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1902 was sufficient cause to reroute the train, with all the passengers aboard, to the nearest police station, where a city health officer got busy with lancet and virus. “Those who objected were sternly admonished and the work went on.” The following month, James Butler, a hostler, and his wife, Kate, living on the third floor of a Third Avenue tenement in Harlem, were discovered “suffering from smallpox in an advanced stage.” A vaccination squad arrived, backed by twenty police officers. Men, women, and children fled down fire escapes or climbed to the roof. “But policemen were at hand at every place of egress, and appeals and entreaties were unheeded,” the Times reported. By the raid’s end, 300 residents had been vaccinated, “the majority of them very much against their will.” James Butler was found hiding in a coal bin. After a struggle, he and Kate were taken to North Brother Island.59

In November 1902, a health department inspector discovered a person with smallpox in a tenement on West Twenty-sixth Street inhabited by forty African Americans. The inspector summoned the police. They stormed the door. As the Times reported, “When the attacking party entered, some of the inmates went to the roof, some climbed out to the fire escape, and others tried to gain the street.” City physicians took out their instruments and began vaccinating the residents. Four were vaccinated in the hallway, others “in the corners of rooms where they had huddled together for refuge.” Still others received their “treatment” on the roof. One of the lodgers, twenty-four-year-old Eva Gerry, climbed out onto the fire escape, lost her balance, and fell three stories to the sidewalk, breaking both of her arms and several ribs.60

The department under Lederle did not do away with compulsion. It expanded the scope and intensity of the same old tactics. In fact, Blauvelt continued to head up the Division of Contagious Diseases. The department’s measures undoubtedly did much to bring the New York City small-pox epidemic of 1901–2 to an end. In 1902, the Division of Contagious Diseases reported 1,516 more cases with 309 more fatalities. Most of them occurred in the first six months of the year, after which the epidemic tapered off. In 1903, only 67 cases were reported, with just 4 fatalities; 40 percent of the people with smallpox treated in the municipal hospitals were new arrivals to the city. The department performed an additional 215,000 vaccinations that year, bringing the grand total under Lederle’s two-year regime to well over a million, roughly one third of the city’s population.61

As Scientific American noted, in a laudatory article on Lederle’s department, the city’s “crusade against smallpox” had engendered “bitter opposition.” It was strongly “opposed by the ignorant and superstitious, and by a considerable body of the more intelligent who were opposed to vaccination on principle. The inspectors were openly abused and resisted, and it was only through the co-operation of the police that an effective campaign was conducted.”62

In November 1903, Mayor Seth Low ran for reelection on a campaign that trumpeted his administration’s victorious war on smallpox. Campaign posters placed on elevated trains displayed the words of the reformer Jacob Riis, who urged New Yorkers to vote for the man who had driven prostitution from the tenements and “wiped out the smallpox in six months.” The voters, though, were not sufficiently impressed. They returned control of City Hall and the health department to the Democrats. Ernst Lederle left the department and founded the profitable Lederle Antitoxin Laboratories, manufacturers of vaccine, sera, and other biological products.63

New York was not the only American city to deploy paramilitary vaccination squads. The Chicago Health Department sent teams of physicians and police on nighttime raids to the tenements and into the cheap lodging houses along South Clark Street. In Boston, a notorious “hotbed of antivaccinationism,” nineteen citizens were prosecuted for refusing to submit to vaccination as city physicians