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At 8 a.m. on February 10, a Black man and woman arrived urgently at Dr. Hubert Royster’s office. They brought troubling news. A locomotive fireman named Peter Scott developed a rash on his face and needed to be examined before he came into contact with anyone else. After finishing with his morning patients, Dr. Royster went to Scott’s home at 224 West North Street—and his worst fears were confirmed. The patient’s lesions were unmistakable: smallpox, with multiple pustules that would scab over and leave the telltale pitted scars.

Royster immediately consulted Dr. James McKee, who was “thoroughly convinced.” According to Josephus Daniels’ News and Observer,

“The house was immediately quarantined and the yellow flag hung out. The other occupants of the house, three negro women and four negro children, were vaccinated and restrained from leaving the premises. A guard has been established at the house and will be kept there day and night. The physicians thought it best to guard and treat the patient where he is than to remove him from the city limits.”

By February 1899, more than sixty smallpox cases had been reported across fourteen North Carolina counties. Peter Scott was one of them.

That afternoon, the city’s Board of Health convened an emergency meeting. The mayor endorsed its actions, and a resolution was passed to establish a pest house to isolate infected individuals. The City Attorney urged immediate vaccination of all citizens, with the city supplying the vaccine and medical staff.

They wasted no time. Mayor Powell and a Board of Health member were among the first vaccinated. “Everyone should be vaccinated at once,” the News and Observer warned. A few days later, the paper reported that in England, unvaccinated people were twenty times more likely to contract smallpox—and 480 times more likely to die from it.

By then, Dr. Lewis had accepted that persuasion alone was not enough. He calculated that the risks of compulsory vaccination were far outweighed by its benefits. The attorney general confirmed that mandatory vaccination was lawful. Lewis pointed to one county where an epidemic had been “stamped out” after compulsory vaccination. By mid-March, Burlington and Greensboro had adopted mandates, and Raleigh had established a pest house for those infected.

In late March, a twenty-year-old Black woman named Caroline Young sought care for persistent illness—possibly from Dr. Lawson Scruggs. She was diagnosed with “grippe” (influenza) and given a hospital admission certificate. Fortunately, she never went. About a week later, she broke out with smallpox. “Her body was wrapped in blankets,” the Morning Post reported. She was cared for by Peter Scott, now recovered, and his wife. Those living with her were vaccinated and confined to their home. When an acquaintance, Madison Jones, cursed at the pest house guard for denying him a visit, he was arrested.

Young, it turned out, had cooked for a “well-known family in a select part of the city.” No one, it seemed, was safe.

By the end of March, twelve new smallpox cases had been reported in the county. The epidemic threatened to undo the fragile health gains achieved by Dr. Scruggs and his colleagues. And it was only beginning.

On April 19, Drs. Royster, McKee, and the rest of Raleigh’s Board of Health met again in crisis. “The situation is grave,” warned Dr. Battle. “It is important not only to the public health but to the business interests of the city that the matter be attended to at once.” In the previous four days, seven new smallpox cases had been identified in the city, and another had been brought in from outside. A young woman had recently died while in quarantine.

Daniels’ News and Observer demanded swift action: “Raleigh will have compulsory vaccination. If it does not, the fault will be with the Board of Aldermen. The Board of Health has, after a thorough canvass of the situation, recommended it. If the aldermen do their duty they will meet immediately and take action.” The paper described the terrifying “confluent and hemorrhagic smallpox—bleeding at the mouth, ears, nose, and bowels.”

Until this point, every known patient had been Black. But white health officials feared the inevitable spread to their own community. Dr. Royster captured the prevailing sentiment: “It makes no difference how many negroes you dump down here with the smallpox if everybody is vaccinated. I think the people are prepared for compulsory vaccination and will support such an ordinance.”

Three thousand residents had already been vaccinated, but far more were needed. The Board of Health recommended near-universal vaccination within a week. Four full-time physicians were already working as vaccinators, with more under consideration. A six-room detention house had been completed, thirteen patients were in the pest house, and two large tents had been erected nearby. All city convicts had been vaccinated. On April 19 alone, roughly one thousand more residents received the vaccine.

After April 1899, smallpox in Raleigh declined sharply—four cases in May, four in June, and none for the rest of the year.

The combined influence of Sarah Hunter, Marie Burgess, Lawson Scruggs, and Richard Lewis surely played a decisive role in that decline. Their shared emphasis on community engagement, public trust, and prevention likely raised compliance with vaccination, quarantine, and education efforts far above what it otherwise would have been. In mid-May, the mayor reported that 90% of white residents and 97% of Black residents in the city had been vaccinated. Their coordinated work may well have been the central force behind Raleigh’s dramatic recovery from smallpox.

Elsewhere, Dr. Richard Lewis continued organizing the people for health.

For the third year in a row, attendance at the Health Conference with the People—held this year in Wilson—was disappointing. There always seemed to be something competing for attention. To avoid a conflict with a large religious gathering, Lewis and the other organizers had postponed the date, but even then, a minstrel show drew the crowds away. “We must confess some disappointment in the size of the audience at night,” the Bulletin reported, “when, the business men of the town being at leisure, we hoped for a large attendance.”

The topics were relevant and well received, as always. But more and more, people had other priorities. Even Board members must have found it difficult to keep the conferences high on their list. The long-term value of cultivating public interest in health and prevention was undeniable—but who had the time or resources to invest in shifting mindsets and behavior when results might not be visible for years or decades?

Immediate threats—an outbreak, a surgery, a crisis—brought urgency and measurable outcomes. Vaccinations, quarantines, and treatments showed quick, tangible results. Lewis eventually gave in. The Wilson meeting would be the final Health Conference with the People.

Perhaps, he began to wonder, educating and empowering the public wasn’t the surest way to improve its health.

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