Pox (14 page)

The smallpox years of 1898 to 1900 were the busiest in the history of the Marine-Hospital Service to date, and those years were also the most mobile of Wertenbaker's career. The surgeon's sorties to smallpox-stricken locales across the American South afforded him an exceptionally broad regional perspective on the tangle of factors—the institutional constraints and conflicts, the clash of interests and beliefs, and the unpredictable behavior of a once-familiar disease and the individuals affected by it—that made small-pox control such an intractable political problem in southern communities. Middlesboro, Wertenbaker learned, had been just the beginning, an extreme example of the social dissension and political failure he would find everywhere. His experiences in the field would turn him into something of an extreme case himself, a strong advocate for greater national control in this traditionally local realm of law and governance, public health.
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L
ike most Americans born before the Civil War, Charles Poindexter Wertenbaker's first loyalties were to family, community, state, and God. Born in Charlottesville, Virginia, on April 1, 1860, Wertenbaker descended from a long line of soldiers, scholars, and scribes, whose generations of service to the Old Dominion he traced back to a distant ancestor, a colonel who sat on the Bacon's Rebellion court-martial in 1676. A great-great-grandfather on his mother's side had received one hundred acres of Virginia soil for his service in the Revolutionary War, a fact Wertenbaker used to establish his right to membership in the Sons of the American Revolution. His grandfather, William Wertenbaker, fought while still in his teens in the War of 1812 and was appointed by Thomas Jefferson in 1825 to be the first librarian of the University of Virginia, a position he held for more than half a century. In his application to the Sons of the American Revolution, C. P. Wertenbaker failed to mention that his father, a cigar manufacturer named C. C. (Charles Christian) Wertenbaker, had spent his prime in a very different war. He fought with General Robert E. Lee's Army of Northern Virginia during the bloody 1862 invasion of Maryland and was wounded himself two years later. C. C. Wertenbaker stood with his regiment when it surrendered, with the rest of General Lee's forces, at Appomattox Court House on April 9, 1865, eight days after Charlie's fifth birthday.
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Charlie Wertenbaker grew up in relative privilege, in a household with three or four servants, white and black. But illness and death were as familiar to his childhood landscape as the green lawns and white columns of Mr. Jefferson's university. Charlie was the eldest of the eleven children born to C. C. and Mary Ella Wertenbaker. Seven of his siblings died in infancy or childhood; his mother died before he turned thirteen. Such family tragedies were common in nineteenth-century domestic life, with influenza, tuberculosis, and other infectious diseases causing most of the misery. But the relentless rhythm of loss in the Wertenbaker home would have been unusual even in the tenement districts of the disease-ridden northern cities. The mortality in the Wertenbaker family exceeded that found among nineteenth-century American slave children, more than half of whom died before reaching the age of five.
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This legacy of loss may partly explain why, when Charlie Wertenbaker came of age, he not only signed on with the Virginia Volunteers, in the family tradition, but enrolled in the medical department at the University of Virginia. At the time, a career in medicine promised neither high status nor great wealth. Still, it was a respectable calling, and by the 1870s educated people were beginning to think of medicine as a powerful science, capable of preventing the spread of infectious diseases, not just treating the symptoms that ravaged the human body. Wertenbaker earned his doctor of medicine degree in 1882. After graduation, he moved to the rebuilt capital city of Richmond, where he worked as an intern at the Retreat for the Sick under the eminent surgeon Hunter McGuire, erstwhile medical director of General Thomas J. (Stonewall) Jackson's Second Corps (and future president of the American Medical Association). From 1884 to 1888, Wertenbaker moved north to work in hospitals in and around New York City. He entered the U.S. Marine-Hospital Service, as an assistant surgeon, in August 1888.
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The federal bureau, with its Washington headquarters and its uniforms of blue, must have seemed to some of his militia buddies a curious career choice for the eldest son of a proud old Confederate. But given the straitened southern economy after the Civil War, many young university-trained physicians from the region competed for positions in the federal government, particularly in the medical services of the Army and Navy and in the Marine-Hospital Service. Southern men would predominate at the Service's entrance exams until the 1930s. Wertenbaker's alma mater was known in the corps as “The University.”
