Necropolis. City of the dead. This is not what most people have in mind when they think of New Orleans, commonly regarded as one of the most boisterous places in nineteenth-century American history. Yet, this is the place to which Kathryn Olivarius takes us in her recent book Necropolis: Disease, Power, and Capitalism in the Cotton Kingdom. In strikingly beautiful prose, Olivarius reconciles the seeming contradictions of a city continuously buzzing with newcomers and substantially growing in size, while objectively being the deadliest US city prior to the Civil War. Initially setting out to explore the extremely high numbers of “unacclimated strangers” (p. 8) who died of the then-mysterious disease of yellow fever, the account culminates in making a compelling case for including – besides class, race, and gender – immunity status as a marker that structured society. Disease does not emerge as the “great leveler” in this account but as an intrinsic element of a political project that consciously and wilfully sought to cement and exacerbate inequality – and even justify slavery. This is an exciting historiographical intervention.

To emphasize the northern states’ view of New Orleans as “a place where people live fast and die young” (p. 1), the book opens by introducing a seventeen-year-old clerk who moved from New Jersey to New Orleans, just to painfully die a few months later at the onset of the summerly yellow fever season. Seemingly effortlessly, Olivarius pulls her readers into the material world, decision-making, and physical sensations of yellow-fever patients and New Orleans residents, and does not loosen her grip until the very last page of the book. Each of the six chapters begins with an individual account that introduces different perspectives of and experiences with yellow fever: A governor who lost his loved ones, a traveller from Boston who buried 300 dead in one month, a German immigrant who grew rich. The way Olivarius pieces together these stories from the documentary record is truly impressive, while the fact that many fewer of the perspectives represented in the book are from women or men of colour gives us an idea of the limitations of the source material. Historical death statistics, she explains, are absent for everybody who was not considered white.

Early on, the book sketches yellow fever as a considerable problem when the US bought Louisiana from France. It undermined American claims to the new territory, stalled the construction of an administrative apparatus, and ultimately delayed Louisiana's application to statehood (which materialized in 1812). Olivarius shows how Americans, rather than taking up the fight against the disease, quickly came to accept it as a given and opted to strive for mass immunity as the only way to be able to keep Louisiana and turn New Orleans into a commercially valuable part of the expanding nation. From now on, residents would be broken down into “acclimated” and “unacclimated”, a division that informed all aspects of their lives, ranging from the jobs they could get, creditworthiness, to marriage prospects. Acclimated persons had contracted yellow fever and survived it, which furnished them with life-long immunity. For white people, immunity opened all sorts of doors, a phenomenon Olivarius innovatively conceptualizes as “immunocapitalism”: a system of class rule in which elites constructed themselves as biologically superior, established uneven social relations, and benefited from the immunity of those that laboured for them.

As a city of immigrants, first predominantly from the East Coast and later from Europe, New Orleans was always filled with new people who lacked natural resistance. Yellow fever appeared annually around July but, every two or three years, the disease became epidemic, killing, on average, eight per cent of the city's population and leaving thousands orphaned and widowed. Since there were always new people to replace the dead and to do the jobs, the “logic of immunological supremacy” (p. 137) presented unacclimated people as disposable and aggravated their exploitation. Probably the most dramatic example Olivarius provides of this are the 6,000 to 10,000 Irishmen who died digging a four-mile canal stretch in the 1830s. Unacclimated workers were considered unworthy, could be palmed off with discount wages, had literally no time to organize, and died en masse “before becoming enfranchised citizens” (p. 161).

It goes almost without saying that the social, cultural, and economic benefits that came with acclimatization were reserved for whites only. Black people could possess immunity, Olivarius intriguingly lays out, but not immunocapital. For those enslaved, the system worked in even more gruesome ways. Since the agenda of giving Louisiana a prominent place on America's commercial map was tightly linked to slave labour, yellow fever also came to play its part in the justification and operation of slavery. Southern slaveholders, and their ally physicians, circulated the idea that enslaved Black people were immune to yellow fever. Therefore, it had to be them who did all the work in this infested place to protect whites from disease. Slavery made Louisiana “safe”. Paradoxically, the market prices for acclimated slaves, typically called “seasoned”, were much higher than for those without immunity and plantation ledgers are full of entries on enslaved workers who suffered or died of yellow fever. After the Civil War, southerners fabricated the lie that Black people were only getting sick now that they were no longer enslaved. These bizarre argumentations are difficult to comprehend today, but Olivarius does a great job disentangling the contradictions and absurdities invented by pro-slavery advocates.

