Pox_ An American History - Michael Willrich [31]
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,