Pox
Page 7
Middlesboro shed its most grandiose aspirations (along with most of its wealthier residents) and settled down to the hardscrabble life of an Appalachian company town. The place more closely resembled a remote settlement of impoverished wage earners than a conventional urban or rural place. The local government carried a heavy debt; without a penny in the treasury, the city routinely paid its schoolteachers and other employees in devalued city scrip. The rest of Middlesboro’s breadwinners, with the exception of the factory superintendents and a small professional class, scratched out a living where they could, doing day labor and working for the mines, works, and factories that still operated. European immigrants had helped build Middlesboro, but almost everyone who stayed was a southern-born American. More than one fifth of the city’s 3,500 residents were African American.
Middlesboro heeded southern racial norms, with segregated schools and much of the black population consigned to work in the meanest jobs and to live in the thickly settled sections known as “Alabama Row” and “Over the Rhine.” (The latter name recalled a defunct German brewery that had once perfumed the area with the sweet stench of hops.) In the fall of 1897, the everyday life of Middlesboro was tied more closely than ever to the furnaces and the mines that fed them. In mid-November, the local newspapers buzzed with the first really good news that anyone had heard in a long time. The Ducktown iron mines over Cumberland Mountain were set to reopen. Soon trains would carry ten cars a day loaded with ore to Middlesboro. The furnaces would run at full blast again: “Prosperity is certainly coming to this section,” the Middlesboro Weekly Herald promised.17
Prosperity never came. Smallpox did.
It started in the Over the Rhine section. In late October, an African American miner named Scott had left the smallpox-infested coal camps around Birmingham and traveled more than three hundred miles for a new job in the Mingo Mines, located just across the border from Middlesboro in Tennessee. He found housing in the Over the Rhine section. Scott was a member of a fast-growing occupation. The number of black miners and quarrymen in the United States doubled during the 1890s. Like the vast majority of African Americans (roughly 90 percent), most of them lived in the southern states. And like roughly one third of all African American breadwinners at the end of the nineteenth century, they worked at least part of the year in nonagricultural occupations, often in rural industries such as mining, turpentine production, and lumbering. The age of Carnegie generated enormous demand for coal. And the rapidly expanding southern railroad network brought southern coal reserves within easier reach of the national market. In southern Appalachia, the coal-rich region stretching from central Alabama to West Virginia, one third of all miners were African American. The work was dirty and dangerous, the jobs mostly nonunion, the bosses white. Typically the first let go when business slowed, a black miner like Scott had to be ready to move.18
Although he had no way of knowing it, he carried a bit of Birmingham with him when he did. A Marine-Hospital Service surgeon stationed in Birmingham during the smallpox epidemics of 1897–98 described black miners as “the great disseminators of infection. Essentially itinerant, they travel from mining camp to mining camp, from town to town, carrying the disease with them.” About a week after his arrival at Mingo, Scott came down with a fever and chills. A week later came the eruption. Someone called for a doctor.19
On November 14, a white Middlesboro physician named Dr. F. P. Kenyon examined Scott. He found the miner lying ill in a building in Over the Rhine. Located across the tracks and the lazy Yellow Creek from the heart of Middlesboro, the section was notorious for its rowdy saloons and bawdy houses where whites and blacks mixed. The building where Scott lay had once housed John Hughes’s saloon, remembered locally, in the words of a white newspaperman, as “the scene of many a bloody coon scrap.” Dr. Kenyon recognized Scott’s condition, but just to make sure he called in a second physician, who confirmed his diagnosis: a “well developed case of smallpox.”20
