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By Root 375 0

Middlesboro epidemic in the winter of 1898, Kentucky officials estimated that “only” two thirds of the state’s residents had ever undergone the procedure. But as local reports came in from across the state, the officials had to revise that figure. Two thirds of Kentuckians had never taken the vaccine. Among African Americans, vaccination status varied with age. Many of the older former slaves had been vaccinated; their masters’ self-interest, if not their vaunted paternalism, had seen to that. But the overwhelming majority of younger blacks, raised in an era of almost total neglect from the white-dominated medical profession, had never been inoculated.45

In his travels, C. P. Wertenbaker learned that ignorance, like knowledge, was a product of history. Medical knowledge—in both its popular and professional forms—still depended upon firsthand experience with illness. As far as smallpox was concerned, the wellspring of experience had (blessedly) dried up in the decades after the Civil War.

Any epidemic of smallpox would have caught most southern communities off guard. But the epidemiological profile of these end-of-the-century epidemics made them particularly difficult to manage. Smallpox struck African Americans first. And the disease took an exceptionally mild form. These two facts shaped how the scientific claims and political demands of public health officials would be received by the South’s many publics.

Addressing a white Mississippi audience in the early twentieth century, Booker T. Washington told his listeners, as he so often did, that “the destiny of the southern white race” was “largely dependent on the Negro.” The eminent African American educator drew upon recent history to make his point. “You can’t have smallpox in the Negro’s home and nowhere else,” he said. “You need to see that the cabin is clean or disease will invade the mansion. Disease draws no colour line.”46

Several years earlier, C. P. Wertenbaker stood outside a grocery store in Richland, Georgia, a whistle-stop town of nine hundred souls not far from the Alabama border. As people came and went from the store, a crowd of children, white and black, loafed outside. One African American boy caught Wertenbaker’s eye. Judging by the scabs on his face, Wertenbaker figured the boy to be in the convalescent stage of smallpox known in the medical literature as “desquamation.” Smallpox experts considered desquamation, when the scabs crumbled and fell from the face and body, to be the most contagious phase of the disease. The boy, Wertenbaker recalled, was “scattering infection everywhere he went.” No one paid the boy any mind.47

It was never easy to get rural people to take mild smallpox seriously, but when the disease appeared to infect “none but negroes” the task proved far more difficult. Federal, state, and local health officials, reporting from points across the South, uniformly identified the African American population as the reservoir for this disease. Newspapers, too, traced local outbreaks to particular African American individuals, families, or settlements. Even after the disease made its appearance among whites, the great majority of reported cases were in black people. In Tennessee and North Carolina, African Americans accounted for three quarters of all reported cases, far exceeding their proportion in the population. In particular locales, officials recorded far greater disparities. In Greenwood, Mississippi, a town of three thousand inhabitants where blacks outnumbered whites by a narrow margin, more than five hundred people contracted smallpox in the winter of 1900; just twenty-three of them were white.48

Wertenbaker observed that many white Southerners, including some physicians, called mild smallpox “nigger itch” and claimed that whites could not catch it. Often, the first whites to contract the disease aroused contempt. When a group of young white men in Stanford, Kentucky, broke out with the “itch,” their neighbors had a ready explanation: the boys had made “indiscreet visits” to the “Deep Well Woods,” an African American settlement