"E" is for Epidemics. An epidemic disease is generally defined as one that affects an unusually high number of individuals within a population or region simultaneously. From the 1680s to the early 20th century, South Carolina—and especially the lowcountry—had a deserved reputation as an unhealthy place. Disease killed enormous numbers of Europeans and Africans, virtually annihilated Native Americans, and proved a significant barrier to European immigration. The biggest contributors to high mortality rates were malaria, dysentery, smallpox and yellow fever. Smallpox was particularly devastating to South Carolina’s Native Americans. The last yellow fever epidemics occurred in the 1870s. Malaria and dysentery were major killers until the 1940s. By the 1950s, most epidemic diseases were eliminated or greatly reduced by a combination of improvements in diet, housing, and public health with immunization and drugs.