Malaria was arguably the most significant disease in the history of South Carolina from the colonial period until the early twentieth century. It attracted less public discussion than yellow fever and smallpox, but its impact in terms of morbidity and mortality was much greater. Whereas yellow fever and smallpox tended to erupt in spectacular but short-lived epidemics, malaria quietly and steadily eroded the lives and energy of a large part of the population. The most common symptoms of malaria are fever, chills and aches. In classic cases spikes in the fever come at regular intervals. Depending on the severity and type of case, malaria may produce vomiting, severe headaches, jaundice, hemorrhaging, blood clots, an enlarged spleen, and renal failure. Before the late 19th century, malaria was referred to by various names, including ague and fever, intermittent fever, and remittent fever. From the late colonial period, many South Carolinians called it “country fever” to distinguish it from yellow fever, which was largely confined to Charleston and other ports.
Malaria is a parasitic infection caused by protozoa known as plasmodia and transmitted by anopheline mosquitoes. Two types of malaria dominated in South Carolina. Both are highly debilitating diseases that produce lethargy and vulnerability to other infections. Plasmodium vivax, which probably came with European settlers in the 1670s, is the less virulent of the two forms. The introduction of the more deadly Plasmodium falciparum came with the importation of large numbers of African slaves in the 1680s and after. Many West Africans were immune to vivax, and some had acquired or inherited resistance to falciparum. The observations of planters and physicians of black resistance to malaria helped give rise to the proslavery argument that blacks were peculiarly adapted to labor in the southern climate. Nevertheless, many blacks suffered severely from falciparum, as they still do in parts of Africa.
By the early 18th century, malaria was endemic in the Lowcountry. It continued to plague the region throughout the 18th and 19th centuries, and was a major contributor to the region’s high mortality rates and reputation for unhealthiness. It was particularly dangerous to infants, young children, and pregnant women. The severity of malaria was the result not only of the Lowcountry’s semitropical climate and marshy topography but also of its plantation economy, particularly the cultivation of rice and indigo, which provided ideal breeding conditions for the anophelines. From the late colonial period, the threat of malaria transformed many of the planting families of the Lowcountry into seasonal migrants. They fled the plantations during the summer and early autumn for locations perceived to be less dangerous: the North, Charleston, the pinelands, the upcountry, and the seashore.
During the 19th century, malaria became a major health problem in much of the state, especially in newly cleared and undrained lands and along river valleys. It reached epidemic status on several occasions during the Civil War and after. In the early 20th century coastal South Carolina was one of the most persistent hyperendemic pockets of the disease in the country. In the 1930s, parasite rates as high as 50 percent were not uncommon among schoolchildren in rural areas, with the highest rates in the coastal counties. In the early 1940s the construction of Santee Cooper hydroelectric dams produced one of the last epidemics of malaria. In the rush to complete the project in the face of war, the upper reservoir (Lake Marion) was not completely cleared of trees. They impeded flow and provided excellent breeding grounds for anophelines. In 1944, 39 percent of people living on the north shore of the lake tested positive for malaria. By the early 1950s, however, the disease had virtually disappeared from the state for reasons that are still not entirely understood, but improvements in mosquito control (especially the development of the pesticide DDT), drainage, housing, and nutrition probably all played a part.
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