In official reports, Boston's chief health officer Samuel H. Durgin represented his vaccination efforts in neutral terms, claiming that he began by merely recommending vaccination in 1901. Only when it became clear that people had failed to heed his advice did he resort to a compulsory vaccination order in which people were “visited and vaccinated if willing to be vaccinated.” Refusals were respected, given an opportunity to change their minds, and only summoned to court if they persisted in their obstinacy. Yet this benign characterization is belied by the fact that force and coercion played a prominent role in Durgin's approach to vaccination. He routinely sent police to accompany his health department vaccinators, and he exercised his authority to its fullest extent to get people vaccinated. When his exhortations and free vaccination stations failed, he resorted to various legal sanctions to compel vaccination. Local health departments could quarantine, if they desired, any establishment in which they found smallpox cases, and Durgin used this threat to nudge local businesses into vaccinating their employees. When business owners made vaccination a condition for continued employment, nearly every worker complied. Before he issued the general vaccination order, Durgin sent out squads of health department physicians, accompanied by policemen specifically tasked to restrain resistors, to conduct a vaccination campaign in various lodging house districts. Confronted with physicians backed up by policemen, most people chose to oblige the doctors. Those who did not were pinioned by police and summarily vaccinated. Only later, during official vaccination sweeps, were refusals accorded due process of law.

Durgin regarded antivaccinationists not only as fools but also as criminals deserving punishment, grumbling: “It is dangerous to allow such teachings to continue, and some day in the near future I will bring some of those fellows into court.” The Massachusetts vaccination law penalized vaccination refusal with a five-dollar fine—a seemingly mild penalty. Yet as the homeopath Conrad Wesselhoeft pointed out: “The rich man can pay his fine and thus save his family from assault, while the poor man who cannot pay the fine, must go to jail and languish there till it pleases the Board of Health to allow him to be discharged.”