Washington's War Against Smallpox

In 1775 when George Washington took command of the Continental Army, America was fighting a war on two fronts. One was a battle for independence from the British, the other was a survival against smallpox. Washington knew about this disease firsthand, so he knew it could ravage his army and cripple it before it even began. Back in this time, inoculations were crude and often deadly, but Washington made the decision to inoculate all American troops that had never had smallpox.

The plan, however, worked, and he was able to stave off smallpox during the years-long fight with the British, and in the process instated the first massive, state-funded immunization campaign in American history.

In 1751, George Washington’s brother Lawrence had tuberculosis and they decided to sail to Barbados hoping the warm air would help cure him of it. After only being on the island one day, they had dinner with a wealthy local merchant named Gedney Clarke. Two weeks later, after the gestation period, Washington came down with smallpox. He had actually written in his diary “We went, myself with some reluctance as the smallpox was in his family.” He should have listened to his gut because he was bedridden for weeks, and no diary entry was written for 24 days.

George Washington survived with just a few scars, which was very lucky since some lost their lives or left with hideous scars all over their bodies from the oozing rash. Then in 1775, when George Washington took over the newly formed Continental Army, Boston was under British control, and smallpox was running rampant throughout the city. So Washington’s first order of business was to safeguard his troops from this debilitating outbreak.

He also understood that his American-born soldiers were far more susceptible to the disease than the foreign-born troops they were fighting. That is because smallpox was endemic in England, meaning that a high percentage of British troops had already contracted the disease as children and now carried lifelong immunity. In contrast, relatively few New Englanders and Southerners had ever been exposed to the virus. For example, only 23 percent of North Carolina soldiers who enlisted in 1777 had ever had smallpox.

Since he had a very primitive understanding of contagions and immunities, Washington had to decide between several anti-smallpox schemes, each one having its own significant risks.

The fist was “herd immunity” which is letting people get exposed to the disease naturally and having them acquire immunity. But that carries the risk that you could lose a large amount of your troops to this disease, which could cause Washington to lose the war. The other is trying to immunize his troops in hopes he loses less troops to that than if they get the disease.

You see, immunization in the late 1700’s was very crude and left between 5% and 10% of people dead. It wasn’t actually like it is today. Back then it was actually variolization, which is cutting a small incision in the flesh of the person being inoculated and implanting a thread laced with live pustular matter into the wound. The intent of this was for the person to come down with smallpox, which in this manner was typically a milder case than if they came in contact with it naturally. After this, the person would require a month to recover and need to stay out of the population, since this would expose them to more serious infections.

In July 1775 in Boston, Washington feared that a large-scale inoculation would sideline his troops, or worse, lead to a full-blown epidemic. During the Siege of Boston, Washington opted for a strict quarantine of both sickened soldiers and civilians. Civilians showing smallpox symptoms were held in the town of Brookline, while military cases were sent to a quarantine hospital located at a pond near Cambridge. “No Person is to be allowed to go to a fresh-water pond for fishing or on any other occasion as there may be a danger of introducing the smallpox into the army,” wrote Washington on July 4, 1775, his second official day as general. The quarantine did its job -- isolating the sick long enough for the British to surrender Boston.

Smallpox continued to thrive as new recruits were placed in unsanitary conditions, and they were from different parts of the country where smallpox hadn’t existed quite yet.

The Continental Army in the Battle of Quebec in late 1775 was so ravaged with smallpox they had no option but to retreat. The long march from Canada to New York was worse as smallpox ran through the ranks of soldiers, sickening and killing them off as they went.

There were even talks that the British soldiers were purposefully sickening American troops with smallpox. This biowarfare conspiracy is not without merit but could not be proven either.

By the time America officially declared its independence on July 4, 1776, the effectiveness of quarantine was thrown into doubt and there was no easy way of calculating the risk of a mass inoculation of the beleaguered American troops.

By the winter of 1776, Washington and his troops were in Morristown, New Jersey, a place where smallpox was rampant. It was there, in February 1777 he decided to inoculate his troops.

This would end up to be quite a task, since medical personnel would need to examine each person to determine whether they have previously been contaminated with smallpox, then do the variolation procedure, which had a 5-10% fatality rate, and if they survived that, the one-month recovery process.