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A 1901 smallpox epidemic, a charismatic quack, and the rise of anti-vax propaganda in Boston

An aggressive smallpox vaccination campaign had nearly contained the outbreak. Then Immanuel Pfeiffer came along.

Editorial cartoons depicting Dr. Immanuel Pfeiffer deliberately exposing himself to a smallpox patient and the aftermath, when he went to his family's farm.

THE SPECKLED MONSTER had returned to Boston.

Dr. Samuel Durgin remembered its last visit well. He had just been appointed to the Boston Board of Health in 1873, when smallpox haunted the city and took the lives of more than 1,000 of its residents. The death toll likely would have been higher if not for an effective vaccination campaign. But now it was May 1901, more than a quarter century later, and smallpox had come raging back.

Durgin had reason to be worried. In the months ahead, an estimated 3 people out of every 1,000 in the city of half a million would contract the disease, and nearly 1 in 5 Bostonians who caught it would die from it. The odds of infection were even worse for the city’s Black residents and immigrant families, many of whom lived in densely packed rooming houses where the airborne disease could spread easily through coughs and sneezes.

Durgin, a 61-year-old Civil War veteran, had been present at Appomattox Court House when Robert E. Lee and his army surrendered. Engaged in a fight with an invisible enemy, the health board chairman deployed his forces like a military commander and unleashed his most effective weapons — smallpox vaccines — to battle the contagion.


In the fall of 1901, Durgin mobilized a massive response to the smallpox epidemic that included free vaccinations at locations around the city. Under an 1855 state law that gave local health boards the power to force people to be inoculated, hundreds of doctors went door-to-door. Anyone who refused could face a 15-day jail sentence or $5 fine, the equivalent of roughly $160 today. Durgin wasn’t shy about employing heavy-handed tactics. He dispatched “virus squads” to rooming houses, where police officers pinned down occupants so that physicians could administer vaccines. One man received his vaccine, as well as stitches for a gash on his head left by a police officer’s club.


Even as his all-out campaign began to show results, Durgin believed that some of his fellow Bostonians were traitors to the cause. That antagonism would lead to one of the country’s earliest vaccine fights.

Boston Board of Health chairman Samuel Durgin, who led the vaccine push that ended the epidemic.

From the time smallpox inoculations were pioneered in Boston in 1721 by Dr. Zabdiel Boylston and preacher Cotton Mather — who first learned of the practice from a West African man named Onesimus whom he enslaved — they had proven controversial. Even by 1901, opposition remained stiff among an entrenched minority of Bostonians.

Anti-vaccination activists in Boston responded to mandatory inoculations with a brochure entitled “Vaccination Is the Curse of Childhood.” It falsely claimed that the vaccines caused smallpox instead of preventing it, and maintained that the only real way to prevent infection was “good drainage, good ventilation, pure water and healthy food.” Anti-vaccinationists, as they were called, branded compulsory vaccination an infringement on their civil rights. And they implored parents to write to a Beacon Street address to receive physician-signed certificates that indicated their children were “unfit subjects for vaccination,” and should be exempt from the state requirement to show proof of vaccination to attend public school.

By January 1902, more than 80 percent of the city’s 586,000 residents had been vaccinated, but that still didn’t appear to be enough to reach herd immunity. Durgin grew increasingly frustrated by the tens of thousands of unvaccinated Bostonians who allowed the epidemic to linger. The number of cases in Massachusetts had grown from around 100 in 1900 to 773 in 1901, with 97 deaths. The new year ahead held the threat of even more.


The smallpox outbreak had become an epidemic of the unvaccinated, with those not inoculated accounting for 9 out of every 10 cases in Boston’s so-called pesthouses. “I have no patience with those who say vaccination is useless and harmful,” Durgin told The Boston Post. “I wish the smallpox would get into their ranks instead of among innocent people.”

Exasperated by the anti-vaccination campaigners, Durgin made an unprecedented decision: He would call their collective bluff with a high-stakes dare to willingly expose themselves to smallpox.

“If there are among the adult and leading members of the antivaccinationists any who would like an opportunity to show the people their sincerity in what they profess,” he announced in The Boston Globe, “I will make arrangements by which that belief may be tested . . . by exposure to smallpox without vaccination.”

“I do not believe there is a man or woman among them who will volunteer to take an exposure to smallpox,” Durgin continued. He couldn’t have expected anyone to take him up on his offer. But he didn’t count on Dr. Immanuel Pfeiffer.

