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34 "Precis," 38. See also Fenner et al., Smallpox and Its Eradication, 6; Michael Kelly, "Small-Pox: Its Medical Treatment," MC, Jan. 1, 1902, 171.

35 Long, "Smallpox in Iredell County," 214. Hopkins, Princes and Peasants, 27781, esp. 277.

36 J. C. Wilson, Fever-Nursing, 2d ed. (Philadelphia: J. B. Lippincott Company, 1895), 165. Fenner et al., Smallpox and Its Eradication, 19, 189.

37 On the names of smallpox, see Fenner et al., Smallpox and Its Eradication, 229; Preston, "Demon in the Freezer," 44.

38 "Precis," 3839. Preston, "Demon in the Freezer," 47. Fenner et al., Smallpox and Its Eradication, 19, 21, 56, 130. See also Stoner, Handbook for the s.h.i.+p's Medicine Chest, 21.



39 "Precis," 37, 38.

40 Long, "Smallpox in Iredell County," 216.

41 Stoner, Handbook for the s.h.i.+p's Medicine Chest, 21, 22. "Precis," 39. Long, "Smallpox in Iredell County," 21516. Fenner et al., Smallpox and Its Eradication, 19, 22.

42 Long, "Smallpox in Iredell County," 217. "Report of Dr. Llewellyn Eliot, M.D.," July 1, 1895, in Annual Report of the Commissioners of the District of Columbia For the Year Ended June 30, 1895, Serial Set Vol. No. 3391, Session Vol. No. 24, 54th U.S. Congress, H.R. Doc. 7, p. 1296. Fenner et al., Smallpox and Its Eradication, 68.

43 Fenner et al., Smallpox and Its Eradication, 5054.

44 "Supply of Coffins Is Short," AC, Mar. 8, 1900, 8. See "Guarding Public Health," ibid., Mar. 23, 1901, 3; "Will Not Ask for Increase," ibid., Dec. 11, 1901, 4.

45 "Precis," 39. Fenner et al., Smallpox and Its Eradication, 22, 139, 167.

46 "Precis," 3839. Fenner et al., Smallpox and Its Eradication, 32, 4, 167. Preston, "Demon in the Freezer," 50. See also Stoner, Handbook for the s.h.i.+p's Medicine Chest, 22.

47 WTC. The image of the scarred man is #1500, t.i.tled "Small Pox (after recovery)."

48 See, for example, the display advertis.e.m.e.nt for the John H. Woodbury Dermatological Inst.i.tute in New York City, NYT, Jan. 26, 1908, 6; and "Woman Choked to Death," ibid., Jul. 15, 1910, 7. See also "Sheriff's Department," Houston Post, Feb. 15, 1897, 6; "Priest's Murder Was Incited by a Rare Jewel," NYEW, May 27, 1907, 2.

49 See generally John Duffy, The Sanitarians: A History of American Public Health (Urbana and Chicago: University of Illinois Press, 1990); idem, From Humors to Medical Science: A History of American Medicine, 2d ed. (Urbana and Chicago: University of Illinois Press, 1993); Gerald Grob, The Deadly Truth: A History of Disease in America (Cambridge, MA: Harvard University Press, 2002). Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge, MA: Harvard University Press, 1998). For a concise overview, see C.-E. A. Winslow, "Public Health," in Encyclopaedia of the Social Sciences, ed. Edwin R. A. Seligman, vol. 11, 64657. The best introduction to the legal aspects of public health administration in the early twentieth century is James A. Tobey, Public Health Law: A Manual of Law for Sanitarians (Baltimore: The Williams & Wilkins Co., 1926).

50 Fenner et al., Smallpox and Its Eradication, 146.

51 Elizabeth A. Fenn, Pox Americana: The Great Smallpox Epidemic of 177582 (New York: Hill and w.a.n.g, 2001). Fenner et al., Smallpox and Its Eradication, 217, 24558. Hopkins, Princes and Peasants , 24953.

52 Fenner et al., Smallpox and Its Eradication, 25873.

53 James Gillray, "The Cow Pock-or-the Wonderful Effects of the New Inoculation!" The cartoon appeared in Vide-The Publications of the Anti-Vaccine Society, June 12, 1802. It is now held in the National Library of Medicine Collection, and may be viewed in vivid color at http://www.nlm.nih.gov/hmd/frankenstein/frank_promise.html, accessed November 9, 2006. For a fascinating discussion of the cultural context, see Tim Fulford and Debbie Lee, "The Jenneration of Disease: Vaccination, Romanticism, and Revolution," Studies in Romanticism, 39 (2000): 13964.

