In previous articles we have examined the major epidemic diseases of colonial times. In this section, we will look at relatively minor diseases such as whooping cough, mumps, measles, typhus, typhoid fever, and other diseases. As with other diseases, children and older adults were often the first victims in any epidemic. Age, poor diet and hygiene also contributed to the high mortality rates in colonial North America. And while relatively few people died from the diseases we will examine here, the deaths were significant enough that records were kept.

Whooping Cough
A highly communicable disease, whooping cough or pertussis, is caused by the bacterium Bordetella pertussis (1). It presents itself as an upper respiratory infection, which involves continual coughing and discharge of mucus, even vomiting. The disease gets its name from the "high-pitched crowing whoop [that develops after 14 days]. 10 to 15 coughs may follow in rapid succession before a breath is taken"(2). The disease is more serious for young children and can lead to pneumonia, asphyxia, convulsions, and brain damage (3). Today the disease can be prevented with early inoculation and treated with antibiotics. In colonial times, the disease was allowed to just run its course. According to John Duffy, whooping cough "aroused little apprehension"(4). It was not until a major outbreak in 1738 that whooping cough really was given any attention. Even though there were fatalities, they were not as numerous as with other diseases. Duffy tells us that whooping cough "can be safely relegated to a very minor role among the epidemic diseases of the period"(5).

Mumps
Considered a child's disease, mumps was rarely fatal. Caused by the virus, epidemic parotitis, it attacks the salivary glands and causes pain and swelling (6). Victims may have a fever and general feeling of illness. Eating is often painful. The infection runs its course within three weeks. Complications may arise if adults contract the infection. According to The Expanded Columbia Electronic Encyclopedia, the heart, thyroid, brain, and reproductive organs may be affected. The cases are rare and in colonial times few records were kept on mumps. Duffy tells us the disease was "inconsequential in comparison with the more virulent epidemic sicknesses of the period"(7). Today the disease is prevented with a vaccine.

Measles
Caused by a highly communicable virus, measles (rubeola) was much more severe and deadly than either whooping cough or mumps. Measles was often ignored because of the severity of other diseases like small pox and yellow fever. Considered a childhood disease because most of its victims were infants and young children, Duffy tells us measles was "one of the leading causes of infant mortality"(8). The disease did give survivors permanent immunity, like small pox, a person would only have the disease once. Measles was often mistaken for either small pox or scarlet fever due to similar symptoms: fever, a reddish rash, and upper respiratory infection. Measles also ran its course in twenty-one to thirty days, similar to small pox. And like small pox, regular epidemics of measles swept the colonies (9), though limited records were kept on measles epidemics in the seventeenth-century (10).

Many people died from a weakened condition and the complications arising from measles, such as bronchial pneumonia and encephalitis (11). The Expanded Columbia Electronic Encyclopedia also showed the following complications could arise: "The measles virus has also been associated with subacute sclerosing panencephalitis (SSPE), which causes chronic brain disease in children and adolescents. After the attack of measles, it can cause intellectual deterioration, convulsive seizures, and motor abnormalities and is usually fatal." Pregnant women were also at risk to measles because the virus can pass through the placenta and infect the unborn child (12). Poor hygiene and sanitation in colonial times spread measles and Duffy considers it endemic. At a time when medical treatments included bleeding and purging, the 1713-15 epidemic of measles led to some beneficial treatments for the disease. The Puritan minister Cotton Mather advised that rest was important in recuperating from the disease and he encouraged avoidance of traditionally invasive procedures (13). He wrote his advisory tract after seeing his wife, 3 children, and a maid die from measles within a two-week period. While there is no evidence as to whether or not his congregation heeded his advice, Mather's observations about treatment are still in force today.

Surprisingly, the 1772 epidemic left so many people immune that measles was one of the few diseases not raging at epidemic levels during the American Revolutionary War (14). Duffy tells us it was not a major killer, but when added to all the other diseases one could suffer from, measles did take its toll, especially among children.

Typhus
While there are a variety of typhus fevers, the most common and fatal in colonial times was Rickettsia prowazeki (15). Also known as "jail fever", "prison fever", "military fever", "hospital fever", "camp fever", "putrid fever", "ship fever", and "spotted fever" it was transmitted through the feces of body lice (16). Duffy tells us typhus was more common in the filthy, poor, and overcrowded urban European communities than in the American colonies "where land was cheap and the economy predominantly agricultural"(17). Therefore, the disease was never endemic and only reached epidemic proportions either when large immigrant groups arrived in port from Europe or during wartime. There were outbreaks of the disease during battles of the American Revolutionary War. And in the eighteenth century, groups of Germans and Scotch-Irish brought the lice with them on their dirty and overcrowded immigrant ships (18). Besides these few outbreaks, typhus was rarely present in colonial America.

