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.