When George Washington took command of the Continental Army in 1775, America was waging a war on two fronts: one for the independence of the British and a second to survive against smallpox. Because Washington knew first-hand the ravages of the disease, he understood that the smallpox virus, then an invisible enemy, could paralyze its army and end the war before it started.
This is why Washington finally made the bold decision to inoculate all American troops who had never been sick with smallpox at a time when inoculation was a rude and often fatal process. His bet paid off. The measure avoided smallpox long enough to win a multi-year fight with the British. In doing so, Washington launched the first massive, state-funded vaccination campaign in American history.
George Washington contracted smallpox in Barbados
In 1751, when Washington was 19 years old, he and his brother Lawrence went to Barbados in the hope that the warm air of the island would cure his brother who was sick with tuberculosis. Just a day after landing, the brothers had dinner at the home of a wealthy local merchant, Gedney Clarke. In his diary, young Washington expressed some reservations.
“We went there, myself with some reluctance, because smallpox was in his family,” wrote Washington.
Washington should have listened to its instinct. Two weeks later, after the smallpox virus finished its incubation period, Washington was down for the count.
“Was heavily attacked with little Pox,” was the last thing Washington wrote in its journal for 24 days. Even if his case was relatively mild, he would still have been bedridden for weeks, shaken by high fevers and chills, severe body pain, a twisted stomach and a telltale rash.
Washington was fortunate to escape with his life and a few visible scars. In very bad cases, the individual smallpox pustules have come together in a single pus-filled rash that has infiltrated, cracked, and evaporated into large leaves. These much more serious smallpox infections were often fatal or left the victim with hideous scars.
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British troops were protected by collective immunity
Fast forward to 1775, when Washington took the reins of a newly formed continental army, besieging Boston under British control. Smallpox was rampant in Boston that summer, and one of Washington’s top priorities was to protect its troops from a potentially debilitating epidemic.
“Washington knew what smallpox looked like and it knew how it could neutralize its army,” says Elizabeth Fenn, professor of ancient American history at the University of Colorado Boulder and author of Pox Americana: the great smallpox epidemic of 1775-82.
Washington also knew that its American soldiers were much more susceptible to the disease than the European enemy. This is because smallpox was endemic to England, which means that a high percentage of British soldiers had already contracted the disease when they were children and now enjoyed lifelong immunity.
In contrast, relatively few New Englanders and southerners have been exposed to the virus. For example, only 23 percent of North Carolina soldiers who enlisted in 1777 had ever had smallpox.
Armed only with a primitive understanding of contagion and immunity, Washington had to choose between several anti-smallpox programs, each with its own significant risks.
“This is collective immunity,” says Fenn. “You have to either let people be exposed to the disease and naturally acquire immunity, which could be devastating for his troops and have devastating consequences for the war.” Or quarantine your troops, which means they will not be able to fight. Or immunize them. “
Vaccination in the 1770s was crude and risky
But vaccination in the 1770s was not what it is today with a single injection and a low risk of mild symptoms. Edward Jenner did not even develop his revolutionary smallpox vaccine for smallpox until 1796. The best inoculation technique available to Washington during the Revolutionary War was an unpleasant and sometimes deadly method called “variolation”.
“An inoculation doctor would cut an incision in the flesh of the inoculated person and implant a wire laced with living pustular material into the wound,” says Fenn. “The hope and the intention was for the person to come with smallpox. When smallpox was transmitted this way, it was generally a milder case than when it was contracted naturally. ”
Variolization always had a fatality rate of 5 to 10%. And even if everything was fine, the vaccinated patients still needed a month to recover. The procedure was not only risky for the individual patient, but for the surrounding population. A person with a mild case could feel good enough to walk around town, infecting countless other people with potentially more serious infections.
When Washington assessed the risks in Boston in July 1775, he feared that a large-scale inoculation would marginalize his troops, or worse, lead to a veritable epidemic. Thus, during the siege of Boston, Washington opted for a strict quarantine of sick soldiers and civilians. Civilians with symptoms of smallpox were detained in the town of Brookline, while military cases were sent to a quarantine hospital located on a pond near Cambridge.
“No one should be allowed to go to the freshwater pond for fishing or any other occasion because there can be a danger of introducing small pox into the military,” Washington wrote July 4, 1775. , his second official day as a general.
