SEVEN

THE ANTIVACCINATIONISTS

The Medical News gave it a billing worthy of P. T. Barnum: “a smallpox case destined to be famous in the history of the progressive victory of therapeutic science over the ranks of ignorance, prejudice, quackery, and sentimentalism.” A more neutral observer (if one could be found) might have described the entire affair as a case of medical brinksmanship gone wrong.¹

It had all started with a dare. On November 25, 1901, Dr. Samuel H. Durgin, lecturer in the Harvard Medical Department and chairman of the Boston Board of Health, made a statement to The Boston Globe. “If there are among the adult and leading members of the antivaccinationists,” he said, “any who would like an opportunity to show the people their sincerity in what they profess, I will make arrangements by which that belief may be tested and the effect of such exhibition of faith, by exposure to smallpox without vaccination, be made clear.” Chairman Durgin said he doubted there was “a man or woman among them”—Boston’s small but fervent antivaccination movement—who would accept his challenge.²

Boston was battling its most serious smallpox epidemic in a generation. The epidemic of 1872–73, Durgin’s first trial as a member of the board, had killed over a thousand people. There was no telling how many would die this time. The first cases, discovered in May 1901 in a Roxbury factory, had killed no one. It seemed that the new “mild type” smallpox, which had been troubling the southern and midwestern states for the past few years, had finally reached Boston. With summer came one small outbreak after another. September brought thirty new cases, October forty-nine, November nearly two hundred. By then, several people had died. With the smallpox hospital on Southampton Street filled to capacity, the board outfitted additional wards at the quarantine hospital on Gallop’s Island, in Boston harbor. According to city physicians, nine out of ten patients turning up at the pesthouses had never been vaccinated. The board opened free vaccine stations around the city. Durgin reached out to Archbishop John Joseph Williams, and his appeal for universal vaccination was read aloud at Sunday services across Catholic Boston. And though the board had yet to issue a vaccination order, hoping to preserve the image of voluntarism for as long as possible, the board’s “virus squad” began its bruising nighttime raids of the city’s lodging houses.³

In the midst of this public health emergency, an anonymous circular appeared on the streets of Boston. Addressed to parents, guardians, and the people, it warned that vaccination caused “disease, constitutional debility, death.” The circular advised that the state law requiring vaccination for all public school pupils—now being strictly enforced in the city—made an exception for any child who presented a certificate, signed by a physician, stating that the child was an “unfit subject for vaccination.” Having won this concession from the legislature in 1894, the antivaccinationists were now making the most of it. “There are hundreds of physicians in Massachusetts who are well aware of the uselessness and evil effects of vaccination,” the circular instructed. To them, no child was a fit subject for vaccination. “Apply to any one of them for a certificate of exemption for your child.” The leaflet provided an address—an office at No. 1 Beacon Street, just steps from the gold-domed State House—to which parents could write for names of such doctors. Asked by the Globe for a comment, Durgin issued his challenge.⁴

It must have seemed to Durgin’s peers that the stress of the job had finally gotten to him. Had the respected chief of one of the nation’s leading public health departments really just dared unvaccinated citizens to expose themselves to smallpox? In all likelihood, Durgin expected no one to take the bait. A man of his experience knew the antivaccinationists were nothing if not sincere. But their beliefs did not constitute a suicide pact. While antivaccinationists considered vaccination a medical fraud and compulsoryvaccination an “atrocious crime,” few imagined themselves invulnerable to smallpox.⁵

One of the few was Dr. Immanuel Pfeiffer of Boston. A Danish immigrant and former dealer in real estate, the sixtyish physician was a handsome man with an erect bearing, a thick head of hair, and a well-groomed beard. He was a public figure of well-known enthusiasms: spiritualism, physical culture, free speech, and, uniting them all, antivaccinationism. An apostle of the idea that the mind possessed almost limitless power over the material world, Pfeiffer offered his own body as the proof of his beliefs, winning a Houdini-like reputation for his vigorous constitution and capacity to withstand physical hardship. In 1900, he garnered national press attention by fasting for twenty-one days. A year later, he fasted for a month. “He has been considered a crank by many people,” the Globe observed; and yet those who knew the man acknowledged that he had “a brain of unusual power and activity, a fitting concomitant of his stalwart figure and imposing carriage.” In his heterodox medical journal, Our Home Rights, Pfeiffer taught readers that the best way to ward off disease was through sanitation, proper diet, and impeccable hygiene. He advertised his services as a “renowned natural healer” who “successfully treats all kinds of chronic diseases by the simple laying on of hands, after having been pronounced incurable by regular physicians.” Regular physicians: to Pfeiffer, that phrase signified unthinking medical orthodoxy and creeping state regulation of the healing arts, a trend he fought as president of the Massachusetts Medical Rights League.⁶

Pfeiffer’s views on vaccination were a matter of public record. In December 1901, one month after Durgin issued his challenge, Pfeiffer attended a lecture at a meeting of the Ladies’ Psychological Institute of Boston. The speaker was Dr. John H. McCollom of Boston City Hospital, an instructor in contagious diseases at Harvard and a prominent member of the Massachusetts Medical Society—a “regular,” through and through. McCollom presented a by-the-book argument for vaccination. As gruesome images of smallpox patients beamed onto a screen from his stereopticon, McCollom narrated humankind’s long struggle with smallpox, culminating in the scientific triumph of Jennerian vaccination. He traced the development of vaccine, touting the virtues of modern glycerinated lymph. He marshaled statistics from historical epidemics to demonstrate that well-vaccinated people rarely contracted smallpox and, when they did, suffered far less than their unvaccinated neighbors. The same argument could be found in countless medical journals, government reports, and newspapers. But with smallpox spreading in the city—perhaps in that very room—the audience hung on McCollom’s every word. Coming to the end of his lecture, he opened the floor to questions .⁷

Pfeiffer rose. “Is it not true, doctor,” he began, “that men of science and immense learning have effectually claimed that persons whose bodies are cleanly, sound and generally healthy are protected from smallpox?”

McCollom responded, “No, it is not true, and I do not recollect of hearing any learned or scientific men making any such claim.”

Pfeiffer: “Is it not admitted by eminent physicians and learned men that there are more ills resulting from vaccination than from the disease of smallpox?”

McCollom said he had “never heard a scientific man” say any such thing.

Pfeiffer: “And did not the people of Ohio rise up against vaccination to such an extent that it has been abolished there?” (He was referring to Cleveland health officer Martin Friedrich’s recent decision to suspend wholesale vaccination in favor of disinfection.) Before McCollom could answer, Pfeiffer launched into another question. Then another. The cross-examination went on like this for some time, as Pfeiffer exhibited his famous endurance and McCollom—and the audience—approached the limits of theirs.⁸

A month later, on January 18, 1902, Pfeiffer wrote to Durgin, seeking permission to visit the smallpox wards at Gallop’s Island “for the purpose of scientifically looking into the disease in all its various forms.” The letter indicated that the two men had already spoken; Durgin had asked Pfeiffer to put his request in writing. To this, the chairman readily assented, waiving the hospital’s strict requirement that all visitors show evidence of recent vaccination. Pfeiffer had not been vaccinated since infancy. Durgin’s dare had a taker after all.⁹

Many would later question the chairman’s decision. By January 1, city physicians had already vaccinated 185,000 residents; family doctors and other agencies had vaccinated roughly 300,000, for a total of 485,000 in a city of 586,000. That was an exceptionally high vaccination rate (83 percent) for a U.S. city. But Durgin seemed determined to reach that final 17 percent and to strip Boston of its national reputation as “a hot-bed of the anti-vaccine heresy.” That January, under authority of a vaccination order issued by Durgin’s board, city doctors and police canvassed East Boston, South Boston, Charlestown, the North End, and the West End. The antivaccinationists stepped up their efforts, petitioning the Massachusetts General Court with bills to abolish compulsion. Nineteen citizens of Boston were prosecuted for resisting vaccination (including one East Boston father, John H. Mugford, who would fight his case all the way to the state’s Supreme Judicial Court). Meanwhile, the epidemic continued. By late January, nearly 700 Bostonians had been stricken with smallpox; 108 had died. Durgin held the antivaccinationists responsible, and Pfeiffer was their most visible leader.¹⁰

On January 23, Pfeiffer toured Gallop’s Island in the company of Dr. Paul Carson, the port physician. Carson, a former Dartmouth football star, instructed Pfeiffer in hospital protocol, helping him don the requisite white gown and cap. The two men walked the wards that housed more than one hundred smallpox-stricken patients, stopping at their grim bedsides so Pfeiffer could examine the disease in its various stages. Pfeiffer complimented his host on the cleanliness of the facility. He remarked that the air lacked the infamous smell of smallpox—an odor one country doctor of the era likened to “a hen-house on a warm April morn.” Carson suggested that Pfeiffer smell a patient’s breath. Pfeiffer leaned in, inhaling deeply. Durgin was not present. But he later told a reporter that he was “glad the suggestion of the breath was made, so that Dr Pfeiffer might be gratified in every conceivable way in his expressed desire.” Arriving at the end of the tour, Pfeiffer returned the robe and cap and, on Carson’s instructions, washed his hands, face, hair, and beard in disinfectant before boarding the boat back to Boston.¹¹

In the days that followed, agents for the board of health kept Pfeiffer under close surveillance. They stood sentry outside his Washington Street office. They shadowed him on his rounds. They trailed him to the State House, where he testified in crowded public hearings on the antivaccination bills. Pfeiffer had drafted one of the bills himself. It called for “obtaining the consent to inject any poisonous substance into the body of any person.”¹²

The surveillance went on for a week, eight days, nine, ten.... Then, on February 3, the eleventh day after his exposure to smallpox—right about the time when a person infected with the virus would be expected to fall ill and become contagious—Durgin’s agents lost Pfeiffer.