54 "Precis," 42.

55 "Precis," 3940, esp. 40. Fenner et al., Smallpox and Its Eradication, 27, 65.

56 Peter Baldwin, Contagion and the State in Europe, 18301930 (Cambridge: Cambridge University Press, 1999), 244354. See also Fenner et al., Smallpox and Its Eradication, 25876.

57 See generally Tobey, Public Health Law.

58 According to the "Precis," "The French army numbered 23,000 deaths by it [smallpox], while the German army had only 278." "Precis," 43. I am using the numbers here from Fenner et al., Small-pox and Its Eradication, 232, a.s.suming them to be more accurate.

59 "Precis," 43. USSGPHMHS 1898, 630.

60 For phony certificates, see "Vaccination Certificate Frauds," NYT, May 9, 1904, 8. For evidence of families taking care of their own (and then being discovered by the authorities), see "Smallpox Nest in Brooklyn," ibid., Mar. 20, 1901, 2; "Defies the Health Board" (Harrison, NJ), ibid., Jul. 27, 1901, 2; "Fight for a Sick Child" (Newark, NJ), ibid., Nov. 12, 1901, 3. For escapes from quarantines or pesthouses, see "'Mother' Jones Arrested" (in a Utah mining camp), ibid., Apr. 27, 1904, 3. For resistance to vaccination in other U.S. settings, see "Miners Resist Vaccination" (Lead, SD), ibid., Apr. 25, 1902, 1; "Object to Vaccination" (African American railway workers on the Western Maryland Improvement), WP, May 3, 1901, 9. For Filipino resistance to U.S. compulsory vaccination in the Philippines, see "Manila Is Healthful," NYT, Aug. 19, 1903, 8. Note these are just a few examples, and they are taken only from the first few years of the twentieth century. I also have collected many examples from the 1890s and further into the decades of the 1900s and 1910s.

61 "Smallpox and Vaccination," BMJ, 40 (Feb. 1901), 525.

62 See for example C. P. Wertenbaker, "Investigation of Smallpox at Columbia and Sumter, S.C.," PHR, 13 (May 13, 1898), 46870.

TWO: THE MILD TYPE.

1 G. M. Magruder, "Pa.s.sed a.s.sistant Surgeon Magruder's Report on Smallpox at Little Rock, Ark.," PHR, 13 (May 6, 1898), 437. See Louis Leroy, Smallpox: Its Diagnosis, Treatment, Restriction and Prevention, with a Few Remarks upon the Present Epidemic, issued by the Tennessee State Board of Health (Nashville: Tennessee State Board of Health, 1900).

2 See Charles V. Chapin, "Variation in Type of Infectious Disease as Shown by the History of Small-pox in the United States 18951912," Journal of Infectious Diseases, 13 (1913), 17196, esp. 173; Charles V. Chapin and Joseph Smith, "Permanency of the Mild Type of Smallpox," Journal of Preventive Medicine, 6 (1932): 273320.

3 C. P. Wertenbaker, "Plan of Organization for the Suppression of Smallpox," p. 62, typescript in CPWL, vol. 6.

4 On public health administration in the southern United States, see Francis R. Allen, "Development of the Public Health Movement in the Southeast," Social Forces, 22 (1943): 6775. On the lack of administrative systems for tracking disease and vital statistics in the states, especially in the South, see USSGPHMHS 1910, 189; USSGPHMHS 1911, 241; U.S. Census Bureau, A Discussion of the Vital Statistics of the Twelfth Census, by Dr. John Shaw Billings (Was.h.i.+ngton, 1904), esp. 78; and Chapin, "Variation in Type," 17172.

5 "Warning Against Small-Pox," Feb. 15, 1898, KBOH 189899, 22. See Chapin, "Variation in Type," 173, 174; G. M. Magruder, "Work of the Service in Suppressing Smallpox in Alabama," PHR, 13 (Mar. 18, 1898), 24651; KBOH 190001, 17; NCBOH 190304, 13; USSGPHMHS 1898, 59899.

6 Richard H. Lewis, "Annual Report of the Secretary of the North Carolina Board of Health, 189899," in NCBOH 18991900, 23. See, e.g., C.P. Wertenbaker, "The Smallpox Outbreak in Bristol, Va.-Tenn.," PHR, 14 (Nov.3, 1899), 1890; "Value of Vaccination," PHR, 14 (Feb. 10, 1899), 180.

