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companies. These men ran mines and furnaces that employed thousands of workers, including many with families. Magruder persuaded the company men to cooperate—with each other and the federal government. They posted notices at their mines and furnaces, stating that no one would be allowed to work who refused to have himself and his family vaccinated. The notices listed all the area companies that had entered into the agreement. Once employers tightened control over their workforce, Magruder reported, the phenomenon of vaccination-induced walkouts “almost entirely ceased.” The surgeon’s plan merged government and private authority in an ingenious solution to a seemingly intractable problem of industrial management and public health. Magruder’s account makes one wonder if the cooperative agreement he engineered among the employers might have laid the foundation for future agreements to control the organization and conditions of labor in their industries.66

Other southern communities watched the Marine-Hospital Service’s work in Jefferson County with great interest. In short order, the mayor of nearby Talladega, Alabama, where smallpox had spread in the cotton mills, asked the Service to step in there, too. During the three months after the Marine-Hospital Service took over at Birmingham, the Service’s corps of inspectors had paid more than 41,000 visits to private residences, many of them the poorly constructed houses and cabins of African American workers and their families, where they had found a great many concealed cases. The corps had vaccinated nearly 39,000 people. The Service had treated 352 patients in its three quarantine camps, with only nine deaths. Among the 225 patients at the Birmingham Quarantine Hospital, all but six were African American; more than two thirds were male; nearly half were in their twenties; and nearly half had never been vaccinated .67

By March 10 (the very date that Representative Colson asked Surgeon General Wyman to intervene at Middlesboro), George Magruder announced that the epidemics in Birmingham, Jefferson County, and Talladega had ceased—at least “for the present.” Magruder had no illusions about the permanency of his achievement in Alabama. Barbed wire, gas torches, armed guards, and men with lancets could only accomplish so much in this industrial frontier, where “large numbers of the unvaccinated persons are daily coming in.” And there were several towns and mining camps where the inspectors had met with such intense local opposition that Magruder had withdrawn them, leaving behind large unvaccinated communities. As he prepared to pull up stakes from Birmingham, Magruder had to concede that despite all his efforts, and the support he had received from employers and citizens’ groups in Birmingham, there were still enough unvaccinated people in the area to “keep the disease alive for some time.” He was right. In 1899 alone, 9,150 cases of smallpox were reported in the state of Alabama. Significantly, 5,265 of those cases were white—a number roughly proportional to the percentage of whites in the state population. In Alabama as elsewhere, the early promise of a special dispensation for whites did not last.68

On March 17, C. P. Wertenbaker officially took over smallpox control at Middlesboro, Kentucky. He set up his headquarters, complete with a telephone, in a suite of offices in the business district. He hired five inspectors and twenty-five guards outfitted with Springfield rifles. He had four physicians on his medical staff, including Dr. Blair from Bell County, who would head up the inspector corps. A crew of nurses, cooks, attendants, and ambulance drivers rounded out the operation. Wertenbaker kept the mountain city under strict quarantine. Armed men guarded the public roads and the train depot, allowing no one to enter or leave the city without a pass signed by Wertenbaker. Within a week, one local newspaper reported, the federal surgeon had the smallpox control operation “running smooth as oil.”69

For all of the similarities between the Jefferson County, Alabama, and