“I find it impossible to keep it from naturally spreading thro’ the whole Army… necessity not only authorizes but seems to require the measure.”
This was in a letter from General George Washington to John Hancock and the Continental Congress, explaining his decision to order his chief medical officer to inoculate all troops in the Continental Army against smallpox (source: National Geographic). As a young man in 1751, Washington visited the Caribbean island of Barbados and contracted smallpox. At the time, the disease caused by the variola virus killed nearly one in every two victims.
Washington was lucky; after months of fever, chills, and painful pustules covering his face and body (the pox), he emerged with a pockmarked face but alive, with future immunity to the virus.
In 1775, the smallpox virus arrived in Boston, carried by British, Hessian, and Canadian troops brought in to help quell the growing colonial rebellion (the Boston Tea Party and the coming Declaration of Independence). The virus was devastating to soldiers and civilians alike as it swept across the burgeoning colonies.
An inoculation procedure against smallpox, dating back to ancient China, was called variolation. It was considered highly controversial in the colonies, and its improper admission had resulted in the painful death from smallpox of the son of King George III, an heir to the British crown.
The treatment required an incision in a patient’s arm, inserting a small dose of the live virus, large enough to trigger an immune system response, but small enough to prevent severe illness and death. A much more exacting process involving live virus is present in many modern vaccines today.
Though Washington had become immune to smallpox, his ragtag troops were not. And the British had just brought 30,000 additional troops to New York harbor, approximately the population of the largest city within the fledgling colonies.
Washington became an advocate for variolation, even convincing his wife,e Marth, to undergo the treatment in May 1776. The opening shots of the war for American independence were not in the colony’s favor. Washington and his ill-trained forces were quickly losing battle after battle, and as New York City fell, Washington escaped with a small consort of remaining troops into neighboring New Jersey.
While Washington considered inoculating his entire Army, many colonial governments forbade the procedure.
Variolation not only had a risk of death; it would also, in the best of circumstances, leave the vaccinated vulnerable for weeks as their bodies fought off and developed new immunity to the infection. Finding the right/best time for attempting mass inoculation was not only a gamble; if known to the British, it could trigger a massive attack when Revolutionary forces were at their weakest.
The Continental Congress ordered Army surgeons not to perform variolations. Washington was hamstrung but instead ordered that all new recruits receive the procedure, hoping that by the time they were trained and battle-ready, they would be fully recovered and newly immune to the pox.
As the epidemic spread, Washington rose. Against the direction of the Continental Congress and the governors of many colonies and their prevailing laws, he directed that all troops would be inoculated. By the end of 1777, nearly 40,000 soldiers had received variolation therapy. Infection rates among the troops dropped from above 20 percent to below 1 percent, while British forces were losing thousands to the smallpox epidemic — significantly more than to musket balls amid battles with Revolutionary forces.
Washington made variolation mandatory for all of his troops. For the British, who were being even more devastated by the pox, it remained voluntary, and both the conscripted, Hessian, and superior British forces feared the treatment that had taken the life of their monarch’s son.
So, the superior British forces were decimated by smallpox as well as typhoid fever, dysentery, and other public health threats of the day. Thousands more British soldiers fell as victims of disease than to colonial musket balls.
Later vaccines were developed, while smallpox remained a global health threat until its eradication in 1980 by another longtime Georgian, Dr. William Foege of the CDC. Tough times require tough decisions to be made.
Occasionally, we simply have to step back, keep some faith, and let our leaders lead. And yes, even when we don’t agree with them.