Thursday, May 14, 2020

George Washington, herd immunity & vaccination

This is a Facebook post backup for future reference.


Garrison Keillor notes that on this day, May 14, 1796, Dr. Edward Jenner inoculated an eight-year-old boy with a vaccine for smallpox, the first safe vaccine ever developed. Jenner inserted pus taken from a cowpox pustule and inserted it into an incision on the boy's arm. He was testing his theory, drawn from the folklore of the countryside, that milkmaids who suffered the mild disease of cowpox never contracted smallpox, one of the greatest killers of the period, particularly among children.

What made it so remarkable was that Jenner accomplished this before the causes of disease were even understood. It would be decades before anyone even knew about the existence of germs. Jenner submitted a paper about his new procedure to the prestigious Royal Society of London, but it was rejected. The president of the Society told Jenner that it was a mistake to risk his reputation by publishing something so controversial.

This reminded me of the account of George Washington's vaccination of the Continental Army some time prior to that in order to give them a strategic advantage against the British army at a time when smallpox was a raging disease. As a smallpox survivor himself, Washington actually broke the law to use what was then called variolation. At the time, variolation was technically outlawed by the Continental Congress, so Washington was openly flouting the law.

The following link has the story.

How George Washington Used Vaccines to Help Win the Revolutionary War

By Ross Pomeroy
September 25, 2016

THE UNITED STATES' victory over the British Empire in the Revolutionary War is our country's quintessential tale of David overcoming Goliath. Birthed as an underdog, we embrace that mindset still.

Winning independence was not an easy task. It was a success that hinged on pivotal moments. The Continental Army's narrow escape across the Delaware River, the British surrender at Saratoga, and foreign intervention from Spain and France are a few of those moments. But lesser known is George Washington's bold decision to vaccinate the entire Continental Army against smallpox. It was the first mass inoculation in military history, and was vital to ensuring an American victory in the War of Independence.

GEORGE WASHINGTON'S first brush with smallpox came long before he was a military commander. At the age of nineteen, he was infected with the disease while traveling in Barbados with his brother. For twenty-six days, Washington battled headache, chills, backache, high fever, and vomiting. He developed the horrific rash and pungent pustules that are the hallmarks of smallpox. At times, his brother wasn't sure he'd make it. In those days, smallpox mortality rates ranged from 15 to 50 percent.

Washington did not succumb, but the infection left him permanently pocked for life. The scars granted Washington the grizzled look that would later contribute to his image as a leader. They also served as a constant reminder of the danger of smallpox.

As a result, the disease was never far from Washington's mind after he took command of the Continental Army in summer 1775. Making the matter all the more prescient was the fact that a smallpox epidemic was just beginning to crop up. It would rage for seven more years in the nascent United States, eventually reaching the Pacific. Tens of thousands would die.

Over the ensuing months after taking command, Washington witnessed the great burden of disease upon his men. None was worse than smallpox. As a result, Washington went to great lengths to minimize its spread, particularly during the nine-month siege of Boston in 1775 and 1776. At the time, the city was reeling from the epidemic.

"Washington restricted camp access, checked refugees, and isolated his troops from contagion to avoid the spread of the disease," historian Ann Becker wrote in 2005.

In an even clearer example, when Washington ordered one of his generals to take the heights outside the city in March 1776, he specified that every single one of the thousand soldiers in the attacking force must have already survived smallpox, and thus have immunity.

Washington's cautious approach to smallpox absolutely helped keep his army healthy and functional. To the north, however, American patriots experienced what happens when smallpox is left to run amok.

AN OFT-FORGOTTEN fact: during the Revolutionary War, American forces invaded Canada. Their aims were to drive British troops from Quebec and even convince Quebec's citizens to bring their province into the American colonies. The effort, however, met with miserable disaster, which is perhaps why it doesn't cling to public remembrance. The chief reason for the defeat? Smallpox.

Approximately ten thousand American troops marched on Canada in fall of 1775, and at one point, nearly three thousand of them were sick. Brutally handicapped, the invasion never stood a chance. Officers fell victim, too. Major General John Thomas died of smallpox during the retreat the following spring.

"By spring [of 1776] the condition of the American soldiers in Canada had deteriorated severely due to continuous outbreaks of smallpox... Approximately half of the soldiers were ill. The majority of the new recruits were not immune to the disease, and reinforcements sent to Canada sickened quickly." Becker recounted. "Contemporary evidence is overwhelming: smallpox destroyed the Northern Army and all hope of persuading the Canadians to join the Revolution."

"Our misfortunes in Canada are enough to melt a heart of stone," John Adams wrote in June 1776. "The small-pox is ten times more terrible than Britons, Canadians, and Indians together."

FULLY AWARE of the disaster in the north, George Washington realized that merely evading smallpox would no longer suffice; he wanted to prevent it altogether. Inoculation was already available, although the procedure -- called variolation -- was not without risks. The vaccines we're accustomed to today were not invented yet, so doctors would simply make a small incision in the patient's arm then introduce pus from the pustules of an infected victim into the wound. Variolation often resulted in a minor smallpox infection with a speedier recovery and vastly lower fatality rates, around two percent. Survivors were granted lifelong immunity.

At first, Washington simply required new recruits to be inoculated. Then, in February 1777, he bit the bullet entirely.

Finding the smallpox to be spreading much and fearing that no precaution can prevent it from running thro' 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.

This was a bold move. At the time, variolation was technically outlawed by the Continental Congress, so Washington was openly flouting the law. Whole divisions were inoculated and quarantined en masse, a process that would continue for months. Strict secrecy was maintained to prevent the British from uncovering the program, lest they launch an attack upon the recovering troops. By year's end, 40,000 soldiers were immunized.

The results were stunning. The smallpox infection rate in the Continental Army rapidly fell from 17 percent to one percent, prompting the Continental Congress to legalize variolation across the states.

With the threat of smallpox vanquished, George Washington and the Continental Army were able to entirely focus on the real enemy: the British. As Becker summed up:

Due in large part to [Washington's] perseverance and dedication to controlling smallpox, the Continental Army was able to survive and develop into an effective and reliable fighting force, unhampered by recurring epidemics of that disease.

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