The Decisive Smallpox Battle

The Overlook

By Tom Clavin

“The Overlook” appears every Thursday at tomclavin.substack.com. An overlook is usually a place from which one can see in many if not all directions, including where one has been and where one is going. If you enjoy the column, please "like" it and let me know what you think by commenting (check out previous ones while you're at it).  Likes, comments, and shares help with author discoverability on Substack.com, and all support is appreciated.Don't forget to hit the ‘Subscribe’ button – it’s free!

          The FDA approval of the coronavirus vaccine will, I hope, spur more people to be vaccinated, especially those who come in contact with children under 12 who do not yet have access to vaccines. I’m not a fan of mandates except in specific occupations such as healthcare workers who routinely encounter the most vulnerable and educators who routinely encounter children. I do think each person has the right to refuse to be vaccinated. It would be foolish to refuse now with the FDA approval plus a factor already present – one cannot find in American history a mass vaccination program that killed or injured large numbers of people. Instead, there is ample evidence, including polio and measles, of many lives saved thanks to new vaccines. We can hope for the same now with the Covid-19 vaccine.

          I’m puzzled by the politicization of the vaccine. It has nothing to do with right/left, red/blue, constitutional freedom, and other nonsense. It is a healthcare and personal choice issue. If you don’t want to be sickened and possibly die and sicken and kill others, get the vaccine. If this is not important to you, don’t get it – but accept that there may be social and legal restrictions on what you can do simply because you pose a serious health threat to others.

I don’t support mask mandates at the state or federal level because they do unnecessarily politicize the issue and are mostly unenforceable. However, even for someone like me who has been vaccinated, if a business wants people to wear a mask, I’ll do so. A mask is not foolproof but I do think it reduces the chances of me contracting a “breakthrough” infection and of infecting others, especially children and those with weaker immune systems. My rights are not being violated by wearing a mask, it’s a smart healthcare practice until Covid-19 is severely curbed or eradicated. How our government handled a global crisis that in the U.S. alone has killed over a half-million people dying is a larger political issue that will be considered and judged by history. The more urgent and non-political matter is saving lives and defeating an ongoing pandemic.

Speaking of history: One of the more interesting ingredients in Valley Forge, written by Bob Drury and yours truly and published three years ago, is that George Washington ordered a mass inoculation of the Continental Army against smallpox. Washington himself was already immune to the disease, having contracted and survived a mild case at the age of 19 when he accompanied his tubercular brother Lawrence to Barbados. Though the experience had left him with barely visible pocks on his body and face, he knew well how smallpox could not only devastate a standing army but frighten away prospective recruits needed for a Spring 1778 campaign.

At one point, New Hampshire’s Gen. Enoch Poor informed his governor that close to half his brigade was down with the pox. And such was the fear of contagion that the pickets and guards posted about the Valley Forge camp’s perimeter were instructed to examine anyone entering for telltale signs of the “dimpled death.” As the virus can be transmitted by air, this was for the most part in vain. Nonetheless, at the first sign of smallpox or any other communicable disease, ailing soldiers were evacuated and carried off in open carts through pelting rain, sleet, and snow to the area’s crude and filthy hospitals. If they survived the journey, they were deposited on the doorsteps of what the contrarian doctor Benjamin Rush aptly labeled “the sinks of human life in the army.”

Yet even these sinks were soon overflowing. The Continental Army had barely settled into Valley Forge before all existing medical centers on either side of the Schuylkill and as far away as New Jersey were soon overwhelmed. This, despite vociferous local protests, necessitated the seizure of village meeting houses, churches, barns, schoolhouses, and even some private residences in the predominantly religious communities to the west and south of the winter camp.

