This was often due to the cramped and dirty living conditions of these places. Washington understood the destructive nature of smallpox and other diseases such as malaria, diphtheria, and scarlet fever. He was one of the first to introduce the idea of compulsory health initiatives such as widespread inoculation. Washington also had experience with disease outside the realm of combat and war. Having himself suffered from many illnesses and observing those of his family, George Washington was an integral part of the establishment of American public health programs. Along with quarantine, another one of Washington's methods for keeping his men healthy was with the use of inoculation. Washington, like others of the time period, was not intimately familiar with the exact mechanisms of the virus. However, he and others were able to realize that men who had previously contracted and subsequently recovered from smallpox were unlikely to become ill a second time. Thus, early on Washington recognized the strategic advantage of these individuals. During an outbreak in Boston, Washington sent troops made up only of men who had previously been infected with smallpox. With this, he was able to both protect his soldiers and take advantage of the vulnerability of Boston and its British inhabitants during the smallpox outbreak of March 1776. Initially, George Washington was reluctant to inoculate his troops. But as he watched many of his men fall victim to smallpox, Washington believed that he would be able to keep his troops healthy through sanitary and quarantine methods. There were several events that contributed to the change of Washington's policy. First, Washington recognized that quarantine and attempted cleanliness were not enough to keep his vital troops healthy and in fighting form. Additionally, many prominent members of colonial society were having themselves and their families inoculated. Eventually, even George Washington's wife, Martha Washington was herself inoculated. It was not long after this that Washington initiated the inoculation of the American troops. Washington recognized the dangers of inoculating these men; many patients died as result of the infection caused by inoculation. However, the importance of keeping his men healthy outweighed the risks, and almost all Continental soldiers were inoculated against smallpox. Washington (a survivor of smallpox himself) understood the danger that smallpox posed to his men, saying "Necessity not only authorizes but seems to require the measure, for should the disorder infect the Army . . . we should have