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Sickness and Disease in the Continental Army

| May 29, 2020
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On the heels of Memorial Day – and amid a global pandemic – I felt it appropriate to use today’s Free Kick Friday platform to highlight how the most dangerous place for a Continental Army soldier during the Revolutionary War was not on a battlefield, but rather within an encampment. In fact, fever and infections killed more soldiers than any wounds suffered in battle.

During the American Revolution, diseases such as smallpox, malaria, and dysentery were commonly suffered by Colonial and British soldiers alike. Given the close-quarters environments of army encampments, any one of these sicknesses could spread rapidly throughout a camp.

Smallpox is a viral disease that carried an approximate 30% mortality rate during the late 1700’s. Those that survived carried severe lingering conditions such as scarring and blindness. Eerily similar to COVID-19, smallpox symptoms can take as many as two weeks to appear in a person – and spreads extremely rapidly. Little Known Fact #1: George Washington’s smallpox infection at age 19 left him permanently pocked for life. The scars gave Washington the grizzled look that would later contribute to his image as a leader (and you’ll notice his portraits of him almost universally depict him from one side).

Most don’t recall American forces invaded Canada early in their quest for independence. Their aims were to drive British troops from Quebec and 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 fell sick. Brutally handicapped, the invasion never stood a chance.

In the wake of the smallpox outbreak forcing the Continental Army’s withdrawal from Quebec in late 1775, Washington implemented the first mass immunization policy in American history. The highly controversial and rather primitive inoculation remedy relied on doctors cutting the skin of a soldier and infecting him with a small amount of the germ from another (infected) soldier’s sores (a process known as variolation). In this way, the soldier would build up an immunity, but would be sick for several weeks. As a result of this mass immunization, mortality from smallpox in the Continental Army plunged to a mere 1-2 percent – and is widely considered the single most successful infectious disease intervention of the Revolutionary War.

Malaria was particularly common in the warmer southern colonies, and (Little Known Fact #2) George Washington had also suffered from this disease as a young man. Fortunately, malaria was actually one of the few infections for which there was an effective treatment at that time. When the Spanish conquered the Peruvian Incan Empire, they were introduced to cinchona bark and its effectiveness in treating fever in general (and malaria in particular). For these reasons, the bark became a staple of a physician’s medicine chest for more than a century.

Although smallpox epidemics were more dramatic, dysentery was far more common and almost certainly a greater cause of disability in Revolutionary War than mosquito-borne illnesses. Dysentery generally results from a bacteria and is marked by fever, abdominal pain, diarrhea, and dehydration. Although it is usually not fatal, dysentery markedly impairs an army’s effectiveness – and therefore Washington required latrines be located at a distance from campsites.

Wound infection was depressingly common. Battlefields were often farmland that had been contaminated with bacteria containing animal feces for years. Surgical procedures were carried out with no understanding of antisepsis and no attempt to prevent wound contamination. In fact, it was universally accepted that wounds would not heal until they had begun to drain so-called laudable pus, a situation that we now understand to be the result of staph infection. During the Revolution, approximately 25 percent of the wounded who were admitted to hospitals died, and the vast majority of those succumbed to unrelated infections. In the final analysis, bacteria killed far more soldiers in the early republic than did bullets.

Finally from the outset of the Revolutionary War, military leaders on both sides recognized the perils of warm weather campaigning in the feverish “low country” of South Carolina and Georgia. Little Known Fact #3: Over 200 battles were fought within South Carolina, more than any other state. Though the 1780 campaign began well (with Sir Henry Clinton's capture of Charleston in May), the British suffered the most significant losses from the region's fevers.

Little Known Fact #4: Clinton's southern strategy seriously undermined the health of his forces, and may have cost the British the war. To secure control over the Lower South required keeping thousands of their soldiers in what was then the unhealthiest region of British North America. British forces continued to sustained heavy casualties from disease in the summer and fall of 1780. In April 1781 Lord Cornwallis cited saving his army from another Carolina fever season as one of the main reasons for his decision to move north to Virginia and his fateful encounter at Yorktown that October.

And now you know the rest of the story! And if you’d like to take in some first-hand history, you can visit the memorial cemetery adjacent to the Washington’s Crossing Historical Park’s Visitor Center in Pennsylvania where an unknown number of Continental soldiers who died during the December 1776 Bucks County encampment are buried. Although no Americans were killed during the crossing and the Battle of Trenton, others did succumb to exposure, disease or previous injuries.

Hope you all enjoyed reading this as much as I enjoyed researching it!

Huzzah!

-Dave

Disease in the Revolutionary War (MountVernon.org)

Revolutionary War Health: The Sickness That Almost Ended America (rapidmed.com)

Diseases and Epidemics During Revolutionary America 1763 – 1783 (Revolutionary War Journal) (Included links to books covering the subject)

How George Washington Used Vaccines to Help Win the Revolutionary War (realclearscience.com)

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