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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