THE CITY’S LOUDEST anti-vaccination voice certainly had a healthy ego. Newspaper advertisements for Pfeiffer’s practice claimed he was “blessed with a natural healing power and peculiar magnetism, which has made him the most wonderful man in the world.” A shameless self-promoter with a luxurious beard and lush head of hair, he bragged of his ability to treat chronic diseases deemed incurable by “regular physicians”; he professed he could do it by the simple laying on of hands at his offices inside the Hotel Pelham at the corner of Tremont and Boylston streets.


A Danish immigrant, Pfeiffer believed that proper diet, exercise, and hygiene were the only reasonable means of warding off disease. He claimed “neither drugs nor prayer did a sick man any good.” He was also a proponent of hypnotism, who believed in the mind’s nearly supreme command over any functions of the body. His mental command over his digestion, he said, allowed him to endure a 21-day fast and survive on an occasional sip of water.

The contents of his 48-page monthly magazine, Our Home Rights, were as eclectic as the editor himself. It carried advertisements from magnetic healers and psychics and regular columns on astrology and women’s rights, as well as the evils of saloons, eating meat, and the American tax code. Pfeiffer saved his strongest opinions to rail against the smallpox vaccine. He assailed compulsory vaccinations as a violation of civil liberties and thought smallpox to be not nearly as contagious or debilitating as health officials claimed.

The pages of Our Home Rights reeked of misinformation about the vaccine. Not only did Pfeiffer claim that it offered no protection, but he considered vaccination more dangerous than smallpox itself, which he attributed to bad hygiene and intemperate habits. He told readers that the syphilitic hands of cow milkers were the original source of the vaccine material and claimed doctors were solely vaccinating patients to enrich themselves. He printed gory tales of Bostonians who suffered serious illness after receiving the vaccination, including a 2-year-old who died from septic abscesses on her shoulder and a young department store worker whose arm had to be amputated.


When Durgin issued his dare to the anti-vaccinationists, the world-class agitator pounced. Pfeiffer had received a smallpox vaccination as an infant more than 60 years earlier, but it had long since lost its potency and afforded no protection. Still, he approached the Board of Health chairman to ask for permission to inspect the smallpox hospital on Gallops Island in Boston Harbor so that he would be better able to diagnose cases.

Figuring he could use Pfeiffer’s desire for publicity to his own benefit, Durgin needed little prodding to make a one-time exception to the requirement that every visitor to the island hospital be inoculated. “Although not knowing you to have been recently vaccinated,” Durgin told Pfeiffer, “I shall keep my promise.”

ON JANUARY 23, 1902, the quarantine steamer Vigilant sliced its way through the icy chop as it carried Pfeiffer 6 miles out into Boston Harbor to Gallops Island. Inside the hospital, more than 100 smallpox sufferers bundled from chills, sweated from fevers, and sought any kind of relief from the oozing red spots that peppered their skin, eyelids, and the insides of their mouths. Dressed in a protective robe and a hat, the unvaccinated doctor came into close contact with the infected patients as he toured the hospital, even stopping to inhale the breath of the sickest among them.

After returning to the city, Pfeiffer boarded a crowded elevated train and attended a meeting at Tremont Temple, where he boasted of waving in friends’ faces a handkerchief “which I used freely while in contact with the smallpox cases.” While acting with the brazen disregard of someone believing himself immune to the contagion, Pfeiffer also thought it was Durgin, not he, who had just fallen into a trap.

“Now I say that Dr. Durgin is either a fool or a knave,” Pfeiffer wrote soon after his hospital visit in Our Home Rights. “If he believes in vaccination, he has laid himself criminally liable by permitting me to do as I did, and if he does not believe in vaccination he is also criminally liable in forcing the Compulsory Vaccination law.”

Durgin, meanwhile, had placed Pfeiffer under daily surveillance by Board of Health officers. Then, 11 days after Pfeiffer’s island sojourn — and right at the end of the incubation period for smallpox — the spotlight-seeking doctor vanished.

The news of Pfeiffer catching smallpox breaks.

Health officials launched a manhunt to locate Pfeiffer before he became a super-spreader. While the doctor’s office staff insisted that he was in Philadelphia — or maybe it was New York — he was instead spotted sneaking through the dark back alley of a Charlestown apartment building. Investigators determined that an ill Pfeiffer had visited a doctor on the night of Thursday, February 6, then hired a carriage to spirit him away to his family’s sprawling Colonial farmhouse in Bedford.

