In the early years of the American Revolution, in addition to shortages of men and supplies, George Washington faced an invisible killer he had once battled as a teenager. Where the earlier fight had threatened only his life, at stake in this confrontation were thousands of lives, both military and civilian alike, the continued viability of Washington's army, and the success of the war being waged for independence from Britain. The unseen killer, caused by a highly contagious virus, was smallpox, which Washington described in 1777 as potentially a greater threat "than...the Sword of the Enemy."

Smallpox patients exhibited a range of symptoms including a continuous high fever, intense back pain, and pustules or skin eruptions, which often led to permanent scarring in those who survived. Survival conferred a lifetime of immunity from the virus. Unknown in America until the coming of Europeans, smallpox was endemic in Asia and Europe and greatly feared. According to some medical historians, up until the mid-18th century, smallpox killed, crippled, or disfigured one-tenth of the human population.

A means of preventing smallpox had been practiced in India for thousands of years, but it did not make its way to Europe until 1718, when an English diplomat's wife brought this technique home with her from Turkey. Inoculation, as it was called, required taking a bit of matter from one of the pustules of a smallpox victim and introducing it under the skin of someone who had never had the disease. The resulting case of smallpox was much lighter and greatly decreased the chances of death and scarring. Some idea of how much milder the disease was when contracted through inoculation can be found in figures from a Boston epidemic in 1764. At that time, 124 of the 699 people who contracted the disease naturally succumbed to it, a mortality rate of over 17%, compared to 46 deaths in 4,977 cases acquired through inoculation, or .9%. However, inoculation was feared by many people on both continents, who were concerned that it would spread the disease, and laws were passed in a number of colonies, including Virginia in 1769, banning or greatly restricting the practice.

Smallpox typically was brought into 18th-century America by either immigrants from England or newly-arrived slaves. Unlike in Europe, however, the majority of the American population led relatively isolated lives on farms and plantations. Except in the coastal cities of Boston, Philadelphia, and Charleston, there was little chance of acquiring the disease. For example, there were no smallpox epidemics in the colony of Virginia prior to 1747. In fact, very few Virginians were ever exposed to smallpox prior to the American Revolution. One of those few was George Washington, who contracted the disease in Barbados in November of 1751 during his only trip away from the American mainland. Washington was just 19 years old at the time, and the illness, which lasted almost a month, left him with only slight scarring. Importantly, it also gave him immunity from further attacks of the disease, the benefits of which would not become apparent for some years. While Washington had faced outbreaks of smallpox among his soldiers in the French and Indian War in 1758 and among some of his slaves in Frederick County, Virginia, two years later, smallpox later became a matter of serious concern.

Miniature portrait of John Parke Custis by Charles Willson Peale, 1776.

In 1770, Washington was approached by the Reverend Jonathan Boucher, his stepson's teacher, with the proposal that the teenager study and travel in Europe. Washington replied with some reservations, but felt it would be prudent to have the boy inoculated against smallpox, whether he traveled overseas or not. Washington's belief in the efficacy of this practice may have been derived from a relative, his second cousin, John Smith, who had set up a smallpox inoculation hospital in Virginia in 1767 and continued to practice the technique until his death in 1771. Washington's stepson, John Parke Custis, underwent inoculation in the spring of 1771 in Baltimore, resulting in a mild case of the disease with only eight pustules on his body. Only after the procedure was successful and the young man restored to health was his very protective mother informed. Other members of the family later followed young Custis's example: Martha Washington was inoculated in the spring of 1776, while the families of Washington's brothers, John Augustine and Samuel, underwent the procedure the following year. Mount Vernon slaves were inoculated as well. Washington was so convinced of the usefulness of inoculation that he confided to one of his brothers in 1777 that:

"Surely that Impolitic Act, restraining Inoculation in Virginia, can never be continued. If I was a Member of that Assembly, I would rather move for a Law to compell the Masters of Families to inoculate every Child born within a certain limitted time under severe Penalties."

It was the coming of the Revolution that made the threat from smallpox all the more serious. Enemy soldiers arriving in America from England and Germany undoubtedly brought smallpox with them. In addition, recruits from all parts of North America joined the Continental Army. Having been exposed to only the limited number of disease-causing agents in their own areas, they brought together in their military encampments germs from all parts of the country, greatly increasing the likelihood of illness. Hunger, exposure to the elements, the stress of being away from home and at war also lowered the soldiers' resistance to disease. Smallpox was one of the first diseases to make an appearance.