Iconoclasts! Charlatans!! Cranks!!! Of “the little coterie of obstructionists who call themselves antivaccinationists,” the leaders of scientific medical opinion in turn-of-the-century America had little good to say. “To call him an ass,” the New York country doctor–cum–memoirist William Macartney said of the antivaccinationist, “is to disparage donkeys in general.” With the same stubborn sort in mind, health officials from Kentucky to California called a tough case of smallpox “the fool-killer.” Dr. James Hyde, the small-pox expert at Rush Medical School, offered a more searching psychological profile of vaccination’s discontents. “A class of men,” he imagined them, “whose minds are so curiously constituted that they will select for study the nether side of the social fabric, the weakness of the best of governments, and the minor defects in the character of the world’s heroes.” For years to come, few medical historians or science writers would feel any professional obligation to soft-pedal their contempt when writing about the “antivaccine, anti-government, and anti-science crowd.”¹³

To be sure, the turn-of-the-century antivaccination movement attracted more than its share of odd characters and showboating extremists. As Boston’s Dr. Charles F. Nichols (the author of Vaccination: A Blunder in Poisons) observed, “The subject evokes strong language—explosives, not apologetics.” The aptly named Dr. Robert A. Gunn told an audience at the Manhattan Liberal Club in 1902 that he would “shoot down as he would a burglar” any health officer who attempted to vaccinate his family, confident “no jury of American freemen” would find him guilty of murder.¹⁴

With the passage of time, the ideas of the early twentieth-century antivaccinationists may seem quaint, or worse. But those ideas, so markedly wrong by modern scientific standards, still offer critical insights into the tumultuous transformation of American society, culture, and government in the Progressive Era. Dr. Hyde’s unflattering psychological profile of the antivaccinationists hints at their deeper historical significance. These men and women, for whom opposition to compulsory vaccination had become a political cause, were profoundly disaffected by the growing administrative power and social reach of the American government in their time. For many of them, active opposition to “state medicine”—a term embraced by the state itself—was part of a larger social and cultural struggle against the dramatic extension of governmental power into the realms of education, family life, personal belief, bodily autonomy, and speech.¹⁵

The antivaccinationists’ sense of themselves as members of a political movement distinguished them from the far greater numbers of Americans who resisted compulsory vaccination during the smallpox epidemics of 1898–1903. For the African American coal miners of Birmingham, the tenement mothers of Italian Harlem, or the barrio dwellers of Laredo, resisting compulsory vaccination was indisputably a political act. By rioting, forging vaccination scars, scrubbing vaccine from their children’s arms, or driving vaccinators from their neighborhoods, thousands of ordinary Americans rebelled against government authority. Their actions emboldened antivaccinationists, but that did not make every “vaccine refuser” an antivaccinationist. For most refusers, resistance was an act in and of the moment; it lasted only so long as did the threat of compulsion itself. Antivaccinationists were different. They were activists—people with a cause. They aimed to win converts, move public opinion, change laws. As John Pitcairn, the wealthy Pittsburgh plate glass manufacturer and president of the Anti-Vaccination League of America, told a committee of the Pennsylvania General Assembly, “There is no money in the cause we represent; it is the cause of truth, the cause of freedom, the cause of humanity.” For some, that cause became a lifelong crusade.¹⁶

Many antivaccinationists had close intellectual and personal ties to a largely forgotten American tradition and subculture of libertarian radicalism. That tradition took on a feverish new life as industrial capitalism, progressive reform, and the professionalization of knowledge fostered the rise of a distinctly modern interventionist state during the Progressive Era. The same men and women who joined antivaccination leagues tended to throw themselves into other maligned causes of their era, including anti-imperialism, women’s rights, antivivisection, vegetarianism, Henry George’s single tax, the fight against government censorship of “obscene” materials (under the late nineteenth-century “Comstock laws”), and opposition to state eugenics. Seventy-year-old Dr. Montague R. Leverson—an English immigrant, onetime California state assemblyman, and perennial leader of the Brooklyn Anti-Compulsory Vaccination League—was denounced, accurately, by The New York Times as “an extreme advocate of personal liberty,” an “untiring writer of letters and pamphlets” on “all sorts of impracticable theories” from the injustice of the obscenity laws to the lawlessness of the U.S. war in the Philippines. It was the antivaccinationists’ uncompromising defense of personal liberty, as they understood it—and not merely their unorthodox medical beliefs—that placed them, in the eyes of so many of their contemporaries, on the wrong side of history. That same “crankiness” makes their words and works an unusually revealing porthole to their times.¹⁷

Antivaccinationism was a worldwide phenomenon in the late nineteenth and early twentieth centuries. The American activists were well aware of the vaccination riots that rocked Montreal in 1885 and Rio de Janeiro in 1904. They knew (if only through Kipling’s stories) of the grassroots resistance that Britain’s vaccination campaigns had aroused across India. But given their common language and the legal and political traditions that they shared, American antivaccinationists always felt an especially close connection to their English counterparts. And together the English and American antivaccinationists proudly claimed the mantle of another unpopular movement: the transatlantic nineteenth-century antislavery movement.¹⁸

A natural affinity linked abolitionism and antivaccinationism. Both upheld bodily self-possession as the sine qua non of human freedom; both distrusted institutions; and each evoked public scorn in its time as the dangerous cause of a lunatic fringe. Frederick Douglass told an English correspondent in 1882 that compulsory vaccination had long offended his “logical faculty” as a man “opposed to every species of arbitrary power.” Some antivaccinationists, including the English leader William Tebb ( 1830–1917) and the California spiritualist Dr. James Martin Peebles (1822–1922), lived long enough to participate in both movements. For others, antislavery provided a rich source of moral inspiration and political rhetoric. Beginning in 1902, Lora C. Little of Minneapolis edited The Liberator, a smartly written antivaccination journal named after William Lloyd Garrison’s abolitionist newspaper from antebellum Boston. Little’s Liberator was well known to Garrison’s son, William Lloyd Garrison, Jr. (1838–1909), a businessman reformer whose causes included anti-imperialism, free trade, women’s rights, repeal of the Chinese Exclusion Act, and antivaccinationism. During the 1840s the elder Garrison renounced the U.S. Constitution as a pro-slavery compact, a “covenant with death,” and “an agreement with hell”; in his son’s time, Immanuel Pfeiffer denounced health boards as “covenanters with death and leaguers with hell.” Addressing the Western New York Homeopathic Medical Society in 1902, Dr. J. W. Hodge of Niagara Falls thundered, “Compulsory vaccination ranks with human slavery and religious persecution as one of the most flagrant outrages upon the rights of the human race.” It may have been the single most quoted line in the American antivaccinationist literature. It is still quoted by antivaccinationists today.¹⁹

For men and women who espoused a form of radical individualism, critics of vaccination were quick to recognize the power of association. “From all parts of the state, and indeed from all parts of the country,” declared the Minneapolis-based Northwestern Lancet in February 1901, “come reports of the organization of small anti-vaccination societies, whose first work is to embarrass health and school officials in their efforts to prevent the spread of small-pox.” As vaccination enforcement surged, organizations long moribund sprang back to life and new leagues appeared on the scene. The longest-running groups had formed in response to the first major wave of compulsory vaccination laws during the 1870s and 1880s. The granddaddy of them all, the Anti-Vaccination Society of America, was established in New York in 1879, during a visit from England’s William Tebb.

Between 1879 and 1900, other organizations formed, including the New England Anti-Compulsory Vaccination League (1882, Hartford), the American Anti-Vaccination Society (1885, New York), the American AntiVaccination League (1889, New York, claiming 380 members by 1901), and an Indiana-based organization called the Anti-Vaccination Society of America (1895, claiming 200 members by 1901). Around the turn of the century, state leagues were up and running in California, Colorado, Connecticut, Massachusetts, Minnesota, Missouri, Pennsylvania, Utah, and other states, in addition to the welter of local societies in communities such as Berkeley, Boston, Brooklyn, Cleveland, Milwaukee, and St. Paul. The existence of two distinct organizations, each calling itself “the” AntiVaccination Society of America, attests to a lack of coordination in the movement. The antivaccinationists had little of the organizational discipline (or membership base) of a national interest group such as the General Federation of Women’s Clubs, whose success in winning protective legislation for female factory workers rested on its ability to mobilize affiliated organizations at every level of the polity. By comparison to the GFWC, the antivaccination movement was an unmade bed.²⁰

Still, even their detractors had to admit that the antivaccinationists constituted a genuine movement, complete with its own polemicists, its own journals (notably the Terre Haute–based Vaccination, 1898–1906, and The Liberator, 1898–1907); its own international literature of pamphlets and books; and its own lawyers (including C. Oscar Beasley of Philadelphia, who specialized in vaccine injury suits, and Harry Weinberger of New York, for whom antivaccination was part of a distinguished career in defense of civil liberties). The societies sent delegates to international congresses in Paris, Cologne, and Berlin. Every well-read American antivaccinationist knew that Leo Tolstoy sympathized with the cause, as he did “with every struggle for liberty in any sphere of life”; that George Bernard Shaw called vaccination “a peculiarly filthy piece of witchcraft”; and that the British naturalist Alfred Russel Wallace had predicted, in 1898, that the practice “will, before many years have passed, be universally held to be one of the foulest blots on the civilization of the nineteenth century.” As American antivaccinationists saw the international “Vaccination Question,” theirs was the enlightened view of the matter. The apologists for state medicine were the true cranks. The antivaccinationists were determined to wipe the blot of compulsion from the statute books of the United States.²¹

Who were the antivaccinationists?

