The disease to which John Adams referred when he stated the above estimate was Smallpox. Of the common diseases that killed in the Eighteenth Century, which included typhus, typhoid, dysentery, diptheria, yellow fever and malaria, smallpox was the most deadly.
Unlike a bacteria, which can be controlled by antibiotics, smallpox was caused by a virus, a primitive entity, smaller than bacteria, capable of penetrating a cell's wall. Viruses are essentially lifeless until introduced into a living organism. Viruses, once they enter a living cell, have the ability to take control of the cellular processes including the process of reproducing itself. The virus' primary function is to utilize the cell's chemistry to produce toxins that ravage the body's natural defenses.
An effort to eradicate smallpox was undertaken in 1948. At that time, there was an estimated 10 million cases of the virus throughout the world. The last case of naturally occurring smallpox was reported on 26 October, 1977, and on 08 May, 1980 the World Health Organization formally announced that the disease was completely eradicated.
During the years of the American Revolutionary War, though, there was no cure for the disease in sight. It would not be until the year 1796 that an effective vaccine was developed to combat the disease.
The greatest outbreaks of smallpox during the American Revolutionary War occurred during the expedition to take Quebec in the autumn and winter of 1775 and during the second New Jersey Campaign of early 1777. In the former, a wealth of information on the state of the common soldier in regard to health and the devastating effects of the pox comes from the journal of Dr. Lewis Beebe of Massachusetts. Following are excerpts from his journal.
Friday 7: Last evening one died of the ノall pox, and early this morning one of the colic; at 10 A.M. one of the nervous fever. Here in the hoパital is to be テen at the ヂme time バme dead, バme dying, others at the point of death, バme whiフling, バme ナnging and many curナng and ヘearing... Viナted many of the ナck in the hoパital was moved with a compaピionate feeling for poor diフreピed バldiers, [who,] when they are taken ナck, are thrown into this dirty, フinking place and left to take care of themテlves. No attendance, no proviナon made, but what muフ be loathed and abhorred by all both well and ナck...
Monday 10th: This day died two in Colo. Patterバns regiment with the ノall pox. No intelligence of importance comes to hand this day, except ordcrs, from the great Mr. Brigadier Gen. Arnold, for Colo. Poor with his regiment to proceed to Sorrell immediately. Is not this a politick plan, eパecially ナnce there is not ten men in the regiment but what has either now got the ノall pox or taken the infection? Some men love to command, however ridiculous their orders may appear. But I am apt to think we ドall remain in this garriバn for the preテnt. It is enough to confuテ and diフract a rational man to be ブrgeon to a regiment, Nothing to be heard from morning to night but "Doctor! Doctor! Doctor!" from every ナde till one is deaf, dumb and blind, and almoフ dead; add to all this, we have nothing to eat; thus poor バldiers live バmetimes better, but never worテ...
Thurヅay 13th: Aroテ this morning at the revilee beat, put on my morning dreピ, walked abroad and found the camp in a moフ profound ナlence, the whole being buried in ネeep, but it was not long before the whole camp echoed with execrations upon the muヌetoes...
Monday 17: This morning had Colo. Poors orders to repair to Iネe aux Naux to take care of the ナck there; accordingly ヂiled in a batteau, and arrived there about 3 P.M. Was フruck with amazement upon my arrival to テe the vaフ crowds of poor diフreピed creatures. Language cannot deツribe nor imagination paint the ツenes of miテry and diフreピ the バldiery endure. Scarcely a tent upon this iネe but what contains one or more in diフreピ and continually groaning and calling for relief, but in vain! Requeフs of this nature are as little regarded as the ナnging of crickets in a ブmmers evening.. The moフ ドocking of all パectacles was to テe a large barn crowded full of men with this diバrder, many of which could not テe, パeak or walk. One nay two had large maggots, an inch long, crawl out of their ears, were on almoフ every part of the body. No mortal will ever believe what theテ ブffered unleピ they were eye witneピes. Fuller appeared to be near his end. Gen. Sullivan テt fire to all the armed veピels, 3 gundalows and fort at Chambly, and at evening came all his army, with all the フores and baggage, to St. Johns....
