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could not explain the phenomenon: when the smallpox came, most Americans had not been vaccinated in years. It seemed a new “mild type” of smallpox had appeared on the epidemiological landscape, the likes of which the “civilized” nations of Europe, England, and the United States had never seen. No one could say how long the new pox would remain mild. Many medical authorities expected the disease to revert to classic, malignant smallpox at any moment. For American health officials, the low mortality rate posed the greatest medical mystery—and the toughest political challenge—of the turn-of-the-century smallpox epidemics.22

The sudden appearance of a new mild form of smallpox altered the political calculus of compulsory vaccination—a measure that had been none too popular in late nineteenth-century America. To this day, medical experts consider smallpox vaccine, which contains a bovine virus called vaccinia, “the least safe vaccine available.” Serious complications, including postvaccinial encephalitis and death, are rare: scientists expect one million vaccinations to cause three to five serious reactions. But milder reactions—rashes, fatigue, headache, fever, painfully tender arms—are common. In 1900, vaccination carried significantly greater dangers. The government compelled vaccination, but did little to ensure that American vaccine makers produced safe, effective vaccine. Newspaper stories, medical texts, and popular rumors linked vaccination to syphilis, tetanus, and the ubiquitous “sore arms” that caused countless American breadwinners to lose days or even weeks of work. Because the new pox killed less than 1 percent of the people whom it infected, many laypeople and even doctors refused to believe it was smallpox at all. In the absence of a recognizably horrific case of smallpox, many failed to see the benefit of vaccination. Many saw vaccination as the greater risk to life and limb. And their resistance to compulsory vaccination would help persuade the federal government to impose new regulatory controls on the American vaccine industry.23

But reasonable health concerns do not alone explain the widespread opposition to compulsory vaccination at the turn of the twentieth century. Antivaccinationism was an international phenomenon, but everywhere it reflected the social divisions and political tensions of its time and place. The roots of American antivaccination sentiment ran deep and wide. Race stymied smallpox control, as white taxpayers, particularly in the South, balked at paying for vaccine to protect blacks; meanwhile, African Americans rightly mistrusted government vaccinators whose chief aim was to protect the white community. Christian Scientists viewed compulsory vaccination as a violation of religious freedom. Physicians who practiced popular forms of alternative medicine decried government vaccination orders as yet another example of creeping “state medicine.” Parents resented school vaccination mandates for encroaching on their domestic authority and for violating their children’s innocent bodies. Antivaccination propagandists traced compulsory vaccination to a corrupt conspiracy between health officials, lawmakers, and vaccine manufacturers. On the broadest level, though, the vaccination question revealed a sharp uneasiness toward the authority of medicine and the power of the state at the height of the Progressive Era, a period of time when both institutions were reaching more ambitiously than ever before into American life.24

Contrary to the Times’s assertion, then, an unquestioning submission to vaccination was anything but the “common sense” of the American people during these smallpox outbreaks—even in the many places where local and state governments made such submission compulsory by law. Ordinary Americans responded to government vaccination orders in a variety of ways, ranging from ready compliance to violent riots. They organized antivaccination societies, conducted legislative campaigns (some of them successful) to repeal state vaccination laws, and flooded the courts with lawsuits challenging