When typhus first presents itself, the symptoms are similar to influenza and include headache, fever, chills, and weakening of the limbs. Eventually a rash develops and covers the body. Victims often become "deranged with fever...and death becomes a welcome release"(19). The best prevention for typhus is adequate sanitation. Pesticides are also used to kill the lice and prevent the spread of the disease.

Typhoid Fever
Caused by poor sanitation, infected water, overcrowding, and war, typhoid fever was transmitted by the bacteria salmonella typhi in feces, vomit, and urine (20). Experts were not sure when typhoid fever first appeared in the colonies, but the "burning fevers" of the Jamestown settlers in 1607 may have been typhoid fever (21). Briggs corroborates that typhoid was "one of the first epidemics to occur in the United States [and] took place in Virginia between 1607-1624. Approximately 85% of the arrivals in James River died from disease which began as a typhoid epidemic"(22). According to The World Health Organization's website, scholars put the total number of deaths for this period at 6,000+ (23).

Typhus was also known as "slow fever", "nervous fever", "continued fever", "burning fever", "long fever", and "bilious fever"(24). Some of the early symptoms of typhus were fever, overall pain, loss of appetite, headache, muscle pain, cough, and restlessness. Later delirium and severe constipation and dehydration occur, which lead to cardiac arrest and death. The disease runs its course in one to three weeks. At first, the disease was confused with dysentery and typhus. Typhoid was first identified in 1659 and by 1880, it had been isolated and recognized separately from typhus.

While the epidemics of typhus in Colonial time were not as frequent as small pox and yellow fever, Duffy tells us typhus has a "high rank among destructive sicknesses...[due to] the increasing extent of the sickness and the number of deaths" from 1730-1770 (25). With increased sanitation, the epidemics began to subside. Today, along with proper sanitation, the typhoid vaccine has eradicated the disease from most developed nations.

Other diseases
While not of major concern in colonial times, Duffy tells us hookworms and parasites were prevalent and especially dangerous for children, but never reached epidemic proportions (26).

Women were at risk for infections-such as puerperal fever-associated with childbirth. While this topic would be better discussed in another article, it is important to note mortality rates for childbearing women were high.

Duffy tells us there was some venereal disease in colonial America, but the outbreaks were nothing compared to those in Europe. The only recorded outbreak was of syphilis in 1773 in lower Canada (27).

Conclusion
In this series of articles, we have covered a major component of the colonization of North America: disease. Along with famine and war, disease decided who survived and settled the colonies. Small pox, while perhaps the most feared disease, was not the major killer. Malaria took more lives than any other disease, mostly because it did not grant immunity like small pox and measles did. Dysentery was the number two killer of colonists. The next most fatal illnesses were the respiratory complaints: influenza, pneumonia, pleurisy, and colds. After that, the ranking would be small pox, yellow fever, diphtheria and scarlet fever, measles, whooping cough, mumps, typhus, and typhoid fever.

Charleston, South Carolina had a higher mortality rate than other regions in the Colonies like New England. Mostly these statistics can be blamed on climate and migration patterns. Since Charleston was one of the biggest seaports, the Carolinas had a lot of traffic in and out and therefore more exposure to diseases from other areas. But no group suffered more than the indigenous American Indian. Small pox killed most natives, as previously shown. The fatality rate from disease in colonial times for Native Americans was 55-90%. One shocking example is the complete decimation of the Pemlico tribe in South Carolina in 1698-99 (28). Recently published research shows evidence that British commander Jeffery Amherst conspired with other leaders to end the siege of Fort Pitt in 1763 by killing off natives with "gifts" of small pox-infected blankets (29). While records show the plan was at least attempted, there are no statistics to prove how many were infected and died.

African slaves also suffered cruelly from small pox, often bringing it with them aboard the slave ships. However, there are no concrete records available as to the total loss of life by disease for African Americans. Overall, isolation, few congested urban areas, increased immigration, and high birth rates helped the American colonies survive the devastation of epidemics.

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

The Expanded Columbia Electronic Encyclopedia. New York: Columbia University Press, 2003. Accessed at http://www.historychannel.com.