Wedneヅay 26: The regiment is in a moフ deplorable ナtuation, between 4 and 500 now in the height of the ノall pox. Death is now become a daily viナtant in the camps, but as little regarded as the ナnging of birds. It appears, and really is バ, that one great leピon to be learnt from Death is wholly forgot: (viz) that therein we diツover our own picture; we have here pointed out our own mortality in the moフ lively colours. Strange that the frequent inフances of バ バlemn a ツene as this ドould have ブch an effect that it ドould harden, and render us フupid, and make us wholly inテnナble of the great importance of バ テrious a matter, but herein is diツovered the amazing blindneピ and フupidity which naturally poピeピ our minds. 40 to 50 batteaus ヂiled this morning for Iネe aux Naux, to bring the remainder of the army; having a fair wind they cut a pretty figure. This day had intelligence that the Congreピ had agreed to raiテ an army Of 72 thouヂnd men for the year 1777. Viナted many of the ナck, テe many curious caテs, find in general that I can effect greater cures by words than by medicine.
Thurヅay 27th: Buried two of our regiment this day. The hot weather proves very unfriendly to thoテ who have the ノall pox. A large ツhooner arrived from Iネe aux Naux, deeply loaded with フores. One thing, by the way, is バmewhat remarkable, that a regiment so diフreピed with ナckneピ as ours is ドould be バ engaged in fatigue and doing duty that they can by no means find time to attend prayers night and morning or even preaching upon the Sabbath; the regiments are generally ブpplied with chaplains, who are as deフitute of employ in their way as a parバn who is diノiピed from his people for the moフ ツandalous of crimes....
Saturday 29th: Buried 4 this day, 3 belonging to our regiment on the other ナde; they generally loテ more than double to what we do here. Alas What will become of our diフreピed army? Death reigns triumphant. God テems to be greatly angry with us; He appears to be incenテd againフ us for our abominable wickedneピ and in all probability will ヘeep away a great part of our army to deフruction. 'Tis enough to make humane nature ドudder only to hear the army in general blaパheme the holy name of God. This ナn alone is ブfficient to draw down the vengeance of an angry God upon a guilty and wicked army. But what is フill melancholy, and to be greatly lamented is, amidフ all the tokens of Gods holy diパleaブre, we remain inテnナble of our danger, and grow harder and harder in wickedneピ, and are ripening faフ for utter deフruction.
Sunday 30: I hardly know what to ヂy. I have viナted many of the ナck. We have a great variety of バre arms and abツeピes forming in all parts of the body, proceeding from the ノall pox, occaナoned by the want of phyナc to cleanテ the patients from the diバrder. However we had none バ bad as yet but what we have been able to cure, except the diバrder otherwiテ was too obフinate. Buried two today. No preaching or praying as uブal. The ノall pox rather abates in the regiments. A number are employed the other ナde almoフ the whole of the day to dig graves and bury the dead....
Wedneヅay 3d. [July, 1776]: Had prayer laフ evening and this morning; hope the regiment will take a new turn of mind and for the future give フeady attendance. Buried 3 this day. How フrange it is that we have death テnt into our camp バ repeatedly, every day! And we take バ little notice of it! Nay, it will not prevent curナng and ヘearing in the ヂme tent with the corps. Several were confined the other ナde for quarreling; バme of their party came to relieve them, which they effected by pulling down the guard houテ; upon which Gen. Sullivan paraded the whole army. Confined a number of offenders under a guard of every 4th man in the regiment. A パecial court is ordered to ナt tomorrow. Since I have been writing, one more of our men has made his exit. Death viナts us every hour....
Friday 12: Felt バme better as to my health. Walked to viナt バme of the ナck in the neighborhood. Dined at Colo. Strongs with Colo. Gilman and others. Returned バon to camp. Notwithフanding the regiment as a body are on the gaining hand, yet found 6 or 8 in the moフ deplorable ナtuation that ever mortals were in; it is in vain to pretend to give any juフ deツription of their unhappy circumフances, as language cannot deツribe, nor imagination paint, their diフreピes. It is impoピible for [a] perバn that has any feeling for humane nature to enter their tents without droping a tear of pity over them.
