May Cravath Wharton, an early female M.D., transformed the landscape of the Upper Cumberland Plateau from her arrival at the end of World War I to the 1950s, when she was able to open the area's first real hospital.
Wharton was a doctor, not a writer, so there is no purple in her prose. But the narrative she tells is arresting enough for anyone, with the additional benefit that it is true.
She describes, as if writing case notes, the utter poverty of the Appalachian people at the time--people so poor that almost no actual cash passed through their hands in the course of their lifetimes; people so poor that their children never saw a dentist, their women often died in unattended childbirths; the logs of their cabins were papered with newspaper to try to keep out the wind; they had to slog through mud and over slippery single-log bridges to get anywhere at all, traveling four or five hours to go a couple of miles across country in a wilderness of unmarked trails.
This was just 100 years ago, not long, a blink of an eye. She frequently referred to the people she found near Crossville, Tennessee as "lost Americans." In an era when government only tentatively extended its fingers toward the residents of the Cumberland Plateau, private charities were unaware of them and could not help them; in fact, the "missionary funds" of most Northern and mid-Western churches could not be applied to helping in the Appalachians. So the people simply lived, suffered, got sick, and died. Quietly, stoically. But they died. And their deaths never rippled the satin dresses of flappers during the Roaring Twenties.
When we envision the world as polemicist and novelist Ayn Rand imagined it--the other side of the gilded world of "strivers" and "makers" in a competitive, ruthless economy--the Appalachia of the 'teens and '20s is the world she would have argued for, at least for the losers in the equation. This is what she wanted. This is what her disciple Paul Ryan wants: luxury for the elite, hopeless and inescapable misery for the poor.
Wharton's story is worth reading both on its own merits as the autobiography of a fearless and strong woman, and in its description of a world that is perilously close to us if, as a nation, we accept the arguments of the newly ascendant right.