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In response to the smallpox epidemic in other parts of the United States, North Carolina took action to safeguard its inhabitants by instituting an approach to public health similar to towns like Boston. Watson discusses the development of public health in the state in response to smallpox and the evolution of preventative measures.
During the 1863/1864 winter, smallpox broke out in runaway slave encampments at New Bern and Beaufort. While soldiers in the nearby Union camps had been vaccinated against the disease, approximately 10% of the 2,500 black refugees at Beaufort were diagnosed with the infection. Union soldiers near New Bern were fortunately able to vaccinate the encampment before the virus spread. Soldiers at the Beaufort camp instead chose to isolate smallpox cases and the outbreak eventually died out.