A. T. McCormack quarantined the entire population of Middlesboro, posting armed guards day and night on the eight roads leading out of town. He took over a deserted row of buildings called “Brown’s Row” and established a new pesthouse and detention camp there, under the charge of Dr. Blair. The city was divided into eight districts; inspectors and vaccinators canvassed each one. As they found people with symptoms, they moved them immediately to the pesthouse. The inspectors disinfected the homes of “the infected” by burning sulfur in the closed rooms. When they found a house too leaky to hold the sulfur gas, they burned it to the ground. “Suspects” were placed under quarantine in their own houses and were visited daily by one of the health officers.38
McCormack put Dr. Bell in charge of the vaccination corps. The medical men entered the neighborhoods with health inspectors and police in tow. The men returned to the same homes later, to make sure the vaccine took. For some residents, the vaccine took too well. In February and March, the newspapers ran four stories about citizens who became sick or temporarily disabled following vaccination. The arm of one mail clerk, according to one newspaper report, “swelled to three times its normal size.”39
African Americans in the Over the Rhine district learned how a smallpox epidemic could transform years of official indifference and neglect into coercion and violence. Racial tensions had risen during the winter, as white officials and newspapers blamed black townsfolk for the events that brought shame on the community. The Weekly Record called for a public law, like the Louisiana separate coach law the U.S. Supreme Court had upheld in Plessy v. Ferguson (1896), to “keep the colored people in a separate section of the town. If it cannot be done by process of law, it can be accomplished by public sentiment.”40
The thin line between process of law and white public sentiment vanished when Dr. Bell’s vaccination corps moved back into the Over the Rhine section in early March. Entering crowded wooden houses and shanties, they confronted the consequences of black distrust of white health authority. The inspectors found twenty or more adults and children suffering from smallpox, who had hidden (or been concealed by their parents) from the authorities. As the inspectors removed the patients from their homes and hauled them to the pesthouse, the physicians examined the arms of the other residents, finding many that had never been touched by a vaccinator’s lancet. As they attempted to enforce the vaccination order, the physicians were met, according to the Weekly Record, with “the greatest opposition.” That was what the police were for. This time there would be no arrests or fines. All who resisted were handcuffed and vaccinated at gunpoint.41
McCormack and his men brought a new measure of expertise, discipline, and violence to Middlesboro. In the ten days after the state took control of the epidemic, the health authorities handled 169 cases of smallpox. Thirty-four of the patients were white, the rest black. The youngest was an infant just one day old when the eruption appeared simultaneously on mother and child. Miraculously, the baby survived. By March 10, many of the patients had recovered, and no further deaths had occurred. Dr. Bell’s vaccination corps had scraped the arms of 1,968 people—the exactness of the count offered as a testament to the state officers’ efficiency. Earlier reports had put the number vaccinated by the city officials somewhere around a thousand. And others had been vaccinated by their own physicians. But the epidemic was not over. There were still seventy people packed into the pesthouse on Brown’s Row. And they were running out of food.42
One thing McCormack and his deputies had not brought to Middlesboro was money. The state board didn’t have much in the first place; its annual appropriation was just $2,500, and half of that went to pay J. N. McCormack’s modest salary. The state was counting on city and county officials to pay for the guards and the pesthouse supplies. But squeezing money from the local governments proved even harder than getting people vaccinated. The Bell County Fiscal Court still refused to contribute a penny, and the scrip (called “warrants”) that the city had been using to cover expenses had become so devalued as to be all but worthless. As a consequence, the guards were virtually working without pay. When A. T. McCormack wired the news to his father, the secretary resorted to the only weapon at his disposal: the threat of a total quarantine against Middlesboro. J. N. McCormack wired Mayor John Glasgow Fitzpatrick: “Unless city or county can arrange [to pay the expenses], will be forced to release you and local Board from duty, stop all trains and advise adjoining counties to protect themselves.”43
Secretary McCormack underestimated the political acumen of the local officials. Shortly after receiving his telegram, Mayor Fitzpatrick, a lawyer and businessman connected to local mining interests, sent a telegram of his own. He wired Middlesboro’s congressional representative in Washington, a favorite son of Yellow Creek Valley named David Grant Colson. A Republican, Colson had served as mayor of Middlesboro for four years before taking his seat in Congress. He understood the situation there better than anyone else in Washington. Fitzpatrick wrote: “County refuses aid; city has no funds. Can Federal aid be had?”