Ideas about yellow fever abounded. A few people even noted a correlation between the numbers of mosquitoes and yellow fever epidemics but failed to recognize a causal relation. The lack of medical understanding led to conflicting advice and contradictory epidemiological protocols, yet it did not reduce the demand for doctors in New Orleans. With health being the biggest market after commodities and slavery, physicians could – literally – capitalize on the city's dramatic health situation in the summer months to amass wealth and buy slaves and plantations. They regularly administered interesting, often dangerous, mixes of treatments, none of which worked, as we now know. Caring for the sick mostly consisted of nursing, and this work was usually done by women, often Black, who were sometimes able to make decent money from it. On the other side of the equation, those who fell sick had to dig deep into their pockets. Olivarius shows how high medical expenditures, payments to churches, and the costly infrastructure of death, which included coffins, hearses, and burial plots, significantly impeded the social mobility of the lower classes.

To spare themselves the risk and the confrontation with the suffering, those who could afford it left the city during the summer. The rest worried every day, suspicious of the slightest headaches and chills. In 1853, they were hit the hardest. Olivarius narrates in forceful tone how, after a couple of tranquil summers, more than half of New Orleans's population was foreign-born and one third of the now 120,000 residents were not immune. This was the year that the city turned into a true necropolis. Twelve thousand people died in three months, their bodies hastily buried in mass graves, dumped into the Mississippi, or piling up in the streets. Yet, the local newspapers remained silent, the authorities did not interfere. Many outsiders were shocked about the lack of any social responsibility in the city. Framing health as a private issue and individual responsibility, those who governed New Orleans avoided investing almost any amount of public money into basic public health infrastructure, sanitization, or quarantine measures. Attempts at quarantine to reduce infections, however, were not entirely absent, and a closer look into when and in relation to which diseases they were employed might have provided some additional nuance. After all, other common diseases, such as cholera and smallpox, play a remarkably small role in Olivarius's account.

About the financial peculiarity of New Orleans, we learn that, while actively promoting immigration, New Orleans allocated less than half the national average to poor relief in the 1850s and, at the same time, had the lowest property-tax rate in the entire country. The city treasury was filled mostly by fees from small-scale entrepreneurs, such as coffeehouse operators and peddlers, and by criminalizing destitution, shooting up arrest rates, and fining all crimes as well as trivial offences heavily. White elites clearly emerge as the designers of this misery, but the book also shows the complicity of the lower classes in gambling “their lives for immunocapitalism” (p. 262). Certainly, many of them unknowingly ended up in this “death trap for immigrants” (p. 214), as Olivarius portrays the Deep South, but they overwhelmingly also bought into the rhetoric of downplaying the dangers of yellow fever. Survivors soon spread the word that only drunks died of yellow fever, and copied the elite's carefully constructed ideology of disease denialism. That way, New Orleans escalated some of the disparaging opinions about the poor that we also know from other times and places: that it was their “innate depravity” (p. 76) that barred them from accessing steady work and, consequentially, from living in healthy conditions. In other words, it was their own fault. Those who survived, the fairy tale went, did so out of their own choosing, thereby proving their strength of character and moral worthiness. Immunocapitalism would reward them with access to the small, shielded, circle of those on top. Based on these baffling observations, Olivarius argues that the actual acclimation was perhaps the “moment many people transitioned from living in mortal fear of yellow fever to denying its seriousness” (p. 211).

Necropolis positions itself at the intersection of the histories of slavery and medicine, a field that has produced a number of extremely insightful works in the past decade or so. The most recent global pandemic has further intensified the scholarly engagement with medicine and science, and also Olivarius must have written parts of this book when the COVID-19 pandemic was in full swing. Indeed, it exhibits more than a handful of implicit parallels to our own times. Olivarius shows how people's mindset changed and adapted when they chose to accept yellow fever as a risk inherent to life, although other US cities successfully mitigated outbreaks during the same period. She also reminds us that it is not the “irresistible logic of the market” that shapes capitalism but “powerful actors” who “mobilize the materials at their disposal to consolidate their dominance” (p. 23). In comparison with other cities in and outside of the United States, New Orleans appears as a particularly disturbing place where the wealthy lived aggressively at the cost of everyone else. The many mechanisms in place to keep the majority of people from advancing – or even surviving – and the conscious attempts to subvert social conscience and public spirit were second to none in their brutality. Yellow fever, in this regard, has proven to be a high-yielding lens through which to study power, capitalism, and the value a society attaches to human life. This intriguing book is a must-read for everyone interested in these issues.