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How did George Washington handle an epidemic? The Founding Father faced a disease that threatened to destroy the Continental Army Joseph Dragovich Follow Apr 21 · 8 min read George Washington (Wikimedia Commons)The Coronavirus has brought the world of epidemic response to the public imagination. Countries all over the world have had different approaches to handling the crisis. Some leaders have been criticized and some praised for their COVID-19 response. But managing infectious disease at scale is not new. In fact, the American Revolution took place during one of the worst smallpox epidemics North America has ever seen. Early in the war, the disease was a major driver of military strategy, and a preoccupation for George Washington as he commanded the Patriot forces. Smallpox is a little known but influential aspect of America’s birth. One that would see Washington navigate the trade offs of fighting a war while an epidemic swirled around his army. The invisible enemy<a href="https://www.cdc.gov/smallpox/about/index.html" class="ct gv jy jz ka kb" target="_blank" rel="noopener nofollow" style="box-sizing: inherit; color: inherit; -webkit-tap-highlight-color: transparent; background-repeat: repeat-x; background-image: url("data:image/svg+xml;utf8,"); background-size: 1px 1px; background-position: 0px calc(1em + 1px);">Smallpox was a scourge of the 18th century world. Highly contagious, it was a disease that killed 20–30% of those that contracted it. Those that survived smallpox, however, were immune for life. Washington knew how awful the disease could be. He himself had contracted smallpox during a trip to the Caribbean in 1751. After the first shots of the American Revolution were fired in 1775, the Patriot and British forces settled in for the long Siege of Boston; the Americans trapping the British in the city. As the siege was starting, smallpox was bubbling up in North America. The rise in the disease put the Americans at a disadvantage. Most of the American troops, coming from more rural surroundings, had never had it. The British Regulars, on the other hand, had come from places where smallpox was endemic or were inoculated against the disease and thus immune. The close quarters of the American camp meant that if smallpox took hold, the results could be disastrous for the Patriot cause. Washington respondsWashington’s first reaction was to quarantine the army against the disease. Civilians escaping the city were put on boats and taken to communities well away from the American lines, and anyone showing symptoms was isolated in special smallpox hospitals away from the main army. Any potential contact with smallpox was to be controlled or eliminated. There was even a point where letters delivered to the army were to be dipped in vinegar as a guard against infection. Washington had reason to be cautious. There were rumors that the British were trying to send infected civilians out of Boston in an attempt to spread the disease to the army. It is difficult to determine the veracity of the rumors, but the British had used smallpox as a weapon before against Native Americans during the Seven Years War. The alternative solution, inoculating the troops against the disease, was a more permanent but riskier solution. Inoculation gave a patient a milder form of smallpox that was less deadly, but they could still spread the more virulent “natural” form of the disease as they were recovering. Inoculating the troops would ensure the army was safe from smallpox, but risked sparking off an uncontrolled run of the disease in the army. Those undergoing the procedure also needed time to recover. If the British found that large numbers of American troops were incapacitated, they could destroy the Continental Army. Washington was unwilling to take such a drastic step. The quarantine at Boston was generally effective. The besiegers were largely free of smallpox until they took control of the city from the retreating British in March. Historian Elizabeth Fenn argues that its success convinced Patriot leaders that the lighter measures of quarantine were sufficient to protect the army from smallpox. However, once the war became more mobile, that assumption would be proven wrong. The Canada disasterIn September 1775, Washington sent a portion of the army north to attack Quebec alongside other American forces. While relatively safe from disease while besieging Boston, they were not so fortunate when they reached Quebec. Smallpox first appeared in the Northern Army in December, and the long march to Canada along with the winter conditions ensured that the disease spread quickly. The epidemic ravaged the American attackers and they were driven out of Canada by summer. “Cruel small Pox! Worse than the sword!” lamented John Adams over the Quebec disaster. By the time the Quebec expedition turned disastrous, smallpox was also taking hold in the troops left to garrison Boston. As smallpox was making inroads into American armies, fear began to exacerbate the problem. More afraid of the disease than the enemy or military discipline, officers and enlisted men alike were undergoing unsanctioned inoculations. Each secret inoculation risked sparking an outbreak of “natural” smallpox. But the more visible the disease, the more likely individuals were to try to protect themselves with inoculation. On the day that America declared independence from Britain, one of Washington’s generals wrote to him saying “The Small pox prevails to such a degree in Boston, and so many of the Soldiers got the disorder, that I apprehend the remainder of them must soon be inoculated.” James Warren, another general wrote to John Adams that constant talk of smallpox in the city was only interrupted by news of the Declaration of Independence. Washington continued to hesitate on inoculating the whole army. Instead he tried to regain control over the unsanctioned inoculations with increasingly harsh punishments. Washington’s General Orders from May, 1776 promised that anyone undergoing inoculation would be expelled from the Continental Army and “have his name published in the News papers throughout the Continent, as an Enemy and Traitor to his country”. However, fear of the disease was not only driving secret inoculations, it was hurting army recruitment. The pressure was mounting for Washington to act. Inoculating the armyIn early 1777, Washington finally ordered the army inoculated against smallpox. Citing the loss in Canada and the recruitment difficulties, the procedures were to be done under the utmost secrecy. While recovering, troops were to be isolated and their clothes cleaned before rejoining the main army. States were urged to inoculate troops before sending them to join the main army. The policy proved successful; few troops died as a result of the procedure and it brought smallpox under control in the Continental Army. Washington would order another round of inoculations while camped at Valley Forge a year later. The smallpox epidemic at the beginning of the American Revolution was an early test for the future first president. Like some of today’s hesitant responses to Coronavirus, Washington had to face some difficult trade-offs. He succumbed to the temptation that the problem could be evaded, and avoided taking the most effective measures for fear of their risks. It is a period of American history that shows dealing with epidemic disease is as old as America itself. medium.com