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. (Photo: Wikimedia, public domain)
Learn more about Charleston epidemics at one of the links below:
Do You Know Your Lowcountry: Charleston Had Unhealty Reputation, Charleston Post & Courier, April 17, 2023

When the first documented case of the COVID-19 virus arrived in the United States in January 2020, Charlestonians had to restructure how we live our everyday lives in many ways. Though living within the restrictions and fear of a pandemic took our generation by surprise, history reminds us that it is far from the first time Charlestonians have faced the challenge of a highly contagious, widespread and deadly disease. 

From its founding in 1670 through the early 20th century, Charleston 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-Atlantic shipping route, Charleston welcomed large numbers of sailors, passengers and enslaved Africans, many of whom carried the latest viral germs from around the world. 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, dysentery, smallpox and yellow fever. Exposure to Western European diseases virtually destroyed the Native American population. Many more natives died by living and trading in peaceful proximity to the Carolina colonists than ever died fighting them. South Carolina's Native population of nearly 10,000 in 1685 had dropped to about 300 by 1790, and those who survived lived in isolated pockets of the state's northwestern mountains, where settlers had not yet become numerous. 

Taken together, malaria, often referred to as the "ague" in historic documentation, and dysentery, commonly referred to as the "bloody flux," accounted for more deaths in Carolina than any other cause, including war and natural disasters such as hurricanes, tornados and earthquakes. Counter intuitively, however, smallpox and yellow fever, though less deadly, 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 prompted widespread public quarantines and economic crises, akin to what we have faced with COVID-19.

And so, throughout its history of epidemic outbreaks and more common, but less widespread endemic surges, Charlestonians have faced many major life-threatening illnesses throughout its history. The worst among them occurred 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 no records remain of how many settlers contracted the disease, historians believe 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 reoccurrence in 1711.


Yellow Fever Epidemic of 1699

Just a year later, as the colony was still 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. 

Newspaper accounts of this outbreak sound similar to today's news coverage. 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 about every five to 10 years until 1748, when it went underground and stayed until 1790. Then, without warning or explanation, 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, roughly 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 outbreak, South Carolina's medical leaders introduced the concept of inoculation 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 Carolina backcountry the year before had 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 infected soldiers returned home, 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 1857

 Samuel H. Lofton lost his wife, two youngest sons, and an enslaved domestic man to the disease within a matter of days. The spread was contained to the Mt. Pleasant area where about two dozen people of the city's 1,200 residents died.

The source of the infection became a matter of great debate between two well-respected Charleston doctors. Dr. Robert Alexander Kinloch believed the infection was the result of piles or areas of waste that included rotting animal or vegetative matter. Dr. William Hume, a professor of chemistry and physics at The Citadel, a physician, and a member of City Council, believed it came in through the ports and supported the quarantining of ships in the harbor.


Yellow Fever Epidemic of 1858

Just a year later, the most deadly epidemic of the 19th century in Charleston hit just a couple of years before the first shots were fired at Fort Sumter to begin 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, genders, and social classes. With a population of about 40,000, Charleston's death toll included about 800 people or 2% of the city's population.

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

To better understand the impact of the great Influenza Pandemic of 1918, it helps to take a look at some of the challenges Charleston was already facing at that time in its history. First, most of its citizens remained wretchedly poor after the devastation of the last half of the 19th century ravaged it: 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, a series of major, destructive hurricanes that not only claimed lives, crops and livestock, but also drove the last nail into the coffin of Charleston's remnant rice culture in 1911. Charleston's importance as a major U.S. port city had vastly deteriorated (and in hindsight, that might have had some advantages vis-a-vis the coming epidemic).

About 61,000 people, equally divided between whites and blacks, lived in Charleston, meaning on the peninsula. Those who lived west of the Ashley, east of the Cooper, or on the sea islands were still living in rural, sparsely populated areas. The College of Charleston only admitted men and the city's health services and news coverage, like so many things, were rigidly segregated by race.

Yet finally, after so many decades of despair, there was an emerging bright spot: in the early years of the 20th century, Charleston's Congressional leadership had secured what would become the city's - indeed, the entire 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. Thus, the future began to look brighter, as the US entered World War I in April 1917. Activity at the base was booming and the local economy along with it.

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 United States. By the summer of 1917, just months after the nation'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 a recent episode of his always engaging podcasts, Dr. Nic Butler, Charleston County Public Library's Historian, lays out a timeline of the epidemic's spread through the Holy City, noting that 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. In newspaper accounts, Butler says, officials assured the community that everything was "well under control."

Despite the quarantine imposed upon the base, its soldiers continued routinely interacting with members of the Citadel Cadet corps. Within days, cadets began getting sick. Its campus, then located near Meeting and Calhoun streets on Marion Square right in the middle of town, 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 notes that the government's official response, which came 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' (e.g., what today we call the flu). . . .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, a fundraiser for the war effort. Later that afternoon, the College of Charleston suspended classes and sent everyone home. Local public schools, however, chose to only send home those children who exhibited symptoms of being ill.

By Oct. 6, officials and the general public finally began to appreciate the seriousness of the pandemic in Charleston. Health officials drew up regulations that the city's mayor then mandated, 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 Loan 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 very young or 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 the sick progressed from mere flu into stages of pneumonia, doctors began recommending whiskey for its health benefits. Unfortunately, South Carolina had been subject to the state's "Dispensary Laws" since the days of Gov. "Pitchfork" Ben Tillman in the 1890s, making public sale of alcohol illegal. On Oct. 12, officials agreed to make the state's stashes of seized bootleg whiskey available to the public for medicinal purposes only, to be administered only by the Red Cross and only by prescription.

By this time, pretty much all of the city's female population were either sick or working with medical teams. Few remained at home to provide nutritious meals for their families, which augmented the epidemic even further. Thus, on Oct. 14, the women of the city collectively began the operation of a public kitchen at the Memminger Normal 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 the next day.

By Nov. 3, the state ended its mandatory quarantines, though 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, according to Dr. Butler.

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 the U.S. declared victory in World War I. Needless to say, Charlestonians celebrated with a huge parade down King Street.

Though the epidemic was officially over, the flu did not disappear immediately, 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.

Charleston's WWI Victory Day Parade was held Nov. 11, 1918, the same day the city's final quarantines were lifted for public schools and the Charleston Navy Base. (Photo: The Influenza Archive)
We share the tragic story of the Lofton family's battle with yellow fever in 1857 on our French Santee Tour.
Charleston's ubiqitous pest the mosquito played a big role in establishing Charleston early on as an unhealthy place to live. It contributes to the spread of both malaria and yellow fever in the Lowcounty.
Health care workers and community volunteers who provided food here in Charleston were on the front line of the 1918 Spanish Flu pandemic much as they are today.

Sources and more information

Bonner, Dr. William. Home in the Village: McClellanville in Old st. James Santee Parish. Corinthian Books, 2002.

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

Handal, Leigh. "Do You Know Your Lowcountry: Charleston Had Unhealthy Reputation," in Charleston Post & Courier, April 17, 2023.

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. 

Deadly smallpox epidemics spread through Charleston's port in both the 17th and 18th centuries.
S.C. Gov. Richard Manning (above) ignored quarantine regulations to join a crowd at The Citadel Oct. 3, 1918, at a military parade meant to encourage support of the Liberty Loan program. (Photo: SCIWAY)