Pox_ An American History - Michael Willrich [61]
Like other Americans of the period, blacks were accustomed to experiencing any number of fevers and skin eruptions during their lives. Their first inclination in naming a new disease was to compare it with others they had known. After inspecting a confluent black patient in a room crowded with “eight or ten negroes” in Princeton, Kentucky, a physician found his diagnosis of smallpox challenged by an “old negro” who said he had survived smallpox himself. “Dat nigger nebber had no small-pox,” the man declared, insisting that the “little bumps on him” were caused by “big-pox” (syphilis).65
As local health authorities raised the pressure—making proclamations, ordering quarantines, calling for compulsory vaccination—critics raised their protests. Some citizens denounced the government officials as capricious and corrupt. Others relied, as rural blacks had since slavery, on the power of rumor. As Wertenbaker frequently witnessed in the field, nothing outran a rumor. Communities of cotton mill workers, who notwithstanding their claims to white privilege were among the most exploited and marginalized of southern laboring people, were deeply distrustful of medical authority. In Charlotte, Danville, and other places in the throes of industrial change, Wertenbaker found the expert claims of health authorities undone by rumors circulating among the mill workers that no smallpox existed.66
Much of the diagnostic dissension came from the medical profession itself. Some local doctors readily conceded their “inexperience” and “distress” at the spread of this bizarre eruptive disease, and they welcomed the expertise of county and state health officials. But others openly dissented against the medical claims of the local officers of the board of health, who were after all physicians like themselves who had been given their extraordinary powers by virtue of a political appointment. Public health officers called their uncooperative peers “kicking doctors” (invoking the ultimate rural symbol of stubbornness: a kicking mule). State health officers openly mocked their local opponents in the medical profession, describing in published reports their encounters with many a “low grade” physician who was “as positive as he was ignorant.” When Inspector B. W. Smock arrived in Jackson County, Kentucky, a community in central Appalachia, a local physician informed him that (as Smock described the conversation) “they had a ‘breaking-out disease’ that was mighty ‘ketching’ up in what is known as Horse Lick Creek.” The local doctor reckoned it was measles. But Smock retorted that this disease was nothing less than “seven-day-in-a-week, stay-with-you-forever small-pox.” City-based state health officials such as Smock wrote up their travels into the heart of Appalachia as if they were conducting anthropological fieldwork. They marveled at the practices of local institutions, recorded (or mocked) local dialects, and cataloged medical folkways. For these state experts, the unruly subjects of their inquiry were not just the (by their lights) primitive mountain folk but also their “ignorant” physicians.67
Local physicians took exception to the increasing interference of government-appointed health officials in their practices. But more than interests were involved. Mild type smallpox simply did not conform to physicians’ expectations. The disease differed in several respects from the classical smallpox described in their medical textbooks, which given the long quiescence of the disease in the South were for many physicians the only source of knowledge on smallpox available. Compared with text-book smallpox, the pocks of the new disease were few and superficial (and usually not confluent). Physicians examining patients for smallpox expected them to have a secondary fever, but mild type smallpox frequently brought none. And smallpox was supposed to be a winter disease. The mild type could prevail during an Alabama summer.68
Wertenbaker had learned in Middlesboro how difficult it could be to pry smallpox