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a man named Will Sheffly died in the pesthouse—the outbreak’s first fatality. The next day smallpox crossed the color line. The first white patient was Charles Dudley Ball, a saloon-keeper, gambling den operator, and deputy sheriff whose brother happened to be the chief of police. Charley Ball was not allowed to suffer the indignity of being the lone white man in the pesthouse. The authorities moved him to a deserted house on the outskirts of town. During the next forty-eight hours, eight more people with smallpox were discovered, four of them whites. Even more than Dr. McCormack’s visit, the infection of white Middlesboro residents, apparently by their black neighbors, gave the city vaccination campaign a sense of urgency among the city’s white leadership.34

The compulsory vaccination of Middlesboro began peacefully, as the overwhelmed city and county physicians attended first to the many residents, white and black, who came forward voluntarily. But after the initial rush subsided, the vaccinators began the slower work of house-to-house vaccination in the neighborhoods, where they met resistance with threats of arrest, jail, and fines. The vaccination order was part of a raft of emergency ordinances enacted by the council. The councilmen closed the schools, churches, and saloons. They forbade the public to assemble in the streets and children to go out at all unless accompanied by a parent or guardian. Inmates of the city jail were put to work cleaning up the city—an act of urban renewal that shows the hold upon medical thinking of the old notion of smallpox as a filth disease, an association that even the ascendance of the microbe in medical science did not dispel. Meanwhile, the postmaster, still the lone agent of federal authority in Middlesboro, set up a fumigating apparatus for all outgoing mail; punching holes in letters and packages, he sealed them in a box for five hours with burning sulfur. Citizens could purchase their own personal disinfection devices from enterprising local merchants. S. R. Sneed Co. touted the Pasteurine Pocket Disinfectant and Deodorizer—“A deadly foe to Contagion.”35

Given how long they had waited to take action, the city officials should have known the epidemic would get worse before it got better. More people with smallpox surfaced almost every day. By the end of February there were fifty-two known cases among African Americans and poor whites from various parts of the city. Several people suffered from confluent smallpox, and a second patient died. To make matters worse, Middlesboro officials were still haggling with Bell County over which government would pay for all of the guards, doctors, and food. The Bell County Fiscal Court continued to reject requests for aid, reasoning that so far the epidemic was confined to Middlesboro, and Middlesboro should take care of its own mess. As a result, the smallpox control effort slowed to a virtual standstill. 36

On February 28, three months after Scott brought smallpox to Middlesboro, the Kentucky Board of Health stepped in. Secretary McCormack sent his son, Dr. A. T. McCormack, the state’s chief sanitary inspector, to run the operation. The younger McCormack, who was just twenty-five, brought along two deputy state inspectors, Dr. Austin Bell and Dr. B. W. Smock, and on his father’s request, the Bell County health officer, Dr. Samuel Blair, moved into the town, too. Most of the manpower—police, inspectors, guards, and vaccinators—were provided by the city government. The state board made clear at the outset that although it was taking control of the epidemic, it would not be paying the bills.37

A. T. McCormack quarantined the entire population of Middlesboro, posting armed guards day and night on the eight roads leading out of town. He took over a deserted row of buildings called “Brown’s Row” and established a new pesthouse and detention camp there, under the charge of Dr. Blair. The city was divided into eight districts; inspectors and vaccinators canvassed each one. As they found people with symptoms, they moved them immediately to the