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Cholera Epidemics in the 19th Century

The Great Plague of London, 1665

The Boston Smallpox Epidemic, 1721

“Pestilence” and the Printed Books of the Late 15th Century

Spanish Influenza in North America, 1918–1919

Syphilis, 1494–1923

Tropical Diseases and the Construction of the Panama Canal, 1904–1914

Tuberculosis in Europe and North America, 1800–1922

The Yellow Fever Epidemic in Philadelphia, 1793

General Materials

Notable People

Related Links


Colonialism and International Medicine

The Medical Missionary, oston: American Board of Commissioners for Foreign Missions, [18--?]. From the holdings of Center for the History of Medicine/Francis A. Countway Library of Medicine—Harvard Medical School
The Medical Missionary. From the holdings of Center for the History of Medicine/ Francis A. Countway Library of Medicine—Harvard Medical School.

Records of exploration, conquest, and trade by land and sea go back at least 4,000 years. Initially, these activities occurred over short distances, but when seafaring European nations began their long-distance voyages to colonize new parts of the world and open up trade routes, contagion spread among peoples with no immunity to diseases carried by the newcomers, and the newcomers were susceptible to diseases local to their destinations.

Spanish conquistadors carried smallpox to present-day Mexico, Ecuador, and Peru early in the 16th century. Infection spread among not only the young and the elderly but also among healthy individuals in the prime of life. Measles, typhus, mumps, and other contagious diseases brought by the Europeans took their toll and devastated civilizations in the New World. North America, the Pacific Islands, Australia, and New Zealand suffered similar population declines following European colonization in the 18th and 19th centuries.

Colonialism, Climate, and Disease

In the age of European exploration and discovery by land and sea, climate, topography, and ecology all contributed to specific chronic and infectious diseases among explorers and missionaries. Ships carried contagion to unexplored lands and continents, and surgeons used nitrous vapor in the late 1700s to fumigate ships against the spread of communicable diseases. The massive number of slaves brought to the West Indies by European colonists caused outbreaks of yellow fever, and shipborne yellow fever outbreaks occurred on the North American mainland, in Havana (Cuba), and in Panama.

European immigrants who explored the American West in the mid-18th century discovered that exposure to fresh air in the Rocky Mountains alleviated the symptoms of tuberculosis. Exposure to fresh air became the preferred treatment for tuberculosis until the early 20th century.

Tropical Medicine and Climate

Hot climates and meteorological influences have long been associated with specific tropical diseases such as malaria because the malaria parasite and its host, the Anopheles mosquito, require specific climatic conditions to survive and multiply. Cyclical climatic changes can also lead to epidemic outbreaks, as in 1878 when an El Niño weather system turned the normally temperate North American Southern winter into a tropical climate followed by the worst yellow fever epidemic in American history.

International Medicine and Public Health

The French government initiated and hosted the first of 14 International Sanitary Conferences in 1851 to standardize international quarantine regulations mainly against the spread of cholera. These conferences provided an international forum for medical administrators and researchers to discuss not only cholera but also other communicable diseases. Ultimately, this spirit of international cooperation inaugurated the World Health Organization in 1948 to direct and coordinate intergovernmental health activities.

Sanitation and public health were early concerns in Chinese history. They included the provision of wells to supply fresh drinking water and emphasis on the prevention of infectious diseases. During the Tang dynasty (618–907 CE) and the Song dynasty (960–1279 CE), medicines were distributed during various epidemics.

Vaccine Campaigns in China

Chinese traditional medicine classified symptoms of smallpox under the syndrome “cold damage,” which, since the Han dynasty (206 BCE–220 CE), explained febrile and contagious diseases in terms of external agents acting on the human body. Beginning in the early 19th century, Westerners introduced the smallpox vaccine in Macau and Canton with limited success. These and other attempts to supersede various methods of variolation with vaccination against smallpox led to tension between Western immigrants and Chinese authorities, and traditional variolation was still practiced mainly in China’s rural areas during the early 20th century.

Plague Vaccination in India

After claiming about 300,000 lives during the first Indian plague epidemic (1896–1897), a second plague epidemic began in Bombay in 1904 that lasted three years. Together, these epidemics claimed an estimated 3 to 4 million lives. In late 1896, Waldemar Mordecai Haffkine’s research team at Bombay’s Grant Medical College developed a vaccine that significantly reduced plague mortality.

