Pox (18 page)

The close living conditions of African American laborers, even in the most rural of settings, aided the spread of smallpox. Especially efficient carriers, it seemed, were itinerant laborers in the fast-growing rural nonagricultural sector, including men who worked at turpentine stills, in phosphate and coal mines, and on the railroads. Unvaccinated African Americans who slept in crowded cabins, shared tents in mining camps, or huddled for warmth in railroad boxcars were extraordinarily vulnerable to airborne germs. Transient black workers, forbidden by law, custom, and their own poverty from sleeping in a white-owned tavern or inn, frequently stayed overnight in the home of a black family, where they shared rooms and often beds with children and other family members. In February 1899, a white Carrollton, Kentucky, physician named F. H. Gaines examined a transient African American man with a “suspicious eruption on his forehead and wrists.” Dr. Gaines diagnosed the eruption as smallpox. He learned from his patient that he had been put off the Madison and Cincinnati packet three days earlier and had spent the next three nights with three separate black families. When the man realized Gaines intended to take him to a pesthouse, he made a quick escape. Two weeks later, smallpox erupted in all three families.
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A truism holds that in the Jim Crow South, whites and blacks lived side by side, while in the “promised land” of the urban North de facto racial segregation prevailed in the housing market. But the history of the southern smallpox epidemics suggests just how much social distance actually existed between the races in southern places. Jim Crow laws, which proliferated in the 1890s, stripped most African Americans of the suffrage, forced them into separate compartments on trains and streetcars, and relegated black children to the most poorly funded schools. For all of their flaws, the public health reports reveal some of the collective impact of this emerging regime of white supremacy, even as they attest to the vitality of black social institutions. Reports traced smallpox clusters to African American boardinghouses, schools, churches, restaurants, opera houses, and a few houses of ill fame—including one in Richmond, Kentucky, whose keeper served well-attended court-day dinners to the community.
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Booker T. Washington had it right. Infectious disease drew no color line. People did—with their customs, practices, institutions, and laws. The color line, in any event, rarely held. Even when local authorities tried to keep smallpox at bay by ordering quarantines of African American sections—as officials did in 1900 in Wertenbaker's native Albemarle County—smallpox crossed that line. When whites did catch smallpox, a disease that had in some places gone unnoticed for months suddenly attracted public attention. The formerly invisible disease became visible.
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Which is not to say it became intelligible. For at that point, as Wertenbaker observed time and again, another problem presented itself. The public refused to believe mild type smallpox was the real thing.

T
he smallpox came to Stithton, Kentucky, on a winter's day in 1899, when the Barker boy rode home from Louisville on a bicycle. A peculiar rash speckled the young cyclist's face, and the town physician who examined him feared the worst. He instructed the boy to ride home and stay there, and then rang the Hardin County health officer. Accompanied by several excited physicians, Dr. C. Z. Aud took a ride out to the Barker place. Aud looked the boy over, ran his fingers over the papules, and in the presence of his attentive colleagues and the boy's father, diagnosed smallpox. Mr. Barker did not gasp with alarm, he did not plead for a second opinion, he did not ask what could be done to save the boy. He just let the Hardin County health officer know that his opinion wasn't worth all that much at the Barker place. “I was not very politely told by the old man,” Aud recalled, “that he had had small-pox himself, and knew a great deal more about it than I did, and he would not submit to vaccination.” Barker's two daughters refused to bare their arms, either. Mrs. Barker said she had already been vaccinated. So Aud and his entourage left. When he got back to his office, Aud learned that Mr. Barker had already called a lawyer to see if he could “get damages from a doctor for saying his son had small-pox when it was a lie.” To Barker, Aud's diagnosis amounted to libel. Time would tell that Barker did not know so much about smallpox. Two weeks later, he and his daughters broke out in pox.
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Though most rural Southerners had never come near a case of small-pox, they expected to know it when they saw it. And when their expectations were not met, they did not, as a rule, defer to the professional expertise of public health officers. Dr. J. R. Burchell of Clay County, Kentucky, found himself 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.”
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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.
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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.”
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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 the medical opinion of a health official above their own.

