<strong>By Scott Graber</strong>

It is Friday, April 17, 2020, and I’m in our minimalist, tastefully furnished living room. This room comes with four large windows, two small sofas and salon-style art that crawls the walls. It is a pleasant place to read and, from time to time, say, “Alexa, play Billy Eckstine.”

This morning I have a copy of “Plagues and Peoples” (Robert McNeill, Doubleday, 1976); a cup of Eight O’Clock coffee; and “I Apologize” as rendered by Billy Eckstine. Robert McNeill’s book comes with an inscription – “Dr. Graber, Just something to to show our appreciation for a fine series of lectures. … from the ‘Peanut-butter Eaters’ of the Class of 81.”

The inside cover is signed by six medical students — peanut butter and jelly eating eating students who once listened to my father pontificate on tuberculosis and tularemia — who must now be in their sixties and, presumably, tending their own patients as our pandemic plays out its hand.

“Plagues and Peoples” begins in Africa, where our ancestors first came down from the trees and — after they figured out fire — learned to “harvest” antelope, wildebeest and bobcats on the ground. While they could organize themselves into small, efficient hunting parties, they couldn’t do much about the invisible, microscopic parasites that lived on the ground and were also foraging for food.

“Opportunities for transfer from one host to another multiply with increased human density, so that, if and when a critical threshold is surpassed, infection can suddenly develop into runaway hyper-infection.”

McNeill explains that human populations in Africa were relatively small; and while bacteria, viruses and fungi were always present, runaway hyper-infection was rare until our ancestors decided to leave Africa and embrace agriculture.

We all know that agriculture led to larger, denser populations along the Tigris and Euphrates Rivers. These riverside communities led to kings, taxes, zoning and presented our microbiotic kinsmen with a smorgasbord — an endless, all-you-can-eat buffet. This would lead to what we now label malaria, measles, typhus, yellow fever, tuberculosis and smallpox.

America — before European discovery — had a few pathogens. But big-time killers (cholera, diphtheria, typhus) came with the colonists. We also know that smallpox was the European gift that toppled the Inca and the Aztec civilizations.

Two other gifts that also made the Atlantic crossing — malaria and yellow fever — made a huge difference in South Carolina in particular.

Walter Edgar (in his “South Carolina History”) says that yellow fever broke out in South Carolina 18 times between 1670 and 1775. During this period, malaria became endemic — always present in the population — and childhood mortality “may have been as high as 80 percent.”

In those long gone days, a fiction in play said if you survived your first year in Charleston — if you somehow got through the “sickly season” of August, September, October and November — chances were good that you would survive indefinitely.

But this was mostly an illusion as hundreds of thousands died regardless of the length of their residency. (If you got sick, and recovered, your chances did improve.)

Notwithstanding the advertising in England that portrayed South Carolina as salubrious, with “healthy air,” ours was filled with mosquitos, Aegypti and Anopheles, and these creatures kept the colony on the edge of extinction. But immigrants continued to come, many to die before they unpacked their bags. Some did survive making their fortunes raising indigo, rice and eventually long-staple cotton on large plantations.

Other than Charleston, there was no significant city, or concentration of people along the South Carolina coast. Yes, I know there were small settlements like Beaufort, Conway and Georgetown. But rice and cotton plantations were large, people kept their distance, and fevers and chills came between August and November thinning-out the young, the aging, the weaker folks.

In 1901, Walter Reed would discover that mosquitoes were the messenger of death insofar as Yellow Fever was concerned. Malaria would be a problem, endemic, well into the 20th century. In fact, St. Helena Island recorded an annual average of eight deaths (among African-Americans) for “malarial fever” between 1920 and 1928.

Malaria would eventually be taken-out (in the United States) by DDT following World War II. These mosquito-borne infections would fade from our collective consciousness as the South Carolina coast filled-up with pastel condominiums, resort hotels and retirement communities.

<i>Scott Graber is a lawyer, novelist, veteran columnist and longtime resident of Port Royal. Email Scott at cscottgraber@gmail.com.</i>