In England, antivaccinationism fostered a cross-class alliance of factory workers, artisans, clerks, and shopkeepers. English vaccination measures explicitly targeted working-class families, and antivaccinationism gained strongholds in workers’ neighborhoods, especially those with robust labor movements. For a half century after the passage of England’s first compulsion statute in 1853, hundreds of thousands of parents joined the movement to resist government-mandated vaccination of their children. Many were fined or jailed. Government distraint sales—public auctions of property seized from resisters who failed to pay their fines—spawned riots. An estimated 80,000 to 100,000 people participated in the Leicester Demonstration of 1885, a grand urban spectacle that featured the hanging of Edward Jenner in effigy. Parliament established the Royal Commission on Vaccination in 1889. After studying the subject for seven years, the commission endorsed vaccination as scientifically sound but advised Parliament to create an exemption for “conscientious objectors”: people who sincerely believed the procedure threatened their own or their children’s health. Parliament introduced that exemption by law in 1898. Within ten years, conscience exemptions reached one quarter of all births in England.²²

In the United States, organized antivaccinationism never enjoyed such a broad, politicized working-class base. Most activists instead came from the country’s broad, educated middle class. A typical league counted among its members businessmen and lawyers, shopkeepers and artisans, schoolteachers and housewives. To an outsider, the most striking fact about antivaccination activists—particularly those who wrote tracts and made public speeches—was how many of them were doctors. Or how many called themselves doctors, a regular physician would have said.

The controversy over the vaccination question was closely tied to the contemporary battle over state medical licensing and the increasing dominance of “regular,” allopathic medicine. So intertwined were the two issues in some states (including New York and Massachusetts) that at times the political fight over compulsory vaccination could seem little more than a proxy war for the professional struggle over licensure. But it was much more than that.²³

The ranks of the antivaccination movement teemed with practitioners of the stunningly diverse systems of alternative medicine to be found in turn-of-the-century America. For many so-called irregular practitioners, the rise of state medicine in the late nineteenth century—with its boards of health, medical licensing bodies, and compulsory vaccination orders—was an insidious development. State medicine posed a direct challenge to their livelihoods and to their ways of understanding the body, nature, and the world. For many alternative practitioners, the fights against compulsory vaccination and medical licensure were two fronts in the same war. By discrediting vaccination, the Indiana “Physio-Medical” practitioner Dr. R. Swinburne Clymer declared, “we are striking at the very root and foundation of so-called scientific or ‘regular’ medicine.”²⁴

It was a long-running war. In the early republic, state licensing laws had granted a professional monopoly to mainstream physicians of the allopathic school. It had been their idea to call themselves “regular” physicians and their upstart competitors in homeopathy and Thomsonianism “irregulars.” During the 1830s and 1840s, those laws were wiped off the books by state lawmakers, part of the broad Jacksonian-era assault on intellectual elitism and government-granted special privileges of all sorts. As the Massachusetts Sanitary Commission lamented in 1850, henceforward “any one, male or female, learned or ignorant, an honest man or a knave, can assume the name of physician, and ‘practice’ upon any one, to cure or to kill, as either may happen, without accountability. ‘It’s a free country!’” Free to healers and also free to patients, who could choose among practitioners, all of whom were equally entitled to hold themselves out as “doctor.”²⁵

By 1900, the United States had an estimated 110,000 orthodox physicians and roughly 20,000 practitioners of alternative medicine. The bestestablished irregulars were America’s 9,000 homeopaths (who treated disease by administering minute doses of remedies known to produce symptoms in a healthy person that were similar to those of the disease) and the eclectics (who favored botanical remedies). Relative newcomers to the medical culture included practitioners of osteopathy, chiropractic, and naturopathy—all forms of drugless healing. Although adherents of each of the unorthodox schools viewed their own system as superior, they shared a general belief in the therapeutic and preventive power of nature—emphasizing the virtues of sound diet, a daily regimen to maintain the integrity of the body, and the administration, in times of illness, of gentle remedies such as herbs. The irregulars rejected the mercurial drugs, bleedings, and other strenuous measures of mainstream practice. They prided themselves on their holistic, empirical, “common sense” approaches to disease. For much of the nineteenth century—the age of heroic surgeries and toxic mercurials—the irregulars’ gentler medicine seemed to many patients the safer approach.²⁶

For years, the unbridled contempt of the mainstream medical societies had only enlarged the irregulars’ self-esteem, and, not incidentally, their market share. From its inception in 1847, the American Medical Association had strived to drive the irregulars (particularly the homeopaths) from the temple of medicine. The association imposed on its members a “consultation clause,” which forbade them to consult with doctors who lacked “proper” (regular) medical credentials. Even in the absence of exclusive state licensure laws, this clause effectively barred homeopaths from practicing in many publicly funded hospitals. Regulars who consulted with unorthodox practitioners faced expulsion from their medical societies. The consultation clause was increasingly perceived by the public as petty and dangerous. (The AMA would eventually do away with the mandatory provision in 1903.) And as Dr. Oliver Wendell Holmes acknowledged as early as the mid-nineteenth century, every insulting comment from a regular physician was “a gratuitous advertisement” for his irregular rival. The irregulars, Holmes observed, “understand the hydrostatic paradox of controversy: that it raises the meanest disputant to a seeming level with his antagonist.” This was a truism of public debate that the antivaccinationists understood as well.²⁷

The final decades of the nineteenth century brought a new campaign for state medical licensing laws, precipitating a struggle between the regulars and irregulars that remained heated well into the early twentieth century. The advent of the germ theory of disease enabled extraordinary advances in medicine, particularly in the field of surgery, an area that alternative practitioners had generally conceded to mainstream physicians. Rising standards of medical education and the general culture of middle-class professionalization in late nineteenth-century America helped win the support of state lawmakers. Nearly every state enacted some form of medical licensing statute. Though homeopaths and eclectics were by that time too well established to legally exclude from the practice of medicine, many still resented the government imprimatur that the new laws conferred upon the regular-dominated state medical societies. In most states newcomers in fields such as chiropractic and naturopathy found themselves subject to prosecution for practicing medicine without a license.²⁸

During its long struggle for authority, the regular medical profession established uneasy but increasingly close ties with American state and local governments. As the AMA and the state medical societies pushed for laws to eliminate their irregular competitors, the AMA helped establish the authority of orthodox practitioners through its pursuit of laws criminalizing abortion and the distribution of information about contraception, and by establishing alliances with boards of health in the control of contagious and infectious diseases. The AMA strongly endorsed compulsory vaccination at its annual meeting in 1899, lamenting that “well-meaning but fanatical persons have, for some time past, been endeavoring to excite a prejudice against vaccination.”²⁹

Those “persons” included a great many irregulars, who perceived that every medical society endorsement of compulsory vaccination carried a rebuke to alternative medicine. Homeopaths (who many regulars grudgingly recognized as well educated and intentioned) were in fact divided on the vaccination question. Some regarded vaccination as clear proof of the homeopathic maxim simila similibus curentur (“Let like be cured by like”), while a vocal minority, including J. W. Hodge, regarded “the state-supported vaccination rite” as an exercise in blood poisoning. The 1901 meeting of the New England Eclectic Medical Association adopted a resolution proclaiming “the right to resist the vaccinator in his disseminating of disease.” Botanical physicians of the Physio-Medical School contributed several leaders to the cause, such as Dr. Clymer, vice-president of the Terre Haute–based Anti-Vaccination Society of America and author of the intermittently brilliant 1904 tract Vaccination Brought Home to You. (Clymer figured out that the best sources of damaging material on vaccination were the regulars’ own medical journals, where doctors let down their public guards and shared personal experiences of vaccinations gone wrong.) The vaccination procedure may have garnered the greatest scorn from devotees of the least legitimate (in regulars’ eyes) schools of drugless healing—including hydropaths and chiropractors. For Dr. T. V. Gifford of Indiana, a “pioneer in Hygeio-Therapy,” antivaccination was simply another part of a sound health regimen, like taking cold baths and avoiding salt, meat, and sex.³⁰

Although beset and beleaguered, alternative medicine survived the return of medical licensing laws. Homeopaths and eclectics won their own licensing acts in some states. And even practitioners of the new or more marginal schools held out the hope that their system would eventually triumph over medical orthodoxy. “The day of powder and pill and knife is nearing its end,” declared one osteopathic text in 1903.³¹

Another source of support for the antivaccinationists came from the growing communities of faith healers in turn-of-the-century America. The cause had long enjoyed support from spiritualists, a movement of alternative religion that flourished in the nineteenth century. Known for séances and “table-rappings,” spiritualists emphasized the fundamental unity of matter and spirit; their anti-institutionalism and strong belief in the sovereignty of the individual tied them to various radical causes, including women’s rights, antislavery, and antivaccination. Vaccinators were persona non grata at John Alexander Dowie’s Zion City, a settlement established outside Chicago in 1899 that banned alcohol, smoking, dance halls, and medical doctors.³²