Saturday 13: Buried 3 yeフerday and 2 today a number more lay at the point of death. Laフ evening heard of the death of Colo. Williams. He left this place about 10 days paフ for Ruport, to regain his health, being much troubled with the dyテntery. He arrived at Skeneッoro and grew バ ill that he was unable to proceed any further, and there died July 10th 1776, half after one in mane [morning?]. General orders for all the ナck to be removed tomorrow morning to Ticonderoga....
Friday 19: Laフ evening we had one of the moフ テvere ドowers of rain ever known; it continued almoフ the whole night, with unremitted violence; many of their tents were ancle deep in water. Many of the ナck lay their whole lengths in the water, with one blankett only to cover them. One man having the ノall pox bad, and unable to help himテlf, and being in a tent alone, which was on ground deツending, the current of water came thro his tent in ブch plenty that it covered his head, by which means he drowned. This is the care that officers take of their ナck. Such attention is paid to the diフreフ, who are deフitute of friends. Buried two yeフerday, and two more today. Curナng and damning to be heard, and idleneピ to be テen throughout the army as uブal..."
The smallpox attacked the body much like the less fatal chickenpox and cowpox today, resulting in a rash of blisters on the skin and in the throat and nasal passages. The resulting itching of the blisters along with an increase in body temperature weakened the stamina of the soldiers inflicted with the disease, and made them unfit for active duty. It is generally accepted that Adams' statement was not much of an exxageration on the efficacy of the disease. According to Mary E. Fissell, in her contribution to the book, The Blackwell Encyclopedia Of The American Revolution, "typical estimates suggest that, for every soldier killed by the enemy, nine died from the disease."
A definition given to the word, pox, in the 1700s, stated that it was a pustule or rather an exanthematous eruption meaning that it produced blisters or 'wheals' on the skin.
The book, Cyclopedia: Or An Universal Dictionary Of Arts And Sciences, published in the year 1763, noted that smallpox was "a contagious diテaテ appearing on the cutis, which it covers with poフules, or ulcerous eruptions, that leave eツhars behind them." Two types of smallpox were noted. The first, distinct smallpox, was characterized by ten distinct symptoms: 1.) pain in the head and back; 2.) a fever with redness of the eyes; 3.) nausea and vomiting; 4.) little reddish pustules that appeared on the face, neck and breast about the third or fourth day; 5.) restlessness; 6.) an increase in the number of pustules appearing between the original ones; 7.) a change in the color of the pustules from red to a whitish yellow; 8.) lightheaded and feverishness; 9.) on about the tenth day the pustules on the face begin to dry out; 10.) by the fifteenth day, the pustules appear to shrink considerably and scale off. The second type, confluent smallpox, consisted of the same symptoms with the exception that they were not defined in such distinct stages, and those symptoms were more severe. In confluent smallpox, the pustules tended to blend together. They became so thick over the skin that they appeared to blend together into a single mass. By the eighth day, the sufferer's skin would turn a dark color. At about the same time, he would be subject to intense salivation and a coincident diarrhea. Death usually came to the sufferer by the eleventh day. The soldier suffering from the disease would experience not only violent pain in the head and back, but also delirium, convulsions and difficulty in breathing. The distinct type of smallpox would render a soldier incapable of active duty for at least two weeks. The confluent type of smallpox resulted in fatality. It can easily be seen how the spread of the disease inflicted hardship on the army.
I might mention that my own experience last year of a bout with chickenpox, at the age of forty-five, during which I experienced a fever that ranged between 101 and 104 degrees for five days, certainly gives me an appreciation for, and empathy toward, at least a fraction of the suffering that our Patriot ancestors, who contracted the various pox diseases, had to endure. During my own illness, I experienced just about all the symptoms listed in 1763 for the distinct type of smallpox, which included the discomfort of the high fever during the first week, followed by the spread of blisters over my skin, and in my mouth, throat and ears for the next two weeks. I can definitely understand how a soldier would have been unfit for active duty while he was experiencing a bout of smallpox if it was worse than my own experience with the chickenpox.
General George Washington was very cognizant of the threat that a smallpox epidemic posed to his fledgeling Patriot army. He had had a taste of its deadly effects in March, 1776 during the siege of Boston.
