Charleston's long history of infectious disease outbreaks and epidemics has given local historians and epidemiologists a point of reference when examining responses to the coronavirus pandemic across the globe and closer to home.
From the first major outbreak of yellow fever in the American colonies in 1699 to the influenza epidemic in 1918, officials in Charleston and ordinary people alike have kept detailed records and notes of many individuals who were ill, where in the city they lived, and other statistical information.
Diseases in Colonial Charleston
Yellow fever was a frequent visitor to the city of Charles Town throughout the 18th century, with epidemics ravaging the city like clockwork. Commercial shipping traffic, including the buying and selling of enslaved Africans, meant frequent outbreaks in the Holy City and other ports, the first of which, in 1699, killed hundreds, wiping out 15 percent of the city's comparatively small population.
Dealing with diseases became part of regular life in colonial cities through the early 19th century, specifically in cities like Boston, Philadelphia, and Charles Town, because so many people from around the world frequently met, congregated, dealt in business, and attended cultural events in these cities.
Few sources of information exist that documented specific impacts of disease on the enslaved people of early Charleston, who made up a significant portion of its population.
Yet, a few specific outbreaks stand out, with help from records that let historians see through the eyes of these past residents.
With every case, medical professionals and trained physicians attempted to treat the sick and to determine the source of the disease to prevent the spread. In many cases, the efforts only made matters worse, according to Brian Fors, curator of the Waring Historical Library at the Medical University of South Carolina.
A common treatment by the late 1700s, Fors explains, was bleeding patients — draining blood from their bodies — in an attempt to restore some balance and rid them of illness. "We now know, of course, this tended to weaken the individuals and hastened their deaths."
Even before the doctors began bleeding their patients, the number of deaths in each outbreak were high. "In the 1732 outbreak, for example," Fors says, "Deaths became so frequent that they stopped ringing the church bells that had become a common practice when someone in the city died."
By the 1800s, sources began to indicate that rest and proper food and drink helped the sick. Alexander Hamilton and his wife took that approach when they contracted yellow fever in Philadelphia in 1793 and recovered, according to Fors, unlike many others.
This knowledge didn't lower the death toll in most cases, however, as another yellow fever outbreak in 1858 killed more than 800 of the city's roughly 40,000 people. What made this epidemic stand out further was that it seemed to affect everyone, regardless of class, wealth, or age, instead of the common victims — children, visitors, and immigrants.
Once physicians were able to draw proper conclusions, records showing patterns that accompanied the development of epidemics in various cities became clearer.
"There would be a realization that there is a disease ravaging the city and panic as residents left or kept themselves isolated, usually those who could afford to do so," Fors explains. "As the initial panic subsided, government and health care officials developed strategies to slow the spread of the disease, discover the source and eliminate it, and treat those who were ill."
In the case of yellow fever and other mosquito-borne illnesses, people discovered efforts to drain standing water and improve sanitation generally slowed infection, but officials didn't draw the connection directly to mosquitos until the late 19th century.
Disease during the Revolution
Yellow fever and other diseases in particular were given partial credit for keeping British invaders at bay long enough to give the new American republic a fighting chance in the Carolinas.
Conflicts during the hot seasons of the Revolutionary War were challenging due to constant threat of infection from yellow fever, smallpox, and malaria, particularly around coastal areas. In 1779, the British were preparing a siege of the city, and due to a rumored smallpox epidemic in the backcountry, militia were slow in getting to the city to back up the Continental Army.
But disease worked against both sides of the conflict.
"You may have heard this before, 'Charleston in the spring is a paradise; in the summer, it's a hell; and in the fall, it's a graveyard,'" says Charleston Museum director Carl Borick. "You have mosquitos being more active, and malaria breaking out among the troops."
During the conflict, roughly 2,400 enlisted men were captured by the British and allowed to go back to their homes as prisoners of war on parole. In 1780, about 1,000 escaped British-occupied areas. The British responded by capturing a number of others and put them on prison ships in the harbor. "The British commander said they lost more men from the diseases on the prison ships than they did the escapes," Borick says.
In the summer of 1782, the British still occupied Charles Town, the American forces were camped out, and Continental Army General Nathanael Greene was recording the number of men they had lost to a malaria outbreak, and the British the same thing.
