Commentary / healthcare

U.S. Precedents in Protecting Public Health

By Nancy Spannaus

March 17, 2020—The United States, and its predecessor colonies, have ample historical precedents for taking aggressive action to protect public health. It’s high time we put appropriate modern versions into effect.

One of the first significant actions came during the Revolutionary War itself. The Continental Army had been plagued by disease virtually from its inception, and in particular threatened by small pox, which was ravaging Boston in 1775. Washington at that time acted by quarantining any soldier with symptoms of the disease and preventing refugees from the disease-ridden City (occupied by the British) from joining the Army.

U.S. Precedents in Protecting Public Health

Gen. Washington deals with small pox during the Revolutionary War.

Small-pox, Washington knew, could be fought with inoculation—although such treatment was not fail-safe and had to be followed by a several week period of recovery, thus weakening the armed force substantially. Washington feared such a period of inactivity in the face of the British assault. That and fears of inoculation led the Continental Congress to issue a proclamation in 1776 prohibiting such action.

General Washington, himself a small-pox survivor and thus immune, delayed taking action until he felt he had no recourse: the scourge of the disease was crippling both the Army and recruitment. Exemplary was the devastating loss of life from the disease among the troops sent to invade Canada in the fall of 1775. This was followed by other crippling epidemics.

Washington finally decided the disease had to be defeated if he was to have an Army capable of fighting the British. First, he ordered all new recruits to be inoculated. Then, in February 1777, after the victories at Trenton and Princeton, he ordered mass inoculation (also called variolation) of the troops, including the construction of at least 11 hospitals to house those recovering from the treatment. The action was effective in preventing the disease from incapacitating operations during the rest of the war.[1]

According to an article in RealClearScience, the results were stunning:

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.

Numerous historians credit Washington’s public health action as critical to the eventual success of the Revolutionary War.

Just the Beginning

George Washington’s action was itself not unprecedented.  Inoculations against smallpox had been carried out in Massachusetts back in the days of Cotton Mather. Nor was it the last of his sweeping actions to protect public health. The second came in 1796, in the fight against the yellow fever.

Rather than review that fight and its aftermath here, I refer my readers to the blog www.statutesandstories.com  run by lawyer Adam Levinson. Levinson has very usefully researched the United States’ legal history of dealing with issues of public health, among other issues. His post on An Act Relative to Quarantine (1796), released this February, gives a detailed overview of the Federal government’s action during the yellow fever crisis, plus a number of adjunct references to fill out the picture. Check it out.

U.S. Precedents in Protecting Public Health

Ravages of the 1793 Yellow Fever epidemic in Philadelphia.

Health measures per se, of course, are not sufficient to deal with epidemic and pandemic scourges such as we are experiencing today. We know now that the most significant advances in public health historically have come from improved water infrastructure, from sanitation to purification. To this, of course, we must add hospitals and extensive medical research, all of which depend upon having a flourishing economic-industrial base.

For further elaboration on the economic aspect of this crisis, please see “Hamilton’s American System vs. the Virus,” and “Quarantine the Wall Street Banks, and the People .”

[1] For a review of Washington action, see https://www.loc.gov/rr/scitech/GW&smallpoxinoculation.html

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