George Washington's Public Health Crisis

 The Forgotten Battle of the American Revolution
by Sarah Kneeshaw

In 1777, George Washington faced an enemy that had the potential to decimate the entire Continental Army: smallpox. More deadly than the British Army, this disease had already taken the lives of thousands in the American colonies. The threat of smallpox was acknowledged by many of the Founding Fathers. John Adams called it “ten times more dangerous than Britons, Canadians and Indians together.” Smallpox was running rampant throughout America, leaving devastation in its wake. In the summer of 1776, almost 40 percent of the Continental soldiers stationed near Quebec became infected. Washington knew that if his soldiers were to continue fighting for independence from Britain, they would also need a plan to defeat this dreaded disease.

Smallpox was a common fear in the American colonies. It would appear seemingly out of nowhere, sweeping through communities and wiping out between ten and sixty percent of the population, then disappearing for long stretches. With much of the population living on farms and plantations, smallpox rarely spread outside of cities, such as Boston and Philadelphia. 

Europeans, however, experienced the disease much differently. With larger and more densely packed cities, smallpox was a constant threat to daily life in Europe; it was a fairly common, and potentially deadly, childhood affliction. Therefore, many soldiers in the British army had likely already survived smallpox. The previous exposure gave them an unseen advantage over their counterparts in the Continental Army: immunity. Once a person survived their bout with smallpox, they developed lifelong immunity to the disease. The relative lack of exposure among Continental soldiers- less than 25 percent of soldiers had contracted smallpox before joining the army- made them more vulnerable to the disease as they left their isolated homes for crowded encampments. 

Washington’s first battle with smallpox was in 1751. He contracted the disease while in Barbados, and was confined to bed for three weeks. During this time, Washington most likely experienced the common symptoms of smallpox: high fever, severe head and back pain, vomiting, and a widespread skin rash that developed into raised, pus-filled bumps. Although his illness was serious, he did recover- granting him future immunity to the disease that would become a plague among his soldiers.

The knowledge that surviving smallpox conferred a lifelong immunity has been around since ancient Greece. Many civilizations over the course of history had developed ways to treat and prevent smallpox, with varying success. The most successful measure was inoculation, a procedure that was first developed in China. The process is relatively simple- pus from a sick person is taken and placed in an open laceration in the skin of a healthy person. The person will then develop smallpox, but a much more mild case. Once they recover, they are immune from catching the disease again. Inoculation can lower smallpox’s fatality rate to one to two percent.

Inoculation was first widely attempted in the American colonies in Boston during the smallpox epidemic of 1721. The movement was led by Puritan minister Cotton Mather, who had lost his wife and three of his children to an earlier wave of smallpox. Mather was inspired by conversations with an enslaved man named Onesimus, who had undergone inoculation in West Africa, and described the process.

Mather then worked with Doctor Zabdiel Boylston to inoculate whoever was willing. This was met with much resistance. Many viewed the procedure as risky, with the possibility to worsen an outbreak, and feared it was against the will of God. Resistance was so high that there was even an attempted bombing of Mather’s home. Despite this, Mather’s inoculation attempt was fairly successful on those who tried it: the fatality rate in this epidemic among the inoculated was two percent, while those who contracted smallpox naturally faced a 14 percent fatality rate.

Washington supported smallpox inoculation. While he was immune to the disease, he often encouraged family members to undergo the procedure. In June of 1776, Washington’s stepson wrote in a letter to Washington, stating that he was happy “to hear that my dearest Mother had gone through the Smallpox so favorably...as She can now attend you to any part of the Continent...unsullied by the Apprehensions on that Disorder.” 

Washington had to be more cautious when recommending inoculation for his troops, however. After inoculating a patient, it was crucial to quarantine them to avoid spreading the disease. The quarantine period for smallpox inoculation was three weeks. Washington was hesitant to isolate groups of soldiers, particularly when they were already outnumbered by the British. Cities continued to be hit hard by smallpox, particularly those cities where large numbers of troops were stationed. Epidemics raged through Boston in both 1775 and 1776, despite Washington’s efforts to maintain sanitary conditions and quarantine sick soldiers.

By 1777, Washington had enough. He started to send groups of soldiers to be inoculated, ordering doctors to “use every possible Means in your Power to prevent that Disease from spreading in the Army...which may prove otherwise fatal to the service.” This continued through 1778, marking the first mass inoculation in American history. 

Washington’s inoculation campaign successfully lowered rates of smallpox deaths among the Continental Army. The next major development in smallpox prevention came in 1798, when English physician  Edward Jenner shared a new process called vaccination. Deriving from the latin word ‘vacca,’ meaning ‘cow’, Jenner’s process drew from the observed link between smallpox and cowpox. As the name suggests, people could catch cowpox from working with cows. This was a much less severe disease, but it was noted that those who suffered from cowpox often developed an immunity to smallpox. 

Jenner tested this theory by exposing an 8 year old boy named James Phipps to fluid from a cowpox lesion on the hand of dairymaid Sarah Nelms. Once Phipps recovered from cowpox, Jenner tried numerous times to infect the boy with smallpox. Phipps remained healthy, and Jenner began to spread word of the new method of smallpox prevention. Although this new method garnered many critics, it’s popularity increased rapidly. By 1800, Boston physician Benjamin Waterhouse introduced the vaccine to America. He received the support of Thomas Jefferson, who was encouraged by the success of George Washington’s original inoculation program.