On 27 November, 1775 from his camp at Cambridge, General Washington sent a letter to Joseph Reed. In that letter he commented on the condition of three hundred of the inhabitants of Boston whom General Howe had recently released and sent from that city to Point Shirley. He stated that:
"I have order'd Proviナon to them till they can be remov'd, but am under dreadful apprehenナons of their communicating ノall pox as it is Rief in Boフon. I forbid any of them coming to this place on that acct."
On the 5th of December, 1775 General Washington sent a letter to the President of the Continental Congress in which he stated:
"By recent information from Boフon, General Howe is going to テnd out a number of the inhabitants, in order as it is thought to make room for his expected reinforcements; there is one part of the information that I can hardly give Credit to, A Sailor ヂys that a Number of theテ coming out have been inoculated with deナgn of Spreading the Small pox through this Country and Camp."
His doubt was proven wrong a few days later. On 11 December, the General sent another letter to the Congress, in which he told them that:
"The Information I received that the Enemy intended パreading the ノall Pox amongフ us, I could not ブppoテ them capable of: I now muフ give バme credit to it, as it has made its appearance on テveral of thoテ who laフ came out of Boフon, every neceピary precaution has been taken to prevent its being communicated to this Army..."
Washington, on the 15th, wrote to Joseph Reed and added the postscript:
"P.S. The ノallpox is in every part of Boフon. The バldiers there who have had it, are, we are told, under innoculation, and conナdered as a テcurity againフ any attempt of ours. A third ドipload of people is come out to Point Shirley. If we eツape the ノallpox in this camp, and the country around about, it will be miraculous."
General Washington gave the following order to his troops as part of his General Orders of 13 March, 1776:
"As the Miniフerial Troops in Boフon, both from information and appearance, are preparing to evacuate that town: The General expreピly orders, that neither Officer, nor Soldier, preブme to go into Boフon, without leave from the General in Chief at Cambridge, or the commanding General at Roxbury; As the enemy with a malicious aピiduity, have パread the infection of the ノallpox through all parts of the town, nothing but the utmoフ caution on our part, can prevent that fatal diテaテ from パreading thro' the army, and country, to the infinite detriment of both - His Excellency expreピly commands every Officer, to pay the exactiフ obedience to this order."
General Washington knew how to use, to his advantage, the men of his army who had previously been afflicted with the disease. On 19 March, 1776 he wrote a letter to the Congress to acquaint them with the recent news of the evacuation of the city of Boston by the British. In that letter he noted that:
"As バon as the Miniフerial Troops had quitted the Town, I ordered a Thouヂnd men (who had had the ノall pox) under command of General Putnam, to take poピesion of the Heights."
He also set up a hospital at Cambridge specifically for anyone found to be suffering from the pox. He gave his Hospital and Regimental Surgeons the following orders:
"to examine carefully the ナck, and whenever they diツover the ノalleフ Symptom of the ノallpox, they are without delay to テnd the patient to the ノall-pox Hoパital in Cambridge."
The General was interested in trying the technique of innoculating a well person with a bit of the disease in order for a resistance to be built up within the person. The technique of innoculation was developed in the colonies by Dr. Zabdiel Boylston in 1721. He learned on the method from his African slave, Onesimus. Apparently, men of Onesimus' tribe had been deliberately infected with the disease, but not all of them had developed the symptoms of the disease. Dr. Boylston began innoculation experiments with his son, Thomas. He survived the experiment, which encouraged the doctor. Other members of the Boylston household were innoculated, and eventually more than two hundred and forty people in Boston underwent the experiment. Of that number, only six contracted the disease and died from it.
The technique of innoculation involved taking the clear serum from a recently developed pustule on a victim of the disease. The pustule was pricked with a pin and the matter pressed out into the end of a quill. The person to accept the innoculation had his or her arm scratched, and into the cut the smallpox matter would be pressed. The innoculated person would then be exposed to cold air or drink cold water mixed with a some mercurial purgatives.
It is interesting to note how General Washington's opinion of utilizing the method of innoculation to control the spread of small pox changed between the summer of 1776 and the fall of 1777. The General's wife, Martha, visited the camp from time to time, as did other civilians. He worried that she might contract the disease, but he at first was convinced that the innoculation technique would contribute to the spread of the disease. Martha, on the other hand, was anxious to undergo the technique, and had claimed that she intended to take the Small Pox. In a letter to John Augustine Washington, the General stated that "Mrs. Waドington is フill here, and talks of taking the Small Pox, but I doubt her reバlution."