Mary Baker Eddy’s Church of Christ, Scientist, established in Boston in 1879 and reaching forty thousand members by 1906, shared the natural healers’ concerns about vaccination. Adherents of Christian Science believed in the power of the mind to cure disease through prayer. During the 1890s, Christian Scientists had denounced compulsory vaccination as a violation of the laws of God and their religious freedom. In Beloit, Wisconsin, a Christian Scientist won a major legal victory in 1897, securing the right for his unvaccinated children to attend the public schools. When the city council of Americus, Georgia, where smallpox was epidemic in 1899, passed an ordinance compelling vaccination, local Christian Scientists rebelled, insisting their faith would protect them against the disease. City authorities arrested the resisters, assessing fines from $3 to $30 and imposing jail terms from ten to thirty days. Some Christian Scientists joined antivaccinationist societies, while others, such as Putnam J. Ramsdell of Cambridge, Massachusetts, took an individual stand, refusing to comply with local vaccination orders.³³

In 1900, with the vaccination controversy heating up across the United States, church leaders adopted a new conciliatory stance toward the government. By that time, the young church had gained extensive experience with the American legal system. Christian Science parents had faced prosecution for failing to provide medical treatment for sick children. In some states, authorities arrested Christian Scientists for practicing medicine without a license. (In their defense, the faith healers argued that they were “practicing religion, not medicine,” an argument for religious liberty that American courts increasingly accepted.) In 1900, Eddy issued a terse statement on compulsory vaccination. She advised her followers that “if the law demand an individual to submit to this process, he obey the law; and then appeal to the gospel to save him from any bad results.” Two years later, Eddy advised Christian Scientists to cooperate with health boards by reporting contagious diseases, including smallpox. Both actions were taken in a time when the church and its faithful were struggling for recognition and religious liberty in the states. Eddy cited Matthew 22:21: “Render unto Caesar the things that are Caesar’s.” But reports from local communities showed that some Christian Scientists continued to dodge vaccination and to insist upon healing smallpox-infected family members by prayer alone.³⁴

Concerned parents formed the largest recruitment pool for the antivaccination societies. Many American parents, including many who would never formally join a society, viewed school vaccination requirements as an unwarranted usurpation of their domestic authority and an unconstitutional denial of every child’s “right” to a public education. More viscerally, many parents feared vaccination would harm their children. Behind almost every antivaccination leader lay a family horror story. J. W. Griggs, president of the Anti-Vaccination Society of St. Paul, recalled how he lost his “faith in the strange practice” of vaccination when his daughter got small-pox, even though she had been vaccinated twice for school. “I began to study the question,” he wrote. “As I looked into it, I began to see the dangers of this process of poisoning the fountain of life, and a little at a time to learn of the disasters and deaths resulting from it—some immediately, and others more remotely; and thus I was stimulated actively to oppose the practice and to work for the repeal of the compulsory vaccination law in this State.” The Pittsburgh industrialist John Pitcairn, already wary of vaccination as an adherent of homeopathy and the Swedenborgian religion, recalled the suffering of his son Raymond from complications of vaccination. Liberator editor Lora Little (of Minneapolis) and Louis H. Piehn (an Iowa banker and first president of the midwestern Anti-Vaccination Society of America) each had a child die from the effects, they believed, of state-mandated school vaccination.³⁵

Critics had trouble making up their minds about the influence of antivaccinationist ideas on American public opinion. Reporting on a meeting of the Anti-Compulsory Vaccination League of Brooklyn in 1901, the Timessneeringly commented, “Nine men, one boy, and seven reporters were present.” Of course, the same words attested to the antivaccinationists’ talent for getting their message heard. Health officials dismissed them as inconsequential anonymities, but when their own vaccination campaigns came up short, the same men blamed antivaccinationism. “Although the vaccine house is built upon a rock, and is not likely to fall,” declared one Boston health department bulletin in 1902, “the noisy storm has frightened many of our people into a dangerous neglect or opposition to vaccinal protection.”³⁶

Antivaccinationism was as old as vaccination itself. In the United States, the protest actually preceded the practice. In 1798, two years before Dr. Benjamin Waterhouse of Harvard performed the first American vaccinations, physicians and clergymen in Boston formed the Anti-Vaccination Society, declaring vaccination an act of “defiance to Heaven itself, even to the will of God.” American antivaccinationists owed a heavy intellectual debt to their British counterparts, who generated a vast literature on the subject between the rise of compulsory vaccination in the 1850s and the act of 1898. And the Americans, in their continuing search for evidence to support their views, kept tabs on the experience of compulsion and opposition on the Continent (and, to a far lesser degree, in Asia and Latin America). Some contributors to the American literature of antivaccination did little more than compile the arguments and data of others; if the Springfield, Massachusetts, physician C. W. Amerige had an original thought as he wrote Vaccination a Curse (1895), he failed to put it on the page. And even the more original and lively writers, such as J. W. Hodge, tended to grow shrill with time, recycling their own arguments at an ever increasing volume. Still, these were not shortcomings unique to antivaccination writing. Their opponents were guilty of the same excesses.³⁷

The sharp-penned English polemicist Alfred Milnes observed that the nineteenth-century debate had produced “a double history to vaccination.” To mainstream medical leaders, the introduction of vaccination in 1798 was the greatest gift ever bestowed upon civilization by science. To the antivaccinationists, the record of vaccination was a “history of failures.”³⁸

The historical debate was really a quarrel about the efficacy of vaccination. Did the practice really deserve credit for causing the sharp decline of smallpox in the West during the first thirty years after its introduction? To antivaccinationists, much of that credit belonged not to the adoption of a new medical practice, vaccination, but to the banning of an old one, inoculation. Inoculation (using actual smallpox virus) had once enjoyed the broad support of the medical profession, notwithstanding the serious risk that a person inoculated with smallpox would infect others. With the arrival of vaccination, the profession discredited inoculation. The abrupt cessation of that perverse practice, antivaccinationists argued, was one key factor in the declining incidence of smallpox. The others were stricter isolation of smallpox patients, rising standards of cleanliness, and the large-scale sanitation projects introduced in European and American cities. Antivaccinationists believed smallpox to be preeminently a “filth disease.” By diverting public attention and government resources from sanitary measures, they argued, the “vaccine nostrum” had been “instrumental in perpetuating the very disease it is supposed to prevent.”³⁹

Both sides drew upon the discipline of statistics to make their cases. Defenders of vaccination marshaled hospital data to show that unvaccinated individuals were far more vulnerable to smallpox than the vaccinated. Antivaccinationists in England and America accused their opponents of obtaining their data from biased sources (hospitals) and of missing the data’s true significance. “Of course the death-rate is greater among the unvaccinated,” said Hodge, building upon an argument made by Wallace. After all, who were the unvaccinated? The poor: ill fed, ill housed, ill clothed, and, consequently, just plain ill. The political solution to smallpox was broad-based structural reform to improve the lives of the laboring poor. “It should require no argument to convince a physician that people who live in sanitary dwellings, on clean streets, and who eat wholesome food, drink clean water and breathe pure air are in a better position to resist diseases, small-pox included, than are other people living under opposite conditions.”⁴⁰

Statisticians love an army. England’s Wallace built much of his case against vaccination in 1898 by citing the incidence of smallpox among the well-vaccinated troops of the British army. American antivaccinationists updated the argument for their own national context, citing the hundreds of smallpox deaths among U.S. soldiers in the Philippines, despite the boast of one Army surgeon that vaccination and revaccination “went on as regularly as the drills at any army post.” American antivaccinationists also Americanized the Leicester argument. Wallace (among other English polemicists) had made much of the fact that in the antivaccination stronghold of Leicester, where health officials emphasized sanitation, the citizens suffered far less smallpox per capita than in “well-vaccinated Birmingham.” The American Leicester was Cleveland, where Friedrich’s wholesale disinfection campaign in 1901 had apparently wiped out a smallpox epidemic. The antivaccinationists tended to leave out the inconvenient fact that smallpox soon returned to Cleveland, killing hundreds of unvaccinated citizens.⁴¹

Antivaccinationists everywhere had the greatest impact when their arguments resonated with pressing public concerns. In turn-of-the-century America, the “noisy storm” ultimately had less to do with vital statistics than vital issues. The antivaccinationists spoke to three of the Progressive Era’s core public concerns: antimonopoly, child protection, and the uncertain meaning of liberty in a modern, urban-industrial society.

The turn of the century was the heyday of federal trust-busting prosecutions and muckraking exposés of the corporate “octopuses” that dominated vital industries such as the railroads, steel, oil, and sugar refining. Antimonopoly and an acute awareness of the role of business interests in corrupting politics at every level were among the most widely resonant reform issues of the era. The antivaccinationists tapped into the pervasive antimonopoly resentments of their day.⁴²

Beneath the aura of public service surrounding vaccination policy, charged the antivaccinationists, lay an unholy conspiracy of self-dealing health officials, profit-seeking vaccine makers, and regular physicians bent on monopoly: the “cowpox syndicate.” “Vaccination yields fees to lymph-peddlers and baby-slashers,” declared the Belgian-born American physician Felix Oswald in his 1901 book, Vaccination A Crime. Who could deny the interest of vaccine makers in a policy that generated artificial demand for their product? The interests of private physicians were not much more subtle. During epidemics, many local governments still contracted with private physicians to vaccinate the public. Porter F. Cope of Philadelphia, a banker’s son and champion of “medical freedom,” estimated the total salaries paid to American public health officials at $14 million. Throw in the $20 million invested in vaccine farms (again, according to antivaccinationists), and compulsory vaccination constituted a substantial interest. “As long as the golden eggs of that goose can be squeezed out by proper manipulation,” wrote Oswald, “Dr. Edward Jenner will continue to be classed with the chief benefactors of the human race.”⁴³