Like other Americans of the period, blacks were accustomed to experiencing any number of fevers and skin eruptions during their lives. Their first inclination in naming a new disease was to compare it with others they had known. After inspecting a confluent black patient in a room crowded with “eight or ten negroes” in Princeton, Kentucky, a physician found his diagnosis of smallpox challenged by an “old negro” who said he had survived smallpox himself. “Dat nigger nebber had no small-pox,” the man declared, insisting that the “little bumps on him” were caused by “big-pox” (syphilis).
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As local health authorities raised the pressure—making proclamations, ordering quarantines, calling for compulsory vaccination—critics raised their protests. Some citizens denounced the government officials as capricious and corrupt. Others relied, as rural blacks had since slavery, on the power of rumor. As Wertenbaker frequently witnessed in the field, nothing outran a rumor. Communities of cotton mill workers, who notwithstanding their claims to white privilege were among the most exploited and marginalized of southern laboring people, were deeply distrustful of medical authority. In Charlotte, Danville, and other places in the throes of industrial change, Wertenbaker found the expert claims of health authorities undone by rumors circulating among the mill workers that no smallpox existed.
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Much of the diagnostic dissension came from the medical profession itself. Some local doctors readily conceded their “inexperience” and “distress” at the spread of this bizarre eruptive disease, and they welcomed the expertise of county and state health officials. But others openly dissented against the medical claims of the local officers of the board of health, who were after all physicians like themselves who had been given their extraordinary powers by virtue of a political appointment. Public health officers called their uncooperative peers “kicking doctors” (invoking the ultimate rural symbol of stubbornness: a kicking mule). State health officers openly mocked their local opponents in the medical profession, describing in published reports their encounters with many a “low grade” physician who was “as positive as he was ignorant.” When Inspector B. W. Smock arrived in Jackson County, Kentucky, a community in central Appalachia, a local physician informed him that (as Smock described the conversation) “they had a ‘breaking-out disease' that was mighty ‘ketching' up in what is known as Horse Lick Creek.” The local doctor reckoned it was measles. But Smock retorted that this disease was nothing less than “seven-day-in-a-week, stay-with-you-forever small-pox.” City-based state health officials such as Smock wrote up their travels into the heart of Appalachia as if they were conducting anthropological fieldwork. They marveled at the practices of local institutions, recorded (or mocked) local dialects, and cataloged medical folkways. For these state experts, the unruly subjects of their inquiry were not just the (by their lights) primitive mountain folk but also their “ignorant” physicians.
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Local physicians took exception to the increasing interference of government-appointed health officials in their practices. But more than interests were involved. Mild type smallpox simply did not conform to physicians' expectations. The disease differed in several respects from the classical smallpox described in their medical textbooks, which given the long quiescence of the disease in the South were for many physicians the only source of knowledge on smallpox available. Compared with text-book smallpox, the pocks of the new disease were few and superficial (and usually not confluent). Physicians examining patients for smallpox expected them to have a secondary fever, but mild type smallpox frequently brought none. And smallpox was supposed to be a winter disease. The mild type could prevail during an Alabama summer.
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Wertenbaker had learned in Middlesboro how difficult it could be to pry smallpox funds from a parsimonious and skeptical county government. To get anything done, health officers needed the support of their local government institutions: vaccination orders (where state law did not give that authority to health boards), money for vaccine and vaccinators' fees, cash to pay the pesthouse guards, and so on. In the larger towns, health officials had to win over the city council. In small towns and rural areas, health officials had to make their cases to county governments—boards of supervisors or, in some states (including Georgia and Kentucky), judicial bodies such as county courts and grand juries. The interests and medical understandings of those government bodies often clashed with those of health officers. For the lay officials, who, as Wertenbaker pointedly observed, were typically merchants, farmers, and other men “unfamiliar with matters pertaining to general sanitation and public health,” the smallpox question came down to taxpayer dollars and common sense. Unlike appointed health officials, most aldermen, county supervisors, and judges had to answer to the electorate. If they strayed too far from the common sense of the community, they risked losing their jobs.
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