A Brief History of Federal Intervention in Public Health

Lena Parkhurst is a third year English and Spanish major at Grinnell College.  She enjoys biking, movies and sleep. Although George Washington’s work with inoculation was pretty snazzy William Howard Taft is still her favorite president.

Medical rights, never exactly an uncontroversial topic in the United States, has become an especially touchy subject with the implementation of the Affordable Care Act. While both sides argue over the veracity of federal control and the morality of mandatory healthcare, it’s worth taking a look at when medicine and the federal government first began to mix. The mandatory inoculation of Continental troops, beginning in the 1770’s, was one of the first instances where the American federal government interfered with patient’s medical rights. These inoculations, meant to counteract the scourge of smallpox, met resistance from individuals and colonies alike. The compulsory inoculation of Continental troops helped shape healthcare in today’s America. For better or for worse, the smallpox inoculations set the precedent of federal control superseding patient choice in order to ensure community wellness.

During the Revolutionary War illness was a constant threat to the well-being of the American troops. Some historians estimate that, at the height of the American troop’s collective ill health, 30-35% of the American soldiers were incapacitated by illness.[1]  Smallpox, as one of the most highly contagious of the colonial diseases was especially feared.  The disease spread through physical contact and was contagious before any symptoms occurred. Moreover, smallpox proved fatal in somewhere between 15-50% of cases and left survivors with severe disfigurements.[2] In short, smallpox was the perfect disease to quickly destroy an army, leaving high mortality and desertion rates in its wake. General Washington knew that one of the major hurtles he faced was ensuring that his troops were properly safe guarded against the pox. Unfortunately, the only known preventative measure was the risky and highly controversial act of inoculation.

Smallpox inoculations were a contentious topic in this time for a lot of very sensible reasons. To begin with, the concept of the smallpox inoculations was “repulsive and offensive to many colonists.”[3] No one wanted to put a terrifying disease into their body or introduce it to their community. Moreover, inoculations were common among minorities, such as Native Americans, which made the new technology seem uncivilized. If a white colonist did overcome their suspicion and fear, the inoculation still carried painful risks. Death or another smallpox outbreak could easily follow inoculation.

Washington’s uphill battle to convince troops of the necessity of inoculation was further complicated by the nature of the Continental Army. American troops were “semiprofessional” soldiers with short enlistment terms and greater freedoms than the contemporary military.[4] Away from their homes and the colony whose medical authority they might accept, soldiers had little reason to submit to mandatory inoculations. Nonetheless, Washington persevered, splitting his persuasive efforts between the continental congress and colonial governors, and emphasizing the vital importance of inoculations to the war effort. In 1776 Washington received permission from the New England Authorities to inoculate a portion of his troops.[5] After this successful trail run in New England, Washington expanded the program and implemented mandatory inoculations for all his troops. It is important to note that Washington, and through him the federal government, asked for permission from the colonies before beginning inoculations.[6] While America’s new federal government took control of the army’s health, its power was still subordinate to the colonies and their own interest in securing colonial wellness.

Throughout US history, the federal government has inscribed its power – positively and negatively – upon the bodies of Americans. The implementation of this power began with General Washington’s mandatory smallpox inoculations. These inoculations did more than help Washington win the Revolutionary War, they also set important precedent for the federal government’s control over patient’s rights. The federal government to proscription of mandatory healthcare in the 1770’s set a standard for personal and public health that continues today.