In the annals of the American Revolutionary War, we often focus on the military tactics, political maneuvering, and battlefield heroics that secured independence. However, one of General George Washington’s most consequential decisions had nothing to do with troop formations or artillery placement. Instead, it involved a bold medical intervention that may have saved the revolution. In February 1777, Washington ordered the mandatory inoculation of Continental Army troops against smallpox, implementing what historians consider the first mass immunization policy in American history. This decisive action against an invisible enemy, a testament to Washington’s strategic foresight, demonstrated his leadership as a military leader and public health advocate.
The Smallpox Threat in Colonial America
Smallpox posed a lethal threat to the American colonies during the Revolutionary War period. The disease carried a mortality rate of approximately 30%, with survivors often left disfigured by characteristic scarring. Unlike in Europe, where smallpox was endemic, many Americans had little to no exposure to the disease. Colonial life centered around isolated farms and plantations, meaning that most Americans, particularly those from southern and rural areas, had never encountered smallpox and thus had no natural immunity.
As troops gathered from across the colonies to form the Continental Army, they created ideal conditions for disease transmission. Smallpox could spread through the air, through bodily fluids, or even by touching contaminated clothing. Once infected, victims experience fever, headaches, body pains, and a severe rash. The close quarters of military encampments made the disease particularly dangerous for Washington’s forces.
Washington’s Personal Experience With Smallpox
George Washington was intimately familiar with smallpox. In 1751, when he was nineteen years old, Washington contracted the disease during his only trip outside the American mainland, when visiting Barbados with his brother Lawrence. The illness lasted nearly a month, leaving Washington with slight scarring but, crucially, providing him with lifelong immunity. This personal experience would later inform his understanding of the disease’s dangers and the potential benefits of inoculation.
Early Losses and Growing Concern
In the initial years of the Revolutionary War, Washington witnessed firsthand how smallpox could devastate military effectiveness. The disease ravaged American forces during the ill-fated invasion of Canada in the winter of 1775-1776, leading to significant casualties not from enemy fire but from infection. After this disaster, Washington became increasingly concerned about smallpox’s impact on his army.
The Continental Army faced another significant challenge: recruitment. Fear of contracting smallpox deterred potential soldiers from enlisting. Connecticut Governor Jonathan Trumbull wrote to Washington on July 4, 1776, noting, “Fear of the Infection operates strongly to prevent Soldiers from engaging in the Service, and the Battalions ordered to be raised in this Colony fill up slowly.” General Philip Schuyler reported similar recruitment problems in New York, where many potential recruits were “extremely apprehensive of being infected with the small pox and not without Reason as it proves fatal to many of them.”
The Momentous Decision
Washington initially prohibited inoculation among his troops. The practice of variolation (the precursor to modern vaccination) involved deliberately infecting individuals with material from smallpox sores, typically leading to a milder case of the disease, followed by immunity. However, during recovery, which could take up to five weeks, patients remained contagious and temporarily weakened. Washington worried that inoculating his soldiers would leave them vulnerable to a British attack during their recovery period.
By early 1777, however, the general had reached a turning point. Observing continued losses to the disease and recruitment difficulties, Washington concluded that smallpox threatened the revolutionary cause more than British forces. On February 5, 1777, he issued a momentous order in a letter to John Hancock, president of the Second Continental Congress, mandating smallpox inoculation for all troops.
The next day, Washington wrote to Dr. William Shippen Jr., the Continental Army’s Medical Director, ordering all Philadelphia recruits be inoculated. His directive was clear and urgent: “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.”
Philadelphia’s Central Role
Philadelphia played a crucial part in Washington’s inoculation strategy. As the colonial capital and a major population center, Philadelphia was particularly susceptible to smallpox outbreaks. It also served as a key transit point for troops from southern states heading north to join Washington’s army in New York or New Jersey, potentially exposing many soldiers to the disease during their journey.
Washington specifically designated Philadelphia as an inoculation center. In a letter dated March 12, 1777, to Lieutenant Colonel David Grier, Washington instructed: “Those [recruits], who have not [had smallpox], are to be sent to Philadelphia, and put under the direction of the commanding officer there, who will have them inoculated.” This strategic decision allowed recruits to undergo variolation and recovery before joining the main army, ensuring they would not introduce smallpox into the camps or fall ill during critical operations.
Most inoculations took place at facilities in Philadelphia and at the army’s encampment in Morristown, New Jersey. Washington deliberately chose winter for this mass inoculation campaign, understanding that fighting typically slowed during colder months. This timing gave his troops adequate time to recover before the spring campaigning season.
Implementation and Success
Washington insisted that the inoculation campaign be conducted in secret. He feared that if the British learned about his forces’ temporary weakness during recovery, they might launch an attack. Despite these security concerns and the controversial nature of variolation, the program proceeded efficiently. By the end of 1777, approximately 40,000 soldiers had received the variolation procedure, marking a significant success in the battle against smallpox.
As the war progressed, Washington had to adapt his inoculation policies. In March 1778, while the Continental Army was encamped at Valley Forge after the British had occupied Philadelphia, Washington modified his orders. Rather than sending uninoculated troops to Philadelphia, which was now under enemy control, he ordered inoculations to continue at the Valley Forge camp. This strategic decision, though risky, allowed Washington to maintain troop strength while continuing the vital inoculation program, demonstrating his adaptability and leadership during challenging times.
The results of Washington’s bold public health policy were remarkable. Before the mass inoculation campaign, estimates point to infectious disease as the cause of about 90% of Continental Army deaths, with smallpox causing the majority of these fatalities. After implementation, smallpox rates plummeted among American forces, giving them a distinct advantage over the British, whose troops continued to suffer from the disease.
A Legacy of Leadership
Washington’s decision to mandate smallpox inoculation for the Continental Army represents an early example of evidence-based public health policy in America. By overcoming widespread fears and opposition to variolation, Washington demonstrated both medical foresight and pragmatic leadership. His willingness to embrace a controversial medical procedure despite public resistance ultimately protected his army and contributed significantly to the American victory in the Revolutionary War.
This episode also established an important precedent for military health practices. Washington’s inoculation policy set the stage for compulsory vaccination programs in the U.S. military that have continued for over three centuries. Even today, service members are required to receive multiple vaccinations to protect against infectious diseases.
The story of Washington’s battle against smallpox reminds us that military success depends not only on strategy and weaponry but also on protecting troops from invisible enemies. It stands as a testament to Washington’s comprehensive vision of leadership, where safeguarding soldiers’ health was recognized as essential to achieving strategic objectives.