Before the season changed, the Americans found out the British were planning to evacuate the city. Even without scientific backing, the soldiers did make a connection between disease and swamp-ridden areas of the Lowcountry — of course, where mosquito populations were highest. By November and December, malaria cases usually fell off. "There is definitely some seasonality with the flu," Borick explains. "That was certainly the case with malaria as well, as it started cooling off, the mosquitos would be less active."
Ultimately, the British wanted to push on into North Carolina in the heat of summer, but disease slowed their advance, giving militia and the Continental Army a chance to prepare, making the British campaign north that much more difficult.
Apathy and hysteria
Port cities like Charleston are global hubs for trade, business, culture, as well as the diseases that come with each. Even in the 1700s, the role of government in helping to stop the spread of harmful disease was hotly debated.
"It's a parallel to what we're dealing with right now and these issues of quarantine," says Jacob Steere-Williams, a College of Charleston professor and author of the forthcoming book, The Filth Disease: Typhoid Fever and Epidemiology in Victorian Britain. "These are the issues that 18th century Americans and Charlestonians had to grapple with as well."
Steere-Williams teaches epidemics and revolutions at CofC, taking a broad, global look at disease and its impact in world history with a focus on Charleston.
"One of the things that's so fascinating to me about the way America is responding to COVID-19, one of the reasons there is both a certain apathy happening and a certain hysteria, is because everyday Americans are struggling to find a kind of analogy to this," he explains.
Steere-Williams says the 1918 flu outbreak is a suitable parallel to the coronavirus of today. Americans have seen more of the same old responses, and officials still struggle to respond in moments like these. "This is what I teach my students throughout the semester," he says. "These are the ways we respond to disease."
Charleston's early 20th century pandemic was more comparable to the Black Plague of the 14th century than some of the city's earlier outbreaks, affecting 10 percent of South Carolina's population, about 150,000-170,000 at the time, killing 4,000-5,000.
While we aren't seeing those numbers in 2020, we have seen toilet paper hoarding and panic buying of supplies. In 1918, people ran to stock up on liquor, read about the panic in the news, and at times distrusted government officials.
"Most Americans don't have the kind of depth of knowledge to think back to an analogy to yellow fever or to smallpox," Steere-Williams says. "But, there is a built-in historical memory, even if people don't have an actual memory of those things."
In his class, Steere-Williams tells students he's hopeful that at some point leaders will see epidemics like these in a different way, using the tools of history to see the difference between panic and preparedness.
It's a more structured way of viewing the world, he says. Steere-Williams says he saw the reflection of the past as he spoke about the virus with strangers around town in mid March.
"Ninety percent of the people thought this was overblown," he says. "They didn't see the need for any of this. It wasn't affecting them, and that kind of apathy is dangerous. I was thinking about it like a historian, and this is exactly how people in the past thought too, until it reached a tipping point."
Looking to the past and future
Even as the clock ticks and governments flail to address the coronavirus pandemic, they are not flying completely blind. History can be a patient zero of sorts.
Steere-Williams says the response in 2020 pales compared to actions of outbreaks passed. "In 1918, schools closed down, public gatherings stopped, there was a complete lockdown of Charleston in the fall. That is, in some ways, more than what we've seen right now.
"If we see an explosion of cases in Charleston, I expect to see more of an intrusive government action," Steere-Williams said. "But, what we're doing now is not unprecedented. In some ways, looking at the past, we've even been a little lethargic in responding to this."
Whatever the level of intervention, without public support there will be less impact, according to Steere-Williams. Only recently have we started to see that change, to where more Americans are believing the scope of the problem, that it will affect them and their loved ones. But without that cultural buy-in, government help simply won't work, the professor says.
Of course, public skepticism is nothing new. In 1832, newspapers reported about cholera, a new disease that had been tied to India and began to spread pandemically. Americans doubted it would affect them like it did for those in far-off lands.
"There's this simultaneous arrogance and denialism," Steere-Williams explains, "the exact thing we saw at the start of the spread of COVID-19.
"Public health has never been and isn't now as easy as hearing the scientific facts and putting them into place," Steere-Williams says.
"This is our reality — COVID-19 is not going to be the last epidemic in our country, probably in our lifetimes," he concludes. "How we respond to it now has an impact on how future generations will respond to these things in the future."