Pox (4 page)

In late January, the North Carolina Board of Health issued a smallpox bulletin. The “justly dreaded disease” had crossed the state line. Wilmington, the state's largest city, had the dubious honor of reporting the first case, in “a negro train hand of the Atlantic Coast Line whose run was into South Carolina.” Soon after, Charlotte health authorities discovered a case in a black railroad hand named William Jackson. He had recently returned from a run to Greenville, South Carolina, the very place Perkins had caught his train north. By the time Perkins arrived at the Charlotte pesthouse, there were three other people detained there. Within twenty-four hours, there would be four more. All of them were African American. Three of them were broken out with pocks, including William Jackson's four-year-old son Frank. Jackson himself was already dead. The remaining five inmates showed no symptoms, but since they had come into contact with the others they would be detained for two weeks.
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Charlotte was in a state of turmoil. The physicians who examined the pesthouse patients disagreed about whether the cases were smallpox at all. At the request of the state authorities, Surgeon General Walter Wyman of the United States Marine-Hospital Service, the federal government's civilian health corps, dispatched an officer to Charlotte. For Dr. Charles P. Wertenbaker, a surgeon in command of the service's station in Wilmington, diagnosing smallpox was fast becoming a specialty. In the quasi-military argot of the corps, Wertenbaker held the rank of “passed assistant surgeon,” meaning he was a midlevel officer who had passed the service's famously rigorous examination for promotion. He told the mayor of Charlotte that all four patients had smallpox. The quarantined inmates would almost certainly develop the disease, too. Instead of segregating suspects from patients, pesthouse officials had put suspects to work nursing the sick.
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To Wertenbaker's eye, Perkins presented a “typical” case, in the “fifth day of the eruption.” But in an old man smallpox was especially cruel. Perkins died in the pesthouse ten days later. He was buried in a nearby woods, more than a hundred miles from home.
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The citizens of Charlotte had dodged a bullet, Wertenbaker announced in a bulletin issued by the state board of health to drum up support for vaccination. Had Perkins been stronger, “he would have come into the city; he might have stood next to any one in a crowd and infected him, he might have come in contact with one of your servants, and in this way sent the disease into your homes.”
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Dr. Henry F. Long learned the truth of these words. From the “seeds” of smallpox Perkins sowed at Mooresville arose the largest outbreak North Carolina had seen in years. An itinerant black preacher named A. B. Smoot unknowingly carried the disease from Mooresville to Statesville. More than sixty cases were eventually reported in Iredell County. It was anybody's guess how many more people suffered, as Perkins had aimed to, in the privacy of their own homes. Dr. Long set up a hospital and detention camp in the woods outside Statesville. He hired the recovered Reverend Smoot to drive the ambulance wagon. When Long tried to organize a county-wide vaccination campaign, he ran up against fierce opposition, most of it “from the whites.” The city council gave Long power to vaccinate the citizens, with or without their consent. One state health official reflected, “The unreasoning prejudice of ignorance is extremely difficult to meet, and sometimes requires a resort to methods that are very obnoxious to Americans.”
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As the summer heat climbed into the Piedmont, the Iredell County epidemic of 1898 ran its course. But as Long put the finishing touches on his report, the fetid odor of smallpox, “insupportable and tenacious,” continued to haunt him. He was not going to escape that smell anytime soon. The North Carolina Board of Health, facing a widening epidemic in counties across the state, was about to create a full-time position for him: State Smallpox Inspector.
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T
he age of AIDS did not invent the notion of “Patient Zero.” Epidemics are dramatic events of cultural as well as scientific meaning, and the hunt for an outbreak's first case has ever served needs and purposes other than those of medicine. One Alabama health officer reached all the way back to Genesis 3:15—the story of the serpent in the garden—to launch his narrative of the Greene County smallpox epidemic of 1883. The epidemic, he said, had begun with the arrival on an evening train from Birmingham of one Eliza Burke, the “colored woman ‘who brought death and all our woe.' ”
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Narrative accounts of smallpox outbreaks—whether recounted aloud to neighbors, scratched into a letter, or prepared, like Dr. Long's history, for a government report—rarely failed to include a few words about the first case. These sketches of suddenly infamous men and women cast flashes of light on obscure figures, most of them otherwise untraceable. The way these stories were told reveals at least as much about their tellers: their forensic certitude, their fixed ideas about race and place, and their faith that buried somewhere in the human wreckage of an epidemic lay the stuff of larger moral reckonings. The desire to begin at the beginning, with a cognizable first case, was particularly strong at a time when the actual agents of so much misery and loss—the unseen, unseeable particles of the variola virus—were so imperfectly understood.
