We Learned This at Valley Forge

The news today carries the tragic story of a Dickenson, Texas city councilman who died of Covid-19 just days after posting on social media about “the folly of vaccinations”.  It is strange to read about so many people being opposed to vaccinations, since I (evidently mistakenly) thought that this was a long-settled topic. 

Being almost as old as dirt, I remember the mass inoculations against smallpox and polio of the fifties—I still have a faint smallpox vaccination scar to prove it.  The vaccines were an incredible success—smallpox has been completely conquered and polio remains endemic only in Afghanistan and Pakistan.   

And those mass vaccinations some seven decades ago are far from the first such endeavors in American history.  Indeed, the very existence of our country may have depended on the very first large-scale inoculation program conducted at public expense.

In the mid eighteenth century, while smallpox was ravaging most parts of the world, the small British colonies of North America were usually spared from the epidemic.  Outside of a small handful of large settlements like Boston, Philadelphia, and New York, most colonists lived in relatively isolated settlements with very little contact with the rest of the world.  While smallpox was not unknown, it was relatively rare.

In 1751, seventeen-year-old George Washington took his half-brother, Lawrence—then suffering from consumption (tuberculosis)—to Barbados for his health.  While there, he accepted an invitation to dine with a wealthy planter despite being warned that members of his family had contracted smallpox.  Ominously, Washington recorded his misgivings about the visit in his diary.  Shortly after the dinner, he writes “Was strongly attacked with the small Pox,”—his last entry in the diary for 24 days.  Washington, of course, eventually recovered, though it took weeks.  Having once had smallpox, Washington carried antibodies, making him immune to the disease.

During the American Revolution, most of the European troops brought to America were immune or benefitted from herd immunity because most had contracted the disease in childhood.  Not so, the American troops:  For the first time in their lives, these soldiers were brought from all of the corners of North America, living in camps with poor sanitation, which provided a perfect breeding ground for all kinds of diseases.  The cases of smallpox immediately began to increase.

There was something that Washington could do:  he could inoculate his troops against smallpox through a process called variolation (named after variola, the virus that causes smallpox).  It involved infecting a thread with live pustular matter from someone with the disease, then embedding the thread into an incision on a healthy person’s arm, deliberately infecting the person with smallpox.  While the patient always became sick, the disease was usually a milder form of the disease.  Still, depending on the source you read, somewhere from 3 to 5% of those treated died from the inoculation…And the patient always took weeks to recover.

Variolation had originated in Western Asia—probably Turkey—and had slowly spread west across Europe.  While the preventive treatment was known, it was still highly controversial and seldom used in the New World.  

Note.  There is a persistent story that Washington inoculated his troops with a different but close variety of the disease, specifically cowpox.  The story goes that milkmaids caught the disease from the cows they cared for, and some alert doctor realized that these milkmaids never caught the more virulent form of the disease.  While the story is quite true, the cowpox method of inoculation was not discovered by Edward Jenner until 1796, well after the end of the Revolutionary War.

Washington had considered inoculating his troops in 1775, but rejected the idea because the treatment would incapacitate at least a third of his troops, inviting an attack from the British.  The general issued orders forbidding the army doctors from using the variolation technique on the troops.  Instead, the general issued travel bans, forbidding visitors from Boston (which was then suffering from a smallpox epidemic) from entering his camp.  In addition, those soldiers who did come down with smallpox were quarantined at a special hospital near Cambridge.

Then, as now, quarantines and travel bans had only limited success.  Over the next year and a half, increasing numbers of Washington’s troops succumbed to the disease.  There were even rumors that the British were intentionally sending infected people to strategic areas in a deliberate attempt to spread the disease.  Though this theory remains unproved, England had employed this tactic during the earlier French and Indian War.

Washington grew increasingly desperate, forcing him to reconsider using variolation to treat his troops.  In a January 6, 1777, letter to John Hancock, Washington wrote "Necessity not only authorizes but seems to require the measure, for should the disorder infect the Army . . . we should have more to dread from it, than from the Sword of the Enemy."

Finally, in February 1777, Washington ordered a mandatory inoculation of the troops, to be done in absolute secrecy to prevent a British attack, and to be carried out in stages beginning with the new recruits.  It was hoped that by the time the recruits received their uniforms, weapons, and a modicum of training, they would have recovered from the symptoms caused by the inoculation.  

This was the first mass public health initiative of the new country—one carried out with government funds.

“Finding the smallpox to be spreading much and fearing that no precaution can prevent it from running through the whole of our army, I have determined that troops shall be inoculated,” he wrote. “This expedient may be attended with some inconveniences and some disadvantages, but yet I trust in its consequences will have the most happy effects.”

Seldom mentioned in history books, but among the horrific conditions experienced by the troops during the winter of 1777-78 at Valley Forge was that the poorly fed, inadequately clothed, freezing troops were also suffering from the fevers and chills as a result of variolation.  Still, because of the treatment, not a single regiment among the revolutionary army was unable to fight due to the disease.

While Washington treated his troops, the British felt no need to initiate a similar program in their troops who enjoyed a measure of herd immunity.  As a result, the disease quickly spread among colonials, Native Americans, and slaves who chose to fight alongside the British, often making such units more of liability to the British cause than assets.

By the end of the war, Washington had inoculated some 40,000 of his troops and had lost only fifty due to the illness.  Despite the horrors of battle, a little math reveals that compared to the general population of the colonists left to suffer the ravages of smallpox epidemics that swept across America as the European troops traveled across America, a colonist had a better chance to survive the war as an inoculated soldier on the battlefield than as an uninoculated civilian.  

Then, as now, while there are a few dangers of being vaccinated, they pale in comparison to not being vaccinated.  There is no way of telling how many people have been saved by vaccinations, but the number is at the very least many millions of souls.  Vaccines work so well that most of us—unlike any previous generation in America—do not personally know anyone who has died of smallpox, diphtheria, measles, or polio.  After 250 years, you would think this debate would have ended.