George Washington made a trip out of America in November 1751 to accompany his brother to Barbados in hopes that the tropical climate would help his brother recover from consumption, now known as tuberculosis. While there, George contracted smallpox, and he was lucky enough to recover with relatively little scarring. His month-long battle with smallpox also left him immune to a future infection. Smallpox would be a factor in a future endeavor: the American Revolution.

Unlike Europe in the 18th century, most Americans didn’t live in large, congested cities, making smallpox spread less likely. Smallpox was present in North America, brought over by Europeans in the 17th century. Smallpox kills about a third of those infected, often leaving survivors severely scarred. In 1721, there was a large outbreak in Boston with more than 6,000 cases and 850 deaths, and several more large outbreaks followed.

A description from that time stated “The head is swollen to a monstrous size, the eyes are entirely closed, the lips swollen and of a livid color, the face and surface of the whole body are covered with maturated pustules, from which issue purulent matter; the miserable being has the appearance of a putrid mass, and scarcely the semblance of a human form remains.”

The American Revolution made smallpox spread more likely. Soldiers from England and Germany were arriving in large numbers, and recruits from all the colonies were joining the Continental Army. Soon after taking command in the summer of 1775, Washington assured the President of the Continental Congress that he would be “particularly attentive to the least symptoms of the small pox,” with plans to quarantine those suspected of having the disease in a special hospital.

During a 1775 smallpox outbreak in British-controlled Boston, there were reports of the British intentionally sending infected people out of Boston to spread the disease to the Continental Army. Washington responded by banning Boston refugees from approaching the camps.

When the British left Boston in March 1776, Washington sent in 1,000 men who were immune to smallpox to occupy the city. Smallpox would continue to haunt the Continental Army, contributing to the retreat from Quebec when about half the troops became infected.

Inoculation against smallpox was known as far back as ancient China, but in 18th-century North America, it was highly controversial. It was illegal in Washington’s home state of Virginia. In May 1776, Washington convinced his wife Martha to undergo it but forbade it for his troops. Finally, in 1777, Washington required inoculation of all troops that hadn’t acquired immunity from a smallpox infection.

Inoculation involved lancing a pustule from a smallpox victim and inserting the blade under the skin of a healthy person. The inoculated person would develop a mild case of smallpox in about two weeks. After the mass vaccination of 40,000 soldiers, all but 50 soldiers survived later epidemics. That eliminated the threat of smallpox as an issue for the Continental Army, and we all know how the Revolution turned out.

Medical Discovery News is hosted by professor emeritus Norbert Herzog, and professor David Niesel of the University of Texas Medical Branch. Learn more at

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