A Most Dangerous Foe*

The disease George Washington regarded as a most dangerous foe was Smallpox. Of the common diseases that killed in the Eighteenth Century, which included typhus, typhoid, dysentery, diptheria, yellow fever and malaria, smallpox was the most deadly.

The worst outbreaks of smallpox occurred during the expedition to take Quebec in the autumn and winter of 1775 and during the second New Jersey Campaign of early 1777. Direct observations of the devastating effects of the pox on soldiers in the Quebec campaign recorded in the journal of Dr. Lewis Beebe of Massachusetts are replicated here.

Friday 7: Last evening one died of the small pox, and early this morning one of the colic; at 10 A.M. one of the nervous fever. Here in the hospital is to be seen at the same time some dead, some dying, others at the point of death, some whistling, some singing and many cursing and swearing... Visited many of the sick in the hospital was moved with a compassionate feeling for poor distressed soldiers, when they are taken sick, are thrown into this dirty, stinking place and left to take care of themselves. No attendance, no provision made, but what must be loathed and abhorred by all both well and sick...

Monday 10th: This day died two in Colo. Pattersons regiment with the small pox. No intelligence of importance comes to hand this day, except orders, from the great Mr. Brigadier Gen. Arnold, for Colo. Poor with his regiment to proceed to Sorrell immediately. Is not this a politick plan, especially since there is not ten men in the regiment but what has either now got the small pox or taken the infection? Some men love to command, however ridiculous their orders may appear. But I am apt to think we shall remain in this garrison for the present. It is enough to confuse and distract a rational man to be surgeon to a regiment, Nothing to be heard from morning to night but "Doctor! Doctor! Doctor!" from every side till one is deaf, dumb and blind, and almost dead; add to all this, we have nothing to eat; thus poor soldiers live sometimes better, but never worse...

Thursday 13th: Arose this morning at the revilee beat, put on my morning dress, walked abroad and found the camp in a most profound silence, the whole being buried in sleep, but it was not long before the whole camp echoed with execrations upon the musketoes...

Monday 17: This morning had Colo. Poors orders to repair to Isle aux Naux to take care of the sick there; accordingly sailed in a batteau, and arrived there about 3 P.M. Was struck with amazement upon my arrival to see the vast crowds of poor distressed creatures. Language cannot describe nor imagination paint the scenes of misery and distress the soldiers endure. Scarcely a tent upon this isle but what contains one or more in distress and continually groaning and calling for relief, but in vain! Requests of this nature are as little regarded as the singing of crickets in a summers evening.. The most shocking of all spectacles was to see a large barn crowded full of men with this disorder, many of which could not see, speak or walk. One nay two had large maggots, an inch long, crawl out of their ears, were on almost every part of the body. No mortal will ever believe what these suffered unless they were eye witnesses. Fuller appeared to be near his end. Gen. Sullivan set fire to all the armed vessels, 3 gundalows and fort at Chambly, and at evening came all his army, with all the stores and baggage, to St. Johns....

Wednesday 26: The regiment is in a most deplorable situation, between 4 and 500 now in the height of the small pox. Death is now become a daily visitant in the camps, but as little regarded as the singing of birds. It appears, and really is so, that one great lesson to be learnt from seath is wholly forgot: that therein we discover our own picture; we have here pointed out our own mortality in the most lively colours. Strange that the frequent instances of so solemn a scene as this should have such an effect that it should harden, and render us stupid, and make us wholly insensible of the great importance of so serious a matter, but herein is discovered the amazing blindness and stupidity which naturally possess our minds. 40 to 50 batteaus sailed this morning for Isle aux Naux, to bring the remainder of the army; having a fair wind they cut a pretty figure. This day had intelligence that the Congress had agreed to raise an army Of 72 thousand men for the year 1777. Visited many of the sick, see many curious cases, find in general that I can effect greater cures by words than by medicine.

Thursday 27th: Buried two of our regiment this day. The hot weather proves very unfriendly to those who have the small pox. A large schooner arrived from Isle aux Naux, deeply loaded with stores. One thing, by the way, is somewhat remarkable, that a regiment so distressed with sickness as ours is should be so engaged in fatigue and doing duty that they can by no means find time to attend prayers night and morning or even preaching upon the Sabbath; the regiments are generally supplied with chaplains, who are as destitute of employ in their way as a parson who is dismissed from his people for the most scandalous of crimes....

