Mass inoculation in 1776

This is quite astonishing to me. 5th Great-Grandfather Colonel Robert Longley was a Captain of a company of Massachusetts volunteers at the time of the Lexington Alarm and the Siege of Boston, April 19, 1775 to March 17, 1776. In trying to determine whether Longley fought at Bunker Hill (it appears he did), I have had to drill down into some of the regimental history. Longley's Company was part of Colonel Asa Whitcomb's Regiment. In doing so, I come across this remarkable order:

Letter from Asa Whitcomb to Dr. David Townsend

Boston, 17 July 1776

To Doctor Townsend:

General Ward has sent an order to Doctor Rand to supply the several doctors of the Regiment with proper medicines for to carry threw the inoculation among the soldiery and these lines are to direct you to apply to Dr. Rand for such medicines as is necessary for my Regiment as soon as may be so

I remain yours,

Asa Whitcomb Coll.

Inoculation? In 1776? That seems improbably early. Fewster's observation about the linkage between prior exposure to cowpox and immunity to smallpox occurred in England just prior to the war. From Wikipedia.

By 1768, English physician John Fewster had realised that prior infection with cowpox rendered a person immune to smallpox. In the years following 1770, at least five investigators in England and Germany (Sevel, Jensen, Jesty 1774, Rendell, Plett 1791) successfully tested in humans a cowpox vaccine against smallpox. For example, Dorset farmer Benjamin Jesty successfully vaccinated and presumably induced immunity with cowpox in his wife and two children during a smallpox epidemic in 1774, but it was not until Jenner's work that the procedure became widely understood. Jenner may have been aware of Jesty's procedures and success. A similar observation had also been made in France by Jacques Antoine Rabaut-Pommier in 1780.

From investigations in England and Europe circa 1770-1774 to an actual campaign of inoculation in 1776? Is that even possible?

Perhaps. From the Siege of Boston article:

As winter approached, both sides faced their own problems. The Americans were so short on gunpowder that soldiers were given spears to fight with in the event of a British attack. Many of the American troops remained unpaid and many of their enlistments would be up at the end of the year. On the British side Howe, who had replaced Gage as commander in October, was faced with different problems. Wood was so scarce that they began cutting down trees and tearing down wooden buildings, including the Old North Meeting House.

To add to this, supplying the city had become increasingly difficult because of winter storms and the rise in rebel privateers. The British troops were so hungry that many were ready to desert as soon as they could. Worse, scurvy and smallpox had broken out in the city. Washington's army faced similar problems with smallpox, as soldiers from rural communities were exposed to the disease. Washington moved infected troops to a separate hospital, the only option then available given the public stigma against inoculation.

I know the American leaders were gulping from the cup of the Age of Enlightenment and could not get enough of the new age of science and reason in Europe but this still seems astonishingly bold.

But it apparently was the case. Brenda Thacker of the Mount Vernon museum indicates that indeed inoculation was considered during the Siege of Boston but supposedly rejected. Later in the war, smallpox inoculation did become standard practice.

In the first years of the Revolutionary War, George Washington and his Continental Army faced a threat that proved deadlier than the British: a smallpox epidemic, lasting from 1775-1782. Infrequent outbreaks and wariness of inoculation made his troops very susceptible to the disease. After heavy losses in Boston and Quebec, Washington implemented the first mass immunization policy in American history.

Smallpox in the Americas

Smallpox, caused by the Variola major virus, spreads only from person to person. It can take up to fourteen days before a person exposed to the virus will show symptoms: fever, headaches, body pains, and eventually the telltale rash. Witnesses and survivors of smallpox describe immense suffering. Death often comes within about two weeks. Survivors can take up to a month to recover fully; they are left with scars, but also lifetime immunity.

European colonization introduced smallpox to the Americas in the sixteenth century. Over the course of a little more than three centuries, outbreaks of the disease appeared sporadically in colonial America. In Europe, smallpox became an endemic disease by the eighteenth century; exposure often happened in childhood, which meant that virtually the entire adult population was immune. The American colonists, however, might have gone for years without any exposure to smallpox. It is difficult to track smallpox deaths during the Revolutionary War, but estimates indicate that Washington’s army lost more troops to disease in general than in combat. One study suggests that for every soldier who fell to the British, ten died from some sort of disease. Washington himself was no stranger to smallpox; while traveling in Barbados in 1751, he contracted the disease while staying with Gedney Clarke. However, Washington did not keep a record of his illness. His case was mild, leaving him with scarring on his nose.

Colonies dealt with smallpox in two different ways: quarantine and inoculation. Each colony had its own quarantine laws, which took different forms and were often enforced at the local level. Some colonials, particularly the wealthy, chose to be inoculated. Inoculation involved deliberate exposure to smallpox, usually through an incision made on the arm. This still resulted in a case of smallpox, but frequently one with milder symptoms and a greater chance of survival, with immunity as the end goal. Many were opposed to inoculation because the practice could still lead to an outbreak if an inoculated person was not properly quarantined while ill. Inoculation was heavily regulated, and banned outright in some places. Combined with the procedure’s expense, this made it a rare practice in America.

