Since the first documented case of the COVID-19 virus arrived in the United States in January, we've heard a lot about the "new normal" that defines our everyday lives now. Fortunately, living within the restrictions and fear of a pandemic is not an everyday occurence here in the Holy City. History, however, reminds us that it is far from the first time Charlestonians have faced the challenge these contagious widespread diseases. 

From its founding in 1670 through the early 20th century, Charleston quickly developed a well-deserved reputation as an unhealthy place to live. There were several reasons for this. As the western terminus of the great trans-Atantic shipping route, Charleston welcomed large numbers of sailors, passengers and enslaved Africans carrying the latest viral germs from around the world. In addition, our climate's propensity for heat and mosquitos further aggravated the city's vulnerability.

Settlers of both European and African descent were at risk of contracting deadly diseases including malaria, dysentary, smallpox and yellow fever. Indeed, let us not forget that exposure to Western European diseases virtually destroyed the entire Native American population. Many more Native Americans died by living and trading in peaceful proximity to the colonists than ever died fighting them. South Carolina's Native population of nearly 10,000 in 1685 dropped to about 300 by 1790, and those lived in isolated pockets of the mountains, where settlers had not yet become numerous. 

Taken together, malaria, often referred to as the "ague" in historic documentation, and dysentary, commonly referred to as the "bloody flux," accounted for more deaths in Carolina than any other cause, including war and hurricanes. Though less deadly, however, smallpox and yellow fever tended to "grab the headlines," as it were, up until the 20th century. Peter McCandless, author of the "Epidemics" essay found in the South Carolina Encyclopedia, attributes the greater fear of the latter two diseases to the fact that they invariably brought with them widespread public quarantines and economic crises, akin to what we are facing today with COVID-19.

And so, throughout its history of periodic epidemic outbreaks and more common, but less widespread endemic surges, Charlestonians have faced many major life-threatening illnesses in the past. The worst among them occured in 1697, 1699, 1738, 1760, 1858 and 1918.


Smallpox Epidemic of 1697/98

Like most colonial-era outbreaks, this killer arrived in Charleston through its port. Though records of how many settlers contracted the disease are not known, it is believed that the pox killed between 200 and 300 victims out of population of less than 5,000. That's about a 5% mortality rate.

Smallpox continued to rear its lethal head in Charleston from time to time throughout the 18th century, including a significant reoccurence in 1711.

Yellow Fever Epidemic of 1699

Just a year after the colony was recovering from its recent smallpox rampage, another several hundred people died of yellow fever, outbreaks of which also arrived periodically in Charleston, most often through slave ships. 

Memories from this outbreak sound a bit similar to today's news in 2020. McCandless quotes one contemporary writer who noted: "Shops shut up for six weeks, nothing but carrying medicines, digging graves, carting the dead; to the great astonishment of all beholders."

Bouts of yellow fever continued to visit Charles Town every five to 10 years until 1748, when it went underground until 1790. Then, without warning, yellow fever epidemics struck Charleston almost annually between 1792 and 1800. 

Smallpox Epidemic of 1738

Smallpox again raged through the colony in 1738, infecting 2,000 of about 6,000 settlers, or put another way about one-third of the Lowcountry's population, with a mortality rate of again about 5%. It is believed that this epidemic arrived upon the slave ship London Frigate

In the wake of this epidemic outbreak, South Carolina's medical leaders introduced the concept of innoculation as a preventative measure, though it proved to be a controversial experiment at best.

Smallpox Epidemic of 1760

While earlier smallpox epidemics had been introduced by ships arriving in port, a major outbreak in 1760 found its way to Charleston via the return of local soldiers who had fought with S.C. Gov. William Lyttleton in the Upstate's Cherokee wars. An outbreak among the Catawba tribes of the colony's backcountry the year before wiped out more than half of that Native population, reducing a population of nearly 4,000 Catawbas in 1690 to fewer than 100 men in 1759. Likewise the Cherokee population had lost nearly two-thirds of its population to settlers' diseases since their arrival.