7 LBOH 189899, 55, 129. n.o.bOH 190001, 2324. "Guarding Public Health," AC, Mar. 23, 1901, 3. As late as 1909, Surgeon General Wyman said no one could predict "whether" the mild type of smallpox would "change to the more usual fatal form." USSGPHMHS 1909, 201.

8 Chapin, "Variation in Type," 196. In 1932, Chapin and his coauthor Joseph Smith published another major scientific article on the subject; Chapin and Smith, "Permanency of the Mild Type," esp. 319, emphasis added. The authors observed: "The statement should rather be, that it [mild type smallpox] has for the most part bred true, for it is not intended to prejudge the question whether it ever reverts to the cla.s.sical type. That it does not revert is the belief of practically all American epidemiologists who have had experience with this disease." Ibid., 276. See Fenner et al., Smallpox and Its Eradication, 96.

9 Fenner et al., Smallpox and Its Eradication, 3, 96103, 32932. K. R. Dumbell and Farida Huq, "The Virology of Variola Minor Correlation of Laboratory Tests with the Geographic Distribution and Human Virulence of Variola Isolates," American Journal of Epidemiology, 123 (1986): 40315.

10 Fenner et al., Smallpox and Its Eradication, 3.

11 Chapin, "Variation in Type." 17196. Charles and Smith, "Permanency of the Mild Type." Fenner et al., Smallpox and Its Eradication, 3, 96103, 32932. J. Pickford Marsden, "Variola Minor: A Personal a.n.a.lysis of 13,686 Cases," Bulletin of Hygiene, 23 (1948): 73546.

12 The phrase "creative destruction" comes, of course, from Joseph A. Schumpeter, Capitalism, Socialism and Democracy (New York: Harper and Brothers, 1942).

13 On the fascinating history of Middlesboro, see Harry M. Caudill, Theirs Be the Power: The Moguls of Eastern Kentucky (Urbana: University of Illinois Press, 1983), 1635; John Gaventa, Power and Powerlessness: Quiescence and Rebellion in an Appalachian Valley (Urbana: University of Illinois Press, 1980); Kenneth W. Kuehn et al., eds. Geologic Impacts on the History and Development of Middlesboro, Kentucky (Lexington: Kentucky Society of Professional Geologists, 2003); Ann Dudley Matheny, The Magic City: Footnotes to the History of Middlesborough, Kentucky, and the Yellow Creek Valley (Middlesboro, KY: Bell County Historical Society, 2003).

14 Quoted in Gaventa, Power and Powerlessness, 47. See ibid., 4783. On British investment in the United States, see Eric Rauchway, Blessed Among Nations: How the World Made America (New York: Hill and w.a.n.g, 2006), 4252, esp. 48.

15 Katie Algeo, "Historical Overview: Settlement History of the c.u.mberland Gap Region," in Kuehn et al., eds., Geologic Impacts, 38.

16 55th U.S. Congress, 2d Session, H.R. Doc. 10, Annual Report of the Comptroller of the Currency (Was.h.i.+ngton, 1897), vol. I: 49697. "Encouraging. Middlesborough Town and Lands Company Has a Meeting in London," MWH, Dec. 3, 1897, 4. See Algeo, "Historical Overview," 78; Gaventa, Power and Powerlessness, 7678; Matheny, Magic City, xxiixxiv, 10221.

17 "Mingo," MWH, Nov. 26, 1897, 1. "Furnaces," ibid., 4. Unt.i.tled editorial, MWR, Feb. 24, 1898, 4. See also "Encouraging," MWH, Dec. 3, 1897, 4. On school enrollments, see "Report of Public School for November," ibid., Dec. 3, 1897, 1. USCB 1900, Vol. I-Population, Part I (Was.h.i.+ngton, 1901), 618. U.S. Census Bureau, Twelfth Census of the United States (1900): Schedule No. 1-Population: Bell County, Kentucky, Middlesboro, Enumeration Districts 18 and 19. For a warmer portrait of race relations in Middlesboro, see Matheny, Magic City, 12732.

18 U.S. Census Bureau, Negroes in the United States (Was.h.i.+ngton, 1904), 11, 13, 60. Herbert R. Northrup, "The Coal Mines," in Blacks in Appalachia, ed. William H. Turner and Edward J. Cabbell (Lexington: The University Press of Kentucky, 1985), 15971. On rural industry in the South, see Jacqueline Jones, The Dispossessed: America's Undercla.s.ses from the Civil War to the Present (New York: Basic Books, 1992), 12766. On postCivil War railroad development in Appalachia, see Robert L. Frey, "Railroads," in Encyclopedia of Appalachia, ed. Rudy Abramson and Jean Haskell (Knoxville: University of Tennessee Press, 2006), 71517.