When public health officials descended upon the 60-acre farm, Pfeiffer’s son tried to keep them at bay. The authorities, however, charged up the stairs to find Pfeiffer covered in smallpox pustules and too ill to say more than a few words. The doctor had become the patient. The next day, a newspaper headline read: “Pfeiffer Has Smallpox. Anti-Vaccinationist May Not Live.”

Health officials posted three guards outside the farmhouse, quarantined Pfeiffer’s entire family, and, except for the doctor, vaccinated them against their initial wishes. Even the farm’s cows and chickens were forced to socially distance from humans for five weeks.

The popular and medical press savaged Pfeiffer. The Boston Herald called him “the victim of his own folly and professional vanity,” while the Philadelphia Medical Journal called his illness “poetic justice.” Even some anti-vaccinationists joined the condemnation. “Pfeiffer was a first class idiot in doing what he did,” said one.

The doctor’s Bedford neighbors didn’t have a much higher opinion of him either, since his daughters had continued to go to school and, for two days, neighbors had purchased milk from Pfeiffer’s farm while the smallpox patient was secretly in their midst. At one point, Bedford considered suing the City of Boston for letting the disease be imported into their town. “Sympathy for him is entirely lacking in the neighborhood, and the epithets applied to him are neither mild nor elegant,” the Globe reported, “one of the least suggestive being that he is ‘an old chump.’ "

As Boston health officials used contact tracing to identify and disinfect every place Pfeiffer may have visited while contagious, and inoculate anyone he may have exposed to the disease, the city’s vaccination efforts received a new push. “Samuel Durgin could not have gotten better publicity for the value of vaccination if he had written it himself,” wrote Karen L. Walloch in her 2015 book The Antivaccine Heresy.

The day after news of Pfeiffer’s illness hit the front pages, 130 Board of Health doctors descended upon the dense North and West ends and vaccinated an additional 12,000 Bostonians. The Boston Post reported they “met with but little objection” and “the case of Dr. Pfeiffer had helped their cause amazingly.” Board of Health officials countered any holdouts by asking, “Did you read about the man who wouldn’t get vaccinated and who is now dying of smallpox?”

Durgin received his share of criticism for endangering the public but did not regret his decision. “I do think it was right, and the best thing, under the circumstances, for the largest number of people,” he said, no doubt because he believed he had made a public health lesson of the anti-vaccinationists. Once again, though, Pfeiffer would surprise him.

PFEIFFER SURVIVED his bout of smallpox, and so did his crusade. After five weeks of quarantine, the doctor emerged to pronounce himself “as strongly opposed as ever to vaccination.” In fact, he continued to question the necessity of vaccines since none of the other family members isolating alongside him contracted smallpox before they were vaccinated. When he resumed publication of Our Home Rights, he described neighbors who became sick after they rushed to get their shots based on what had happened to him.

Pfeiffer also insisted that his own case was none too serious, which he baldly presented as evidence that public health officials exaggerated the disease’s potency. “I laughed and told jokes and played games most of the time, and the disease of small-pox, dreadful as it is said to be, never caused me pain for one minute,” he boasted. He insisted that he had contracted smallpox because he had been overworked, not because he had been unvaccinated.

Pfeiffer’s campaign of misinformation would have immediate consequences. Around the time he was all over the newspapers, Cambridge Board of Health officials knocked on the door of holdout Henning Jacobson. When the pastor refused to be inoculated, he was fined $5. Jacobson sued the state in a case that eventually made it to the US Supreme Court. In a landmark 1905 decision, the court upheld compulsory vaccination for the public good.

Durgin’s vaccination efforts ultimately succeeded, though he and other frustrated health officials lamented that anti-vaccination activists had elongated the stay of smallpox. The disease finally faded from the city in 1903, after 1,596 infections and 270 deaths. The city’s last case was diagnosed in 1932. Thanks to a global immunization campaign, the scourge of smallpox was finally eradicated in 1980.

Anti-vaccination propaganda, however, was here to stay. In 1926, a proposed state mandate to require vaccination for private school students was stopped by anti-vaccination activists. The holding power of their dangerous message was something the Massachusetts Board of Health had warned about years earlier, at the end of the Pfeiffer affair. “Boston is practically a hot-bed of the anti-vaccine heresy,” the board reported in 1903. “Although the vaccine house is built upon a rock, and is not likely to fall, the noisy storm has frightened many of our people into a dangerous neglect or opposition to vaccinal protection.”

Christopher Klein is the author of “When the Irish Invaded Canada: The Incredible True Story of the Civil War Veterans Who Fought for Ireland’s Freedom.” Follow him on Twitter @historyauthor. Send comments to magazine@globe.com.