The profit-seeking of the “vaccine trust,” antivaccinationists argued, was a natural result of the regular physicians’ place-seeking campaign for a “medical monopoly.” The prospect of fees was probably far less important to the regulars than the government imprimatur conferred by legislatures and health boards upon vaccination—a measure closely identified with the mainstream physicians’ struggle for authority. The return of medical licensing troubled Americans who had nothing personally at stake in the matter. “I don’t know that I cared much about these osteopaths,” Mark Twain testified before the New York legislature, “until I heard you were going to drive them out of the State; but since I heard this I haven’t been able to sleep.” For William James, the licensure problem ran deeper still. The power to license doctors was the power to grant a monopoly over belief itself.⁴⁴

The distinguished Harvard psychologist (and older brother of Henry James) testified in March 1898 before a “tremendous throng of men and women” at the Massachusetts State House. The legislature’s committee on public health was holding hearings on a bill that would make it a criminal offense to practice medicine without being certified by a state medical board. As everyone understood, the state exam would test for knowledge of allopathic medicine. The bill’s framers touted it as “a blow at charlatanry—at medical quacks.” The crowd of spiritualists, Christian Scientists, mind curers, and antivaccinationists in the room understood that meant them. “Ostensibly an act to protect the community from malpractice,” said William Lloyd Garrison, Jr., “this is really meant to secure the monopoly of treating a disease to those who bear the credentials of a recognized school.”⁴⁵

James agreed. His quarrel with the bill reflected a set of ideas about the contingency of truth that he would later develop in his famous lectures that became The Varieties of Religious Experience (1901–2) and Pragmatism (1907). He noted that of the therapeutic methods presently in good repute, many had arisen from outside the regular medical profession. Successful treatments “appealed to experience for their credentials”—not to some state board. In an age of medical hubris, the professor asked for some professional humility. “The whole face of medicine changes unexpectedly from one generation to another in consequence of widening experience; and as we look back with a mixture of amusement and horror at the practice of our grandfathers, so we cannot be sure how large a portion of our present practice will awaken similar feelings in our posterity.” To the lawmakers he warned, “You dare not convert the laws of this Commonwealth into obstacles to the acquisition of truth.” The committee voted unanimously to reject the bill.⁴⁶

Few antivaccinationists were as open-minded as William James. But like him, the antivaccinationists who railed against medical monopoly saw licensure as a threat to personal beliefs and to scientific progress. Three years later, in April 1901, the Massachusetts General Court debated another medical licensing bill. This time, Immanuel Pfeiffer testified. Though himself a registered physician, Pfeiffer demanded an amendment that would prevent the state from interfering with the practice of “any cosmopath, clairvoyant, hypnotist, magnetic healer, mind curist, masseur, osteopath or Christian Scientist.” The lawmakers assented—but only so long as no such healer held himself out as a bona fide “practitioner of medicine.”⁴⁷

Antivaccinationism also spoke to the era’s heightened social concern for children. Twelve-year-olds tending dangerous machines in textile mills, little boys playing unsupervised in city streets, fourteen-year-old delinquents tried as if they were grown men in municipal police courts: these once familiar sights became unthinkable in a relatively few short years around the century’s turn. Infant and child mortality emerged as major social issues, with reformers pushing for better maternal and infant health care. Even as health officials promoted vaccination as a boon to childhood, antivaccinationists reached out to parents with their message that mandatory childhood vaccinations endangered the young, a modern-day reprise of Herod’s “Slaughter of the Innocents.” “There is a great cry of ‘Save the children,’” said Harry Bradford of Kensington, Maryland. “Let us begin by stopping the infliction of compulsory disease on the defenseless.”⁴⁸

The vaccine safety issue was always the most politically promising of the antivaccinationists’ arguments. Even the staunchest defenders of vaccination had to concede, as did Dr. William Welch of Philadelphia Municipal Hospital, “this measure is not entirely devoid of some danger.” The appalling record of American-made vaccines during the 1898–1903 epidemics lent the issue a new urgency. Vaccine safety concerned everyone, especially parents. In most communities, children were the segment of the population most vulnerable to compulsory vaccination and thus to whatever dangers attended the procedure. Many antivaccination texts featured photographs of children—deformed, disabled, or lying dead in their coffins—identified by their captions as “Victims of Vaccination.”⁴⁹

The finest American example of the victims-of-vaccination genre was Lora Little’s 1906 book, Crimes of the Cowpox Ring: Some Moving Pictures Thrown on the Dead Wall of Official Silence. The culmination of Little’s work as editor of The Liberator, the book delivered on the muckraking promise of its title. Little was the Ida Tarbell of the antivaccination movement, a dogged reporter driven by a powerful vision of the injustices committed by business interests in collusion with corrupt or feckless state governments. Little drew upon the most effective tactics of the contemporary muckraking genre. Hers was a journalism of exposure, built from interviews, affidavits, and the public record, and written in the sensational style that made Lincoln Steffens a household name. And like thousands of muckraking pieces that appeared in American magazines between 1900 and World War I, Little’s book narrated a clash of “the people” against organized economic interests through affecting portraits of individuals. With its short profiles of 336 “victims” of vaccination, most of them fatal, Crimes of the Cowpox Ring was not just an indictment of vaccination and its perpetrators. The book was a compendium of pain and loss. The most moving story in it was Little’s own.⁵⁰

Born in 1856, in a log cabin in the Minnesota Territory, Lora Little had worked as a seamstress, teacher, printer, and homemaker. In Crimes of the Cowpox Ring, she described her painful decision to allow her only child, seven-year-old Kenneth, to be vaccinated in 1895 so he could attend public school in Yonkers, New York. “He must go to school, and he could not go to school until he was vaccinated,” she recalled. “Here was a risk. Children had died from vaccination. Why subject my only darling to this thing?” But all the other children were getting vaccinated. “He needed the association that school life afforded. If I were to keep him at home and teach him myself, and he miss the common lot, and be marked as an exception, perhaps as queer, with a freakish mother who would not let him be vaccinated—how would all this affect his life?” It was a dilemma shared by countless mothers and fathers. Little feared not only the loss of the privilege of a public education but social ostracism, for her child and herself. Ultimately, she consented. Kenneth was vaccinated. Soon after, he suffered an attack of “catarrh of severe and stubborn kind,” followed by measles, and then diphtheria “without known exposure.” It was the diphtheria that killed him. Though she could never prove it, Little was convinced the vaccination was to blame. “My child was as really torn from me by the vaccinator, as tho he had died the day his arm was punctured.” Three years later, Little was living with her husband, a civil engineer, in Minneapolis, speaking out against the local school board’s vaccination rule and criticizing the Army’s system of vaccination.⁵¹

In Crimes, Little argued that vaccination persisted, in the face of great opposition, because it served the economic interests of its “agents and producers.” The “cowpox ring” had always been willing to face down the statistical evidence that vaccination was no preventive of smallpox. But they responded with a “conspiracy of silence” to the “other side of the statistical question, the ruin wrought by vaccine virus.” This silence was the ring’s “last and most impregnable stronghold.”⁵²

She began collecting cases on January 1, 1902, culling newspapers and conducting interviews with “the afflicted” or a surviving parent or relative. Even though she was unable to investigate all of the reports and rumors she received, she went to press with the stories of 336 confirmed (to her satisfaction) victims of vaccination from across the United States. She provided names, dates, and locations for each case (including many verifiable in surviving local newspapers). Most of the accidents had happened during the epidemics of 1898–1903. The “victims” suffered postvaccination complications including anemia, blindness, blood poisoning, cancer, diphtheria, erysipelas, impetigo, lockjaw, meningitis, and tuberculosis.⁵³

There is no way to confirm that vaccination caused all of this hurt and heartache. It is possible to dismiss Little’s project as an exercise in overly simplistic post hoc reasoning: the children died following vaccination, therefore vaccination must have been the cause. Still, many of Little’s “victims” had suffered complications acknowledged by medical scientists as possible, if rare, results of vaccination, whether caused by impure vaccine or secondary infection of the vaccine wound.

But Lora Little’s book is most powerful at its least rational, as a dutifully compiled archive of belief and grief—not just hers, but of the hundreds of parents who told her their sad stories. “91. Death. Henry C., son of H.C. Petterson, St. Paul. Vaccinated Aug. 1901 to go to school. Three vaccinations in succession were necessary to get a take. Child then took sick, and was never able to go to school. Was not confined to bed, but gradually grew weaker til he died, Nov. 2, 1901. He was a fat, healthy little fellow all his life until vaccinated. The sore that formed on his arm never healed. Three doctors tried to save his life.” Little patiently recorded hundreds of such stories. Neither doctors nor city health officials nor his boss could persuade railroad conductor Homer E. Sturdevant of Buffalo that his daughter’s death from blood poisoning in May 1902 was not caused by the vaccine that had been scraped into her arm thirteen days earlier. Sturdevant paid to have the cause of death, as he saw it, inscribed on Lucille’s tombstone in Forest Lawn Cemetery: “Lucille Sturdevant died May 28, 1902, aged 6 years. Vaccination poisoning at School 35.”⁵⁴

Like its antimonopoly and child protection arguments, the distinctive libertarian thrust of American antivaccinationism engaged an area of broad public concern. A robust language of personal liberty, anchored in the Anglo-American common law tradition and the state and federal constitutions, lay at the heart of antivaccinationist ideology. “Every man’s house is his castle,” wrote the San Diego spiritualist James Martin Peebles in 1900, “and upon the constitutional grounds of personal liberty, no vaccination doctor, lancet in one hand and calf-pox poison in the other, has a legal or moral right to enter the sacred precincts of a healthy home and scar a child’s body for life.” The passage illustrates the rhetorical range of these unlikely radicals: their righteous mixture of religion and constitutionalism, masculine prerogative and republican domesticity, a faith in clean living and a suspicion of state medicine, old-fashioned populism and a new libertarianism that might have startled old John Stuart Mill himself.⁵⁵

