During the 19th century, hospitals and medical facilities would not accept patients who had a communicable disease. This was, primarily, due to the fact that hospitals were not equipped to house patients with contagious diseases and therefore would be large groups of others at risk for acquiring and spreading the disease. There were no or limited effective treatments for many communicable diseases. A vaccine was developed for smallpox but many citizens did not heed warnings to get vaccinated. With a lack of funds and the significant rates of infection for diseases like smallpox, many communities built or retrofitted houses and referred to them as “pest houses” to segregate or quarantine individuals with communicable diseases. Pest houses were not a new concept, however, as these “houses” can be dated to the Bubonic Plague and beyond.
According to the 1900-1901 Kentucky State Board of Health Report, smallpox was imported from Honduras in the summer of 1897 and began its rapid spread throughout the mining regions of Alabama and Tennessee. The disease was “singularly mild in form” and was noted as primarily being limited to the “colored” race. The first case of smallpox in Kentucky came to Middlesboro from Tennessee early in December of 1897. Shortly after, the disease broke out at Jellico, a state-line town, and two months later a negro who had contracted the disease in Knoxville, Tennessee came down with it at Richmond, Kentucky. The character of smallpox was recognized early in Middlesboro but due to the lack of a hospital and “higgling” from county fiscal authorities, hundreds of exposures had occurred. Additionally, it was noted in the report that, “ignorant and designing persons spread the report that it was “Elephant Itch,” “Cuban Itch,” “African Itch,” all names which clung to the disease in this and other states, much to the confusion of the popular mind.” Smallpox spread rapidly resulting in the most severe and expensive epidemic that has ever visited an interior town in this State.
The following letter was circulated to every health and civil official, physician, and newspaper in the state:
A mere six weeks later, a more dire letter was released to the public:
In spite of these “admonitions” from the State Board of Health, towns and counties were largely found to be unprepared to deal with the disease and thus it spread from place to place. By 1899, the State Board of Health had already exhausted its fund to the point of being overdrawn at the bank. The State Board of Health could only send inspectors to counties whose fiscal authorities would agree in advance to bear the expense. In the same year, smallpox had affected 110 out of 119 of Kentucky’s counties. Once the State Board of Health began exerting their authority, it had a salutary effect.
In later December of 1900, the Kentucky State Board of Health made the decision to quarantine an entire county; Greenup County and each of its inhabitants were forbidden to enter or leave, except to pass through. This also included railroad, steamboat, or any other passenger transportation company to make any stops to deliver any passengers or freight to or from the county. The town of Russell, who had an independent Board of Health and enforced compulsory vaccination, was exempted from the quarantine. The proclamation took effect at noon on Sunday, December 23.
Over time, there would be court battles fighting the required vaccinations against smallpox, amongst other issues, yet the disease still managed to prevail. Pest houses were built or retrofitted to house and segregate those with smallpox.
By 1903, anyone in the Commonwealth of Kentucky who had been exposed to smallpox and is liable to take the disease and refuses to seclude himself was subject to be taken to any justice of the peace of the county and confined in some secluded place, at his own expense, until such time that the disease has passed through or if the person is released by the Board of Health. Every person in Kentucky counties, including children over the age of three months, who has not been inoculated with the smallpox vaccine is required to be vaccinated immediately. If families were unable to pay the fee for the smallpox vaccination then families were encouraged to inform their physician who would inform that county and foot the fee(s) for the vaccination. Any person who had smallpox and went upon the streets, highways, or elsewhere, so as to expose others to the disease, was subject to a fine of not less than one hundred dollars and not more than one thousand dollars. Anyone who refused to obey any of the rules and regulations of the Board of Health was to be fined not less than ten dollars and not more than one hundred dollars.
By the middle of the 20th century, the need for pest houses was essentially obsolete. Many were closed, destroyed, or found other uses.
Faces of Smallpox
(Photos From the 1900-1901 and 1902-1903 Reports of the State Board of Health)
Contributed by Shawn Logan | firstname.lastname@example.org
⁘ Works Cited ⁘
- Kentucky. State Board of Health. Biennial Report, 1900-1901. Louisville, Ky: Geo. G. Fetter Printing Co. 1901.
- The Big Sandy News (Louisa, Kentucky), 20 February 1903, p. 3.
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