It was a good question. The United States in 1898 had no federal welfare state as such. But since 1790, Congress had on roughly one hundred occasions used its spending powers under the Constitution’s “general welfare” clause to appropriate relief for the hapless victims of wars, floods, fires, famines, cyclones, grasshopper invasions, and other disasters. Yellow fever epidemics and Mississippi floods had aroused Congress to send aid to southern communities on more than one occasion since the Civil War. But long-standing practice dictated that such appropriations be reserved for cases in which blameless people had been overwhelmed by circumstances beyond their control. The Middlesboro smallpox epidemic did not meet that test. The misguided parsimony of public officials, rather than an act of God or some other uncontrollable force, had caused the “disaster” in the mountain city. And how would Congress have responded to the Middlesboro leaders’ racial theory of the epidemic? Were African Americans a force beyond their control? Was this “African” epidemic an act of God? Congress never had an opportunity to ponder such questions. Rather than make the hard case for congressional relief, Colson contacted Walter Wyman.44
Colson may have been aware that Wyman’s federal health bureau, the U.S. Marine-Hospital Service, had for the past two months been working with local authorities in Birmingham, Alabama, to control a smallpox epidemic there. In his message to the surgeon general, the congressman narrated the Middlesboro epidemic as an emergency. “The situation is a very grave one,” he wrote. “Neither the municipal, county or state authorities are able to control the epidemic.” But Colson astutely crafted his case for Marine-Hospital Service intervention in the political language of federalism. “All Southwest Kentucky, East Tennessee, and Southwest Virginia are involved, or liable to be.” Middlesboro’s location on the border made an uncontrolled epidemic there a danger to other states. This fact alone made direct federal intervention plausible. For good measure, Colson enclosed a note from Rep. Walter P. Brownlow, a fellow Republican whose district lay in northeastern Tennessee, just across the border from Middlesboro. “I fully concur in the above,” Brownlow said. “Smallpox is spreading in my district. I ask for immediate action.”45
Passed Assistant Surgeon C. P. Wertenbaker was working at his station in Wilmington, North Carolina, later that day when the telegram came in. “Proceed to Middlesboro, Ky,” Wyman ordered. “Report on situation there and neighborhood with recommendations.” The surgeon general added a word of caution to his officer before he embarked upon his five-hundredmile journey from the Carolina coast to the heart of Appalachia: “Local authorities should meet expenses, [federal] government expenditures are interstate only.” Wertenbaker caught the next train west.46
It was dark by the time the surgeon reached the mountain city, the high wooded ridge of Cumberland Mountain a presence more felt than seen in the cool March night. A clock had only just tolled eight, but the broad streets were virtually empty, the saloons shuttered, t
he trains dead on their tracks. Out on the public roads, men toting lanterns and shotguns guarded the quarantine line. No one in, no one out. The guards at the train station, though, had made an exception for Wertenbaker. They’d been expecting him.
