Rx for the Small Pox?

"Nothing to be heard from morning to night but 'Doctor! Doctor! Doctor!' " That was Dr. Lewis Beebe's vivid recollection of Brigadier General Benedict Arnold's expeditionary forces retreating from Quebec Province last month. As firsthand accounts of the debacle are gathered, it becomes increasingly clear that the expedition's most dangerous enemy was not gunfire but disease. Says Congressional Delegate John Adams of Massachusetts: "The small pox is ten times more terrible than Britons, Canadians and Indians together. This was the cause of our precipitate retreat from Quebec, this the cause of our disgraces."

Even before the Quebec expedition, the small pox proved to be a menace. Boston had so many cases that the disease helped deter General George Washington from trying to fight his way into the city last spring. Said he: "If we escape the small pox in this camp and the country around about, it will be miraculous." Only after General Howe evacuated the city did Washington send in 500 of his men who had already had the disease.

The small pox is one of the oldest scourges on earth. In North America, the Colonies have already suffered more than 50 epidemics. The disease is extremely contagious, often fatal, and there is no known cure. But there is a highly controversial and dangerous treatment: inoculation. This consists of placing pus from a blister on an infected person directly into the bloodstream of a healthy one. In theory, this causes a mild form of the disease and therefore protects the inoculated person from ever catching it again. But because of the dangers, not only to the person being inoculated but to others who risk contagion, the treatment is prohibited in many colonies.

The treatment derived more than a half-century ago from the Orient and the Ottoman Empire. Lady Mary Wortley Montagu, wife of the British ambassador to Constantinople, was so impressed by the Turks' resistance to the small pox that she had her own children inoculated by the Turkish method and recommended the procedure to the royal family. King George I tried it first on six captives at Newgate Prison, then on eleven charity children. Since they survived, he had his granddaughters inoculated.

When Boston Clergyman Cotton Mather learned of the new technique, he tried to persuade local doctors to inoculate as many citizens as possible during the epidemic of 1721. But the city's leading physician called inoculation an "infatuation" and denounced as heathen any treatment adapted from "the Musselmen and faithful people of the prophet Mahomet." Only Mather's friend Dr. Zabdiel Boylston agreed to try the new tactic. Complained Mather: "Not only the physician who began the experiment but I also am the object of the [people's] fury." One opponent of inoculation threw a bomb through Mather's window. Another tried to set Dr. Boylston's house afire. In the course of the epidemic more than 5,000 people caught the disease and 844 of them died, whereas there were only six deaths among the 286 who had been inoculated. That was the first large-scale proof that inoculation was effective. As the treatment gained adherents, it became almost a fad. Fashionable ladies in Paris wore bonnets with spotted ribbons (to simulate the pox). Empress Catherine of Russia summoned an English doctor to inoculate her and her courtiers (for which she paid him a fee of -L-10,000 plus -L-2,000 for expenses, an annuity of -L-500 for life, and a barony in the Russian empire). Despite these successes, critics kept insisting that inoculation spread the disease. As a result, the practice was banned at one tune or another in almost all the colonies. The New York law of 1747, for example, "strictly prohibits and forbids all [doctors] to inoculate for the small pox any person or persons ... on pain of being prosecuted to the utmost rigour of the law."

As the troop movements have spread the disease, demands for inoculation, legal or not, have increased. Says Hannah Winthrop, wife of Natural Philosophy Professor John Winthrop of Harvard: "The reigning subject is the small pox. Men, women and children eagerly crowding to inoculate is I think as modish as running away from the troops of a barbarous George was last year."

Even when successful, inoculation can be an extremely unpleasant experience. One of Dr. Boylston's grandnephews, now a member of the Continental Congress, decided to have his wife and four children inoculated. They all confined themselves in a friend's house in Boston, along with a cow to provide milk. Two of the children soon developed eye inflammations, and one of them became covered with what her mother described as "above a thousand pussels as large as a great green pea... She can neither walk, sit, stand or lay with any comfort." The mother also reported that all the children "puke every morning but after are comfortable." The fourth child had to be inoculated three times before the treatment brought out pustules, and then he was delirious for two days. All in all, the family had to stay confined for seven weeks and to pay 18 shillings per person per week, as well as one guinea per inoculation.

Right now the most critical problem is the health of the Continental Army. Among the 8,000 troops who marched to Canada, more than 2,000 fell ill from the small pox. General Washington himself had the disease as a young man and insisted last May that his terrified wife Martha be inoculated --but as Commander of the Continental Army, he must respect all local statutes against the possible spread of infection through inoculation. On May 20, from his headquarters in New York, he issued an order declaring: "No person whatever, belonging to the Army, is to be inoculated for the small pox." A week later he went even further: "Any officer in the Continental Army, who shall suffer himself to be inoculated, will be cashiered and turned out of the Army ... as an enemy and traitor to his country."

These are hard words, but the continuing spread of the disease may force Washington to change his orders. For even though the spread is sometimes worsened by the haphazard inoculation of soldiers, the Army's own chief physician, John Morgan, insists that "wherever inoculation has once had a fair trial, those prejudices, that are apt to infect vulgar and weak minds, soon vanish." Thus the solution to Washington's problem may be not to forbid the treatment but to isolate and then inoculate every soldier in his Army.

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