The American antivaccinationists were personal liberty fundamentalists. They quoted chapter and verse from Mill’s On Liberty (1859): “Over himself, over his own body and mind, the individual is sovereign.” They reached past Mill to Sir William Blackstone, the eighteenth-century commentator on the common law whose Commentaries on the Laws of England (1765–69) formed part of the ideological bedrock of the American Revolution. Blackstone wrote (as Pitcairn reminded his early twentieth-century audiences), “The right of personal security consists in a person’s legal and uninterrupted enjoyment of his life, his limbs, his body, his health and his reputation.” So precious were the personal rights to life and limb, that the laws of England and America pardoned “even homicide, if committed in defense of them.” Compulsory vaccination—the only medical procedure required by the state—trampled upon these elemental liberties. The antivaccinationists found support for their beliefs in the fundamental law of their nation. As the New England freethinker George E. Macdonald commented, “The law under which [the vaccinators] operate should carry a clause providing that all sections of the Constitution guaranteeing the security of person or property are hereby repealed.”⁵⁶

From alternative medicine, antivaccinationists learned that the key to health was to preserve the body’s “integrity”—the soundness of its constitution, the purity of its blood. Vaccinators invaded “the integrity of the healthy body,” said Dr. Hodge, penetrating the skin and corrupting the blood. How could introducing pus matter from a diseased cow into a healthy human body possibly protect a person from disease? “The right of every man to his own body, to keep it clean and pure and uncontaminated by poison, the right of every parent to guard the life and health of his children, are among the most sacred of human rights!” declared the New York–based Anti-Vaccination News and Sanatorian. Lora Little agreed. “It is because vaccination robs us of our physical integrity, contaminates and destroys our bodies,” she wrote, “that we object to it.”⁵⁷

The vaccination question always circled back to freedom of belief. Chairman Durgin dared the Boston antivaccinationists to test their “belief ” through a public “exhibition of faith, by exposure to smallpox without vaccination.” American antivaccinationists proposed their own test of the state’s vaccination “rite.” “Let those, then, who have faith in the rite get poxed just as often as they choose to, and be satisfied with their own ‘protection,’ ” said J. W. Hodge. “Being themselves ‘secure’ they can have no valid reason for inflicting the loathsome rite upon the unwilling and unbelieving.” Public health officials countered that the purpose of universal vaccination was to render an entire community invulnerable to infection. Still, even some of the most ardent believers in compulsion, such as The New York Times, had to concede there was “a shadow of logic” in arguments like Hodge’s. The Times cited the “natural inclination” of the enlightened public not to see “fellow-mortals cut off untimely by a preventable disease.” Beyond altruism, another motive justified compulsion. “[T]he presence of smallpox in any community endangers business as well as life,” said the Times.⁵⁸

The antivaccinationists’ libertarian radicalism seems utterly out of place in the Progressive Era. Their uncompromising defense of personal liberty sounds almost quaint next to the progressive intellectuals’ brilliant assault upon laissez-faire and classical liberal individualism. As the forces of industrial capitalism and urbanization fashioned a more connected and self-consciously interdependent society around the turn of the century, leading progressives—including Jane Addams, Louis Brandeis, and John Dewey—called for a new liberalism that would value social interests above individual autonomy. Under modern social conditions, the progressives argued, a new concept of liberty was required. Liberty defined as “freedom from” government interference (the right to be left alone) may have made sense in the agrarian world of Jefferson and Jackson. But in Roosevelt’s United States—an industrial nation of cosmopolitan cities, powerful corporations, and stark inequalities between rich and poor—the old liberty fell short. “Real liberty,” redefined as the individual citizen’s capacity to participate fully in the economy and polity, required purposeful government intervention. In this new self-consciously “social” age in Europe and the United States—with its movements for social Christianity, social democracy, and socialized law—the antivaccinationists carried the torch for individualism.⁵⁹

But their individualism was not simply a quaint artifact of America’s agrarian past. No less than the progressives’ concept of social interdependence, the antivaccinationists’ individualism bore the impress of its historical moment. The antivaccinationists fashioned their defense of a robust conception of personal liberty—bodily integrity, freedom of belief, the right not to participate in a state-sanctioned rite—in response to real changes in American society, culture, and politics. Like Mill, writing in Victorian England, the turn-of-the-century American antivaccinationists wrote at a time when their government was in fact reaching more deeply than ever before into their nation’s economy and society. They challenged the expansion of the American state at the very point where state power penetrated the skin.

Was antivaccinationism antiprogressive? Most defenders of compulsory vaccination thought so. To them, antivaccinationism was founded in misguided individualism and willful ignorance. Antivaccinationists countered that theirs was the true cause of progress. Vaccination, they pointed out, originated as a folk remedy—“the tradition of the milk-maids”—promoted by Jenner back when physicians still routinely bled their patients. The medical profession’s blind adherence to the Jennerian rite had diverted resources from sanitation and hygiene, the real scientific advances of the nineteenth century. The genuine American progressives were men like Tom Johnson and Martin Friedrich of Cleveland, who stood up to the cowpox trust and abandoned the dangerous and unpopular policy of vaccination. Benjamin O. Flower, founder of the reform magazine Arena, praised Cleveland’s action as an example of “the best progressive thought of the age.”⁶⁰

To some antivaccinationists, the progressiveness of their cause lay in their fundamental belief in the right of ordinary citizens in a democracy to participate in scientific deliberation and medical decision making. Antivaccinationists pointed out that the demand for compulsory vaccination laws had not come from the general public but from health officials and medical societies. Which was why compulsory vaccination so often joined the regular physician’s lancet to the policeman’s nightstick.⁶¹

Lora Little—the movement’s most democratic voice—was a keen student of the burgeoning American archive of popular resistance to compulsory vaccination. Violent imagery pervaded antivaccination texts: the frontispiece of Clymer’s book pictured a police officer, armed with a copy of the Vaccination Law, seizing a baby from its mother’s lap while the angel of death waited with open arms. Lora Little found material enough in the public record. “It is for this ghoulish work that churches, theaters, business blocks, and whole neighborhoods have been raided;” she wrote, “ocean liners’ populations cowpoxed; a shipload of negro laborers driven off the vessel with clubs at Panama, and poisoned in spite of resistance; arrests have been made and innocent persons cast into jail and there jabbed with the virus; and most atrocious of all, the annual army of babies graduating from nursery into school are required to bare their little arms and receive this injection of disease.” For middle-class antivaccinationists, the plight of working-class vaccine refusers, “pinioned by police officers and vaccinated,” revealed the “tyranny” and “despotism” of the entire system of state medicine. “If this can be done and upheld by the legal machinery of this country, what next have we to expect?” asked Clymer. “Why not chase people and circumcise them? It surely would be a good preventative against certain kinds of disease. Why not catch the people and give each a compulsory bath?”⁶²

It may sound absurd to contemporary ears, but antivaccinationists were in fact more conscious than were most progressives of the coercive potential of the new interventionist state. In a few short years, American eugenicists would be persuading state legislatures to enact compulsory sterilization laws for the “feeble-minded,” epileptics, and other people deemed “unfit” to reproduce. The eugenicists’ chief legal precedent for their measures would be compulsory vaccination.⁶³

For Lora Little, though, antivaccinationism was ultimately more than a struggle for personal liberty—though it most certainly was that. It was also a progressive movement for the democratization of health. “A first step in health culture,” she called it. She envisioned the struggle against compulsory vaccination leading to a broader, popular movement for health, a grassroots culture alternative to, and when necessary in opposition to, the official, top-down health movement of the state.⁶⁴

The most ambitious American antivaccinationists tried to use the political system to abolish compulsory vaccination. The decentralized structure of the American political system made their task fundamentally different from that of their counterparts in England. Although the English Vaccination Acts were administered locally, they were the legislative product of a single national body, Parliament. That focused reform efforts. A half century of protest and lobbying culminated in the hearings before the Royal Commission on Vaccination, which in turn persuaded Parliament to make an exception for conscientious objectors. The U.S. Congress had no such power. When public health officials and medical societies sought authority to enforce vaccination on unwilling members of the public, they necessarily turned to local boards of health and education, city councils, county courts, and, ultimately, to state legislatures. The antivaccinationists had to make their case for abolishing compulsion to the same bodies.

Antivaccinationists used every political weapon available. They flooded legislatures with petitions. They litigated. They turned out the vote. Although the “tyrannical” boards of health were normally appointive bodies, insulated from democratic pressures, local school boards were typically elective. During the epidemics of 1898–1903, a number of communities made their school board elections turn upon the candidates’ positions on the vaccination question. The voters of Norwich, Connecticut, turned their board of education into a bulwark against compulsion.⁶⁵

But in the antivaccination fight, the big game was a state law banning compulsory vaccination. From Massachusetts to California, several state legislatures debated such measures around the turn of the century. In the end, the antivaccinationists won their biggest victory in the nation’s youngest state.