That simple act of naming Scott’s condition brought the miner and the physicians into the orbit of the law. A Kentucky statute required all physicians and heads of household to report any contagious and infectious diseases to their local board of health. In most communities in this predominantly rural state, “local” meant the county. But under state law, a city of Middlesboro’s size (more than 2,500 residents) was supposed to have a board of health and a health officer of its own. Middlesboro had no hospital in 1898, let alone a functioning board of health. But two of the three members of the Bell County Board of Health, Dr. T. H. Curd and Dr. L. L. Robertson, lived in the city, and they, too, confirmed the diagnosis, estimating that roughly fifteen people had come into contact with Scott. That night, residents clustered in the streets to discuss the rumored outbreak, the latest insult in a long run of bad luck. Some said it was time to leave Middlesboro for good. Meeting in an emergency session, the city council ordered the police to enforce a quarantine against the Over the Rhine district. Priding itself on its healthy mountain air, Middlesboro had no pesthouse. Scott and several African American residents known to have been exposed to him were placed under guard in the old Hughes saloon.21
Politically, the city council’s strategy for thwarting a smallpox epidemic had two things going for it: it didn’t inconvenience the white citizenry much, and it was cheap. Kentucky law held local governments liable for the cost of managing an epidemic. In a legal case arising from the Bardstown smallpox outbreak of 1883, a Kentucky court noted that this obligation went further than “the ordinary social duty to care for the helpless.” “If the poor man is neglected he may starve or freeze, but the calamity is personal, and his grave hides it; but if, having an infectious disease, which poisons the air, he is left where he lies, the entire community is menaced.” Whether this fiscal responsibility properly fell on Middlesboro, Bell County, or both would become a heated issue. For now, the city council decided that local police, already on the payroll, would enforce the quarantine. A more aggressive approach—a targeted quarantine and a well-run pesthouse coupled with compulsory vaccination of the entire population—would have been much more expensive. A pesthouse cost money: fees for the physician, wages for the guards, and food for the indigent patients. A general vaccination order posed other problems.22
Vaccination was not popular in Kentucky. Although state board of health rules required that public schoolchildren submit to vaccination, the board estimated that at least one third of the state’s white residents and a larger part of its African Americans had never been vaccinated. In Middlesboro, according to one estimate, nine tenths of the population had never undergone the procedure. And when a local government ordered a general vaccination, it was liable under state law for the cost of providing vaccination free to the poor. In a place as impoverished as Middlesboro, that meant paying a lot of doctor’s fees and buying a lot of vaccine.23
Another factor weighed into the political calculus. A good many Middlesboro residents, including the editors of the local newspapers, greeted the news of a smallpox outbreak with skepticism. The Weekly Herald described Scott’s illness as “a malady something like smallpox.” Scott had a relatively mild case, and it may have looked just like chicken pox to the few people who got a look at him. Economic self-interest and civic pride strengthened medical doubts. To call the “malady” smallpox would threaten the reputation and livelihood of Middlesboro. The city council of neighboring Pineville, the county seat, had already ordered a quarantine against Middlesboro, forbidding anyone from the mountain city to enter the town. The Middlesboro newspapers, which agreed on little else, warned citizens not to spread “wild exaggerated reports” that might lead other towns to choke off the flow of people and goods to and from Middlesboro. In Middlesboro’s straits, the spread of rumors seemed more dangerous than the spread of smallpox itself.24
And then the smallpox “scare” ended. Scott recovered. No new cases had come to light. On December 9, the city council declared victory and lifted the quarantine. And so,
as life returned to normal in Middlesboro, the population remained almost entirely unvaccinated.25
Weeks passed before the white officials of Middlesboro realized their quarantine had failed. A smallpox outbreak often begins slowly. Due to variola’s long incubation period, two weeks may pass between the initial discovery of a single smallpox case and the appearance of the next cluster, or “generation,” of cases. The medical logic of the quarantine is that by waiting out the incubation period, keeping potential carriers—“suspects”—apart from everyone else, officials can contain an outbreak and eventually snuff it out. But for those who must live on the other side of the quarantine line, the medical rationale is not always its most salient feature. When Pineville had announced its quarantine against the entire city of Middlesboro, city leaders had cried foul. The historical record mentions no such public outcry from the African American residents of Middlesboro’s own quarantined district, who were confined to a territory ostensibly justified by the public health but drawn explicitly by race. But the unanticipated consequence of this policy was that African Americans in the district did not notify the white authorities when more people in their community broke out with smallpox.26
