The Last Smallpox Epidemic in Boston and the Vaccination Controversy, 1901–1903

Abstract

One hundred years ago, Boston had its last epidemic of smallpox. We describe this final epidemic, the controversy over compulsory vaccination, and ethical issues that remain relevant today. Epidemiology and Protection through Vaccination In May 1901, an outbreak of smallpox, initially unrecognized, was followed by a series of outbreaks in various neighborhoods of Boston.1 From 1901 to 1903, there were 1596 cases of smallpox (Figure 1), with 270 deaths,1–3 in a city with a population of approximately 560,900. The attack rate was 3 cases per 1000 persons, with a case fatality rate of 17 percent. Of 243 consecutive patients . . .