When the infected soldiers returned, Charleston had a population of about 8,000, between one-half and three-quarters of whom caught the disease. Nine hundred people, or 11% of Charleston's citizens died, and this time a disproportionate number of those were African Americans.

Yellow Fever Epidemic of 1858

The worst epidemic of the 19th century in Charleston hit shortly before the first shots were fired at Fort Sumter to open the Civil War. While earlier epidemics tended to focus on a particular demographic group or recent immigrants, this rampage played no favorites. It struck and killed equally the young and old, all races and social classes, and pregnant women. With a population of about 40,000, the death toll was about 800 people or 2%.

The last yellow fever epidemic to hit Charleston was in 1876. Nevertheless, the public's fear of the disease continued well into the early 20th century.

Spanish Influenza Pandemic of 1918/19

To better understand the impact of the great Influenza Pandemic of 1918/19, it helps to take a look at how Charleston was then. First, its citizens remained retchedly poor after the devastation of the last half of the 19th century ravaged it through the Great Fire of 1861, four years of the Civil War and occupation by Federal troops, devaluation of Confederate currency and the economic hardships and social upheaval of the Reconstruction Era, the Great Earthquake of 1886, and then finally, the series of major, destructive hurricanes that not only claimed lives, but drove the last nail into the coffin of Charleston's remnant rice culture in 1911. Charleston's importance as a major US port city deteriorated (and in hindsight, that might have had some advantages vis-a-vis the coming epidemic).

The City of Charleston only included the peninsula's population of about 61,000 people, pretty much equally divided between blacks and whites. Those who lived west of the Ashley, east of the Cooper, or on the sea islands were still living in relatively rural, sparsely populated areas. The College of Charleston only admitted men and the city's health services were rigidly segregated.

In the earliest years of the 20th century, however, Charleston's Congressional leadership had secured what would become the city's - indeed, the state's - principal economic engine throughout the rest of the century: the installation of a new Navy Base about 10 miles outside of town along the banks of the Cooper River. There, the future began to look brighter, as the US had entered World War I in April 1917, and activity there was booming.

Military recruits began heading overseas where they were exposed to an influenza virus that was believed to have originated in Spain. Fighting in foxholes and close quarters allowed the flu to spread through the soldiers' ranks like wildfire. Many of those affected began returning home to the US. By the summer of 1917, just months after the US's entry into war effort, the flu began taking hold in northern port states and began spreading. The first case of the Great Spanish Influenza's arrival in Charleston was documented at the Navy Base on Sept. 17, 1918.

In his always engaging podcast, Dr. Nic Butler, Charleston County Public Library's Historian, goes on to lay out a timelines of the epidemic's spread through the Holy City.

The Navy Base responded with an immediate quarantine that same day. Nevertheless, within three days, 350 cases of the flu were documented on the base.

Despite the quarantine imposed upon the base, its soldiers continued to work closely with member's the local Citadel Cadet corps. You'll recall that at this time, the Citadel was located near Meeting and Calhoun streets on Marion Square. Cadets began getting sick. Its campus was shut down Sept. 29.

Butler shares a quote from the Sept. 30 edition of the local newspaper that sounds remarkably familiar to what we've been hearing lately: “The public had just as well prepare themselves for a spread of the disease if they did not take every precautionary measure possible to prevent this. If the public wants to stamp out the disease it can do it by individual preservation. It is going to be impossible to quarantine every public gathering, for this would seriously cripple essential industries. . . the best thing to do is to avoid public gatherings as much as possible, walk to work in the morning rather than be exposed to a crowded conveyance [such as a trolley].” 

Butler then goes on to note that the government's official response the next day, Oct. 1, 1918, sounded a lot like that which we initially heard from some of our federal leaders during this COVID-19 drama “The disease itself is not so dangerous: in fact, it is nothing more than what is known as 'Grippe'. . . . The danger lies in the careless spreading of the disease, and careless treatment, allowing pneumonia or other dangerous maladies to develop."