Kunitz, Stephen J. Disease and Mortality in the Americas since 1700. Cambridge World History of Human Diseases. Ed. Kenneth F. Kiple. New York: Cambridge University Press, 1993. pgs 328-334. Click here to purchase the book Disease and Mortality in the Americas since 1700.

Sofge, Christine Whittaker. "Microbe Wars." History Magazine. April/May 2003: 49-51. World Health Organization, The. "Fact Sheet N149: Typhoid Fever." March 1997.
"Microbe Wars." History Magazine.

1-3, 6, 11, 15, 16 The Expanded Columbia Electronic Encyclopedia
4-5, 7-8, 10, 13-14 Duffy p. 165-183
9 Kunitz p. 331
12, 19, 20, 22 Briggs p. 52-69
17-18, 21, 24-28 Duffy p. 223-244
23 The World Health Organization
29 Sofge p. 50

Click this chart to see Whooping Cough, Mumps, Measles, Typhus, Typhoid Fever, etc. in Colonial North America.

Sources:
Duffy, John. Epidemics in Colonial America. Baton Rouge, LA. Louisiana State UP, 1953. Click here to purchase the book Epidemics in Colonial America

*Briggs, Elizabeth. A Family Historian's Guide to Illness, Disease, & Death Certificates. Winnipeg, Manitoba, Canada: Wesgarth, 1993.

World Health Organization, The. "Fact Sheet N149: Typhoid Fever." March 1997.
Fact Sheet N149: Typhoid Fever

Sources for further reading about epidemics

Books: Bray, R.S. Armies of Pestilence: The Impact of Disease on History. Barnes & Noble: New York, 2000. This book is a survey of disease and war from Ancient Rome to modern Africa. Bray, a biologist, looks at diseases such as plague, malaria, yellow fever, typhus, cholera, and influenza. Click here to purchase the book The Impact of Disease on History.

Chambers, J.S. The Conquest of Cholera: America's Greatest Scourge. Macmillan: New York, 1938. Asiatic cholera originated in India, but was always confined to that continent and its environs. But the British colonization of India soon spread the disease outside the country. An outbreak in 1826 led to the U.S. outbreak in 1832. Carried by traders and travelers alike, cholera encircled Europe. In 1831 many Irish immigrants fleeing the epidemic at home carried it to the U.S. on filthy and crowded ships. Chambers discusses the spread of the disease on the east coast and Canada and its slow progress across the continent to the California gold fields. He also looks at medical contributions toward eradication of the disease. Outbreaks of cholera in 1866 and 1873 are also examined. The book contains an index and bibliography, also numbers illustrations and maps. Originally published in 1938, Chambers language is a bit extravagant, but easy for any reader to follow. He was a medical doctor and professor at the University of Kentucky when the book was published.

Chase, Marilyn. The Barbary Plague: The Black Death in Victorian San Francisco. New York: Random House, 2003. Chase's work traces the 1900 plague in San Francisco and discusses the two men assigned to handle the crisis; Drs. Joseph Kinyoun and Rupert Blue. She also looks at how the Chinese in San Francisco were discriminated against during the 1900 outbreak. Chase also looks at the 1906 earthquake and its influence on the spread of disease in San Francisco. Includes endnotes, extensive bibliography , and index. Click here to purchase the book The Barbary Plague

Duffy, John. Sword of Pestilence: The New Orleans Fever Epidemic of 1853. Baton Rouge, LA: Louisiana State UP, 1966. Discusses what Duffy calls "probably the worst single epidemic ever to strike a major American city"-since over forty percent of the population contracted the disease and a tenth died. Includes endnotes, bibliography, and index.

Rothman, Sheila M. Living in the Shadow of Death: Tuberculosis and the Social Experience of Illness in American History. New York: BasicBooks, 1994. This text looks at specific cases for New England men between 1810-60; the individual case of Deborah Vinal Fiske, 1806-44; and cases of people who went west between 1840-90. The last chapter is about cases between the years of 1882-1940. Includes endnotes and index. Click here to purchase the book Living in the Shadow of Death

Websites: 1918 Influenza Timeline. This fascinating website was created by PBS, along with the timeline, it has an interactive map which shows how fast influenza spread in 1918. There is also a graph with U.S. death rates by month.

World Health Organization While the WHO website does not offer a historical perspective, it is searchable for diseases still present today.