Quarantine did its job, isolating the sick long enough for the British to travel to Boston. But as the struggle for independence moved elsewhere, smallpox followed the US military as an unwavering curse. Army life in the 18th century was cramped and unhealthy with new recruits mixing germs with soldiers from entirely different parts of the country. Needless to say, smallpox has thrived.
Smallpox ravages troops after the Battle of Quebec
The virus proved to be a formidable enemy during the The Battle of Quebec took place on December 31, 1775, during which the Continental Army was so weakened by smallpox that it had no choice but to retreat. As it turned out, the long march to southern Canada through New York was almost worse than the battle as smallpox ripped through the ranks.
“There are horrific accounts of men dying in a place called Île aux Noix at the northern tip of Lake Champlain with lice and fleas and maggots crawling all over the place,” says Fenn. “It was just a horrible, horrible scene.”
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There were even rumors circulating among American military leaders that the British were engaged in biological warfare, deliberately sending sick soldiers and civilians to infect the revolutionaries. While there is no gun evidence that such a plot was made, it was not without precedent.
“There is this famous event at Fort Pitt during the Pontiac uprising in 1763 in which several different British officers, including Jeffery Amhurst, had the idea of deliberately transmitting smallpox to the enemies and implementing it,” explains Fenn. “It was not a new idea during the Revolutionary War.”
By the time America officially declared its independence on July 4, 1776, the effectiveness of the quarantine was questioned and there was no easy way to calculate the risk of a massive inoculation of the besieged American troops.
“Little Pox! The little Pox! “John Adams wrote to his wife, Abigail.” What will we do with it? ”
Washington calls for inoculation
The following winter, Washington and its troops camped in Morristown, New Jersey, where the threat of smallpox was more serious than ever. The stoic general of the United States hesitated back and forth over inoculation or not, even ordering mass inoculation and then canceling it. Finally, on February 5, 1777, he appealed in a letter to John Hancock, president of the Second Continental Congress.
“The small pox has made such a head in every neighborhood that I find it impossible to prevent it from spreading through the entire army in a natural way. So I decided, not only to innocent all the troops present here, who don’t have it, but I’ll order Docr. Shippen to inoculate the recruits as soon as they get to Philadelphia. ”
Fenn says that the inoculation of all troops without natural immunity against smallpox was a daunting task. First, medical personnel had to examine each individual to determine if they had contracted the disease in the past, and then performed the risky variolation procedure, followed by a month-long recovery process followed by teams of nurses.
During this time, this whole process – the first of its kind and of its magnitude – had to be carried out in the greatest secrecy. If the British caught the wind that a large number of American soldiers were put to bed with smallpox, it could be the end.
“I need not mention the need for as much secrecy as the nature of the subject will admit,” wrote Washington. “There is no doubt that the enemy will take advantage of the event as much as he can “.
Inoculations added to misery at Valley Forge
Fortunately for the Americans, the 1777 vaccinations in Philadelphia went off without a hitch and without warning the British. What is even more remarkable is that a second large series of smallpox inoculations was carried out in the midst of the infamous winter of 1778, when Washington troops were stationed at Valley Forge.
“Notwithstanding the orders I had given last year to have all recruits cleared, I found, after examination, that between three and four thousand men had not had small pox,” wrote Washington in January 1778, “this disorder began to appear in the camp, and to avoid its natural spread, the whole was immediately inoculated. “
It is hard enough to imagine the privations that the Continental soldiers experienced during this cold and bitter Pennsylvania, but it is almost impossible to think that many of them also voluntarily contracted smallpox during the grueling episode.
“It was one of the things that made this Valley Forge winter of 1778 so difficult,” says Fenn. “We all know of the traces of blood in the snow and the shortages of food and clothing. Add to this the fact that soldiers who had not had smallpox were also vaccinated that winter. ”
In the spring of 1778, the ranks of the Continental Army swelled with recruits immune to smallpox ready to fight against the British. And while Washington’s risky decision to inoculate the entire army against smallpox did not win the war alone, Fenn believes it deserves a place among the most important deciding factors in the American victory.
“The general,” she writes in Pox Americana, “Had overwhelmed his enemy.”