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By Root 331 0

It was the worst visitation of smallpox in a generation or more, and the last Americans would experience on a continental scale, as a national event. From Alabama to Alaska, no state or territory was untouched. Smallpox made its way across an increasingly interconnected American landscape: from southern tobacco plantations to western mining camps to immigrant tenement districts in aging east coast cities; from the nation’s capital in Washington to Filipino and Puerto Rican villages on the farthest edges of the new American empire. The epidemics did not confine themselves to a few “remote corners” of the country. Many major American cities experienced deadly epidemics. New Orleans reported nearly 1,500 cases and 450 deaths in 1900. In Philadelphia, smallpox infected 2,500 people and killed nearly 400. Boston recorded 1,600 cases and 270 deaths. And by the time the smallpox epidemic that started on All Nations Block was through with New York City in 1902, the health department had recorded 2,100 cases, and 730 men, women, and children lay dead.19

No reliable figures exist to quantify the overall damage done by small-pox to American lives, commerce, and property during these epidemic years. The U.S. Public Health and Marine-Hospital Service, the federal disease-control agency, conceded that its smallpox statistics were woefully incomplete. The federal officials dutifully published the data they received from state and local health boards, but in many states those agencies were just coming into their own. Many smallpox-infected communities lacked the will or the wherewithal to accurately report cases of infectious disease.

Still, the admittedly spotty statistics of the federal health service suggest the broad chronological arc of the epidemics. At the beginning of 1898, smallpox was largely absent in the United States, apart from a few trouble spots, mostly in the South, including Birmingham, Alabama, and a hard-bitten Appalachian coal town called Middlesboro, Kentucky. As Surgeon General Walter Wyman of the Public Health and Marine-Hospital Service recalled, “[I]t was during the winter of 1898–99 that the disease began to assume great proportions.” In 1899, the service reported more than 12,000 cases, from all over the South, followed by 15,000 cases, now in the mid-western states, too, in 1900. In 1901, the number of new cases surged to nearly 39,000. According to the Medical News, by then the distribution of smallpox in the United States had become “alarmingly general.” In 1902—the year Wyman would remember as “the high-water mark” of the epidemics—the service counted 59,000 new cases. The agency tallied another 42,590 new cases in 1903. By the end of that year, the surgeon general assured the nation that “the disease has spent its force and will now continue to decrease until it practically disappears.” In fact, smallpox did taper off dramatically in 1904, but the disease did not disappear. Smallpox would continue to trouble American communities until the last reported U.S. case occurred in 1949. All told, during the five-year wave of epidemics around the turn of the century, the federal service counted 164,283 American cases of smallpox. The actual number of cases may have exceeded five times that figure.20

But for American public health officials, the truly stunning statistic from those epidemics was the body count. It was shockingly low. According to the federal health service reports, only 5,627 people died. Again, the mortality figure was impressionistic at best; the Census Bureau independently reported nearly 4,000 smallpox fatalities in 1900 alone (more than five times the health service’s figure for that year). Still, all agreed that the death toll was astonishingly, inexplicably, blessedly small. If smallpox had measured up to its historical virulence, the epidemics of 1898–1903 would have killed at least 50,000 Americans .21

Although in some places smallpox proved as destructive as ever, in the vast majority of American epidemics after 1898, the disease seemed to have lost its lethal force. Vaccinal protection