19 G. M. Magruder, "Work of the Service in Suppressing Smallpox in Alabama," PHR, 13 (Mar. 18, 1898), 246. "A Big Scare," MWR, Nov. 18, 1897, 1. "Unwarranted," MWH, Nov. 19, 1897, 4.

20 "A Big Scare," MWR, Nov. 18, 1897, 1.

21 L. L. Robertson, "Bell County Board of Health," in KBOH 190001, 2425. "Laws, Rules and Regulations," in KBOH 189899, 17778. "A Big Scare," MWR, Nov. 18, 1897, 1. "Unwarranted," MWH, Nov. 19, 1897, 4.

22 "Laws, Rules and Regulations," in KBOH 189899, 17380, 186. Nelson County Court v. Town of Bardstown, Superior Court of Kentucky (1885) in ibid., 17376, esp. 176.

23 On the state board's vaccination estimates, see "The State Board of Health Urges All Kentucky Cities and Towns to Take Prompt Action," LMH, Feb. 8, 1899, 4. For the Middlesboro estimate, see Matheny, Magic City, 226.

24 "Unwarranted," MWH, Nov. 19, 1897, 4. Unt.i.tled editorial, MWR, Nov. 18, 1897, 4. See also "Smallpox," LMH, Nov. 17, 1897, 1.

25 "Quarantine Raised," MWH, Dec. 10, 1897, 4.

26 See "Quarantine Jottings," MWR, Feb. 17, 1898, 2.

27 "Aunt Mariah ______," MWR, Feb. 24, 1898, 2. Due to the poor quality of the microfilm, the last part of the headline is illegible.

28 "Chicken-Pox," MWR, Nov. 26, 1897, 5. "Quarantine Raised," ibid., Dec. 10, 1897, 4. "Smallpox," ibid., Feb. 3, 1898, 3. KBOH 189899, 21.

29 Tazewell Progress quoted in unt.i.tled editorial, MWR, Feb. 10, 1898, 4. "Smallpox," ibid., Feb. 3, 1898, 3. See Matheny, Magic City, 228.

30 See "Laws, Rules and Regulations," in KBOH 189899, 17186.

31 Judge Charles Kerr, ed., History of Kentucky (New York: American Historical Society, 1922), vol. 4: 450. John E. Kleber, ed., The Kentucky Encyclopedia (Lexington: The University Press of Kentucky, 1992), 592. The best sources on J. N. McCormack's ideas and work are the reports of the state board.

32 KBOH 189899, 28.

33 J. N. McCormack viewed the quarantine power as "an indispensable weapon" against "counties and towns whose authorities failed or refused to adopt proper precautions against the disease." KBOH 190001, 11. For an example of such a quarantine order (issued against Greenup County in December 1900), see ibid., 12. See also "Small-Pox Up-to-Date," MWR, Feb. 17, 1898, 2.

34 "Small-Pox Victim Dies," LMH, Feb. 13, 1898, 8. "Small-Pox Up-to-Date," MWR, Feb. 17, 1898, 2. "Spreading," LMH, Feb. 15, 1898, 8. On the Ball brothers, see Matheny, Magic City, 14154.

35 "Smallpox in Middlesboro," WP, Feb. 16, 1898, 9. "Small-Pox Up-to-Date," MWR, Feb. 17, 1898, 2. "Uncle Sam Fumigating," ibid., Feb. 24, 1898, 1. The advertis.e.m.e.nts appeared in ibid., Feb. 17, 1898, 1.

36 "Small-Pox: Situation More Grave," MWR, Mar. 3, 1898, 6. "Laws, Rules and Regulations," 177.

37 A. T. McCormack's brief report on the smallpox epidemic at Middlesboro appears in KBOH 189899, 4748.

38 A. T. McCormack's report.

39 Short, unt.i.tled reports of postvaccination illnesses appear in the MWR, Dec. 9, 1897, 3; Feb. 24, 1898, 1; Mar. 10, 1898, 12.