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From its humble origins in 1798 as a federal fund to support sick and disabled seamen, the Marine-Hospital Service had grown after 1870 into an increasingly centralized and professional federal bureaucracy. Overseen by the secretary of the treasury, the Service modeled itself after the medical corps of the Army and Navy. It adopted a system of rigorous examinations, commissioned ranks (rising from assistant surgeon to passed assistant surgeon to surgeon), merit-based pay grades, and uniforms for the surgeons assigned to its many hospitals and relief stations at ports along the nation's coasts and major inland waterways.
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The presence of the national government in the South had receded after the collapse of Reconstruction and the removal of the last federal troops from the South Carolina statehouse in 1877. But in the control of epidemic disease, the political current flowed in the opposite direction. As Congress expanded the Service's scope of action, and the bureau's cadre of mobile medical officers moved into areas of governance hitherto dominated by the state and local authorities, the South proved the greatest recipient—sometimes solicited, sometimes not—of federal aid. The National Quarantine Act of 1878, enacted during the devastating yellow fever epidemic that killed twenty thousand people in the Mississippi and Ohio river valleys, empowered the Service's officers to enforce quarantine regulations in the region, a major expansion of federal authority in the realm of internal police power. The yellow fever work made the institution and its officers more familiar to Americans in the South than in any other region.
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The scale and scope of the Service's activities continued to grow after Wertenbaker joined it, and not only in the South. In 1890, Congress gave the bureau permanent authority to administer interstate quarantine regulations. The following year Congress put the Service in charge of medical inspection of immigrants at the nation's major border crossings and ports, including Ellis Island. Among the many things the U.S. medical men demanded of arriving immigrants was proof of a recent successful vaccination against smallpox—preferably in the form of a fresh vaccination wound on the upper arm. After war broke out with Spain in 1898, the Service followed the flag, administering quarantine at the coastal ports of Puerto Rico, Cuba, and the Philippines. By the time Congress renamed the institution in 1902, calling it the U.S. Public Health and Marine-Hospital Service, the bureau had already achieved that position in fact, with its hospitals, stations, state-of-the-art National Hygienic Laboratory, and traveling surgeons. In the eyes of Surgeon General Walter Wyman, who presided over this institutional growth, the United States finally had “a sanitary structure worthy of this nation.”
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The manly martial and scientific culture of the Service offered Wertenbaker a way of living in the world that he must have found both familiar and exotic. Wyman, a St. Louis native who bore a passing resemblance to Theodore Roosevelt, recognized that enforcing maritime quarantines and traveling to epidemic zones was lonely and dangerous work. And though the surgeon general could be an overzealous enforcer of bureaucratic edicts, he cultivated camaraderie in the ranks. This esprit de corps rested upon a soldierly discipline and the faith that, as one officer put it, “scientific investigation at the bench and in the field would yield eventually the knowledge to deal with the diseases of man.”
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Wertenbaker's Service career, from 1888 to 1916, coincided with the meteoric rise of scientific medicine. Professionals in medicine, the biological sciences, and public health were dramatically reducing Americans' rates of mortality and morbidity from infectious diseases. Wyman encouraged his surgeons to think of themselves as men of science working at the front lines of this historic campaign. He dispatched them to medical conferences. He published their field reports in the Service's journal. And when his surgeons fell in the line of duty, he honored them in words redolent of the values of the institution they had served. Yellow fever killed Assistant Surgeon John William Branham, a young husband and father, in Brunswick, Georgia, in 1893. The surgeon general praised him for his “education and medical attainments, . . . manliness of deportment and gentlemanly bearing.”
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As Wertenbaker rose in the Service and built a small family of his own, he kept that eulogy in his personal files, not far from his two life insurance policies. He must have wondered if he, too, would one day be remembered as an honored citizen-soldier in Walter Wyman's war against disease.
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C.
P. Wertenbaker could not have foreseen that he would spend several years of his life fighting smallpox. Until 1898, the Service's work consisted chiefly of running its 22 hospitals and 107 relief stations for American seamen on the coasts and interior ports, manning immigrant inspection stations, and administering maritime quarantines when yellow fever threatened. Suppressing a smallpox epidemic was a different proposition from inspecting vessels and passengers at port. Fighting smallpox involved close control of entire local populations, on their own turf. To do the job right meant compelling men, women, and children to undergo an unpleasant and unpopular medical procedure, vaccination. With the exception of the major entry points for immigrants into the American nation, such intervention was still viewed as a matter of police power, like punishing criminals and regulating noxious trades.

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.
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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.
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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.
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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.”
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