The Manchurian Pneumonic Plague, 1910–1911

This plague outbreak in August 1910 originated in the Trans-Baikal region and spread over 1,000 miles across Manchuria, killing 60,000 people by March 1911. The carriers of this pneumonic plague were wild marmots trapped for their fur by inexperienced Chinese migrant laborers working in Manchuria. The disease spread quickly along the Chinese Eastern Railway in September 1910 after the first reports appeared of cases in the crowded migrant camps.

After the Manchurian plague subsided, the newly founded North Manchurian Plague Prevention Service laid the groundwork for China’s public health system, whose preventive measures reduced fatalities during the next Manchurian pneumonic plague epidemic in 1920.


Selected Contagion Resources

This is a partial list of digitized materials available in Contagion: Historical Views of Diseases and Epidemics. For additional materials on the topic “Colonialism and International Medicine,” click here or search the collection’s Catalog and Full Text databases.

Web Pages

The Boston Smallpox Epidemic, 1721
Concepts of Contagion and Epidemics
William Gorgas, 1854–1920
Florence Nightingale, 1820–1910
International Sanitary Conferences
Medical Geography
Public Health
Tropical Diseases and the Construction of the Panama Canal, 1904–1914
The Yellow Fever Epidemic in Philadelphia, 1793


Lantern slides, 1910–1911 Manchurian Pneumonic Plague. From the Papers of Richard Pearson Strong, 1911–2004, 1911–1945 (bulk). Center for the History of Medicine/Francis A. Countway Library of Medicine—Harvard Medical School.



Academy of Medicine of Philadelphia. Proofs of the Origin of the Yellow Fever, in Philadelphia " Kensington, in the Year 1797, from Domestic Inhalation and from the Foul Air of the Snow Navigation from Marseilles and from That of the Ship Huldah, from Hamburg: in Two Letters Addressed to the Governor of the Commonwealth of Pennsylvania. Philadelphia: Printed by Thomas & Samuel F. Bradford, 1798.
Barton, James L. The Medical Missionary: Some Account of His Task, Equipment and Experiences in the Work of the American Board. [18––?].
Bloodgood, Delavan. An Account of the Yellow Fever Which Appeared in December, 1866, and Prevailed on Board the United States Ship Jamestown, Store and Hospital Ship at Panama.
Bryson, Alexander. Report on the Climate and Principal Diseases of the African Station: Compiled from Documents in the Office of the Director–General of the Medical Department, and from Other Sources, in Compliance with the Directions of the Right Honorable the Lords Commissioners of the Admirality. London: W. Clowes and Sons, 1847.
Hargis, Robert B. S. The Ship Origin of Yellow Fever: With Comments on the Preliminary Report of the Havana Yellow Fever Commission. Pensacola, Fla.: Gazette Book and Job Office, 1880.
Johnson, James. The Influence of Tropical Climates, More Especially the Climate of India, on European Constitutions: The Principal Effects and Diseases Thereby Induced, Their Prevention or Removal, and the Means of Preserving Health in Hot Climates, Rendered Obvious to Europeans of Every Capacity: An Essay. London: 1815.
Smyth, James Carmichael. The Influence of Tropical Climates, More Especially the Climate of India, on European Constitutions: The Principal Effects and Diseases Thereby Induced, Their Prevention or Removal, and the Means of Preserving Health in Hot Climates, Rendered Obvious to Europeans of Every Capacity: An Essay. London: Printed for J. Johnson, in St. Paul’s Church-Yard, 1799.
Smyth, James Carmichael. The Effect of the Nitrous Vapour, in Preventing and Destroying Contagion: Ascertained, from a Variety of Trials, Made Chiefly by Surgeons of His Majesty’s Navy, in Prisons, Hospitals, and on Board of Ships: With an Introduction Respecting the Nature of the Contagion, Which Gives Rise to the Jail or Hospital Fever; and the Various Methods Formerly Employed to Prevent or Destroy This. London: Printed for J. Johnson, in St. Paul’s Church-Yard, 1799.

