Without treatment, half of the patients who enter the second phase die within ten to fourteen days. Similar to yellow fever, malaria was transmitted to humans through mosquito bites, causing symptoms such as fever, fatigue and vomiting. Difficult to recognize at first, malaria continues to cause yellowing of the skin, convulsions and even death; these symptoms normally begin ten to fifteen days after contraction. Malaria was introduced to America through slavery and killed millions of people between the 17th and 20th centuries. During the growth and expansion of America there were several outbreaks of both endemic and epidemic diseases such as smallpox, measles, yellow fever, and malaria. Beginning with the Columbian trade and slavery, these diseases were brought to the new world and spread like wildfires that devastated both native and non-native populations. Known most commonly for the number of deaths among Native Americans, these diseases were so costly due to low resistance, poor sanitation, and inadequate