Saturday 29th: Buried 4 this day, 3 belonging to our regiment on the other side; they generally lose more than double to what we do here. Alas What will become of our distressed army? Death reigns triumphant. God eems to be greatly angry with us; He appears to be incensed against us for our abominable wickedness and in all probability will sweep away a great part of our army to destruction. 'Tis enough to make humane nature shudder only to hear the army in general blaspheme the holy name of God. This sin alone is sufficient to draw down the vengeance of an angry God upon a guilty and wicked army. But what is still melancholy, and to be greatly lamented is, amidst all the tokens of Gods holy displeasure, we remain insensible of our danger, and grow harder and harder in wickedness, and are ripening fast for utter destruction.

Sunday 30: I hardly know what to say. I have visited many of the sick. We have a great variety of sore arms and abscesses forming in all parts of the body, proceeding from the small pox, occasioned by the want of physic to cleanse the patients from the disorder. However we had none so bad as yet but what we have been able to cure, except the disorder otherwise was too obstinate. Buried two today. No preaching or praying as usual. The small pox rather abates in the regiments. A number are employed the other side almost the whole of the day to dig graves and bury the dead....

Wednesday 3d. [July, 1776]: Had prayer last evening and this morning; hope the regiment will take a new turn of mind and for the future give steady attendance. Buried 3 this day. How strange it is that we have death sent into our camp so repeatedly, every day! And we take so little notice of it! Nay, it will not prevent cursing and swearing in the same tent with the corps. Several were confined the other side for quarreling; some of their party came to relieve them, which they effected by pulling down the guard house; upon which Gen. Sullivan paraded the whole army. Confined a number of offenders under a guard of every 4th man in the regiment. A special court is ordered to sit tomorrow. Since I have been writing, one more of our men has made his exit. Death visits us every hour....

Friday 12: Felt some better as to my health. Walked to visit some of the sick in the neighborhood. Dined at Colo. Strongs with Colo. Gilman and others. Returned soon to camp. Notwithstanding the regiment as a body are on the gaining hand, yet found 6 or 8 in the most deplorable situation that ever mortals were in; it is in vain to pretend to give any just description of their unhappy circumstances, as language cannot describe, nor imagination paint, their distresses. It is impossible for a person that has any feeling for humane nature to enter their tents without droping a tear of pity over them.

Saturday 13: Buried 3 yesterday and 2 today a number more lay at the point of death. Last evening heard of the death of Colo. Williams. He left this place about 10 days past for Ruport, to regain his health, being much troubled with the dysentery. He arrived at Skenesboro and grew o ill that he was unable to proceed any further, and there died July 10th 1776, half after one in marne. General orders for all the sick to be removed tomorrow morning to Ticonderoga....

Friday 19: Last evening we had one of the most severe showers of rain ever known; it continued almost the whole night, with unremitted violence; many of their tents were ancle deep in water. Many of the sick lay their whole lengths in the water, with one blanket only to cover them. One man having the small pox bad, and unable to help himself, and being in a tent alone, which was on ground descending, the current of water came through his tent in such plenty that it covered his head, by which means he drowned. This is the care that officers take of their sick. Such attention is paid to the distrest, who are destitute of friends. Buried two yesterday, and two more today. Cursing and damning to be heard, and idleness to be seen throughout the army as usual..."

The smallpox attacked the body resulting in a rash of blisters on the skin and in the throat and nasal passages. The resulting itching of the blisters along with an increase in body temperature weakened the stamina of the soldiers inflicted with the disease, and made them unfit for active duty. It is generally accepted that this was not much of an exaggeration on the efficacy of the disease. According to Mary E. Fissell, in her contribution to the book, The Blackwell Encyclopedia Of The American Revolution, "typical estimates suggest that, for every soldier killed by the enemy, nine died from smallpox."

A definition given to the word, pox, in the 1700s, stated that it was a pustule or rather an exanthematous eruption meaning that it produced blisters or 'wheals' on the skin.