40 Unt.i.tled editorial, MWR, Mar. 3, 1898, 4. Plessy v. Ferguson, 163 U.S. 537 ( 1896).

41 A. T. McCormack's report, 47. "Small-Pox: Situation More Grave," MWR, Mar. 3, 1898, 6.

42 A. T. McCormack's report, 4748. C. P. Wertenbaker, "Smallpox at Middlesborough, Ky.," PHR, 13 (Mar. 25, 1898), 27374.

43 KBOH 189899, 48. Unt.i.tled Editorial, MWR, Mar. 10, 1898, 4.

44 Much of the correspondence arising from this episode is reprinted in KBOH 189899, 4761. Fifty-fifth U.S. Congress, Congressional Directory ( Was.h.i.+ngton, 1897), 52. For an excellent history of federal disaster relief, see Michele Landis Dauber, "The Sympathetic State," Law and History Review, 23 (2005): 387442.

45 KBOH 189899, 4849. The emphasis in Colson's quotation is mine.

46 Walter Wyman to C. P. Wertenbaker, Mar 10, 1898, CPWL, vol. 1.

47 I have formed my impressions of Wertenbaker by reading his personal papers and letter books (collected at the Library of the University of Virginia) and his published dispatches and reports. For an overview of his career, see "Death, Here, of Noted Surgeon," Daily Progress (Charlottesville, VA), July 13, 1916, 1.

48 Wertenbaker, "Smallpox at Middlesborough," 273.

49 Ibid., 274. "Death of Dr. A. T. McCormack" (U.S. Children's Bureau), The Child, 8 (1943), 47.

50 Wertenbaker, "Smallpox at Middlesborough," 27374. "Investigating," LMH, Mar. 15, 1898, 3. "Spreading," ibid., Mar. 15, 1898, 8. "The Smallpox Situation at Middlesboro," Grand Forks Herald (North Dakota), Mar. 15, 1898, 8. See also C. P. Wertenbaker, "One Case of Smallpox in Wilmington, N.C.," PHR, 13 (Jan. 14, 1898), 25; C. P. Wertenbaker, "Investigation of Smallpox at Charlotte, N.C.," PHR, 13 (Feb. 18, 1898), 14041.1.

51 Unt.i.tled editorial, MWR, Mar. 10, 1898, 4. "Smallpox Situation at Middlesboro." "Starving in a Pesthouse," NYT, Mar. 15, 1898, 3. "Seventy Cases of Smallpox," AC, Mar. 16, 1898, 5. Wertenbaker, "Smallpox at Middlesborough," 274.

52 "Uncle Sam to the Rescue," MWR, Mar. 17, 1898, 3. KBOH, 18989, 49.

53 A. T. McCormack's report, 47.

54 Ibid., 4950.

55 Ibid., 50.

56 Ibid.

57 Ibid.

58 Ibid., 51.

59 Ibid.

60 "Uncle Sam in Charge of the Small-Pox Cases at Middlesboro," LMH, Mar. 20, 1898, 5.

61 For a useful short history of public health in Jefferson County, see "History," Jefferson County Department of Health Web site, http://www.jcdh.org/default.asp?ID=10, accessed January 25, 2007. In one of his several irate letters to Walter Wyman regarding the Service takeover at Middlesboro, Secretary J. N. McCormack of the Kentucky Board of Health said, "We hesitated to give you absolute control because of the ineffectual methods adopted by your Service in Alabama, which had permitted the present epidemic in Tennessee and Kentucky." If this complaint was genuine, McCormack was acting on erroneous information. The arrival of the miner Scott in Middlesboro preceded the Service's takeover at Birmingham by at least two months. Secretary McCormack to WW, Apr. 9, 1898, published in KBOH 189899, 59.

62 "Three New Cases of Smallpox," AC, Jul. 29, 1897, 3. G. M. Magruder, "Smallpox in Birmingham, Ala.," PHR, 13 (Jan. 14, 1898), 2225.

63 G. M. Magruder, "Work of the Service in Suppressing Smallpox in Alabama," PHR, 13 (Mar. 18, 1898), 24651. See also "Three New Cases of Smallpox," AC, Jul. 29, 1897, 3; "Smallpox Scare in Birmingham," ibid., Aug. 7, 1897, 2; "Prevent Smallpox Spread," ibid., Aug. 8, 1897, 2; "Why Smallpox Is Not Checked," ibid., Aug. 9, 1897, 2; "Wyman Sends Surgeons South," ibid., Jan. 7, 1898, 1; "Pest Prevails in Alabama," ibid., Jan. 14, 1898, 2.

64 Magruder, "Work of the Service," esp. 24647, 250.

65 Ibid., 24748.

66 Ibid.

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