Outbreaks in War

Immunity to smallpox became an important factor during the Revolutionary War in two ways. First, the British and Continental forces were disproportionately affected by the epidemic. The British troops arriving from Europe were more likely to be immune to the disease, either through inoculation or natural exposure. This was not true of Washington’s forces. As soldiers concentrated themselves in camp, the chances of a smallpox outbreak increased. Second, the British took quickly to inoculating fresh troops because the chances of triggering an outbreak were slim. Washington, on the other hand, struggled with the question of inoculation. Doing so would not only risk an outbreak; it would also leave a portion of the army unfit for battle while they recovered.

It was for these reasons that Washington decided against inoculation during his army’s first encounter with smallpox: the Siege of Boston in 1775. Civilians and soldiers who showed symptoms were kept from the rest of the army. When safe passage out of Boston was secured for some, the presence of smallpox was taken into account. There is some indication that the British, going against the agreement, used the disease as a biological weapon by forcing potentially infected Bostonians to leave the city. When the British gave up the city in the spring of 1776, the outbreak became even harder to control. Refugees spread smallpox throughout Massachusetts, and Boston’s outbreak continued until the end of summer. During the same period, the Continental forces besieging Quebec also suffered great losses due to smallpox. The soldiers were already in poor health, making them more susceptible. A quarantine was put in place, but it was not enforced strongly enough. When they were forced to retreat, smallpox went with them. These losses signaled to Washington and other revolutionary leaders that the army’s smallpox policy was not effective.

Mass Inoculation

After weeks of indecision, Washington issued the order to have all troops inoculated on February 5, 1777, in a letter to President John Hancock. The next day, a second letter was sent to Dr. William Shippen, Jr. that ordered all recruits arriving in Philadelphia to be inoculated:

“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 some 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.”

The practice was soon implemented across the colonies. Army physicians also inoculated veteran soldiers who had yet to be exposed. Washington needed the process to be done in secret. He feared that the British would learn of the army’s temporary weakness and use it to their advantage. In March 1778, the inoculation orders were altered slightly. At Valley Forge, Washington encountered thousands of troops that had managed to avoid smallpox, either through inoculation or natural exposure. In need of immediate reinforcements, Washington realized that the army might not survive the delay of inoculation. Instead, he ordered that inoculations continue at the camp in Valley Forge. If quarantine procedures failed, there was a risk of an outbreak. However, the soldiers awaiting inoculation could be called to the front lines if necessary.

Clearly Whitcomb's order supports that there was at least some limited program of inoculation in 1776.

I am truly astonished. Whitcomb does not specify what the men were being inoculated against. Possibly it was some other disease. If it was for smallpox, as historians seem to agree, then we are looking at only a seven year period between the first observation that cowpox inoculates against small pox, and only a couple of years between the first experiments to induce inoculation by prophylactic treatment and an active campaign in a deployed army. When transatlantic journeys were 2-4 months in duration, that is a pretty remarkable dissemination of emerging scientific knowledge.

Especially when compared to the dissemination of treatment for scurvy which killed thousands of sailors a year in the British Navy alone. The first proof that a diet rich in citrus could eliminate scurvy came in 1747 but it took till 1795 before providing vitamin C rich foods such as citrus was adopted. The motive force behind that adoption came from Fleet Admirals, not the Admiralty itself.

With the coming of war in 1793, the need to eliminate scurvy acquired a new urgency. But the first initiative came not from the medical establishment but from the admirals. Ordered to lead an expedition against Mauritius, Rear Admiral Gardner was uninterested in the wort, malt and elixir of vitriol which were still being issued to ships of the Royal Navy, and demanded that he be supplied with lemons, to counteract scurvy on the voyage. Members of the Sick and Hurt Board, recently augmented by two practical naval surgeons, supported the request, and the Admiralty ordered that it be done. There was, however, a last minute change of plan. The expedition against Mauritius was cancelled. On 2 May 1794, only HMS Suffolk and two sloops under Commodore Peter Rainier sailed for the east with an outward bound convoy, but the warships were fully supplied with lemon juice and the sugar with which it had to be mixed. Then in March 1795, came astonishing news. Suffolk had arrived in India after a four-month voyage without a trace of scurvy and with a crew that was healthier than when it set out. The effect was immediate. Fleet commanders clamoured also to be supplied with lemon juice, and by June the Admiralty acknowledged the groundswell of demand in the navy had agreed to a proposal from the Sick and Hurt Board that lemon juice and sugar should in future be issued as a daily ration to the crews of all warships.

It appears that within seven years of observing that cowpox inoculates against smallpox and nearly simultaneously with the first efforts in Britain to conduct tests of prophylactic inoculation, that knowledge had already crossed the Atlantic. Senior levels of the leadership of the new American Continental Army considered an inoculation campaign for the Continental Army but initially rejected the idea at the time of the Siege of Boston.

It also appears, however, that General Artemis Ward, a native of Massachusetts, proceeded with inoculation of some of the units of Massachusetts militia despite the rejection of that course of action by the Continental Army leadership.

And of course it is ironic that I come across this at the very moment when the world is in the middle of a modern-day pandemic. We have come a long way in 245 years but the nature of epidemics, the cost, the tragedy, the uncertainty, and the fear of the unknown (and currently unknowable) remain with us yet.