Pox_ An American History - Michael Willrich [54]
If Shaffer was right, the horrors of wartime vaccination burned more brightly in the memories of the people than did smallpox itself. Many places had not seen a single case since the war’s end. Like other rural Southerners, the people of Monroe County, Kentucky, had come to think of smallpox, in the words of a local physician, as “a disease confined to cities . . . a disease to be read about in the newspapers.” North Carolinians could boast of the “blessed fact that epidemics of infectious disease of any magnitude have been extremely rare in our State.” But the downside of this “wonderful immunity” was that in the Tar Heel State, as in more plague-prone areas of the South, a generation had come of age with no clear memory of how the symptoms of smallpox compared with those of the common childhood eruptive diseases such as chicken pox or measles. It did not seem to matter how much publicity heralded the spread of smallpox across the region. Each new outbreak seemed to catch the infected community by total surprise, like the unexpected return of some obnoxious but long-forgotten relation.42
Southern physicians suffered from the same memory deficit. “Many physicians have never seen a case of smallpox, and are unfamiliar with the methods necessary for its suppression,” Wertenbaker wrote in May 1898 after visiting Columbia, South Carolina—which was, after all, a state capital, not a one-horse town. Old-timers in the profession remembered small-pox all too well: Dr. M. H. Young recalled treating hundreds of cases during his service as a surgeon in the Fourth Kentucky Volunteer Infantry during the war. But a generation of younger men had entered the field who had never laid a compress on a smallpox-rubbled face, never inhaled the sickening odor of an infected person’s room, or, for that matter, never received much college instruction on the subject.43
Vaccination, meanwhile, had fallen by the wayside. The procedure, though simple, took time and care to perform correctly, and it normally garnered the physician a nominal fee. In the decades since the war, the once standard practice of arm-to-arm vaccination had been largely abandoned in favor of bovine vaccine, cowpox or vaccinia lymph harvested from cows and dried onto ivory points. The shift from so-called humanized virus to bovine points was hailed by most scientific authorities as a great innovation that reduced the transmission of human diseases, such as syphilis. But for a small-town physician, the changing technology imposed a new burden. If he chose to offer vaccination as part of his regular practice, he had to keep a stock of fresh vaccine on hand. In the absence of either much risk of smallpox, or much reward for performing the procedure, many physicians decided vaccination was not worth the bother. The practice had become, in the words of Secretary McCormack, “one of the ‘lost arts’ to the majority of country physicians.” To laypeople, it became an exotic and dodgy procedure, best left alone.44
And so, when the disease returned in the late 1890s, Southerners in general—and African Americans and poor whites in particular—were caught almost uniformly unprotected. Service surgeon Joseph J. Kinyoun, a North Carolina native and the first director of the National Hygienic Laboratory, warned that “Small-pox is more of a menace to the Southern people than to the northern people,” because in the South vaccination was “practiced but little, and only in places of large population.” In North Carolina, scarcely 10 percent of the population had ever been vaccinated. In Georgia, a Service surgeon placed vaccination levels closer to 25 percent, but that was after smallpox had been back for a few years. At the outset of the