Pre-confederation Newfoundland was a challenging place to grow up, especially for children in low-income families. Infectious diseases—including cholera, typhus, smallpox, tuberculosis, diphtheria, gastroenteritis, and whooping cough—circulated unchecked. Poverty, poor sanitation, ignorance, and isolation coupled with poor transportation compounded the effects of poor health. Health care was difficult to access, particularly in outport communities.