In 1900, the predominantly Mormon state of Utah was just four years old. With smallpox threatening in the mountain states, Utah became a battleground over compulsory vaccination. That year, three thousand cases of smallpox were reported to the state board of health; twenty-six people had died. The scale of the epidemic alarmed health officials, but its relative mildness (with a case-fatality rate of less than 1 percent) sharpened popular sentiment against compulsion. The new mild type variola virus continued to spread dissension as efficiently as it did disease.⁶⁶

In January, when Salt Lake City boards of health and education moved to compel vaccination of public schoolchildren, a de facto schools strike erupted. Eight thousand of the city’s schoolchildren failed to present “the scars of vaccination entitling them to their seats.” In April, one Salt Lake father, John E. Cox, won a court order compelling the school board to admit his unvaccinated daughter; on appeal, the Utah Supreme Court upheld the board’s action as a “reasonable regulation in the aid of the public health.” The Salt Lake Medical Society and the state and local boards of health came to the defense of compulsion. Meanwhile, meetings of the Utah Anti-Compulsory Vaccination League in Salt Lake City attracted crowds of two hundred people or more.⁶⁷

Like many other leagues that first surfaced during the epidemics of 1898–1903, the Utah Anti-Compulsory Vaccination League formed in response to a new effort to enforce vaccination. Unlike the long-standing antivaccination societies (the sort that produced journals and books), these new leagues were not necessarily led by irregular doctors eager to drive back state medicine in general. Instead, these more transient political organizations tended to be single-issue groups with a much broader base of activated people. They borrowed rhetoric and ideas from the antivaccination literature but in the interest of their own immediate fight. These groups could be stunningly effective.

The Utah league left a fuller impression on the historical record than most. The Salt Lake Herald covered its meetings and reported the names of the league’s leaders, speakers, and members assigned to draft resolutions—a cross-section of nineteen of the most involved members. All of these activists, who came to meetings in the Fourteenth Ward from areas across the city, were white (hardly surprising for Salt Lake City in 1900). And most were male. In economic status, the group ranged more widely. Lucretia Kimball, a banker’s wife, served on the resolutions committee with publisher J. H. Parry, bookkeeper D. H. Tatham, wrapper-of-dry-goods H. J. Walk, and hardware salesman James M. Barlow. The first elected officers of the league included President Thomas Hull, an office manager; Vice President Scott Anderson, a bill poster; Secretary C. S. Booth, a bookkeeper; and Treasurer Bernard H. Schettler, a banker. More than half (ten) of the activists had been born outside the United States: a striking number (seven) were natives of Great Britain, two hailed from Sweden, and one from Germany—all countries where compulsory vaccination of infants was national policy. But the nine others were native-born Americans, the majority from Utah. All in all, the group seems to have been a bastion of white, male, taxpaying respectability—neither a working-class “mob” nor a “coterie” of “crank” doctors.⁶⁸

The 1900 Census reveals the most important commonality among these members. All but one was a parent of one or more schoolchildren. (The other, attorney LeGrande Young, had children who were already grown.) Most of the members had large families. H. J. Walk had nine children living at home, including three at school and three school-bound. Of the six children in Bernard Schettler’s household, four were still in school. The Utah Anti-Compulsory Vaccination League was an organization of local taxpaying parents with a strong sense of ownership in the city’s schools.

Outside critics, including The Denver Post, decried the surging antivaccination movement in Utah as a Mormon phenomenon—a charge local newspapers such as the Ogden Standard-Examiner roundly denied. Neither census records nor local newspaper accounts identified the religious composition of the league, though its membership certainly matched the profile of a predominantly Mormon organization. Church leaders were in fact divided on the issue. Although Mormon teachings had nothing in particular to say about vaccination, decades of political conflict with the U.S. government prepared Utah Mormons to view with distrust any use of government authority to impose scientific beliefs or behavioral mandates upon the public without democratic deliberation. Distinctly Mormon voices—such as Charles W. Penrose’s Deseret Evening News, an organ of the Church of Jesus Christ of Latter-day Saints—applauded the public opposition to compulsory vaccination. Still, religious imagery and language is notably absent from the public record of the controversy. The Deseret Evening News said the people of Utah were open to persuasion on the vaccination question: “It is the policy of force which arouses the indignity of the great bulk of the citizens.” The relative homogeneity of the Utah citizenry may help explain the exceptionally strong support there for antivaccinationism. But there is little evidence to suggest that most Mormons viewed antivaccination as a Mormon cause.⁶⁹

The goals and rhetoric of the Utah Anti-Compulsory Vaccination League reflected its broad social base. Its purpose was not to debate the merits of vaccination, but to prevent the Salt Lake City Board of Health from compelling healthy schoolchildren—theirhealthy schoolchildren—to submit to the procedure. Beyond that, the organization urged the legislature to “keep from the statutes anything that savors of compulsory vaccination.” The league made its case in the constitutional keywords of American public life: popular sovereignty, separation of powers, and the rule of law. “The highest medical authority is divided on the question of vaccination,” one resolution noted, “many taking the ground that it is always dangerous, and sometimes productive of fatal results.” To date, the legislature had faithfully “expressed the sentiment of the people by refusing to pass a compulsory vaccination law.” The health board’s action—“to compel a medical operation not authorized by law” and not justified by the “condition of the public health”—threatened to “usurp the authority of the people.” The people should resist by “an emphatic protest.” And that the people delivered.⁷⁰

The climax of Utah’s “vaccination war” came in January 1901, as the legislature debated a bill introduced by Rep. William McMillan, a Mormon bishop from Salt Lake City. The McMillan bill made it unlawful for any public board to compel the vaccination of any “person of any age” or to make vaccination “a condition precedent to the attendance at any public or private school in the state of Utah, either as pupil or as teacher.” The bill was the most controversial piece of legislation in the state’s short life. While the hearings went on, the Salt Lake Board of Education passed a resolution, on a slim majority of 5 to 4, holding that it was “not the duty” of school officials and teachers to enforce the Utah Board of Health’s vaccination order. At the insistence of Dr. T. B. Beatty, secretary of the state board, those five members of the local school board were arrested. The Utah Anti-Compulsory Vaccination League held a mass meeting, adopting “strong resolutions” in favor of the McMillan bill. Inside the statehouse, the defenders of compulsion seemed determined to confirm their critics’ worst charges about them. Dr. Beatty testified that the critics of vaccination did not understand science. Dr. Alexander MacLean offered to expose his own vaccinated son to “the most virulent forms of smallpox” in the city pesthouse, if a critic of vaccination agreed to “subject his unvaccinated child to a similar danger.”⁷¹

On January 31, 1901, the Utah legislature passed the McMillan bill by a wide margin: 37 to 6 in the House, 13 to 5 in the Senate. Governor Heber M. Wells vetoed the bill. “To place among our statutes such a bill would be a step backwards, which will be disastrous,” he cautioned. Political credibility seemed to loom as large in his mind as public health. He had received dispatches from nearly every American governor, standing “almost as a unit for vaccination.” If the law stood, Utah would be one of the few states that forbade local boards of health to order vaccination to stamp out smallpox. Both houses of the legislature voted to override Wells’s veto. Newspapers and medical journals across America reported with disbelief the anti-vaccinationists’ triumph. The Medical Standard denounced the law as a “pronunciamento”—a Mormon coup d’état. “It is an unpleasant thing to suggest at the present juncture and we hope our friends in Utah may be spared,” the journal warned, “but it usually happens that chickens of this kind ‘come home to roost.’ ”⁷²

The following year, Immanuel Pfeiffer and the Massachusetts antivaccinationists put several bills before the General Court’s joint committee on public health. All of the bills aimed to repeal the state’s compulsory vaccination laws. All were killed in committee, an outcome the activists may well have anticipated. Antivaccination bills were a more common event in Massachusetts than in Utah. The packed hearings on Beacon Hill had the aspect of ritualized performances: public bouts between old foes who knew each other’s arguments well. But that did not lessen the public drama.

Day after day, committee members and the assembled public heard speeches by health officials (including Chairman Durgin and Dr. McCollom) and doctors from both sides of the vaccination question. Dr. Pfeiffer testified that the board of health’s vaccination stations were places unfit to hold cattle. Dr. Caroline E. Hastings of Boston claimed smallpox tended to increase in proportion to the extent of vaccination in a community. Jessica L. Henderson, a mother from suburban Wayland, vowed she would go to jail before allowing her children or herself to be vaccinated. On the other side, Durgin and his peers paid the antivaccinationists the compliment of taking their campaign seriously. The defenders of compulsion assembled a parade of luminaries from the fields of bacteriology, medicine, and public health to testify against the bills—including Harvard professor of pathology William T. Councilman, Massachusetts Medical Society president Francis Draper, MIT professor William T. Sedgwick, and Azel Ames (who told the committee of his recent experience fighting smallpox in Puerto Rico).⁷³

The antivaccinationists saved their most powerful witnesses for the final day. The bodies of children—present or remembered—were placed, once again, into evidence. The petitioners presented to the committee one “little child whose head was almost one mass of sores.” Mrs. Smith of Winthrop introduced her son Benjamin, who she said had lost the use of his arm following vaccination. Fred W. Hatch of Dorchester said his daughter had suffered a severe case of eczema following vaccination. With the Camden tetanus cases still in the news, Mrs. Caswell of Cambridge told the committee of losing her five-year-old daughter Annie to lockjaw. The death certificate listed tetanus as the cause of death, with vaccination as the contributing cause.⁷⁴

The antivaccinationists failed to move the committee. At the end of February, the committee adversely reported all of the antivaccination bills, effectively killing them. The following month, the committee favorably reported a new vaccination bill, introduced by Chairman Durgin. The Durgin bill, which was soon enacted by the General Court, made the exemption for “unfit” children from the school requirement more stringent. It required that a physician actually examine the child before signing a certificate. The antivaccinationists had tried to squeeze something for their side from the Durgin bill, submitting an amendment that would extend the health exemption to adults as well as children. But lawmakers rejected it.⁷⁵

Despite their string of defeats on Beacon Hill, the antivaccinationists had succeeded in keeping the state lawmakers and the public focused on their cause through much of the winter of 1902. The State House debate provided the high political drama of a larger struggle over vaccination that would continue in the streets, the schools, and, increasingly, the courts.

