Life

“Immunoprivilege” During a Pandemic Is As Dangerous As the Disease

When yellow fever ravaged 19th-century New Orleans, wealthy white people who “acclimated” were rewarded. Everyone else was out of luck.

A view of a busy 19th-century street in New Orleans
Canal Street in New Orleans, seen on Jan. 1, 1862. Hulton Archive/Stringer

Vincent Nolte, 19th-century German immigrant and cotton merchant, made millions after he survived a bout of yellow fever and went on to prosper in New Orleans. As historian Kathryn Olivarius writes, Nolte benefited from “immunoprivilege”: Since he had made it through the sickness, he became credit-worthy and found himself accepted in elite society. His experience did not, however, endow him with much sympathy for his fellow victims of yellow fever. He believed both that God had blessed him and that he had saved himself, having “not at all fe[lt] like dying.”

Olivarius wrote about New Orleans’ 19th-century culture of immunoprivilege in the New York Times way back in April, when we didn’t yet know how complicated the question of coronavirus antibodies was going to be. Back then, some were floating the idea of asking young people to deliberately infect themselves with the coronavirus so they could, brimming in antibodies, spearhead the “reopening” of the economy. Reading Olivarius’ work—an article in the American Historical Review, her dissertation—in the more uncertain month of August, I felt a violent shock of recognition at the social phenomena she chronicles.

In New Orleans, Olivarius finds, elites refused to do anything at all about yellow fever for a hundred years. Theirs was a mindset of fatalism and cruelty that reinforced the society’s many human hierarchies; they saw yellow fever as a dangerous rite of passage that the truly worthy would come through. But poorer people who survived yellow fever were rewarded with the worst, most dangerous jobs; white people used Black people’s supposed “natural” resistance to yellow fever to justify the continuation of slavery. And the wealthy often turned profoundly hypocritical when it was their own families in danger. (That era’s elite fled to their summer houses too.)

Olivarius’ book, Necropolis: Disease, Power, and Capitalism in the Cotton Kingdom, which will be coming out next year, is about the Deep South—Louisiana, Mississippi, Alabama, and eastern Texas. Since the work I was able to read was about 19th-century New Orleans’ culture of yellow fever, that’s what we covered in our conversation, which has been edited and condensed for clarity.

Rebecca Onion: At this point in the pandemic, as opposed to when you first wrote about the history of immunoprivilege, we obviously don’t know who is going to be “immune,” under what circumstances, and we may not know that for a while. There are so many uncertainties.

So I wanted to talk about the way an attitude of fatalism around yellow fever worked to keep elites in New Orleans in charge: what they thought about their own immunity, and what those thoughts about their immunity translated into when it came to policy around the disease.

Kathryn Olivarius: New Orleans had a big yellow fever problem in the 19th century because of three things: hot weather, a large population of Aedes aegypti mosquitos, and a lot of immunologically naïve people who are densely packed together. With this, you get epidemics. New Orleans had some pretty serious epidemics in the 1790s, but then in 1804, the first year of American rule after the Louisiana Purchase, it had a very, very bad epidemic of yellow fever, and that just continued and continued through the 19th century as more and more people came there.

There was this idea that the Louisiana Purchase was this absolute windfall for this young nation because it opened up this vast territory (which of course had thousands and thousands of people already living there, but that’s what they thought). And New Orleans, because it’s at the base of the Mississippi River, is a strategic spot. And so there was a disease problem that set in, but also an attitude that we have to maintain New Orleans because we need this depot at the base of the Mississippi.

There was this attitude that we can’t give New Orleans up. An attitude like, A lot of people will die here, but that’s the price we will pay as a nation, and individuals have to take this risk themselves. If you were a white man, and you were ambitious and wanted to make money in cotton or sugar, through the violent suppression of African and African American enslaved people, if you want to tap into this El Dorado, you have to risk your life with disease first, and that’s just the way it will be.

As wild as this sounds, it’s even wilder when you consider how terrible yellow fever was. It was a dramatic disease.

Yes, famously, just before you die, you vomit up this sort of coagulated blood that looks a lot like coffee grounds—it’s very painful. I have these examples of pious minsters and pious people screaming profanities at the end. It’s so painful.

But even so, one of the truisms that developed in New Orleans was that everyone has to get “acclimated.” There’s wrangling about what exactly it means to “get acclimated.” Some doctors said it just meant you basically have to live in the South for a long period of time, not survive yellow fever. Then by around the 1830s it was pretty clear: You had to have gotten sick, with yellow fever, and survived, and then developed lifetime immunity.

But the problem is of course this getting acclimated was a very, very risky process. About 50 percent of people died.

A 50 percent case fatality rate.

Yes. In that century, yes. So you’re very much gambling your life.

There developed this immune elite of white men over time. The people called “Creoles,” born and raised in Louisiana—that terminology meant something a little different in the 19th century than it means today—probably developed immunity early in life from having yellow fever as a child, when it was less dangerous, just some flu-like symptoms. Those men, and the Americans and European white men who came to New Orleans and who got acclimated, had this sort of guild. They adopted an attitude that, yes, it’s risky here, but we did it—we survived yellow fever, so you can do it too.

And until you survive, people will not take you seriously. We will not employ you. You cannot purchase life insurance. All kinds of social disabilities were attached to not being “acclimated.”

Meanwhile, immigrants coming to New Orleans from the North or from Europe would die of it all the time.

Yes, New Orleans was the second biggest immigration destination after New York City for large parts of the 19th century before the Civil War, especially in the 1830s and 1840s. There was an influx of people mostly from Ireland, escaping the Potato Famine, and the German states, fleeing from the political upheavals around 1848.

