According to The Speckled Monster, smallpox is by "…far and away the most voracious killer ever to stalk the human species." Smallpox is caused by the virus Variola major. Smallpox spreads through human contact and by contact with a victim's clothing, bedding, etc. It takes about 12 days for symptoms to appear. During part of this period, victims are contagious, unknowingly infecting others.
The symptoms, which may last another two weeks, include fever, weakness causing the victim to be bedridden, and attacks upon multiple organs of the body often causing death. The skin erupts into large blister-like pustules, which leave the survivors with permanent disfiguring scars. Survivors of the disease had both the scars and lifetime immunity.
However, even in favorable settings, ten to fifty percent of the victims died. Chances were better for those who had genetic resistance, contacted a milder form as an adult and had people around (those with smallpox scars on their faces) to nurse them during the time they were bedridden. Children and pregnant women faced death rates of up to eighty percent.
Native Americans had little knowledge of the disease. They had neither genetic resistance nor immune nurses with smallpox scars. Periodic smallpox epidemics would claim over ninety percent of the Native American population.
In Europe and the New World, the only known effective measures against smallpox were quarantine, i.e. isolating ships, travelers and people with smallpox, and nursing care. The Speckled Monster tells how knowledge of a new preventive measure became known to the English-speaking world in 1721.
Lady Mary Wortley Montagu, herself terribly disfigured by smallpox, visited Turkey in 1719. She visited a bath and was impressed by the sight of hundreds of women without smallpox scars. She learned that each autumn Turkish children got scratched on the arm with a needle dipped in pus from a smallpox victim. This gave them the disease and lifelong immunity with little scaring.
In 1721, a smallpox epidemic raged in Boston. The Rev. Cotton Mather and Dr. Zabdiel Boylston learned of a similar technique from African slaves. Dr. Boylston managed to use it successfully. This technique, scratching live smallpox into the arm, was called inoculation. England's Royal Family, among others, soon became inoculated.
Inoculation had problems. It still killed from one to three percent of its victims—far better than the disease--which killed around thirty percent. It could also start a smallpox epidemic among the people who were exposed to the innoculee. And due to the need for nursing care while the disease ran its course, only the wealthy could afford it.
For these reasons, inoculation was prohibited in New England and the Southern colonies during the 1700s. These colonies were somewhat isolated and tended to remain smallpox-free.
The Mid-Atlantic Colonies, such as Rhode Island, had smallpox circulating on a semi-regular basis and permitted inoculation. In an early form of medical tourism, wealthy Americans such as Abigail Adams travelled to be inoculated.
Pox Americana : the Great Smallpox Epidemic of 1775-82 notes that the smallpox epidemic raging across the Americas was possibly the greatest challenge facing General Washington during the American Revolution. American troops had little exposure to smallpox and were not immune. Early on, an army sent to invade Canada was nearly wiped out by smallpox.
The British had few problems. Most of their Old World soldiers had survived smallpox and had the scars to prove it. Those few without the scars were inoculated and nursed back to health by the others.
The American Army at first prohibited inoculation fearing that inoculations would cause severe epidemics among the troops. Not only would an epidemic kill and incapacitate most of the army, but few Americans had the scars to prove their immunity to smallpox. There would be no one to nurse the disease victims back to health.
In the later years of the Revolution, General Washington began requiring recruits to receive inoculations in their hometowns before joining the army. This strategy, while successful, greatly slowed recruitment. Recruits not only required a month to recover, but then had to serve as nurses for the next batch of recruits.
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