The book, Cyclopedia: Or An Universal Dictionary Of Arts And Sciences, published in the year 1763, noted that smallpox was "a contagious disease appearing on the cutis, which it covers with postules, or ulcerous eruptions, that leave eschars behind them." Two types of smallpox were noted. The first, distinct smallpox, was characterized by ten distinct symptoms: 1.) pain in the head and back; 2.) a fever with redness of the eyes; 3.) nausea and vomiting; 4.) little reddish pustules that appeared on the face, neck and breast about the third or fourth day; 5.) restlessness; 6.) an increase in the number of pustules appearing between the original ones; 7.) a change in the color of the pustules from red to a whitish yellow; 8.) lightheaded and feverishness; 9.) on about the tenth day the pustules on the face begin to dry out; 10.) by the fifteenth day, the pustules appear to shrink considerably and scale off. The second type, confluent smallpox, consisted of the same symptoms with the exception that they were not defined in such distinct stages, and those symptoms were more severe. In confluent smallpox, the pustules tended to blend together. They became so thick over the skin that they appeared to blend together into a single mass. By the eighth day, the sufferer's skin would turn a dark color. At about the same time, he would be subject to intense salivation and a coincident diarrhea. Death usually came to the sufferer by the eleventh day. The soldier suffering from the disease would experience not only violent pain in the head and back, but also delirium, convulsions and difficulty in breathing. The distinct type of smallpox would render a soldier incapable of active duty for at least two weeks. The confluent type of smallpox resulted in fatality. It can easily be seen how the spread of the disease inflicted hardship on the army.

General George Washington was very cognizant of the threat that a smallpox epidemic posed to his fledgeling Patriot army. He had had a taste of its deadly effects in March, 1776 during the siege of Boston.

On 27 November, 1775 from his camp at Cambridge, General Washington sent a letter to Joseph Reed. In that letter he commented on the condition of three hundred of the inhabitants of Boston whom General Howe had recently released and sent from that city to Point Shirley. He stated that:

"I have order'd Provision to them till they can be remov'd, but am under dreadful apprehensions of their communicating small pox as it is Rief in Boston. I forbid any of them coming to this place on that acct."

On the 5th of December, 1775 General Washington sent a letter to the President of the Continental Congress in which he stated:

"By recent information from Boston, General Howe is going to send out a number of the inhabitants, in order as it is thought to make room for his expected reinforcements; there is one part of the information that I can hardly give Credit to, A Sailor says that a Number of these coming out have been inoculated with design of Spreading the Small pox through this Country and Camp."

His doubt was proven wrong a few days later. On 11 December, the General sent another letter to the Congress, in which he told them that:

"The Information I received that the Enemy intended spreading the small Pox amongst us, I could not suppose them capable of: I now must give some credit to it, as it has made its appearance on several of those who last came out of Boston, every necessary precaution has been taken to prevent its being communicated to this Army..."

Washington, on the 15th, wrote to Joseph Reed and added the postscript:

"P.S. The smallpox is in every part of Boston. The soldiers there who have had it, are, we are told, under inoculation, and considered as a security against any attempt of ours. A third shipload of people is come out to Point Shirley. If we escape the smallpox in this camp, and the country around about, it will be miraculous."

General Washington gave the following order to his troops as part of his General Orders of 13 March, 1776:

"As the Ministerial Troops in Boston, both from information and appearance, are preparing to evacuate that town: The General expressly orders, that neither Officer, nor Soldier, presume to go into Boston, without leave from the General in Chief at Cambridge, or the commanding General at Roxbury; As the enemy with a malicious assiduity, have spread the infection of the smallpox through all parts of the town, nothing but the utmost caution on our part, can prevent that fatal disease from spreading through the army, and country, to the infinite detriment of both - His Excellency expressly commands every Officer, to pay the exactist obedience to this order."

General Washington knew how to use the men of his army who had previously been afflicted with the disease, insightfully appreciating the immunity of convalescence. On 19 March, 1776 he wrote a letter to the Congress to acquaint them with the recent news of the evacuation of the city of Boston by the British. In that letter he noted that:

"As soon as the Ministerial Troops had quitted the Town, I ordered a Thousand men (who had had the small pox) under command of General Putnam, to take possesion of the Heights."

He also set up a hospital at Cambridge specifically for anyone found to be suffering from the pox. He gave his Hospital and Regimental Surgeons the following orders:

"to examine carefully the sick, and whenever they discover the smallest Symptom of the smallpox, they are without delay to send the patient to the small-pox Hospital in Cambridge."

The General was interested in trying the technique of inoculating a well person with a bit of the disease in order for a resistance to be built up within the person. The technique of inoculation was developed in the colonies by Dr. Zabdiel Boylston in 1721. He learned on the method from his African slave, Onesimus. Apparently, men of Onesimus' tribe had been deliberately infected with the disease, but not all of them had developed the symptoms of the disease. Dr. Boylston began inoculation experiments with his son, Thomas. He survived the experiment, which encouraged the doctor. Other members of the Boylston household were inoculated, and eventually more than two hundred and forty people in Boston underwent the experiment. Of that number, only six contracted the disease and died from it.