Tropical Medicine and Climate

Conclusions of the Board of Experts Authorized by Congress to Investigate the Yellow Fever Epidemic of 1878: Being in Reply to Questions of the Committees of the Senate and House of Representatives of the Congress of the United States, upon the Subject of Epidemic Diseases. Washington: Judd & Detweiler, printers, 1879.
Lindsay, James Alexander. The Climatic Treatment of Consumption: A Contribution to Medical Climatology. London: Macmillan, 1887.
Murray, J. How to Live in Tropical Africa: a Guide to Tropical Hygiene: The Malaria Problem: The Cause, Prevention, and Cure of Malarial Fevers. London: G. Philip, 1895.
Spinzig, Carl. Epidemic Diseases as Dependant Upon Meteorological Influences. St. Louis, Mo.?: [s.n.], 1874 (St. Louis, Mo.: Ahner, Menning & Co., printers).

International Medicine and Public Health

Weng, Zhongren. Weng Zhongren xian sheng yuan ben You ke qi zhong da quan. Shanghai: Shou gu shu dian, [Qing mo, between 1875 and 1912].
Wenren, Gui. Wenren shi Bohuan xian sheng Dou zhen lun: er juan. [China], Ming Wanli [i.e. between 1573 and 1620].
Wu, Mianxue. Huangdi su wen Ling shu jing: 12 juan. [China]: Wu Mianxue, Ming Wanli 29 [1601].

Vaccine Campaigns in China

Zhang, Lu. Zhang shi yi shu. [China: s.n.], Kangxi 48 [1709].

Plague Vaccination in India

Bengal (India). The Bengal Vaccination Act, 1880: (Bengal Act V of 1880), as Modified up to the 1st June, 1902. Calcutta: Bengal Secretariat Press, 1902.
Haffkine, W. M. Joint Report on the Epidemic of Plague in Lower Damaun, Portuguese India, and on the Effect of Preventive Inoculation There. [1897?].
Koch, Robert. Reise-Berichte über Rinderpest, Bubonenpest in Indien und Afrika, Tsetse– oder Surrakrankheit, Texasfieber, tropische Malaria, Schwarzwasserfiebe. Berlin: Springer, 1898.
Nathan, R. The Plague in India, 1896, 1897. Simla: Printed at the Govt. Central Print. Office, 1898.
Plague Research Laboratory (Bombay, India). Summarised Report on the Bombay Plague Research Laboratory for. . . [Bombay: s.n., 1903?–1904?].

The Manchurian Pneumonic Plague, 1910–1911

Strong, Richard Pearson. Studies on Pneumonic Plague and Plague Immunization Manila: Bureau of Printing, 1912.
Grainger, James. An Essay on the More Common West-India Diseases: and the Remedies which that Country Itself Produces, to Which Are Added, Some Hints on the Management, &c. of Negroes. London: Printed for T. Becket and P.A. De Hondt, MDCCLXIV [1764].


The following sources were used in writing this page.

Anderson, W. “Where Is the Postcolonial History of Medicine?” Bulletin of the History of Medicine, New York and 79 (1998): 522-530.
Arnold, David. Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth–Century India. Berkeley: University of California Press, 1993.
Arnold, David., ed. Warm Climates and Western Medicine: The Emergence of Tropical Medicine, 1500-1900. Amsterdam: Rodopi, 1996.
Curtin, Philip D. Death by Migration: Europe’s Encounter with the Tropical World in the Nineteenth Century. Cambridge [England]: Cambridge University Press, 1989.
Harrison, Mark. Public Health in British India: Anglo–Indian Preventive Medicine, 1859–1914. Cambridge: Cambridge University Press, 1994.
Koplow, David A. Smallpox: The Fight to Eradicate a Global Scourge. Berkeley: University of California Press, 2003.
Kumar, Anil. Medicine and the Raj: British Medical Policy in India, 1835–1911. Vol. 103, No. 2. (Apr., 1998), pp. 373–418.
MacLeod, Roy M. and Milton James Lewis, eds. Disease, Medicine, and Empire: Perspectives on Western Medicine and the Experience of European Expansion. London: Routledge, 1988.
Meade, Teresa A. and Mark Wallker, eds. Science, Medicine and Cultural Imperialism. London: Macmillan, 1991.
Watts, S. J. Epidemics and History: Disease, Power, and Imperialism. New Haven: Yale University Press, 1997.


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