By December 1901 smallpox had settled into Boston, eluding health department efforts to control its spread. The health department chairman Samuel Durgin tried to alleviate public anxiety by referring to the epidemic as a “flurry of smallpox,” as if it were no more than a minor snowstorm that would soon pass. Yet he had to admit that this epidemic presented a unique challenge: “The prevalence of the disease is not subsiding and is not likely to for a while yet. People are not yet sufficiently vaccinated. The ambulant and unrecognized cases are spreading the disease, and have been doing it to an extent which has never before obtained in my experience.” Additionally, ignorance of the need to revaccinate only worsened the situation. Too many people and their physicians assumed that a primary vaccination early in life would provide adequate protection many years later. Although he might have blamed himself and his own department for failing to promote vaccination sufficiently, he chose instead to direct the blame more amorphously: “With regard to Boston, I am sorry to say that she has been caught in a poorly-vaccinated condition. We went through the city in the winter of 1872 and 1873 and gave thorough vaccination. Since that time we have experienced an unusual freedom from smallpox, much indifference and some misguided objection to vaccination, and are, in consequence, easy victims to smallpox.” As the memory of smallpox receded over time, Boston residents had forgotten about the need for vaccination. Durgin also blamed this avoidance of vaccination on Boston's antivaccinationists. In his view, they frightened people with their pamphlets and lectures, “trying to prejudice the public mind against vaccination.” By directing attention away from himself and his department, Durgin displayed the deft hand of a seasoned veteran of municipal politics. He understood that this epidemic's stubborn persistence would attract criticism of his performance as a public health leader, but he knew how to weather such storms after a nearly thirty-year career in Boston's tumultuous civic affairs.

In 1901, Durgin was sixty-two years old and nationally acknowledged as a leading public health officer. He possessed impeccable academic and social credentials. Born in Maine to a farming family that could trace its ancestry back to the colonial period, he attended first Dartmouth College and then Harvard Medical School.