This failure or outright refusal to cooperate with the local white power structure had its own unintended political effect. For when the authorities realized that smallpox had spread in the Over the Rhine section, the discovery merely reinforced their belief in the legitimacy of their quarantine. The Middlesboro Weekly Record ran a series of satirical dialect pieces that purported to represent the “niggahs’ ” point of view on the smallpox situation. In one piece, an old “aunt” tells a reporter that the only way to stop “dem low down niggahs from spreading smallpox is for de perlice” to “scrub that’ol Alabama dirt . . . off’n ’em.”27
In late December, a second case was reported in the Over the Rhine district, followed by several others. At first the city council did nothing, reluctant to spend money it did not have in the absence of public alarm. Although the Bell County Board of Health called upon the county government to provide funds, the county Fiscal Court, in charge of such appropriations, said it viewed this as a Middlesboro matter. Among the people of Middlesboro, rumors still circulated that the disease was not smallpox. A winter surge of chicken pox added to the diagnostic confusion: many people had trouble distinguishing one disease from the other. Some Middlesboro blacks were calling the mild smallpox “Elephant Itch,” a name that, according to some accounts, old-timers, former slaves, had long used for smallpox. Another name, “African Itch” (the polite, newspaper euphemism for “Nigger Itch”), expressed the belief of many local whites that this disease, whatever it was, wouldn’t trouble them as long as they kept their distance from blacks. For well over a month, the disease did in fact remain confined entirely to African Americans. And when the city government finally got around to setting up a pesthouse, in mid-January, all of the patients and suspects detained there were black. In early February, the Weekly Record made a plea for calm: “Up to the present, no white people have been attacked and there is positively no occasion for alarm.”28
One nearby community after another instituted shotgun quarantines against Middlesboro. Given the city’s border location, the epidemic inflamed interstate politics. Lee County, Virginia, quarantined against Middlesboro. A Tazewell, Tennessee, newspaper called the Middlesboro authorities “criminally negligent.” Officials in Claiborne County, Tennessee, home to Tazewell and the Mingo Mines, promised to enforce their quarantine against Middlesboro “if there is any virtue in a Winchester.” The Middlesboro council denounced these actions as “unwarranted, uncalledfor, unprofessional, ungentlemanly, and unworthy.” The quarantines cost local businesses thousands of dollars.29
A series of events in mid-February finally spurred the local officials to take serious measures to stop the epidemic. The first was the long-anticipated arrival, on February 12, of Dr. J. N. McCormack, secretary of the Kentucky Board of Health. Students of American government use the term “federalism” to describe the distinctively decentralized operation of political power in the United States before the New Deal. The states, especially in the South, had their own form of federalism: localism. Controlling infectious diseases—like policing the streets, running public schools, and administering poor relief—was the indisputable province of local authority. And where that authority rested, so did liability for the cost of disease control. The Kentucky Board of Health, a body of prominent physicians with a small staff of inspectors and the power to issue statewide regulations, only intervened in local affairs when local officials let local matters get totally out of hand. Which is exactly what McCormack’s presence in Middlesboro signified.30
Joseph Nathaniel McCormack of Bowling Green knew the Kentucky health laws as well as anyone. He’d written most of them himself. The fifty-year-old Kentucky native held medical degrees from the Miami Medical College in Cincinnati and the University of Louisville. He had served on the state board since 1879, holding the position of secretary for most of that time. He would remain as the state’s top health officer until his death, in 1912, when the Kentucky political leadership passed that office on to his son, Arthur Thomas McCormack. Joseph’s Kentucky pride did not extend to its communities’ fierce independence in matters vital to the health of the entire state. He devoted much of his life to the quixotic project of building a unified state health system.31
