During the 1700’s, smallpox epidemics raged throughout the American colonies. They would severely impact the new Continental Army during the Revolutionary War. The first signs came during the early battles of the American Revolution in 1775-1776 – at the siege of Boston, the siege of Quebec, and Britain’s Virginia regiments. These deadly outbreaks pushed Washington and his medical staff to make crucial decisions regarding smallpox control. He ordered all Continental soldiers to be inoculated in 1777. Historians credit this mandate with the colonists’ ultimate victory in the Revolutionary War for Independence.
Throughout history, smallpox epidemics sparked panic amongst the population. Before vaccinations began in 1796, people had very few ways to protect themselves. For many, the disease proved fatal. Small pox is caused by the contagious variola virus. It typically spread by infection of the respiratory tract. The initial signs came 12 days after exposure. Early symptoms were flu-like with fever, headache, body aches, vomiting and malaise. By Day 4, the face flushed and the first painful pox appeared – not on the skin, but in the mouth and throat. Eating and drinking became painful. The next day, the dreaded skin rash began.
In the worst cases, patients died early from hemorrhaging.
Pustules then erupted on the skin in a pox. If the pustules became confluent, 60% of patients died. Around Day 10, the pustules turned blistery and cracked open, releasing a foul stench. For survivors, near the end of the second week, scabs formed. If you survived to week 3, the fever subsided and patients were left with unsightly scars replacing the poxes. Survivors were now strangely blessed though. Having endured the disease, they were now immune.
With every outbreak, those who survived the disease rarely got smallpox again. This observation led to the advent of inoculation, the process of contracting smallpox on purpose to induce future immunity. A doctor removed pus from an active pox of an infected person and inserted it into the hand skin of a non-infected person. The insertion resulted in the inoculated person contracting smallpox but with only mild symptoms.
Smallpox was rampant in crowded European cities. Most people did not make it through childhood without contracting the disease. Thanks to widespread inoculation, most gained immunity, including the British military. The disease spread across Europe and into America, thanks to English and Spanish colonization. Because most American colonists lived in isolated villages, few were inoculated, so the colonies experienced sporadic epidemics. It would devastate the Native American populations as well
Doctors could employ only two weapons: quarantine and inoculation.
Inoculated individuals did contract smallpox, and were fully capable of infecting others. So they should be quarantined lest they spread the disease. For this reason, inoculation was highly controversial in the colonies. Many believed the procedure was more deadly than the disease. In England, where smallpox had long been endemic, the procedure was widely accepted. This meant that at the beginning of the American Revolution, the British forces had the advantage.
This brings us to the War for Independence. During the 1760s, Dr. Joseph Warren operated a smallpox inoculation clinic on Castle Island in Boston Harbor. There he inoculated future President John Adams, amongst other Sons of Liberty. Abigail Adams later inoculated herself and her children against the disease.
Despite inoculations, a smallpox epidemic seized Boston in 1775. After the Battle of Bunker Hill, smallpox was gripping the citizens of Boston and General Howe’s Redcoats. The Continental Army was entrenched around the city. General George Washington knew from his medical advisors that his Continental soldiers were not immune to smallpox and would be devastated by the outbreak.
Washington also had to contend with a sizeable exodus of refugees from the stricken city. Colonial spies reported that General Howe was deliberately infecting fleeing refugees with an intent to spread the disease among the rebels. Washington banned the refugees entering from the American army camps. He ordered any soldier showing ‘the least symptoms of Smallpox’ to be immediately quarantined.
In March 1776, General Howe and the British army abandoned Boston. Despite this victory for the colonists, Washington forbade his troops from entering the city because of the epidemic. He permitted only one thousand men who had previously contracted smallpox to enter and retake the city. Washington ordered that no one susceptible could enter; no one with visible symptoms could leave. Finally, by autumn, the epidemic waned.
Smallpox also raged on the Canadian front.
In 1775, Continental soldiers, led by Colonel Benedict Arnold, marched towards Quebec to prevent the British from taking the city. In December, the first case of smallpox was reported among his soldiers. It crippled the American forces in Canada, preventing them from launching an attack. Many soldiers told their superiors they would NOT re-enlist due to fear of the disease. They would rather desert the revolutionary cause than risk death by the dreaded smallpox.
This forced General Richard Montgomery to attempt an assault on Quebec in the winter. Only about 800 men were able to fight, as the rest were sick with the pox, resulting in a crushing failure. British forces killed Montgomery, wounded Arnold, and captured hundreds of rebels. Benedict Arnold managed to maintain forces around Quebec, however, the lack of reinforcements due to smallpox prevented any future attack.
Wanting protection from the disease, fearful soldiers began inoculating themselves! These men failed to quarantine however, and instead spread the disease further amongst their fellow soldiers. Arnold forbade self-inoculation by penalty of death to prevent its rampant spread.
In March 1776, Major General John Thomas took control of the forces in Canada. Thomas refused to allow any inoculations. He felt the soldiers would not have enough time to recuperate in quarantine for a British attack. Thomas also refused to be inoculated himself to show solidarity with the his men. He contracted the disease and died from it.
“It was apparent that smallpox, rather than British might or Continental Army inadequacy, was the reason for the Army’s defeat in Canada.” – John Adams
After a miserable, five-month siege of Quebec, 1,500 Americans retreated up the St Lawrence River. The men struggled through knee-deep snow. While quarantine had worked at Boston, it failed at Quebec. Half of the retreating troops were sick with the pox. One soldier wrote: ‘My pocks had become so sore and troublesome, that my clothes stuck fast to my body, especially my feet; and it became a severe trial to my fortitude to bear my disorder.’