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After the fashion of Harvey Perkins, or the minstrel actor who stayed over on All Nations Block, the alleged source of infection was typically an outsider or a marginal local figure whose work or wanderings brought him in promiscuous contact with strangers. Consider three first cases reported by county physicians to the Kentucky Board of Health during the outbreaks of 1898 and 1899: smallpox invaded Boyd County in the body of a deckhand who worked on a “steamboat plying between Pittsburgh and St. Louis”; the disease was spread around Clay County by “a young girl of bad reputation”; and it struck Lincoln County in the person of a peripatetic real estate salesman named Joseph Sowders, a white man whose taste for the “biled juice of the cereal corn” had landed him in a smallpox-ridden Catholic mission in Columbus, Ohio, before he stumbled home to Lincoln. When smallpox struck Los Angeles in the winter of 1899, infecting thirty-five people and killing seven, officials blamed unnamed “tramps or trainmen from Arizona.” In port cities from New York to San Francisco, anyone arriving by boat, especially in steerage, loomed as a potential threat. North and south of the Mason-Dixon line, itinerant African Americans were the most prime of suspects: laborers “traveling afoot,” performers in “Uncle Tom's Cabin” shows, missionary preachers, Pullman porters, coal miners, roustabouts, even, in the case of Columbia, South Carolina, a “runaway student” from a black college.
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Other reports attributed the spread of smallpox not to a single individual but to the undifferentiated inhabitants of entire encampments of people on the move: railroad camps, mining camps, logging camps, Army camps, convict labor camps, African American revival meetings, fairs, lodging houses, and any other short-lived settlement where strangers crowded in an unfathomable mass. “The camp as a focus of disease is more potent than all others,” wrote Dr. James N. Hyde, a smallpox expert at Chicago's Rush Medical School. In such places, Hyde argued, people who had become adapted to the particular microbial environment of their distant homes were thrown together, “under subjection,” unable to choose where or with whom they slept. “The chances of thus begetting disease are enormously multiplied.”
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The United States was not just a nation of farms, small towns, and industrial cities. For the country's poorest working people, America was a vast archipelago of camps. Nothing did more than smallpox to reveal this rarely mentioned fact about American society at the turn of the twentieth century.

During his tenure as state smallpox inspector, Dr. Long developed his own theory about the origin of the great wave of epidemics that struck the southern states beginning sometime in 1897: it all started in a single labor camp in Mexico. A few years before the southern epidemics, Long explained, a railroad contractor from Birmingham had taken a crew of African American railroad workers across the border to do a job. They contracted smallpox in the camp there and brought the disease back home with them. From Birmingham smallpox had slowly made its way, in the bodies of itinerant black workers, to the east and north, unnoticed or at least unremarked by the white public health authorities. Maybe the narrative of the North Carolina outbreaks properly began there.
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Epidemiological uncertainty made moral certainty easier. A common, cautionary theme pervades this accumulating archive of smallpox narratives: “The pestilence that walketh in darkness” travels unseen in the bodies of the strangers and outliers who move among us. And it is fearful indeed.
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A
t the end of the nineteenth century, smallpox still reigned as the most infamous and loathsome of infectious diseases. Since the 1870s, serious epidemics of smallpox had grown relatively uncommon in the United States, but that did not lessen the fears attached to the disease. Nor did the fact that Americans of the period were far more likely to fall ill or die from diphtheria, influenza, scarlet fever, typhoid fever, or consumption. Smallpox occupied a special place in the hall of human horrors. As J. N. McCormack, secretary of the Kentucky Board of Health, put it, “One case of smallpox in a tramp will create far more alarm in any community in Kentucky than a hundred cases of typhoid fever and a dozen deaths in the leading families.”
