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the object of “many a cursing” when he warned his neighbors that smallpox was spreading among them. “One gentleman’s idea of smallpox,” this health officer reported, “was that when a man had small-pox he was in a hell of a bad fix, and as no one had been in that condition, therefore there had been no small-pox.” It proved a difficult position with which to argue. Public health officers at points across the South agreed that one of the greatest obstacles to smallpox control was the doubt that existed in people’s minds as to the true nature of this new disease. Frequent bouts with naysayers led some officers to wish, in published government health reports, for the appearance of a “fool-killer”: a fatal case of smallpox. As one North Carolina official put it, the best cure for a doubting public was “a good first-class case of small-pox.”62

That even a second-class case of smallpox could arouse so little public concern speaks to the amount of physical suffering that Americans raised in the nineteenth century expected to endure during their lives. Even in ordinary times, southern newspapers advertised patent medicines promising relief from all kinds of fevers and “itching skin diseases.” It took something stronger than mild smallpox to make people welcome government doctors into their lives. Even in a “mild” outbreak, Wertenbaker might see as many as a dozen grotesque confluent cases and one or two deaths. In December 1900, one of Wertenbaker’s Service colleagues, Assistant Surgeon John D. Long, inspected a gang of African American railroad workers in a Washington train station. The men had just finished digging a tunnel for the new West Virginia Short Line Railroad and were making their way south. For months, a disease—variously called “Cuban itch,” “nigger itch,” or “black measles”—had been spreading among white and black workers in the Short Line construction camps. As Long questioned the men, he jotted down their symptoms: “headache, fever, general weakness, vomiting, and pain in the neck and back,” followed by a rash that went through the usual stages of “vesiculation, pustulation, and desquamation.” Most of the men had been unable to work (or collect wages) for up to two weeks. The camps they had left behind had seen at least 140 cases of smallpox, with 4 deaths. That was “mild” smallpox.63

Clusters of severe cases occurred during otherwise mild epidemics often enough to keep Wertenbaker in an almost constant state of apprehension. In each fatal outbreak he envisioned smallpox regaining its historical virulence. From a public health perspective, though, the most dangerous thing about mild type smallpox was that it did not lay people low enough. Some people recovered without ever taking to their beds. Particularly in the convalescent stage of the disease—when patients would ordinarily be confined under close quarantine—people with mild type smallpox often felt well enough to go about their business. Children with infectious scabs on their faces and hands played in the streets. Contagious men and women worked in the fields and factories, ran grocery stores, and mingled in the crowd on court day. Secretary Lewis of the North Carolina Board of Health complained that a man with mild smallpox was “exactly in the right condition for visiting around among the neighbors, or loafing at the railway station, or above all, attending a gathering of any kind—political preferred.” The eruption might be so insignificant as to attract no notice. Nevertheless, it was “the genuine article,” Lewis warned, “and capable of causing in the unvaccinated the most virulent and fatal form of the disease.”64

The turn of the century is remembered today as the advent of the modern expert, when university-trained professionals in medicine, the sciences, and law acquired a new authority in American life. But southern health officials often found the public, business interests, and even their own local governments unwilling to accept their warnings or yield them the diagnostic ground. Like Mr. Barker of Stithton, many citizens saw no reason to elevate