In his crisp blue uniform, Charles Poindexter Wertenbaker was the very model of a Marine-Hospital Service physician during Walter Wyman’s long tenure as surgeon general (1891–1911). A university-trained medical man with the discipline of a soldier and the bearing of an officer, Wertenbaker knew how to handle a microscope, a pen, and a gun. Wertenbaker was thirty-seven years old. An inch or two shy of tall, he had fair skin, light eyes, and a thick mustache that in his younger days he had waxed into a fashionable pair of handlebars. He had spent ten years in the Service, working the federal outposts in a succession of American ports: Norfolk, Galveston, Chicago, and Lewes, Delaware. He took over at Wilmington just days before the smallpox arrived there, reportedly in the body of an African American railroad hand. Now, three months later, he was still figuring out the politics of smallpox control. For him, Middlesboro would be an object lesson.47
When daylight broke on March 14, Wertenbaker toured Middlesboro on foot with A. T. McCormack. As they walked, Wertenbaker noted the Old World character and surprising sturdiness of the Appalachian boomtown: the broad streets with their English names, the imposing bank buildings and substantial storefronts of the business district, the Victorian mansions of the finer neighborhoods. Even the wood-framed houses constructed for the workers looked built to last. On many of those houses hung the telltale placards or yellow flags. McCormack told him that four hundred residents, roughly one ninth of the population, were now under domestic quarantine—prisoners in their own homes. Another seventy-two people were in the pesthouse. So far, McCormack told Wertenbaker, his men had vaccinated nearly two thousand people. At this point, anyone who had not been vaccinated probably aimed to keep it that way. In any event, as Wertenbaker reported to Wyman later that day, “forcible vaccination is still progressing.”48
McCormack did not hide his resentment at Wertenbaker’s presence in Middlesboro. McCormack was a young man, but he was no country doctor. He had a medical degree from Columbia University. The Kentucky Board of Health was, in a sense, the McCormack family business. He was his father’s most trusted man in the field. He did not intend to let the Middlesboro debacle tarnish the board’s honor and reputation. The physician assured Wertenbaker that he had wasted his time in coming all the way to Middlesboro. The state had everything “under control.”49
Next the men arrived at the pesthouse. The crowded structures, located in a thickly settled part of the city, housed seventy-two men, women, and children. As he moved through rooms thick with the sickening sweet smell of smallpox, Wertenbaker kept a running tally. Forty-nine of the inmates had already broken out with clear cases. The rest showed some early symptoms or were being detained as “suspects.” According to the standard Service practice, the suspects should have been kept apart from the patients, to avoid unnecessarily spreading the disease. Most of the inmates were African American; seeing Middlesboro from the perspective of smallpox, Wertenbaker mistakenly concluded that half of the city population was black. From his experience in North Carolina during the past few months, Wertenbaker couldn’t have been surprised that smallpox and Jim Crow had conspired in Middlesboro, too. But something else did surprise him. The inmates were not just sick, or in imminent danger of becoming so. As he wired Wyman later that day, “the patients are without food.”50
Months of haggling between city and county authorities had come to this. Without the backing of the Bell County Fiscal Court, the city scrip was worthless. A few days earlier, the grocer who had already supplied the pesthouse with $500 worth of food refused to provide any more until he was “satisfied of reimbursement.” While Wertenbaker traveled to Middlesboro, the last of the food had run out. Some guards now refused to work until they were properly paid. The strategy of the McCormacks, father and son, was to exploit the public embarrassment of the pesthouse crisis and the threat of a county-wide quarantine in order to finally squeeze an appropriation from the county government. It must have seemed a sensible strategy to the McCormacks; thanks to the wire reports coming out of the city, newspapers as far away as Grand Forks, North Dakota, and New York City were running stories on the “starving” pesthouse inmates of Middlesboro, Kentucky. But locals knew better than to underestimate the fiscal parsimony of Judge James Neal of the Bell County Fiscal Court, whom the Middlesboro Weekly Record described as “a little, one-horse, whipper-snapper of a judge with a brain about as big as a mustard seed and a soul infinitely smaller.” And so while government officials engaged in a standoff over funds, the pesthouse inmates went hungry. If more guards abandoned their posts, could anyone expect the inmates to stay in the pesthouse?51
