One Man's Opinion: Leadership Requires Making Tough Calls

"I find it impossible to keep it from spreading thro' the whole Army in a natural way....necessity not only authorizes but seems to require the measure," letter from General George Washington to John Hancock and the Continental Congress explaining his decision to order his chief medical officer to inoculate all troops in the Continental Army against smallpox. (source National Geographic magazine)

As a young man in 1751, George Washington visits the Caribbean island of Barbados, contracting smallpox. At the time, the disease caused by the variola virus killed nearly 1 in every 2 victims. Washington was lucky, after months of fever, chills, and painful pustules covering his face and body (the pox), he emerged with a pockmarked face, but alive and with later immunity to the virus

In 1775, the smallpox virus arrived in Boston, carried in by British, Hessian and Canadian troops brought in to help quell the building Colonial rebellion (Boston Tea Party and coming Declaration of Independence). The virus was devastating to soldiers and civilians alike as it swept across the burgeoning colonies.

An inoculation procedure against smallpox, dating back to ancient China, was called variolation. It was considered highly controversial in the colonies, and its improper admission had resulted in the painful death from smallpox of the son of King George III, an heir to the British crown.

The treatment required an incision in a patient's arm, inserting a small dose of the live virus, large enough to trigger an immune system response, but small enough to prevent severe illness and death. A much more exacting process involving live virus is present in many modern vaccines today.

Washington was now immune to smallpox, but his ragtag troops were not. The British had just brought an additional 30,000 troops to New York harbor, approximately the population of the largest city within the fledgling colonies.

Washington became an advocate for variolation, even convincing his wife Martha to take the treatment in May of 1776. The opening shots of the war for American independence were not in the colony's favor. Washington and his ill-trained forces were quickly losing battle after battle, as New York City fell, and Washington escaped with a small consort of remaining troops into neighboring New Jersey. A New Jersey signer of the Declaration of Independence recanted his participation and declared his loyalty to the crown, and while Washington considered inoculating his entire Army, many colonial governments forbade the procedure.

Variolation not only had a risk of death, but it would also in the best of circumstances lay the vaccinated up for a few weeks as their body fought off and developed new immunity to the infection. Finding the right/best time for attempting mass inoculation was not only a gamble but if known to the British could trigger an en-masse attack when Revolutionary forces were at their weakest.

The Continental Congress ordered Army Surgeons NOT to perform variolations. Washington was hamstrung but ordered instead that all new recruits receive the procedure, hoping that by the time they were trained and battle-ready they would be fully recovered and newly immune to the pox.

As the epidemic spread, Washington took a risk and against the direction of the Continental Congress, and Governors of many colonies and their prevailing laws, he directed that all troops are to be inoculated, and by the end of 1777, nearly 40,000 soldiers had received variolation therapy. Infection rates among the troops dropped from above 20 percent to below 1 percent...while the British forces were losing thousands to the smallpox epidemic, significantly more than to the musket balls and battles with Revolutionary forces.

Washington made variolation mandatory for all of his troops. For the British who were being even more devastated by the pox, it remained voluntary, and both the conscripted, Hessian and superior British forces feared the treatment which had taken the life of their monarch's son.

The superior British forces were as a result decimated by smallpox, as well as typhoid fever, dysentery, and other public health threats of the day. Thousands of more British soldiers fell as victims of disease than to colonial musket balls.

Later vaccines were developed, while smallpox remained a global health threat until its eradication centuries later in 1980 by another longtime Georgian, Dr. William Foege of the CDC. Tough times require tough decisions to be made. At times we simply have to step back, keep some faith, and let our leaders lead.

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