For more than 3,000 years, smallpox killed or badly disfigured many millions of people. On average, the disease killed up to thirty percent of those infected, and the majority of survivors carried deep scars (pockmarks), oftentimes concentrated on their faces.
Throughout history, disease outbreaks sparked fear for many. Before the invention of vaccinations in 1796, people had very few ways to protect themselves from disease.
When Spanish and Portuguese conquistadors arrived in the Americas, they brought smallpox with them, which devastated the Indigenous populations of South and Central America. During the French and Indian War, British forces used smallpox as a biological weapon to weaken the Indigenous tribes that assisted the French.
With every smallpox outbreak, people observed that those who had survived the infection typically did not get smallpox again. For those who contracted smallpox a second time, the infection was much less severe and usually not fatal.
These observations led to the creation of inoculation, the process of contracting smallpox on purpose to induce immunity and reduce the risk of death. Smallpox inoculation was a simple procedure: a doctor removed pus from an active pustule of an infected person, and then inserted that pus into the skin of a non-infected person via a small incision.
Because few American colonists had contracted the disease before, the colonies experienced sporadic and deadly outbreaks of smallpox. There was never a widespread epidemic that resulted in herd immunity. (NPS)
Colonial Boston had faced many smallpox outbreaks throughout the 1700s, the most severe of which occurred in 1721, 1752, 1764, and 1775.
When American colonists launched their revolution against Britain, they quickly encountered a second but invisible enemy that threatened to wipe out the new Continental Army: highly contagious smallpox. (National Geographic)
Despite the progressive acceptance of inoculation throughout the colonies, another smallpox outbreak seized Boston in 1775. After the Battle of Bunker Hill in June of 1775, military actions between the British, led by General William Howe, and the colonists, led by George Washington, stalled.
In 1775, Continental soldiers, led by Colonel Benedict Arnold, marched from Cambridge, Massachusetts towards Quebec to prevent the city from falling to the British. Just one month later, in December, smallpox was reported among the soldiers.
Smallpox crippled the forces in Canada, preventing them from launching an attack on Quebec in late 1775. Many soldiers’ scheduled enlistment ended on January 1, 1776 and a majority warned their superiors they planned to not reenlist due to fear of the disease.
These soldiers would rather desert the cause than risk death by smallpox. These soon-to-be expired enlistments forced Arnold and General Richard Montgomery to launch their assault on Quebec before the year’s end.
Montgomery later reported that only about 800 men were able to fight, as the rest were sick with smallpox. The lack of healthy soldiers resulted in a spectacular failed attack on Quebec on the 30th of December. British forces killed Montgomery, wounded Arnold, and captured hundreds of colonists.
Arnold maintained substantial forces around Quebec in hopes of launching a second, successful assault, however, the lack of reinforcements and the ravages of smallpox impeded any future attack.
Washington understood the grave threat smallpox imposed upon the Continental Army and their chances of winning the war. He even described smallpox as “more destructive than the sword.”
Personal experience played an important role in Washington’s attitude toward and understanding of the variola virus. While traveling in Barbados in November of 1751 with his brother Lawrence, Washington himself had been stricken with smallpox.
Confined with the illness for twenty-six days, he suffered greatly and was permanently pocked by the experience. Only nineteen at the time of the attack, Washington developed lifelong immunity as a result.
The disease may also have rendered him incapable of fathering children, as modern scientists have documented infertility as a complication of smallpox. (Becker)
However, Washington also feared the spread of smallpox between soldiers who did not quarantine after inoculating.
In a February 6, 1777 letter to Dr. William Shippen Jr., director of the medical department of the Continental Army, Washington proclaimed: “Finding the Small pox to be spreading much and fearing that no precaution can prevent it from running through the whole of our Army, I have determined that the troops shall be inoculated.”
“Necessity not only authorizes but seems to require the measure, for should the disorder infect the Army in the natural way and rage with its usual virulence we should have more to dread from it than from the Sword of the Enemy.”
“Under these circumstances I have directed Doctr Bond to prepare immediately for inoculating in this Quarter, keeping the matter as secret as possible,”
“If the business is immediately begun and favoured with the common success, I would fain hope they will be soon fit for duty, and that in a short space of time we shall have an Army not subject to this the greatest of all calamities that can befall it when taken in the natural way.”
With this order, George Washington enacted the first medical mandate in American history. Washington declared his order to Congress that all troops must be inoculated, and he ordered that all new recruits entering Philadelphia must be inoculated upon entry.
To offset the temporary loss of soldiers while they healed from the inoculation, military doctors inoculated divisions in five day intervals. The military used private homes and churches as isolation centers to control spread of the disease.
Smallpox was under control, supplies were adequate, patients were, for the most part, housed in buildings specifically designed for their care, the staff was large in proportion to the number of patients, fresh vegetables were available from local gardens, and evidence even indicates that sheep and cattle were now being delivered on the hoof.
By May 1777, therefore, the Hospital Department in the North was well prepared to handle the casualties of another hard campaign.
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