During the next three years, American antivaccinationists won two more legislative victories. In Minnesota, in 1903, Lora Little and activists from Minneapolis and St. Paul placed an antivaccination bill before the state legislature. The bill made it unlawful for any public board to compel the vaccination of any child or make vaccination “a condition precedent to the school attendance.” Dr. Henry M. Bracken, secretary of the state board of health, recalled, “At first this bill hardly seemed worthy of notice on the part of sanitarians.” To his dismay, the House passed the bill. When doctors mobilized in opposition, the Senate amended the bill, adding a clause that allowed boards to require vaccination in the event of an actual smallpox epidemic. Little denounced the amended law as “a disgusting piece of legislative folly.” But health authorities would later complain that the law was all too effective. In 1906, AMA president William J. Mayo, a Minnesota physician, charged that his state’s “inability to enforce vaccination” had unleashed a smallpox epidemic, infecting 28,000 of the state’s citizens—“all due to a small but vociferous band of antivaccination agitators.”⁷⁶

In California, a crowd of three hundred assembled in Berkeley in 1904 to form an Anti-Compulsory Vaccination Society and protest the “unjust” school vaccination law. The group’s leaders included the president of the local board of education and a local minister. The movement gained traction. In the winter of 1905, the state legislature passed a bill banning compulsory vaccination from the schools. Governor George C. Pardee, a physician, vetoed the bill on March 8, 1905. He cited the “vast preponderance of expert medical authority throughout the civilized world” that viewed vaccination as “the prime cause of the practical disappearance of smallpox.” Pardee insisted that the number of vaccination accidents was “infinitesimal” compared to the “millions of times that this beneficent procedure is practiced.” The legislature let Pardee’s veto stand. In the wake of this political defeat, antivaccinationists in Berkeley announced plans to open a private school, a separatist institution where students and teachers would not be required to show proof of vaccination in order to receive an education.⁷⁷

From Boston to Berkeley, the vaccination issue revealed tensions at the heart of American public life in the Progressive Era. The conflict pitted scientific authority against democracy, rising government social intervention against an uncompromising individualism, an increasing paternalism in public policy against the rights of parents themselves. Striking communities across the United States with a disease often perplexingly mild, the epidemics brought old debates to a head and provided both sides with new fuel for argument.

For the antivaccinationists, the epidemics provided a welter of fresh evidence. They cited the deaths from smallpox of hundreds of previously vaccinated U.S. soldiers in the Philippines. Martin Friedrich’s Cleveland experiment replaced the antivaccination stronghold of Leicester, England, as the American antivaccinationists’ favorite exhibit in their case for a sanitary approach to smallpox. To the Rivalta, Italy, syphilis outbreak and other Old World examples of vaccination gone awry, 1901 brought Camden—an appalling new American monument to the “victims of vaccination.” The violent clashes between virus squads and working-class populations in innumerable local places provided a powerful public record of the czarist “tyranny” inflicted by public health boards upon the public they were meant to serve.

Lora Little was one of the few American antivaccinationist writers whose vision of the question extended to racial politics. Seemingly alone among her peers, she saw the connection between the bludgeoning of Martinican laborers in the Panama Canal Zone and physical force vaccination in American tenement districts. It was Little, the careful student of newspapers and medical journals, who protested the “brutal invasion” of an African American faith-healing church in Philadelphia by a vaccinating force. “It is time we had a Reconstructed North,” she declared. To Little, writing from her desk in Minneapolis, the routine violence that attended public health enforcement in so many African American neighborhoods showed how far the nation had fallen from “the true idea of freedom and equality before the law which has been the professed ideal of our government.” For Little, at least, the constitutional problem of compulsory vaccination was not just the harm it did to liberty; in practice, the measures also trampled the promise of equal protection of the laws.⁷⁸

For health officials, too, the epidemics provided a fund of new data and experience. Some were moved to question the practicality of compulsion, convinced by the experience of those years that persuasion might be the better way to achieve their goal of a well-vaccinated community. But others were strengthened in their belief that ignorance was best met with force. From health departments and hospitals across the United States came the evidence: the unvaccinated suffered far worse than the well vaccinated. Before the Boston epidemic ended, in May 1903, 1,596 cases of smallpox were reported, with 270 deaths. A majority of the sufferers showed no evidence of previous vaccination. They died at twice the rate of vaccinated patients .⁷⁹

And so, to their nemeses the antivaccinationists, leading American public health officers and physicians threw down the gauntlet. The dares issued by men like Boston’s Samuel Durgin and Salt Lake City’s Alexander MacLean were born of medical certitude and frustration. To such men, the smallpox epidemics provided many stories of the proverbial chicken “coming home to roost,” as the trusted “fool-killer” smallpox stole the health and lives of a number of committed opponents of compulsory vaccination. In July 1902, The New York Times reported that the well-known Christian Scientist Putnam J. Ramsdell of Cambridge, Massachusetts, had “die[d] of the disease he defied.” In Charlotte, North Carolina, five vaccine refusers died of the disease later that year. In June 1903, on the very same day that the Minnesota legislature enacted the anticompulsion law he had championed, the Minneapolis antivaccinationist Charles Stevens died of smallpox at his home. “Providence seems to have been somewhat against the antivaccinationists,” smirked Secretary Bracken of the Minnesota Board of Health. The Times could barely contain itself when fifteen Dowieites fell ill at Zion City in August 1904. “Now that smallpox has broken out in ‘Zion,’ ” the paper declared, “there is likely to be an excellent, though rather dangerous, opportunity to see what can be done with a disease of that sort by the exercise of ‘faith.’ ”⁸⁰

But for America’s anti-antivaccinationists, no case of smallpox was sweeter than the one that nearly killed Immanuel Pfeiffer.

The manhunt lasted five days. Only later would the public learn the details of those tense hours. The interrogation of Pfeiffer’s clerk, who insisted the doctor was away in Philadelphia. The interview with the janitor of a Charlestown apartment house, who had seen the doctor, looking weak and accompanied by an unnamed woman, exit by the back door and enter a hack. The search for the hack and its driver, who had taken Pfeiffer and his “companion” (presumed, it appears from newspaper accounts, to be his mistress) to the offices of a certain Boston doctor. The doctor’s denial that he had seen Pfeiffer. The discovery that Pfeiffer and “the woman in question” had engaged another carriage bound for Bedford, the town twenty miles northwest of Boston where Pfeiffer’s wife, Olive, and their children lived on a dairy farm he rarely visited. The health officers’ race to Bedford. The rounding up of the local selectmen. The drive to the farmhouse, where a doctor examined Pfeiffer and declared him “in a very serious condition from a thoroughly developed case of smallpox.” The announcement, by the Boston Board of Health, that Dr. Pfeiffer “probably will not recover.”⁸¹

How many had been exposed to smallpox in the days between Pfeiffer’s disappearance and the arrival of the health officials at his Bedford bedside? No one knew. Bedford officials placed the Pfeiffer farm under quarantine, ordering all on the premises vaccinated. Learning that Pfeiffer’s two daughters had been to school since his arrival, officials ordered all the town’s pupils to get vaccinated or stay home. Boston authorities tracked down the two carriages in which Pfeiffer had traveled and disinfected them. All of the residents of the Charlestown apartment house were vaccinated.

To everyone’s surprise (except perhaps his own), Immanuel Pfeiffer’s famous constitution pulled him back from the brink of death, and he began his long recovery. The race for the moral high ground began even before his survival was assured. Durgin announced that several other physicians had visited Gallop’s Island that season, and, having previously been vaccinated, none had come down with smallpox. The Boston Globe dubbed Pfeiffer “a victim of his own zeal and bravado.” The Pfeiffers’ Bedford neighbors took no pity on the man one called an “old chump.” Medical authorities across the nation reminded their publics that the moment was larger than the man. They praised Durgin for his “wisdom and his scientific foresight” in orchestrating this “object lesson” for the American people. Meanwhile, the intended recipients of that lesson—the antivaccinationists—condemned Pfeiffer, too. Boston antivaccinationist B. F. Nichols could find no sympathy for any man “who recklessly exposed himself to contagion.”⁸²

As the days passed, the realization dawned (at least to some observers) that Pfeiffer and Durgin were a dangerous match. The episode showed how far a committed antivaccinationist and an equally determined vaccination advocate would go to make a point. The citizens of Bedford, stuck with a bill of $1,000 for containing the resulting emergency, recognized this better than anyone. Some called for lawsuits against both parties—Pfeiffer, for failing to notify the local authorities of his disease, and the City of Boston for the “inexcusable negligence” of its health authorities.⁸³

In the end, the people of Bedford dropped the matter and moved on. But they’d had a point. Both Durgin and Pfeiffer were true believers who had played Russian roulette with the public health. A jury of their peers, though, might have discerned a difference of culpability between the two men. Pfeiffer believed that vaccination was a sham and that a man of his constitution, psychic power, and cleanly habits was impervious to small-pox; he had, as The New York Times conceded, shown the “courage of his convictions,” however wrongheaded those convictions might have been. Durgin, a sworn government officer of the public health, had staged a public event whereby an unvaccinated man was exposed to smallpox; he had done so with full knowledge of the risks to that man and the general public. Pfeiffer may have been misguided. But Durgin was reckless.