They get to New Orleans after a journey on a ship for about two or three months—you’re going to be immunosuppressed. Bad food, bad water on board. The Middle Passage that brought Africans into slavery in the New World was far worse, but I wouldn’t want to be on basically any ship in the 19th century going anywhere.

Oh, me neither. No thanks!

So they arrived in New Orleans like this. Every mortality report you look at, you see how they died at horrible rates, extremely high death rates—in the 1853 epidemic for example, which was the worst epidemic of yellow fever in New Orleans, where about 12,000 people died—1 in 12 citizens of the city, and 1 in 5 Irishmen. A hefty number of people.

A lot of Creoles were nervous about an influx of immigrants: They’re going to run roughshod over customs and laws. So, many people living in New Orleans were actually happy about the effects that yellow fever had on the immigrant population. They used metaphors, like it’s checking the tide; it’s the dam holding back the waters.

And of course, they said things about immigrants—they bring it on themselves, they get it because of their dissolute lifestyle, their poor morality. Yellow fever was often called “the stranger’s disease.”

All of this is pretty familiar in thinking about other 19th-century responses to epidemics—blaming poor people for getting cholera, for example—but I found it extremely interesting to read your analysis of the way that rich people incorporated the death of their own into that worldview. Because sometimes they did die. You said in a footnote that it sometimes seemed like “rhetorically, the rich and poor died from two different diseases.” There wasn’t a coherent ideology about what it meant to die from yellow fever; it shifted, based on the needs of power.

Yes! If a rich, slaveholding white lady, a Creole lady, died from yellow fever, it was God’s will. If the poor died, they brought it on with their own dissolute choices.

This is something that’s obviously happening today with COVID, where there’s condemnation of some victims for having “brought the disease on themselves,” through mention of any number of underlying factors that are dog whistles for poverty or for being African American.

I feel like, at the beginning of our own pandemic, a lot of us who believed the coronavirus was a big problem were saying to one another, OK, when it gets to the point where most people know somebody who has died or been very sick, even disbelievers will change their tune. With a few months’ experience, I see how naïve that was. And your work made me see how very capable people can be of accommodating all kinds of deaths in their worldview.

Of course! We’ve learned a great deal about COVID over the past four or five months, but there’s still so much we don’t know, and when we don’t know things, diseases are very apt to be made into metaphor, as Susan Sontag said.

I think a lot about how, in the 19th century, people in New Orleans were living in this very high-risk, low-information setting. And today, we’re in a high-risk, high-information setting, where we have so much—we were able to map a genome of the coronavirus basically instantaneously; we’re probably on our way to a vaccine; there are already books being published about COVID. We have so much information, but there’s so much it’s almost unintelligible, and we’re in the same trap as people in the past, where we pick and choose what we want to see.

That’s another thing about the way people incorporated yellow fever into their worldview in 19th-century New Orleans: There was so much uncertainty about the epidemics. It feels like a whole century of uncertainty that you’re writing about, basically.

There was so little known about it. They didn’t know that it was spread by mosquitoes. There was no conclusive evidence why it came to affect certain people more than others. It wasn’t clear whether a doctor’s attention actually helped; it wasn’t clear what medicines actually worked for people.

So basically, everyone became a 19th century version of our armchair epidemiologists. Everyone was talking about yellow fever all the time, theorizing based on what they’d heard and seen. That’s one thing people say all the time in letters—they’ve just arrived in New Orleans, they know that yellow fever is a problem, but they’re exhausted, within weeks of arriving, of everyone giving them yellow fever advice. Should they be eating fruit? Should they be taking exercise? If the fever comes, should they escape town? What doctor should they use? Everybody’s an expert.

And they all spent so much money on medicine. People, even poor immigrants, were told basically to squirrel away as much as you can for their inevitable health costs, when they inevitably get yellow fever. And it was so much money to pay for treatment for a bout of yellow fever! Fifty dollars, maybe more if you went to a private hospital or used certain doctors. That was many months of salary for a clerk. And of course, this was free people; if you were enslaved and didn’t have any money, you were in a particularly dire situation.

This is an era that predates health insurance of any kind. So people are spending their entire life savings, if they have life savings, on surviving the disease. There are many people who talk about how they can’t plan for the future, they can’t purchase property, because they have to keep this money on retainer for when they get sick.

One thing I really wonder, given the present-day conflict between people who care about COVID deaths and people who shrug, is whether there were countervailing opinions—whether there were people who were horrified at the way New Orleans handled its epidemics, who argued for something different.

Yes, there were! There were people who said, What are we doing? Especially by the 1850s, when there was a very large epidemic in 1853 and another one in 1854. There was at least one doctor, J.C. Simonds, who argued that there was an economic and social cost to letting yellow fever run through New Orleans—he basically said, We’re losing capital, we’re losing reputation, because people hear about this, and not only do they physically not want to come to New Orleans in person, they don’t even want to invest money here. He was saying, This is lunacy.

By the time of the 1840s and 1850s there were doctors with a public health bent who were saying, We should be doing something like what other cities are doing—imposing quarantines, which were controversial in New Orleans because they slow commerce, maybe draining the streets, installing water pumps and systems to help sanitize the city. Medical professionals in New Orleans maintained an anti-contagionist stance longer than most—they continued to argue that yellow fever was spread miasmatically, through “bad air,” so that it wouldn’t make a difference whether or not the city quarantined incoming vessels.

So there are voices that do argue for trying to ameliorate the problem, but they are always much quieter than the voices that essentially say, “No, we don’t want to do that.” New Orleans’ City Council spent less on public health than any other American city of its size, even other Southern cities. The elites thought, All this money, on pumps, on quarantine, is just delaying the inevitable process of acclimation.

The attitude was, It’s not the government’s responsibility to protect your health. You must take this on yourself. And if you survive, if you’re a white man, we will help you make money. But until you get acclimated, there’s nothing we can do.