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George Washington and Smallpox: A Revolutionary Hero and Public Health Activist.

George Washington is familiar as America’s Revolutionary War general and inaugural president. But less known is that Washington, while audaciously battling the British Army, simultaneously waged a behind-thescenes public health campaign against a serious, sinister, and pathological threat to American military readiness: smallpox. Washington himself had contracted smallpox as a 19-year-old traveling abroad in 1751. The disease nearly took his life, but he survived with pockmark scars and life-long immunity. When he assumed command of the Continental Army in 1775, General Washington was deeply aware of the ever-present threat of smallpox and pledged “the utmost vigilance...against this most dangerous enemy.” Because smallpox was common in Europe, most British and Hessian soldiers had already been exposed and were immune; but smallpox was still uncommon in America, meaning the average Continental soldier had no immunity. To protect his ranks, Washington ordered military surgeons to quarantine any soldier suspected of being infected. Although he was familiar with the 18th-century inoculation technique known as variolation, Washington delayed ordering mandatory inoculations for several reasons. First, the procedure was outlawed by continental and state legislatures. Second, his military physicians widely believed it carried the risk of spreading the disease. Finally, variolation required isolation for several weeks, which posed a logistical and strategic challenge for a military commander confronting a large enemy force with superior equipment and training. In 1776, however, smallpox epidemics reemerged in Boston and Philadelphia. Eventually, half of the 10 000 Continental troops dispatched to capture Quebec contracted the disease, forcing a hasty retreat. Some historians believe this tactical setback extended the Revolutionary War and is the reason Canada did not become an American colony. Washington repeatedly petitioned Congress to legalize variolation. He even lobbied Virginia Governor Patrick Henry to repeal a law against variolation, so that troops traveling north from the Carolinas could be inoculated. In a letter to John Hancock, Washington conceded: “The small pox has made such Head in every Quarter that I find it impossible to keep it from spreading.” (vol5, p222) Finally, in 1777, emboldened by successive military victories and armed with mounting scientific evidence (including successful mass variolations in Massachusetts and the effective inoculation of his wife, Martha), General Washington ordered the mandatory smallpox inoculation of any soldier not previously infected. By year’s end, nearly 40 000 troops were inoculated. The following year, infection rates fell from 17% to 1%—a landmark achievement representing the first successful case of inoculating an entire army against a disease. Washington’s revolutionary thinking earned the admiration of the Continental Congress, which subsequently legalized variolation. More important, it averted another health crisis within the Continental Army and dramatically altered the outcome of the Revolutionary War.