Pox (10 page)

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

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.”
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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.
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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.
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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.”
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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?”