In the last issue, we explored smallpox and its devastation on the peoples of colonial North America. Smallpox is considered by many to be the most horrifying epidemic of colonial times because of the terrible suffering it inflicted, especially with the high mortality rates and disfigurement it left behind. However, when other diseases like malaria, dysentery, diphtheria, scarlet fever, yellow fever, and even the common cold are considered, smallpox may seem less ominous. Indeed, John Duffy claims, in his book Epidemics in Colonial America, that respiratory diseases weakened and eventually killed more colonists than smallpox . Also, the endemic diseases of malaria and dysentery were continually present in colonial times. These diseases did not always kill people; often they were weakened enough that a mild outbreak of influenza or measles would finish them off. Children and older adults were often the first victims in any epidemic. Along with age, poor diet and hygiene also contributed to the high mortality rates in colonial North America.

Endemic Diseases: Malaria and Dysentery
A disease is considered endemic if it is localized and recurs year after year. Malaria and dysentery were endemic for the entire colonial period. Malaria was also known as "ague", "quartan ague", "tertian ague", and "the Kentish disorder." Passed to humans by mosquitoes, the parasites that cause malaria led to chills and fever, vomiting, and other flu-like symptoms. Eventually, victims either die because their red-blood cells are destroyed and anemia results, or their capillaries, (which lead to the brain or vital organs), are clogged. Either way, malaria was a horrible disease. Specific colonies -- New Jersey, Pennsylvania, New York, and Delaware -- were more prone to malaria because of their climate and the resident mosquitoes. The mosquito's role in transmitting the disease was not discovered until the twentieth century. Colonials believed in the miasmic theory; that breathing air near stagnant water made one sick. The term malaria itself comes from the Italian words mala and aria, which mean "bad air. "

Malaria was so common that outbreaks often were not recorded. Indeed, Duffy says that for the colonists, "the spring and fall flare ups [of epidemic proportions] were as inevitable as the seasons themselves." In his opinion, malaria was "directly or indirectly one of the most fatal of colonial diseases." Colonists who survived malaria often developed some immunity and resistance, but often they were physically weakened and more susceptible to other diseases or another malaria outbreak. Newly arrived immigrants were often among the fatalities from the diseases. Indeed, Duffy claims that malaria was more widespread and affected more people than smallpox or yellow fever and calls it a "major hurdle in the development of the American colonies." One ethnic group, however, was not as susceptible to malaria. African slaves who came from West Africa and colonies in the West Indies were genetically better equipped to ward off attacks of malaria. According to David Rosner, this resistance is due to their sickl e cell trait, which "is associated with greater resistance to malaria." Duffy says this immunity "made possible the development of rice plantations in South Carolina" -- plantations run by African slave power because the white settlers were either constantly sick, or died from diseases like malaria and yellow fever that were endemic in those regions.

Charleston, which was often hard-hit with other diseases, was never really bothered by malaria. Duffy attributes this to the city's close proximity to salt water, an inhospitable climate for mosquitoes. New England, while troubled by malaria outbreaks during the early colonial days, had almost eradicated the disease by the American Revolutionary war. Conversely, outbreaks became more severe in the other colonies in the late 1700s.

Dysentery
Like malaria, dysentery had devastating effects on colonists. Also known as "camp fever" and "camp disorder" the disease was spread by either a bacteria, parasitic worms, or protozoa through feces-contaminated water and food, flies, or handling of food in unsanitary conditions. A soldiers' camp or immigrant ship would be just such a place for dysentery to commence its painful course. Those with the disease usually died from dehydration because of severe diarrhea. Children are especially susceptible to the disease. While today we have a better understanding of the importance of cleanliness and a greater availability of antibiotics, in colonial times people just had to endure and let the disease run its course. Some people suffered for long periods before dying while others suffered for short amounts of time; there was no timeline of infection and recovery with dysentery, unlike with smallpox. Unfortunately, like malaria, dysentery often left its survivors sufficiently weakened and susceptible to other diseases. Duffy says it was "endemic and epidemic, recurrent, debilitating, and often fatal."

Yellow Fever
John Duffy calls it a "strange and unaccountable pestilence that brought death in a horrible fashion to its victims." Known also as "Bilious Plague" and "Black Vomit" it was transmitted by mosquitoes and often arrived from the West Indies. The mosquitoes are thought to have survived in buckets or containers of stagnant water on board ship; once the mosquitoes hit port cities with temperate climates -- like Charleston -- the yellow fever quickly spread. The virus transmitted by the mosquitoes had a quick o nset and left its victims tired, feverish, and jaundiced; they would also often hemorrhage. Duffy says it "was one of the most dreaded diseases in the affected regions…[and had it] adapted itself to all areas in the British American colonies, yellow fever would undoubtedly have ranked with smallpox as a leading cause of death." And like malaria, whites were more susceptible to the disease than blacks. Charleston was the hardest-hit, though as evidenced by this chart, other large port cities suffered epidemics. Most outbreaks started in the tropical West Indies and Bahamas, where fatalities were higher than in the American colonies. Between the years of 1760 and 1793, Duffy tells us that yellow fever disappeared from the colonies. He credits this to stronger and better-enforced quarantine laws .