The technique of inoculation involved taking the clear serum from a recently developed pustule on a victim of the disease. The pustule was pricked with a pin and the matter pressed out into the end of a quill. The person to accept the inoculation had his or her arm scratched, and into the cut the smallpox matter would be pressed. The inoculated person would then be exposed to cold air or drink cold water mixed with a some mercurial purgatives.

It is interesting to note how General Washington's opinion of utilizing the method of inoculation to control the spread of small pox changed between the summer of 1776 and the fall of 1777. The General's wife, Martha, visited the camp from time to time, as did other civilians. He worried that she might contract the disease, but he at first was convinced that the inoculation technique would contribute to the spread of the disease. Martha, on the other hand, was anxious to undergo the technique, and had claimed that she intended to take the Small Pox. In a letter to John Augustine Washington, the General stated that "Mrs. Washington is still here, and talks of taking the Small Pox, but I doubt her resolution."

The General's initial distrust of the inoculation technique can be seen in his General Orders of 20 May, 1776, in which he stated:

"No Person whatever, belonging to the Army, is to be inoculated for the Small- Pox - those who have already undergone that operation, or who may be seized with Symptoms of that disorder, are immediately to be removed to the Hospital provided for that purpose on Montresor Island. Any disobedience to this order, will be most severely punished - As it is at present of the utmost importance, that the spreading of that distemper, in the Army and City, should be prevented."

General Washington's stance on the subject of inoculation was primarily influenced by advice from the Marquis de Lafayette and the orders issued by the various provincial assemblies. On 26 May, 1776, upon the receipt of correspondence from the New York Provincial Congress, which provided an account of the arrest of Doctor Azor Betts for administering the inoculation to four officers of the Patriot army, General Washington issued the following General Orders:

"The General presents his Compliments to the Honorable The Provincial Congress, and General Committee, is much obliged to them, for their Care, in endeavoring to prevent the spreading of the Small-pox (by Inoculation or any other way) in this City, or in the Continental Army, which might prove fatal to the army, if allowed of, at this critical time, when there is reason to expect thay may soon be called to action; and orders that the Officers take the strictest care, to examine into the state of their respective Corps, and thereby prevent Inoculation amongst them; which, if any Soldier should presume upon, he must expect the severst punishment.

Any Officer in the Continental Army, who shall suffer himself to be inoculated, will be cashiered and turned out of the army, and have his name published in the News papers throughout the Continent, as an Enemy and Traitor to his Country.

Upon the first appearance of any eruption, the Officer discovering of it in any Soldiers, is to give information to the Regimental Surgeon, and the Surgeon make report of the same, to the Director General of the hospital."

Perhaps General Washington's opinion of the inoculation technique was swayed in the opposite direction when he received, only a few days later, the information that Martha had indeed underwent the inoculation technique. To John Augustine Washington, the General wrote, on 31 May, 1776:

"Mrs. Washington is now under Inoculation in this City; and will, I expect, have the Small pox favorably, this is the 13th day, and she has very few Pustules; she would have wrote to my Sister but thought it prudent not to do so, notwithstanding there could be but little danger in conveying the Infection in this manner."

In view of the fact that the General eventually changed his mind on the matter of allowing the troops to undergo the inoculation technique, one can only wonder if Martha's favorable outcome had anything to do with it. Washington's change of mind on the matter of inoculation was made evident in a letter he sent to Doctor William Shippen, Jr from his headquarters at Morristown, New Jersey on 06 January, 1777.

"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. This expedient may be attended with some inconveniences and ome disadvantages, but yet I trust, in its consequences will have the most happy effects. 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 Doctor Bond, to prepare immediately for inoculating in this Quarter, keeping the matter as secret as possible, and request, that you will without delay inoculate all the Continental Troops that are in Philadelphia and those that shall come in, as fast as they arrive. You will spare no pains to carry them through the disorder with the utmost expedition, and to have them cleansed from the infection when recovered, that they may proceed to Camp, with as little injury as possible, to the Country through which they pass. If the bussiness 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."

The threat of a smallpox epidemic in the Patriot army was undeniably averted by General Washington's decision to have the troops inoculated.

*Reference: Beebe, Lewis. Journal of Lewis Beebe A Physician on the Campaign Against Canada, 1776. Edited by Frederick R. Kirkland. Philadelphia: Historical Society of Pennsylvania, 1935. [Originally published in Pennsylvania Magazine of History and Biography, 59 (October 1935), pp. 321-361.]