The exact number of these unofficial infirmaries has never been recorded, although they surely ran into the scores if not the hundreds. In either case, they were not so much hospitals as abattoirs. Ostensibly supplied with sugar, milk, barley, mutton broth, and perhaps even a bit of medicinal port or Madeira, in reality they provided at best a warm bath and a scant ration of rice while nurses, usually camp followers paid two dollars a month, watched and waited for the patients to die, as some 1700 men did in these facilities over the winter of 1777-1778. The few who did recover often reported back to duty wrapped in blankets or even naked, as the doxies had stolen their clothes. Washington attempted to tighten security by stationing a field officer in each facility to act as ward masters. This had little effect on the pilfering; nor did the Commander in Chief’s numerous personal visits to cheer up the troops.

By mid-January of 1778, Washington had seen enough. Horrified and exasperated by the filthy, overcrowded conditions of the general hospitals – it was not unusual for 20 patients to be packed into a room meant for a half-dozen – he ordered the brigade commanders at Valley Forge to construct a series of what he termed “flying hospitals” to tend the less seriously ill. These 15-feet by 25-feet structures were erected at a distance of no less than 100 yards from each brigade’s headquarters\ and were essentially a larger version of the hut lodgings – with two exceptions. No sod or dirt was to be used as chink, as Washington believed this caused an unhealthful dampness; and there were to be windows on two walls for aesthetic purposes. But no porthole view, no matter how glorious, could offset the 18th Century’s primitive medical mores.

In both the more established infirmaries and the flying hospitals, patients with contagious diseases mixed with soldiers recovering from minor wounds or illnesses, giving rise to the new phrase “hospital fever,” which would kill you as surely as the frequent outbreaks of dysentery, typhus, and typhoid known collectively as camp fever. Medical science of the era had no idea of the relation between body lice and typhus, and infected blankets and straw used by the recently deceased were issued to new patients. Surgeons’ tools were rarely washed, much less sterilized, before amputations with no anesthetic were performed, and post-surgical infections spread like the ubiquitous vermin who carried them. And as the early signs of typhus and smallpox bore a striking resemblance to one another, doctors often treated men for the wrong disease.

So frightening was the idea of being consigned to one of these slaughterhouses, some soldiers instead opted to conceal their fevers and die in their huts. In what may seem a minor clerical inconvenience but was in fact a bureaucratic nightmare for Commander in Chief bent on shaping an army for its next campaign, many of the men who passed – either in hospital or in hut – were carried on the active-duty rolls for months after their deaths. There was little Continental Army doctors could do to successfully treat the majority of pestilences swirling in and around Valley Forge that winter. Yet one of the few medical triumphs they could claim resulted from the controversial steps Washington took to eradicate the dread smallpox.

A year earlier, as the army overwintered in Morristown, New Jersey, he had experimented on small units with an inoculation technique known as variolation. The procedure – practiced for millennia in China but new, and therefore mysterious and frightening to Western minds – consisted of deliberately exposing healthy soldiers who had never contracted the virus to small doses of infected smallpox scabs or puss, which was churned into a powder and rubbed into superficial cuts on their skin. The patients would develop pustules and the symptoms similar to naturally occurring smallpox – fever, nausea, fatigue, muscle aches. But after a few weeks these manifestations would subside, followed by recovery and immunity.

While the death toll from smallpox outbreaks hovered around 16 percent of those who contracted it up and down America’s eastern seaboard at the time, less than one percent of the soldiers at Morristown who underwent variolation died.At Valley Forge, Washington went even further, insisting that the entire army undergo the inoculations. The purposeful infections began in January and were done in secret, lest the British be alerted that at any given moment whole brigades might be incapacitated. By some reports, after some 4,000 troops had been treated by mid-March, deaths from smallpox dropped seventeen-fold.

The first smallpox vaccine was developed in 1798. That disease no longer exists. No doubt there were some people who refused it. Over time they either gave in, were forced to do it, or died. At a much-quicker pace, we will see that happening with the Covid-19 vaccines.

Tom Clavin is the bestselling author/co-author of 18 books, including this latest collaboration with Bob Drury, Blood and Treasure: Daniel Boone and the Fight for America’s First Frontier, published by St. Martin’s Press. Please go to your local bookstore or to Bookshop.org, Amazon.com, or BN.com to purchase a copy.

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