When reinforcements finally arrived, they were terrifying by the scenes that greeted them, and quickly succumbed as well. ‘My eyes never before beheld such a seen’, wrote John Lacey of Pennsylvania, ‘nor do I ever desire to see such another – I did not look into a tent in which I did not find either a dead or dying man.’ Two mass graves consumed thirty to forty bodies a day.
General Philip Schuyler wrote to George Washington, warning him that further reinforcements would rather weaken than strengthen their Army unless inoculated. It is likely that smallpox killed roughly a thousand men during the Canadian campaign. Returning soldiers then instigated further outbreaks in New England, New York, and Pennsylvania.
Washington feared every day of the spread of smallpox amongst his soldiers.
“Finding the smallpox to be spreading much, I have determined that the Troops shall be inoculated. For should the disorder rage with its usual Virulence, we should have more to dread from it, than from the sword of the enemy.” – George Washington.
With this order, Washington enacted the first medical mandate in American history. Washington ordered that all troops and all new recruits must be inoculated. The military used private homes and churches as isolation centers to control spread of the disease during their quarantine.
Washington took a huge risk with these mass inoculations. If the British found out, they could have launched an attack on the weakened Continental Army. Therefore, it had to be kept secret. Though gaining support across each colony was difficult, as fear of smallpox ran rampant, mandated inoculations proved successful.
By 1777, the procedure was established in the Continental Army, and prevalence of the disease was greatly reduced. With smallpox diminished, the Continental Army even saw a surge of new recruits in 1777.
To the south, in the colony of Virginia, the royal governor, Lord John Murray, had promised freedom to all “slaves belonging to Rebels” who would fight for the king. At least 900 African-Americans joined Dunmore, donning uniforms and fighting in several skirmishes. But smallpox would turn out to to be their worst enemy. In February 1776, smallpox appeared in Dunmore’s troops near Portsmouth, Virginia. By May, over 300 had died and he lost more of his black regiment every day.
Lord Dunmore set up an inoculation camp at Gwynn’s Island in Chesapeake Bay.
In July, now under attack by Virginia rebels, Dunmore was forced to give up the island. Virginians who arrived were appalled at the scene. “We were struck with horrour at the number of dead slave bodies, in a state of putrefaction, strewed all the way from their battery to the point, about two miles in length.“
They found others gasping for life. Some had crawled to the water’s edge to cool their fevers. In all, some 500 slaves died on the island. As in Canada, rebel soldiers carried smallpox with them, sparking more outbreaks in Virginia and Maryland. In 1778, the disease seemed to have faded away in the army thanks to Washington’s orders. Continuing through the year, the American forces went through inoculation and quarantine at West Point, Valley Forge, Alexandria, and Fairfax.
In 1779, as the theatre of war moved further south, so did smallpox. In early 1779, a British force of Hessian troops carried it through the southern colonies. Smallpox erupted in Charleston and Savannah and plagued the south for two more years. Particularly hard hit were the slaves who fled to promised freedom in General Cornwallis’ Redcoat army. This time, the British turned on the infected African Americans and forced them to return to their masters, in an attempt to spread smallpox to the American army.
As the Revolutionary War reshaped colonial America on the east coast, a very different upheaval shook the entire North American continent. In 1779, the virus moved westwards from the colonies, finding vast susceptible populations of frontier colonists and Native Americans. Trade and colonial expansion joined the army in transporting the disease. In 1779, smallpox had travelled via the Spanish Catholic missions and struck Mexico City, afflicting 44,000 and killing 18,000.
Smallpox arrived in the frontier province of Texas in 1780, where it killed over 5,025.
In a description of smallpox among the Narragansetts ‘They lie on their hard matts, the pox breaking and running one into another, their skin cleaving to the matts they lie on; when they turn them, a whole side of skin will fall off at once.‘
Smallpox launched a simultaneous attack on the plains territory by way of the Comanches, who engaged in trade with the Shoshone in Wyoming and Montana. Before long the disease appeared among the Iroquois, Cree and Blackfeet. The Shoshones transmitted the plague to the tribes of the upper Missouri River. The Sioux marauders contracted it during their assaults on those Missouri villages. The disease decimated the indigenous tribes.
While smallpox on the southern and northern plains began to wane, the epidemic, did not. Smallpox reached the northwest Pacific coast, most likely from Shoshone nomads following native trade routes down the Columbia River to the ocean. References to abandoned villages and smallpox-scarred natives can be found on different British voyages to the Pacific northwest.
From 1775 to 1782, revolutionary upheaval rocked the east coast, while smallpox wreaked its havoc from the colonies to the plains to the Pacific. From Mexico to Hudson Bay, the continent was alive with trade and tribes, and the smallpox virus followed them all and left decimated populations behind.
Cruising the northwest coastline of America in 1792, Captain George Vancouver wondered, where were all the natives? The land and sea were abundant with an unlimited supply of food, but there were few people. Instead, they found abandoned villages scattered with human skulls and bones. The conclusion was inescapable: ‘By some event, this country has been considerably depopulated!’
Nevertheless, despite the smallpox surge and the pandemic tragedy, America survived. Without the bravery and determination of 18th century doctors, inoculation and quarantines may have never gained widespread acceptance in the new United States. And without General George Washington’s decisive and unpopular inoculations, the American colonists may never have won the Revolutionary War against Britain and achieved their independence.