By many accounts, nineteenth-century New Orleans was a hellscape. In the summer months, thousands died in yellow fever epidemics–notably 1825, 1853, and 1878. Every couple of years an epidemic killed 8% of the population. What began with a fever often led to bleeding from the eyes, vomiting black bile, organ failure, and a generally tortuous end. Treatments, ranging from heavy doses of castor oil to an opium and coffee cocktail, seldom brought relief. The epicenter of the “Yellow Fever South”—a city known alternately as “the widow-making capital” and the “headquarters of death”—New Orleans was far and away the nation’s most deadly place to live (p. 15).

Most of the dead from the fever were the poor and disenfranchised, particularly newcomers to the city: Irish and German immigrants, enslaved people brought from the Upper South, and anyone else unlucky enough to be laboring out of doors in the heat, humidity, open sewerage, and swarms of mosquitoes. Known widely as “the stranger’s disease,” yellow fever took down, in the most gruesome way, those not acclimated to the deadly bite of the female Aedes aegypti mosquito. For instance, well upward of 6,000 Irishmen died of yellow fever digging the New Basin Canal in the 1830s.

The lucky ones who contracted the fever and survived had lifelong immunity. Children and the elderly appeared to be the least vulnerable. Adults between the ages of 18 and 40 years were the most likely to perish, and men, in particular, since they were most often walking the city’s streets in summer. In the decades just after the Louisiana Purchase, when the city, its population, and its economy were on a rapid rise, many professional men in other cities had the chance to make their fortune in New Orleans; however, many also opted out. Individuals such as landscape architect Benjamin Latrobe, who did come, knew that summer was to be avoided. Why, he wondered, would one endure the “ennui” of New Orleans in August if one could go elsewhere (p. 162)? Alas, Latrobe succumbed to the fever in 1820.

How could a city and its economy survive such a deadly scourge? According to Kathryn Olivarius’s Necropolis: Disease, Power, and Capitalism in the Cotton Kingdom, New Orleans’s “danse macabre” with yellow fever was, by the 1840s, a source of power for the wealthiest enslavers in the nation’s second largest export city (p. 71). Olivarius argues that New Orleans’s elite built itself out of slavery, cotton, and viral immunity. In fact, “disease did not attack and destroy existing class and racial structures: it was part of their very foundation” (p. 8). Creoles who acclimated from childhood and members of the professional class hoping to profit from slavery and the cotton trade (doctors, lawyers, pastors, and politicians) practiced what the author terms “immunocapitalism” (p. 9). Those with both means and immunity to the virus did not share the vulnerabilities of newcomers and the city’s working classes. Hence, “local elites embraced yellow fever risk, mobilized disease for discriminatory ends, and used their own immunity as proof that they deserved success, consolidating their power atop the cotton market,” peddling the nation’s most lucrative commodity (p. 9).

Despite waves of epidemics, the elite retained as much wealth as possible while keeping commerce humming. Vulnerable immigrant populations in the nineteenth century were a staggeringly renewable resource. City leaders mostly left the poor and sick to fend for themselves. With control of the city government, property holders owed nearly nothing in taxes (just a fraction of what their counterparts in other cities paid), and they contributed little to public health and sanitation. Public hospitals relied upon the Catholic Church and private charities such as the Howard Association.

Enslavers also held tight to the idea that the people they enslaved had natural immunity to yellow fever. While many Africans arrived in colonial Louisiana already acclimated, by the mid-nineteenth century the notion that enslaved people were impervious to the virus was absurd. Yet the pretended immunity of enslaved people, in the rhetoric of enslavers, reinforced racial slavery and justified the city’s reliance upon it. Instead of being a great equalizer, then, yellow fever had the opposite effect in New Orleans. According to Olivarius, “the constant possibility of painful death made for more inequality not less” (p. 8).

As the century progressed, other coastal cities prone to fever epidemics, such as Philadelphia and Charleston, drove down mortality rates through sanitation and public health measures, including quarantines. But New Orleans’s elites stood firm in their belief that quarantines were—for them—a waste of money. Clever job seekers alluded to their acclimated status to secure positions. Politicians and even physicians hoping to defend their social status touted the benefits of serial epidemics—for instance, the idea that the periodic ravages of yellow fever served to weed out the weakest among them. Such crackpot “theories” were justifications for doing nothing, making money, and defending the institution of slavery.

Any hopes on the part of New Orleanians that “the yellow jack” would wipe out the Union troops that occupied the city in 1862 were short-lived. General Benjamin Butler, disgusted by the filth he encountered in the city, ordered improved drainage and sanitation. The fever did not return in earnest until the end of the Reconstruction period, in 1878, when the city was again under the control of the old Southern elite. This time, however, the outbreak made New Orleans appear a riskier investment than before the war, and a new generation of businesspeople pressed forward with sanitary reforms that would encourage capital investment.

Throughout the book, there are comparisons to other US cities, but relatively little space is given to the powerful role of the Catholic Church, the city’s economic ties to the Caribbean, and its active Afro-Caribbean culture. The local elite appear to operate, unchallenged, in a vacuum. The author’s heavy reliance on travelers’ accounts and the city’s pro-slavery newspapers for social commentary, in turn, cannot explain the social webs that sustained the city’s Black working class—enslaved, free, and freed—and shaped the politics, culture, and economy of the city itself. A deeper study of New Orleans would have also underscored the significance of the author’s work. The legacies of immunocapitalism are evident in the twenty-first century city—minimal property taxes on the wealthy, too little investment in public health, and a reliance on private donations and charitable organizations to fill in the gaps. Indeed, overly wealthy, overly poor, creative, and resistant, New Orleans has often shown Americans the future.