Arriving in Middlesboro, McCormack inspected the pesthouse, examined all of the known cases in the city, about twenty in all, and interviewed the health officers. What McCormack saw convinced him, as he said later, that “the parsimony and incapacity of the city and county officials” had laid “the foundation of an epidemic.” Standing before a special session of the city council, McCormack testified that every case he had examined was smallpox. He “recommended” that the council order compulsory vaccination.32
Up to this point, the half-dozen private physicians and company doctors working in Middlesboro had vaccinated a few hundred people, but most residents remained unprotected. The councilmen had a strong incentive to carry out the secretary’s recommendation. If they did not, the state board would exercise its full quarantine power against the city. The state board had the power to forbid anyone to enter or leave the city and to prevent any transportation company from delivering freight (coal, iron ore, food) without the board’s written permission. The board could bring Middlesboro’s already beleaguered economy to a standstill. Before adjourning that afternoon, the council passed a compulsory vaccination ordinance and ordered the edict published on posters and distributed about the city.33
That same afternoon, a man named Will Sheffly died in the pesthouse—the outbreak’s first fatality. The next day smallpox crossed the color line. The first white patient was Charles Dudley Ball, a saloon-keeper, gambling den operator, and deputy sheriff whose brother happened to be the chief of police. Charley Ball was not allowed to suffer the indignity of being the lone white man in the pesthouse. The authorities moved him to a deserted house on the outskirts of town. During the next forty-eight hours, eight more people with smallpox were discovered, four of them whites. Even more than Dr. McCormack’s visit, the infection of white Middlesboro residents, apparently by their black neighbors, gave the city vaccination campaign a sense of urgency among the city’s white leadership.34
The compulsory vaccination of Middlesboro began peacefully, as the overwhelmed city and county physicians attended first to the many residents, white and black, who came forward voluntarily. But after the initial rush subsided, the vaccinators began the slower work of house-to-house vaccination in the neighborhoods, where they met resistance with threats of arrest, jail, and fines. The vaccination order was part of a raft of emergency ordinances enacted by the council. The councilmen closed the schools, churches, and saloons. They forbade the public to assemble in the streets and children to go out at all unless accompanied by a parent or guardian. Inmates of the city jail were put to work cleaning up
the city—an act of urban renewal that shows the hold upon medical thinking of the old notion of smallpox as a filth disease, an association that even the ascendance of the microbe in medical science did not dispel. Meanwhile, the postmaster, still the lone agent of federal authority in Middlesboro, set up a fumigating apparatus for all outgoing mail; punching holes in letters and packages, he sealed them in a box for five hours with burning sulfur. Citizens could purchase their own personal disinfection devices from enterprising local merchants. S. R. Sneed Co. touted the Pasteurine Pocket Disinfectant and Deodorizer—“A deadly foe to Contagion.”35
Given how long they had waited to take action, the city officials should have known the epidemic would get worse before it got better. More people with smallpox surfaced almost every day. By the end of February there were fifty-two known cases among African Americans and poor whites from various parts of the city. Several people suffered from confluent smallpox, and a second patient died. To make matters worse, Middlesboro officials were still haggling with Bell County over which government would pay for all of the guards, doctors, and food. The Bell County Fiscal Court continued to reject requests for aid, reasoning that so far the epidemic was confined to Middlesboro, and Middlesboro should take care of its own mess. As a result, the smallpox control effort slowed to a virtual standstill. 36
On February 28, three months after Scott brought smallpox to Middlesboro, the Kentucky Board of Health stepped in. Secretary McCormack sent his son, Dr. A. T. McCormack, the state’s chief sanitary inspector, to run the operation. The younger McCormack, who was just twenty-five, brought along two deputy state inspectors, Dr. Austin Bell and Dr. B. W. Smock, and on his father’s request, the Bell County health officer, Dr. Samuel Blair, moved into the town, too. Most of the manpower—police, inspectors, guards, and vaccinators—were provided by the city government. The state board made clear at the outset that although it was taking control of the epidemic, it would not be paying the bills.37