s (or for many years thereafter)—no policy of the state or the mill owners that would compensate men, women, and children who worked in the mills for their loss of wages due to bad vaccine. Lewis urged all large employers in the state to promise their workers half pay during any vaccination-induced disability.
⁷⁸

In his public speeches and writings, Wertenbaker tried to dispel the worst rumors about vaccination: “Rumors of arms, legs, or life lost as the result of vaccination, have, as a rule, no foundation in fact,” he said. But, like Lewis, he developed a real empathy for the predicament of breadwinners. And as he realized how much harm vaccination as it was currently practiced could do, he became an advocate for reform.
⁷⁹

He turned into a strong proponent of “glycerinized lymph,” a newer form of vaccine in which glycerin was used to kill the bacteria that proliferated in vaccine material (which was, after all, an animal virus harvested on the skin of cows). Glycerinized or “glycerinated” vaccine had been in use for several years, but the old, glycerin-free dry points were more widely distributed in the South during the first years of the epidemics. Wertenbaker was not the first public health officer to suggest that it was the dry points—not vaccination in general—that caused so many sore arms in the South. But the issue became a cause for him. He wrote letters to vaccine manufacturers, complaining about impure products. He sent samples of vaccine, including two dry points and two tubes of glycerinized lymph, to the Service's National Hygienic Laboratory in Washington for testing. Passed Assistant Surgeon Milton J. Rosenau extracted the vaccine material from the samples and heated the material in his laboratory. The tests showed that both of the dry points crawled with bacteria, including virulent
Staphylococcus pyogenes aureus
, with which Rosenau inoculated a mouse. It died. The samples of glycerinized virus were hardly models of purity. They, too, yielded thousands of colonies of bacteria. But at least these proved nonvirulent.
⁸⁰

Explaining the superiority of the new glycerinized lymph became a regular feature of Wertenbaker's smallpox lectures. By speaking so candidly about the hazards of the dry point, he won a measure of trust from his audiences. As a regular feature of his performances, he offered to vaccinate volunteers with a tube of glycerinized lymph he carried with him. If all went well, leading citizens would step forward and roll up their sleeves to be scraped before the attentive crowd. On his best days, Wertenbaker told Wyman, “the persons who have been loudest in proclaiming that they will never, never be vaccinated, come up and ask that I vaccinate them at once.” Wertenbaker probably exaggerated when he claimed that, as a result of his talks, “the opposition to vaccination almost entirely disappears” and “the people usually readily acquiesce in any measure directed by the authorities.” But in their own reports local health officials praised his visits, one calling a Wertenbaker performance “of inestimable benefit.” And even when Wertenbaker failed to win over hearts and minds, his talks gave local health officials the leverage they needed to persuade mayors, county supervisors, and judges to appropriate money and take action.
⁸¹

Wertenbaker always concluded his talks by presenting his plan for wiping out smallpox in the community. In the published version of “The Plan,” which Wertenbaker gave to his official hosts, he noted such details as the appropriate window shades for the smallpox hospital, pondered the relative merits of formaldehyde versus sulfur disinfectants, and specified the daily routines of numerous physicians, guards, and inspectors. (“By 8 a.m., the officer in charge is at his desk. . . .”) He advised (as if such advice were necessary) that in communities “where race feeling is strong,” separate smallpox hospitals be set up for whites and blacks. The Marine-Hospital Service surgeons forced local governments to take the health of African Americans seriously, which was in itself a real achievement. But the federal agents showed no interest in upsetting Jim Crow.

Wertenbaker's plan was a model of “military authority”: house-to-house inspections by physicians and police, compulsory vaccination of everyone who could not show a recent vaccination scar, the relocation of all suspected disease carriers into detention camps, and treatment of all small-pox patients in an isolation hospital. Wertenbaker leavened this litany of logistics with aphorisms drawn from his experience in the field. “A policeman is of great assistance to an inspector.” “Measures, good or bad, half done are worse than useless, as they give a fancied security.” “Smallpox cannot be suppressed without the expenditure of money. The more promptly you act the less it will cost.” Middlesboro could not have been far from his mind as he wrote those last lines.
⁸²

Like all measures of health policing since the invention of the quarantine in fourteenth-century Venice, Wertenbaker's “Plan” had a draconian streak. But for all of Wertenbaker's frustration with southern political institutions and officials—who, in his view, had let an eminently manageable pestilence run wild—his smallpox work instilled in him a certain optimism that those officials often lacked about the potential of the people. The people might be ignorant. They might spread false rumors. But in his travels through the southern states, Wertenbaker had learned from them. Above all, he had come to appreciate the ethical and political value of candor. Public health work required a big stick, to be sure, but it achieved little in the long run if the public remained unconvinced. Wertenbaker advised local health authorities to leaven force and discipline with education and persuasion. “If these facts are explained to the people by someone in whom they have confidence,” he promised in the “Plan,” “much of the opposition to vaccination will disappear.”
⁸³