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By Root 401 0

” of smallpox ensured that many cases went unreported. The people most vulnerable to smallpox, unvaccinated African Americans and poor whites, were the members of southern society least likely to receive professional medical care—or to volunteer information about kinfolk and neighbors to police and health officials. When health authorities declared an epidemic, the public record thickened, because that declaration obliged local governments to seek out and isolate all infected people and their known contacts. But the efforts of state health boards and the federal Marine-Hospital Service to keep tabs on smallpox invariably came up short. The vast majority of Southerners who contracted smallpox during these years probably went uncounted.4

Still, a visitation of this magnitude did not go unrecorded. Local newspapers, state health boards, and the federal Marine-Hospital Service tried to survey the damage to people, commerce, and local reputations. Smallpox struck every southern state from 1896 to 1900, affecting hundreds of local communities. The first reported outbreak of the mild type began in Pensacola, in the Florida Panhandle, on November 20, 1896: 54 people caught the disease, and no one died. The first major epidemic began in the summer of 1897, some 250 miles north of Pensacola, in the manufacturing center of Birmingham and the surrounding coal camps of Jefferson County. Within a year, Alabama reported 3,638 cases with 51 deaths (a case-fatality rate of just 1.4 percent). Meanwhile, smallpox broke out in every state in the old Confederacy, as well as West Virginia, Kentucky, and a few northern and western states. A Kentucky Board of Health bulletin observed, early in 1898, that the disease showed “an unusual tendency everywhere to break over official control and assume an epidemic form.” By the end of 1901, the board had counted 394 separate outbreaks; only 9 of the state’s 119 counties escaped infection. All told, Kentucky reported 11,279 cases with 184 deaths (1.63 percent). From January 1898 to May 1903, North Carolina reported 11,735 cases and 331 deaths (2.82 percent). In other states the story was much the same. Almost everywhere, health officials wondered at the exceptional mildness of smallpox—and the fact that they seemed unable to get rid of it.5

Leading health officials, including Surgeon General Walter Wyman of the U.S. Marine-Hospital Service, warned local governments and the public that they could not afford to take mild smallpox lightly. Smallpox was smallpox. Mild or not, the disease still caused suffering and occasional death, and epidemics slowed local industry and commerce. No one knew what made the mild type mild, and no one could predict how long it would remain so. Given the scientific knowledge available to them, responsible health officials proceeded under the reasonable assumption that smallpox could regain its full lethal force at any moment. Trying to convey this concern to a skeptical and predominantly rural public, North Carolina health officials warned that mild smallpox might be planting the “seeds” for a truly horrific epidemic.6

The wisdom of such predictions seemed confirmed by localized outbreaks that claimed many lives. The experience of New Orleans, the South’s largest city, was worrisome. The mild smallpox reached the city, reportedly in the body of a “negro steamboat laborer,” in February 1899. (The theory of origin would have shocked no one: almost every epidemic to reach New Orleans since its foundation had been traced to a sailor or riverman.) That year, the New Orleans Board of Health reported 283 cases and only 6 deaths (2.1 percent). But the following year, during what city health officials described as “an almost incessant battle” with smallpox, New Orleans recorded 1,468 cases and 448 deaths (30.5 percent). Mississippi weathered deadly winter epidemics in 1900 and 1901. In just the first six weeks of 1901, the state reported 2,066 cases and 456 deaths (a 22 percent fatality rate)—a greater toll, noted the Atlanta Constitution, than the dreaded yellow fever had taken there