Map of Boston, Henry Pellham, London, 1777.

Within days of taking command of the army at Cambridge, Massachusetts, in the summer of 1775, Washington wrote to assure the president of the Continental Congress that he had been "particularly attentive to the least Symptoms of the Small Pox," quarantining anyone suspected of having the disease in a special hospital, and promising that he would

"continue the utmost Vigilance against this most dangerous enemy."

By the fall of that year, however, the inhabitants of the nearby city of Boston, then under British occupation, were suffering from a smallpox epidemic, which threatened the health of Washington's army. There were even reports that the British were practicing what we would now term biological warfare, by deliberately spreading the disease within Boston and by sending infected people out of the city to spread the epidemic in the American lines. Washington was forced to forbid refugees from Boston to come near the American camp. Even after the British left the city in March of 1776, Washington sent in a force of 1,000 smallpox-immune American troops to occupy Boston.

Smallpox continued to plague the American Army--as well as the civilian population--and fear of the disease prevented many from enlisting. Epidemics broke out in both Boston and Philadelphia in the summer of 1776, leading John Adams to write, "This Distemper is the King of Terrors to America this year." The retreat of an American force sent to take Quebec was blamed on a number of factors, including the prevalence of smallpox among the soldiers. Their pathetic condition was described by Adams in a letter to his wife:

"Our Army at Crown Point is an Object of Wretchedness, enough to fill a humane Mind, with Horror. Disgraced, defeated, discontented, dispirited, diseased, naked, undisciplined, eaten up with Vermin-no Cloaths, Beds, Blanketts, no Medicines, no Victuals, but Salt Pork and flour....I hope that Measures will be taken to cleanse the Army at Crown Point from the small Pox, and that other Measures will be taken in New England, by tolerating and encouraging Inoculation, to render that Distemper less terrible."

While Washington certainly believed in the efficacy of inoculation, in May of 1776 he ordered that no one in his army be inoculated; violations of this order would result in severe punishment. The summer campaigns were about to begin, and Washington could not afford to have a large number of his men incapacitated for a month and vulnerable to attack by the British. Washington eventually instituted a system by which new recruits would be inoculated with smallpox immediately upon enlistment. In this way, they would contract the milder form of the disease at the same time they were being outfitted with uniforms and weapons. They would, consequently, be completely well, and supplied, by the time they marched off to join the main part of the army or, as Washington expressed it, "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."

Among the many items added to the Mount Vernon collections this year was a revealing document dealing with this aspect of Continental Army life under Washington's command.

Detail of a warrant authorizing payment to Dr. David Townsend for medicines he supplied to smallpox victims in the summer of 1776.

Dating from the summer of 1776, when smallpox threatened the populations of Boston and Philadelphia, as well as the Continental Army, is a warrant authorizing payment to Dr. David Townsend, the Surgeon General of the Sixth Continental Army, for medicines he supplied for soldiers suffering from smallpox during July and August. According to one medical historian, credit for the fact that smallpox did not have more serious consequences during the Revolution should go directly to George Washington "due to the unusual precautions exercised for its prevention by inoculation." Thanks to this new manuscript, we will now be able to share with our visitors the importance of Washington's leadership in this little-known area--to let the public know that Washington was, in the words of one of our Library staff members, "First in Public Health."

Mary V. Thompson Research Specialist Mount Vernon Annual Report, 2000 (As amended, 5/16/2001)

Selected Bibliography:

Blanton, Wyndham B. Medicine in Virginia in the Eighteenth Century. Richmond, Virginia: Garrett & Massie, Incorporated, 1931.

Butterfield, L.H., editor. Adams Family Correspondence, 2 volumes. Cambridge, Massachusetts: The Belknap Press of Harvard University Press, 1963.

Clendening, Logan, compiler. Source Book of Medical History. New York: Dover Publications, Inc., 1960.

Fitzpatrick, John C., editor. The Writings of George Washington from the Original Manuscript Sources, 1745-1799, 39 volumes. Washington, DC: United States Government Printing Office, 1931-1943.

Hening, William Waller. The Statutes at Large..., Volume VIII. Richmond, Virginia: J. & G. Cochran, printers, 1821.

Jackson, Donald, and Dorothy Twohig, editors. The diaries of George Washington. Charlottesville: University Press of Virginia, 1976-1979.

Mary V. Thompson,
Research Specialist
Mount Vernon Annual Report, 2000