Diphtheria and Scarlet Fever
In a time when almost half the children under age five died, diphtheria and scarlet fever were major causes of childhood death. The symptoms of both diseases were so similar that they were not differentiated between until the late 1800s. Sore throats, major symptoms for both diphtheria and scarlet fever, were common and often unattributable to a specific disease. Duffy believes diphtheria was present in the early colonial days but "it did not attract the attention of the medical profession until the occurrence of a virulent outbreak in New England during 1735-36."

Caused by bacteria, a false membrane would form in the throat, which would swell and often led to suffocation. The bacterium was contagious and "transmitted from person to person by droplet infection produced from respiratory secretions." Until a vaccination was developed the only solution was a tracheotomy that would bypass the false membrane and allow the victim to breathe freely.

Families often lost half and sometimes all of their children to the disease. In the epidemic of 1735-36, there were over 1,000 deaths. And 90% of the deaths in New Hampshire were of children under the age of 10. By 1740, over 1,000 people had died in Connecticut alone. Such statistics led Noah Webster to call diphtheria "'the plague among children'."

Scarlet Fever
Like diphtheria, many of this disease's victims were small children. Spread by close contact, streptococcus leads to a high fever, vomiting, sore throat, enlarged tonsils, and a red or "scarlet" rash . In severe cases, the throat enlarges and the victim suffocates similarly to diphtheria. Even though Duffy believes scarlet fever was first identified in 1675, it was often confused with smallpox, measles, and diphtheria . It was called a "frontier disease" because it did not start in large urban centers like other diseases. Duffy points out that while scarlet fever was sometimes fatal, it was a minor disease of that time.

Respiratory Diseases: Influenza, Pneumonia, Pleurisy, and colds
Duffy classes respiratory disorders among the "major causes of morbidity and mortality" in colonial America . This seems surprising when one reads about the devastation that smallpox, yellow fever, and diphtheria left in their wakes. However, as pointed out earlier, in a time when diets were unhealthy, living conditions unsanitary and overcrowded, and frequent exposure to the elements weakened many colonists, "winter diseases" like the flu and a cold often proved fatal. While influenza itself caused comparatively few deaths in colonial America, complications sometimes arose and led to secondary infections, such as pneumonia.

Pneumonia
People with low resistance, the aged or very young, were especially susceptible to pneumonia. Caused by different pathogens -- including bacteria or viruses --victims often developed a chill, pain in the chest, fever, headache, cough, rapid pulse and breathing. Death was not as common with pneumonia as with other diseases, but no exact statistics were kept.

Pleurisy
A catchall term used to describe any cough or condition that restricted breathing, pleurisy was endemic, not epidemic in colonial America. Respiratory diseases were very common, and therefore, not often recorded. Duffy's research found pleurisy was usually only referred to in personal correspondence and not in the newspaper headlines.

Colds
Sometimes described as a winter sickness or catarrh, colds were very common. However, there are no available records to measure the loss of life in colonial times. Duffy puts it as his opinion that the economic cost of respiratory illnesses far exceeds those of the more publicized epidemics. He continues, "if adequate statistics were available, respiratory diseases undoubtedly would rank high on the list of fatal sicknesses which attacked the American colonists." To be continued next time in Part Three: Whooping Cough, Mumps, Measles, Typhus, Typhoid, and other diseases

Sources:
Briggs, Elizabeth. A Family Historian's Guide to Illness, Disease, & Death Certificates. Winnipeg, Manitoba, Canada: Wesgarth, 1993.
Duffy, John. Epidemics in Colonial America. Baton Rouge, LA. Louisiana State UP, 1953.
Click here to purchase the book Epidemics in Colonial America

Duffy, John. "History of Public Health and Sanitation in the West since 1700." The Cambridge World History of Human Diseases. Kenneth F. Kiple, ed. New York: Cambridge UP, 1993. 200-206.
World Health Organization. "What is Malaria?"
http://www.rbm.who.int/cmc_upload/0/000/015/372/RBMInfosheet_1.htm
Rosner, David. "Epidemics." The Reader's Companion to American History
http://college.hmco.com/history/readerscomp/rcah/html/ah_028800_epidemics.htm