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The 1898 outbreaks coincided with the centennial commemorations of the invention of vaccination. In 1798, the English physician Edward Jenner had published his first paper on his experiments with smallpox vaccination (which he had conducted in 1796). Newspaper articles, magazine stories, and public speeches across the United States regaled Americans about the horrors of smallpox and the scientific triumph of Jennerian vaccination. In a speech to the “plain people” of Winston, North Carolina, “Colonel” A. W. Shaffer of the state board of health proclaimed that smallpox had been a “vile destroyer” since before “the first century of the Christian era.” “Great kings and royal princes, stately women of high degree and matchless beauty, and babes at the mother's breast fell alike before its destroying blast and were disfigured and deformed for life, or thrust into the same hole with the filthy carcasses of their meanest subjects.”
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Shaffer did not exaggerate. The variola virus had been entangled with human history, to devastating effect, for millennia. No one knows when or how the virus first infected human beings. The earliest unequivocal descriptions of smallpox date to the fourth century A.D. in China, but scientists have long believed that the pustules found on the cheeks of Egyptian mummies from the twelfth century B.C. were caused by smallpox. Smallpox may have emerged as early as six thousand years ago—when the introduction of irrigated agriculture enabled human civilizations to grow large and dense enough to sustain the disease. By the time of Christ, smallpox was probably commonplace in the thickly populated valleys of the Nile and Ganges rivers, spreading from there across southwestern Asia. An inveterate camp follower, variola hitchhiked in the bodies of traders, soldiers, and other migrants. It spread east along the Burma and Silk roads and into China. In the eighth century, Islamic armies carried it through North Africa into the Iberian Peninsula. By the end of the tenth century, its expanding territory included much of southwestern Asia and the Mediterranean littoral of Africa and Europe. Many places had yet to be touched by the disease. But during the next six hundred years, smallpox became endemic in much of Europe, from whence it spread to most inhabited regions of the world. By the end of the eighteenth century, when Jenner first introduced vaccination in England, 400,000 Europeans were dying each year from smallpox.
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If the early history of smallpox remains mysterious, the origin of the variola virus itself is murkier still. The most plausible theory holds that the virus originated in a rodent, made the species leap to humans, adapted to its new host, and never went back. This much is certain: the variola virus has a special affinity for humans. Variola is one species in a larger genus of disease agents—the
orthopoxviruses—
that infect diverse members of the animal world. There is cowpox, monkeypox, raccoonpox, camelpox, and so on. Many of those poxviruses infect multiple species. Cowpox, for example, has naturally occurred in cows, gerbils, rats, large cats, rhinoceroses, elephants, and humans. But the natural host range for variola is decidedly more narrow. It only infects people.
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The bond between variola and humans is not merely a virological curiosity. It is a fact of epidemiological and even world-historical significance. It is perhaps the essential fact about a virus that killed at least three hundred million people during the twentieth century alone—more than all of the century's wars. There is no animal reservoir or vector for smallpox. It cannot be transmitted by mosquitoes (as with malaria) or lice (typhus) or rat fleas (bubonic plague) or domestic animals (anthrax). Nor, for that matter, can smallpox infect people through their sewage-tainted water supplies (as does cholera) or contaminated food (typhoid fever). Smallpox can spread only from one person to another, normally through face-to-face contact.
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Smallpox is, as George W. Stoner observed in his
Handbook for the Ship's Medicine Chest
(1900), a “self-limited disease.” An attack followed a distinctive clinical course for which there could be but two outcomes: smallpox either killed its victim or left the survivor immune for life. Although particles of the virus could persist for long periods in scabs on the bodies of the dead, variola did not remain in a living body after convalescence. There was no chronic recurrence, as in many herpes viruses. Smallpox survivors did not become symptomatic and infectious time and time again. They could never again get or spread the disease. This, rather than an appreciation for the poetry of the situation, was why Dr. Long hired Reverend Smoot to drive the pesthouse wagon.
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