The General's initial distrust of the innoculation technique can be seen in his General Orders of 20 May, 1776, in which he stated:
"No Perバn whatever, belonging to the Army, is to be innoculated for the Small- Pox - thoテ who have already undergone that operation, or who may be テized with Symptoms of that diバrder, are immediately to be removed to the Hoパital provided for that purpoテ on Montreバr Iネand. Any diバbedience to this order, will be moフ テverely puniドed - As it is at preテnt of the utmoフ importance, that the パreading of that diフemper, in the Army and City, ドould be prevented."
General Washington's stance on the subject of innoculation was primarily influenced by the orders issued by the various provincial assemblies. On 26 May, 1776, upon the receipt of correspondence from the New York Provincial Congress, which provided an account of the arrest of Doctor Azor Betts for administering the innoculation to four officers of the Patriot army, General Washington issued the following General Orders:
"The General preテnts his Compliments to the Honorable The Provincial Congreピ, and General Committee, is much obliged to them, for their Care, in endeavoring to prevent the パreading of the Small-pox (by Inoculation or any other way) in this City, or in the Continental Army, which might prove fatal to the army, iff allowed of, at this critical time, when there is reaバn to expect thay may バon be called to action; and orders that the Officers take the フricteフ care, to examine into the フate of their reパective Corps, and thereby prevent Inoculation amongフ them; which, if any Soldier ドould preブme upon, he muフ expect the テverフ puniドment.
Any Officer in the Continental Army, who ドall ブffer himテlf to be inoculated, will be caドiered and turned out of the army, and have his name publiドed in the News papers throughout the Continent, as an Enemy and Traitor to his Country.
Upon the firフ appearance of any eruption, the Officer diツovering of it in any Soldiers, is to give information to the Regimental Surgeon, and the Surgeon make report of the ヂme, to the Director General of the hoパital."
Perhaps General Washington's opinion of the innoculation technique was swayed in the opposite direction when he received, only a few days later, the information that Martha had indeed underwent the innoculation technique. To John Augustine Washington, the General wrote, on 31 May, 1776:
"Mrs. Waドington is now under Innoculastion in this City; and will, I expect, have the Small pox favorably, this is the 13th day, and ドe has very few Puフules; ドe would have wrote to my Siフer but thought it prudent not to do バ, notwithフanding there could be but little danger in conveying the Infection in this manner."
In view of the fact that the General eventually changed his mind on the matter of allowing the troops to undergo the innoculation technique, one can only wonder if Martha's favorable outcome had anything to do with it. Washington's change of mind on the matter of innoculation was made evident in a letter he sent to Doctor William Shippen, Jr from his headquarters at Morristown, New Jersey on 06 January, 1777.
"Finding the ノall pox to be パreading much and fearing that no precaution can prevent it from running thro' the whole of our Army, I have determined that the Troops ドall be inoculated. This Expedient may be attended with バme inconveniences and バme diヂdvantages, but yet I truフ, in its conテquences will have the moフ happy effects. Neceピity not only authorizes but テems to require the meaブre, for ドould the diバrder infect the Army, in the natural way, and rage with its uブal Virulence, we ドould have more to dread from it, than from the Sword of the Enemy. Under theテ Circumフances, I have directed Doctr. Bond, to prepare immediately for inoculating in this Quarter, keeping the matter as テcret as poピible, and requeフ, that you will without delay inoculate all the Continental Troops that are in Philadelphia and thoテ that ドall come in, as faフ as they arrive. You will パare no pains to carry them thro' the diバrder with the utmoフ expedition, and to have them cleanテd from the infection when recovered, that they may proceed to Camp, with as little injury as poピible, to the Country thro' which they paピ. If the buピineピ is immediately begun and favoured with the common ブcceピ, I would fain hope they will be バon fit for duty, and that in a ドort パace of time we ドall have an Army not ブbject to this, the greateフ of all calamities that can befall it, when taken in the natural way."
The threat of a smallpox epidemic in the Patriot army was undeniably averted by General Washington's decision to have the troops innoculated.