From the 1680s to the early twentieth century, South Carolina, especially the lowcountry, had a deserved reputation as an unhealthy place.

An epidemic disease is generally defined as one that affects an unusually high number of individuals within a population or region simultaneously. Epidemic diseases are often contrasted to endemic diseases, those constantly present but which do not necessarily affect large numbers of people. The terms are far from precise, however. Some diseases may be endemic to a particular place but be labeled epidemic when they reach a certain indeterminate level of incidence.

From the 1680s to the early twentieth century, South Carolina, especially the lowcountry, had a deserved reputation as an unhealthy place. Disease killed enormous numbers of Europeans and Africans, virtually annihilated Native Americans, and proved a significant barrier to European immigration. It thus played a major role in shaping the demographic profile of the colony and the state. The biggest contributor to high morbidity (disease) and mortality rates was infectious disease, especially malaria, dysentery, smallpox, and yellow fever. Malaria (known then as ague and fever or as intermittent, remittent, or country fever) and dysentery (bloody flux) were endemic and occasionally epidemic from the first years of European and African settlement until the early twentieth century. Endemic or epidemic, they were perhaps the greatest contributors to morbidity and mortality rates until the late nineteenth century and remained significant problems until the 1940s.

Yet malaria and dysentery received less public attention and aroused less fear than smallpox and yellow fever, which were more clearly epidemic in the traditional definition. Not only were they repulsive diseases that could infect and kill large numbers of people in a short time, but epidemics of smallpox and yellow fever invariably brought stagnation of trade and quarantine of people on ships, in houses, or in pesthouses on Sullivan’s Island.

The first major outbreak of smallpox, in 1697–1698, killed between two hundred and three hundred settlers out of a total population of no more than five thousand. Several other smallpox epidemics struck South Carolina between 1711 and 1763, and then the disease virtually disappeared until 1816, perhaps due to widespread inoculation and vaccination. In the later nineteenth century small-pox revived in epidemic form several times, probably because of neglect of vaccination. In 1905 the state passed a compulsory vaccination law. The disease was eradicated from South Carolina by 1930.

The smallpox epidemics of 1738 and 1760 are particularly notable in South Carolina history. The epidemic of 1738, which spread through the colony from a slave ship, the London Frigate, infected more than two thousand of the roughly six thousand people in Charleston and killed more than three hundred. It also produced a major controversy over the first known use of inoculation as a preventive measure in South Carolina.

Unlike most smallpox epidemics, which arrived via ships, the epidemic of 1760 most likely came from the upcountry. It was apparently spread throughout the colony by soldiers returning to Charleston in December 1759 from Governor William Lyttleton’s expedition against the Cherokees. Precise statistics are impossible, but in Charleston alone about one-half to three-fourths of the population of about eight thousand were infected naturally or by inoculation and perhaps as many as nine hundred died. Mortality was especially high among Africans and French Arcadian refugees.

Smallpox was particularly devastating to South Carolina’s Native American populations. It was largely responsible for the decline of South Carolina’s Indian population from about ten thousand in 1685 to about three hundred east of the mountains by 1790. In 1697 and 1698 smallpox destroyed the Pemlicos and killed untold numbers of Indian people hundreds of miles inland. The epidemic that struck the backcountry in late 1759 killed almost one-half of the Catawbas. By then this people who had numbered about four thousand in the 1690s could muster only one hundred fighting men. The number of Cherokees dropped by about two-thirds during the eighteenth century, largely due to smallpox.

Yellow fever, named for the jaundiced appearance of its victims, was generally confined to ports, such as Charleston and Beaufort. It was unusual, but not unknown, in rural areas. The disease was usually imported in slave ships from Africa and the Caribbean. Yellow fever seems to have first struck Charleston in a devastating epidemic in 1699 that killed several hundred inhabitants. One observer claimed that the effects were far worse than those from the Great Plague of London (1665), given the comparative smallness of Charleston: “Shops shut up for six weeks, nothing but carrying medicines, digging graves, carting the dead; to the great astonishment of all beholders.” Yellow fever visited Charleston with similar results every five to ten years until 1748 and then virtually disappeared until the 1790s. Between 1792 and 1800 yellow fever epidemics struck the city seven times. Epidemics in Charleston were common once again from the 1820s to the 1870s and particularly severe in the 1850s.

The epidemic of 1858, which killed more than eight hundred people in the city, was the worst of the nineteenth century. It also differed from most others in that it seemed to affect the entire spectrum of the population. In most epidemics the victims were said to be children, recent immigrants, and visitors–hence the source of the name “Strangers Fever.” The last yellow fever epidemics struck the state in 1876 (Charleston) and 1877 (Port Royal), but fear of the disease continued for decades.

Many other diseases, notably influenza, pneumonia, measles, diphtheria, scarlet fever, polio, typhoid, pellagra, and tuberculosis, have produced major epidemics in the state. Influenza (“flu”) has reached epidemic status many times throughout the history of South Carolina. Influenza mortality has usually been small compared to the large numbers infected in epidemics. But a major exception to this occurred in 1918 and 1919, when the worst pandemic (worldwide epidemic) since the fourteenth-century plague infected about ten percent of the state’s population (about 150,000–170,000) and killed between 4,000 and 5,000 people.

By the 1950s most of the old epidemic diseases were eliminated or greatly reduced in incidence and virulence by a combination of improvements in diet, housing, and public health with immunization and drugs, notably antibiotics. In South Carolina, as in the developed world generally, acute infectious diseases have largely been replaced by chronic degenerative diseases such as cancer, heart disease, stroke, and chronic obstructive pulmonary disease (emphysema, asthma, and chronic bronchitis).

Banov, Leon. A Quarter Century of Public Health in Charleston, South Carolina. Charleston, S.C.: Charleston County Department of Health, [1945?].

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

Farley, M. Foster. An Account of the History of Stranger’s Fever in Charleston, 1699–1876. Washington, D.C.: University Press of America, 1978.

Krebsbach, Suzanne. “The Great Charlestown Smallpox Epidemic of 1760.” South Carolina Historical Magazine 96 ( January 1996): 30–37.

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.

  • Title Epidemics
  • Author
  • Keywords affects an unusually high number of individuals within a population or region simultaneously, virtually annihilated Native Americans, malaria, dysentery, smallpox, and yellow fever, compulsory vaccination law, epidemic of 1738, epidemic of 1858, “Strangers Fever.”
  • Website Name South Carolina Encyclopedia
  • Publisher University of South Carolina, Institute for Southern Studies
  • URL
  • Access Date October 2, 2022
  • Original Published Date
  • Date of Last Update July 26, 2022
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