That afternoon Wertenbaker and McCormack addressed a roomful of indignant local businessmen and political leaders at the Middlesborough Hotel. Speaking for the state board, McCormack told the assembly that national government aid was unnecessary, the epidemic was already under control, and the county “could and would be made to pay.” Wertenbaker told the men that he could not take control of the epidemic unless the state board of health appealed to the surgeon general for assistance. Upon hearing this, several of the locals constituted themselves as a Citizens’ Committee. They drafted a telegram to Governor W. O. Bradley and J. M. Mathews, president of the state board of health, asking them to call on the national government. The decision to appeal to Mathews, the political appointee who presided over the board, rather than J. N. McCormack, who actually ran it, no doubt stoked the indignation of both McCormacks.52
The Citizens’ Committee’s telegram was but the opening salvo in a war of the wires—a clash of rhetorical performances that would last three days and reverberate for months afterward. The entire discussion centered on cash, control, and, in an indirect way, the Constitution. The McCormacks blamed the episode on Wertenbaker, whom they came to see as an arrogant interloper who had usurped their authority by promising the citizens of Middlesboro a bag full of United States currency. As A. T. McCormack recalled bitterly, “A number of citizens who had given us little or no aid during our hard work consulted and reconsulted with the Service surgeon, and, inspired by either his talk or their dreams of government pelf, they kept the wires hot with messages appealing for government assistance.”53
J. M. Mathews wired back to the Citizens’ Committee that, after consulting with the governor, he would happily authorize Dr. Wertenbaker to take charge—“if the Federal Government will defray expenses. There is no money in our treasury and no law to appropriate any for this purpose.” Having no doubt received a copy of Mathews’s telegram, Secretary McCormack then wired to Chief Inspector McCormack and told him to gather his men and leave Middlesboro at once. Once J. N. McCormack recalled the state officers, Wertenbaker was eager to take control, wiring the surgeon general that the state withdrawal left Middlesboro “absolutely unprotected.” “If authority in Mathews’ telegram is sufficient, I recommend that I be authorized to take charge to-night.... Please authorize necessary immediate expenditures for provisions, guards, etc.”54
Walter Wyman was furious. He ordered Wertenbaker to notify both McCormacks that he had not been authorized to take control, and the state officers should not be recalled. “The [federal] government’s interest is in protecting other states,” he said, “and nowhere is the whole expense borne by the government. Every municipality should have enough pride in itself to suppress this ordinary contagious disease.”55
But the men who had controlled the Middlesboro epidemic for the past two weeks had already caught the night train out of town. The Bell County Board of Health was back in charge—without any funds. A. T. McCormack and his men had barely left town before Judge Neal announced, again, that the county would not appropriate a dime.56
The same message arrived soon from Frankfort, as the governor and Kentucky lawmakers abdicated respons
ibility for the Middlesboro debacle. After receiving the Citizens’ Committee’s telegram on March 14, Governor Bradley had wired his fellow Republican, Representative Colson, to intercede with the surgeon general. His confusion about the legal authority of the federal government in such a situation was evidently total. “Act of Congress not in library,” Governor Bradley said. “I do not know what the law allows. Am told Surgeon-General of the United States may be appealed to take charge immediately. If such can be done, request him in my name to take charge.” The next day, Bradley appealed to the state legislature for an emergency appropriation, but the lawmakers adjourned without granting his request.57
Meanwhile, Mayor Fitzpatrick wired Surgeon General Wyman with a direct appeal. The mayor framed the Middlesboro situation as a relief crisis. “Middlesboro has 3,500 people dependent for support on wages of working people,” Fitzpatrick said. “People poor; business suspended; request for immediate assistance.” The mayor’s language was telling. He appealed not in the name of the city government, which he headed, but in the name of the deserving wage earners of Middlesboro and their families. He was trying, belatedly, to craft a narrative about a blameless community deserving of federal aid. Significantly, he left race out of his story.58
For Walter Wyman, the request from Governor Bradley was enough. On March 16, Wyman wired J. M. Mathews and told him the Marine-Hospital Service was prepared to “furnish medical officers, attendants, guards, inspectors, and attend to vaccination and disinfection.” The local authorities would still be expected to “care for poor not sick” and to furnish the pesthouse with food “so far as possible.” Wyman did not want to open up a massive federal relief effort in Middlesboro. It was J. N. McCormack who wired back to accept Wyman’s offer, so long as the Service intended to “aid and co-operate under our regulations.” Wyman agreed to this face-saving language. But he added a condition of his own: “All expenditures . . . must be supervised and accounted for by our own officer.” A reasonable condition, to be sure. But also a brisk slap in the Kentuckian’s face.59
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