An acute, highly contagious viral disease, smallpox was a major threat in South Carolina from the late seventeenth century until the late nineteenth century. Worldwide, smallpox killed and disfigured untold millions of people before it was effectively eradicated by 1977 through a combination of vaccination and isolation of those infected. Its characteristic symptoms included fever, skin and throat eruptions with pustules (“pox”), sloughing, and scarring of skin. Fatalities generally occurred when it attacked internal organs and/or caused internal and external hemorrhaging. No cure was ever discovered. During the sixteenth century an extremely virulent form of smallpox (variola major) developed in the Old World and gradually spread to the New. It was one of the most feared diseases in the world, not only because it often killed upward of twenty percent of the infected, but also because it often left survivors scarred with facial “pock marks” and sometimes blinded them in one or both eyes.

Smallpox was endemic (always present) in some large European cities by the eighteenth century, but it was an occasional epidemic import into South Carolina. It arrived via ships from the Old World or the Caribbean, or by sea or land from other parts of eastern North America. Many epidemics of smallpox struck South Carolina between 1697 and 1897. Those of 1697–1698, 1711, 1738, and 1759–1760 were particularly deadly. Each killed hundreds of Europeans and Africans and devastated local Native American populations.

The epidemic of 1738 was significant as the first occasion in South Carolina when doctors resorted to widespread inoculation as a smallpox preventive. According to one of the main Charleston inoculators at the time, James Kilpatrick, between 800 and 1,000 people were inoculated and 8 died. The editor of the South-Carolina Gazette, who was unfriendly to inoculation, claimed that 437 were inoculated and 16 died. Inoculation had previously been used in epidemics in Boston and Philadelphia, but the numbers inoculated there were much smaller. Methods of inoculation varied but generally involved placing matter from the pustules of smallpox victims under the skin of the uninfected in hopes of producing a mild infection and immunity. Although this practice occasionally produced a serious infection and death, contemporary statistics show that it was far less likely to kill or disfigure than a natural infection was. Although widely employed throughout the eighteenth century in South Carolina, it was highly controversial. Opponents accused inoculators of needlessly spreading the disease or interfering with Divine Providence.

In the early nineteenth century inoculation was gradually replaced by vaccination. The method developed and publicized by the English physician Edward Jenner in the late 1790s involved placing matter from what he claimed was cowpox, a related but mild disease, under the skin in the same manner as inoculation. Vaccination (from the Latin vacca, or “cow”) was safer than inoculation. But it was soon discovered that the immunity it provided was only temporary and that periodic revaccination was required. By 1802 several South Carolina physicians were promoting vaccination. One of them, David Ramsay, confidently predicted the imminent demise of smallpox through vaccination. But many people opposed it for much the same reasons that they had opposed inoculation. The state did not make vaccination compulsory until 1905. Several major smallpox epidemics occurred in the late nineteenth century, but by 1930 the disease had been eradicated from South Carolina.

Banov, Leon. As I Recall: The Story of the Charleston County Health Department. Columbia, S.C.: R. L. Bryan, 1970.

Duffy, John. Epidemics in Colonial America. Baton Rouge: Louisiana State University Press, 1953.

Hopkins, Donald R. The Greatest Killer. Chicago: University of Chicago Press, 2002.

Kirkpatrick, James. An Essay on Inoculation Occasioned by the Smallpox Being Brought into South Carolina in the Year 1738. London: J. Huggonsohn, 1743.

Waring, Joseph I. A History of Medicine in South Carolina. 3 vols. Columbia: South Carolina Medical Association, 1964–1971.

Wood, Peter. “The Impact of Smallpox on the Native Population of the 18th Century South.” New York State Journal of Medicine 87 (January 1987): 30–36.

Citation Information

The following information is provided for citations.

  • Article Title Smallpox
  • Author Peter McCandless
  • Website Name South Carolina Encyclopedia
  • URL
  • Access Date July 2, 2020
  • Publisher University of South Carolina, Institute for Southern Studies
  • Original Published Date August 1, 2016
  • Date of Last Update October 24, 2016