Pediatric Annals

editorial 

Important History

Stanford T Shulman, MD

Abstract

Had Washington not made this decision, we could today all be singing "God Save the Queen."

Abstract

Had Washington not made this decision, we could today all be singing "God Save the Queen."

What was the first large scale state- sponsored immunization campaign in American history? Read on and find out!

Tliis is the second of three Pediatrìe Annals issues that we are devoting to terrorism topics. Included is a timely review of smallpox immunization by Norm Waecker and Braden Hale. As you are all aware, federal authorities have urged hospitals to develop teams of volunteer vaccinated health care personnel to provide care for initial cases of smallpox.

Those of you with a historical bent should enjoy reading Elizabeth H. Perm's recent book Pox Americana (Hill and Wang, New York, 2001, $25) describing the great North American smallpox epidemic of 1775-1782. This period was just prior to Edward Jenner's highly successful immunization against smallpox by use of the much less virulent cowpox matter in 1796. Protection against smallpox before 1796 could be achieved only by the much riskier procedure of intentional inoculation with smallpox matter (variolation) or by surviving a clinical case of smallpox. The risk of variolation included (1) the possibility of developing a full-blown case of smallpox rather than the intended, milder form of the illness, as well as (2) the potential of an inoculated person to spread smallpox to other susceptible individuals.

The stamps that I've chosen for this column include the recent green US 23t postcard stamp showing General Washington, the stamp from Guinea showing the back of a child with smallpox, the Irish stamp depicting Jenner's immunization of a baby (notice the observing cow), and two stamps (from the Bahamas and the Republic of Georgia) honoring America after September 1 1 , 2001 .

The stamps that I've chosen for this column include the recent green US 23t postcard stamp showing General Washington, the stamp from Guinea showing the back of a child with smallpox, the Irish stamp depicting Jenner's immunization of a baby (notice the observing cow), and two stamps (from the Bahamas and the Republic of Georgia) honoring America after September 1 1 , 2001 .

Perm's book chronicles the remarkable extent to which smallpox impacted the people of North America during the time of the American Revolution, upon the armies, the Indians, and the African- Americans. Perhaps most remarkably, she details how raging smallpox among the Continental armies under General George Washington contributed to its disastrous Canadian campaign that culminated in defeat at the Plains of Abraham, Québec city, in late 1775 and early 1776.

General Washington ultimately realized that it was essential that his troops be immune to smallpox or the war against the British (who were immune) could not be won. At Valley Forge in the winter of 1777-1778 he recognized that there were as many as 5,000 people susceptible to smallpox and that smallpox was spreading in the camp. Washington (who had almost died of smallpox at 19) ordered the variolation of all who were susceptible in the camp and of all newly arriving susceptible soldiers immediately on arrival. This was the first large-scale government-sponsored immunization program in American history. Perm's book suggests that had Washington not made this decision, we could today all be singing "God Save the Queen."

10.3928/0090-4481-20030301-03

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