Pox_ An American History - Michael Willrich [26]
Because of the diagnostic confusion that followed “the mild type” wherever it went, public health officials found themselves fighting a hard public campaign on many fronts. They had to persuade town and county officials, who held the purse strings, to appropriate scarce funds for smallpox control. They had to convince skeptical physicians that this new disease was smallpox at all. They had to protect their own communities from infection by neighboring towns where lax or inept officials let epidemics spiral out of control. And they had to get the people vaccinated. This last task would prove the most intractable. Public health officials used every available tactic to secure universal vaccination among citizens who detested the procedure and feared its results. Those political tactics included education, intimidation, and, with the aid of local police, criminal sanctions. Especially when they confronted opposition from African Americans, the authorities readily resorted to violent force.
Public health imperatives alone did not determine the impact of smallpox in the South. Particular features of the region’s social and political landscape eased the spread of the mild smallpox and made its eradication extraordinarily difficult. Faced with an escalating public health disaster of regional scope, many local and state governments would turn for assistance to an unlikely ally: the federal government.
Smallpox burned across the South, without respect for such man-made boundaries as county lines and state borders. Even the color line, which for a while seemed to hopeful whites to hold the virus at bay, proved an ephemeral barrier. As indifferent as smallpox was to such political and ideological boundaries, they did shape how Southerners and their governments experienced and battled the disease. The smallpox epidemics of the end of the century constituted an event of regional and, ultimately, national significance. But in a more fundamental sense, they happened locally. And mild smallpox proved at least as adept as the most devastating variola major of the past at revealing the true boundaries and character of a community.
One place in particular—Middlesboro, Kentucky—showed the nation in the winter of 1898 just how much damage even the mild type of smallpox could do under the right social and political conditions. An Appalachian mountain city of 3,500 souls, Middlesboro occupied a shallow valley at the northern end of the fabled Cumberland Gap, just a few miles from the spot where the borders of Kentucky, Tennessee, and Virginia met. The “Magic City,” as local boosters called it, was just ten years old. Already it stood as a stark monument to the creative destruction of industrial capitalism. Before the epidemic there ended, the city would stand for failings of a decidedly more personal nature.12
Middlesboro was “west” before it was “south.” In the late eighteenth and early nineteenth centuries, thousands of westering Americans passed through Cumberland Gap, the natural passageway in the Appalachian range made famous by Daniel Boone, on their way to the Kentucky bluegrass and the North American interior. But few stopped long in the three-mile-wide geomorphic basin known as Yellow Creek Valley. Railroad construction bypassed the area in the early nineteenth century, and the traffic through the Gap reversed itself; the historic gateway to the West became a muddy conduit for men driving hogs to market in Tennessee and North Carolina. During the Civil War, Union and Confederate forces fought for control of the Gap. The mountain people of neutral Kentucky would