Regardless of medical officials' warnings, S.C. Gov. Richard Manning joined a crowd of Charlestonians just two days later at a military parade on Marion Square, adjacent to the Citadel. The purpose of the parade was to help encourage popular support for the Liberty Loan program, an fundraiser for the war effort. Later that same afternoon, the College of Charleston suspended classes and sent everyone home. The local public schools, however, chose to only send home those children who exhibited symptons of being ill.

By Oct. 6, officials and the general public finally began to appreciate the seriousness of the pandemic in our city. Health officials drew up regulations which the city's mayor issued as mandatory, including the immediate closing of "all churches and Sunday schools, public and private schools, theatres, movie houses, pool rooms, public and private dances, secret and fraternal associations, sewing circles, card parties, and all other places and forms of congregation." Nevertheless, in their sense of patriotism, officials continued fundraising door-to-door for the Liberty Load program.

Over the next week, hundreds of cases were reported daily in Charleston. Like the yellow fever epidemic of 1858, the 1918 flu pandemic struck all population demographics: young, old, all races, ethnicities and social classes. This time 20 to 40 year olds were hit just as hard as the young or the elderly. To make things even worse, many of Charleston's doctors and nurses were in Europe, working with the war effort. Their absence left the local population pretty much in the hands of the American Red Cross, which began hiring (mostly) women either with or without medical experience.

As flu victims progressed from the flu into stages of pneumonia, doctor began recommending whiskey for health benefits. Unfortunately, South Carolina had been subject to the state's "Dispensary Laws" since the days of Gov. "Pitchfork" Ben Tillman since the turn of the century, making alcohol illegal. On Oct. 12, officials finally consented to make available stashes of bootleg whiskey they had been seizing under the Dispensary Act.

By this time, pretty all of the city's female population was either sick or working with medical teams. There were few at home to provide nutritous meals for families. The absence of nutritous meals only augmented the flu epidemic even further. Thus, on Oct. 14, the women of the city collectivelly began the operation of a public kitchen at Memminger School on Beaufain Street, where families could receive three healthy meals a day.

A week later, on Oct. 21, the official count of the ill reached its peak with 5,064 cases, including 130 deaths. It began to recede.

By Nov. 3, the state ended its mandatory quarantines, though locally, Charleston, as an urban center, continued enforcing the quarantines for another three days. The last of the Memminger kitchen meals was served on Nov. 6. Between Oct. 14 and Nov. 6, the kitchen had served an estimated 5,677 meals, or 242 a day.

By Nov. 7, the city had pretty much ended all quarantines, with the exception of the public schools and the Navy Base, which remained under quarantine until Nov. 11, the same day that the U.S. declared victory in World War I. Needless to say, Charlestonians celebrated in a major way!

Though the epidemic was officially over, the flu did not disappear immmediately, with cases continuing to be reported in Charleston through early 1919. Official counts note 7,154 cases in all with 291 deaths. Medical officials of the day, and historians now, are confident that these numbers were grossly underreported and suggest that there were between 15,000 to 18,000 cases in South Carolina.

Electric trolleys continued to operate in Charleston during the Great Influenza pandemic of 1918/19, but were required to keep their windows open and limit the number of passengers per car.


Butler, Dr. Nicholas. "Pandemic and Panic: Influenza in 1918 Charleston" podcast for the Charleston County Public Library, March 20, 2020.

McCandless, Peter. "Epidemics" essay in the South Carolina Encyclopedia, edited by Walter Edgar, published by the University of South Carolina Press, 2006.

Raskin, Hanna. "Spanish Flu might offer clue to what coronavirus holds for downtown Charleston restaurants," in (Charleston) Post & Courier, March 9, 2020.

"The American Influenza Epidemic of 1918-1919," University of Michigan’s Digital Influenza Encyclopedia.