The Geography of Immunology

Immunology at the Mouth of the Mighty Mississippi

by John S. Emrich
August 2015, pages 22–25

IMMUNOLOGY 2015™ in New Orleans, Louisiana, featured an exhibit chronicling notable developments in Louisiana’s medical and public health history. Below is an expanded version of the text accompanying the exhibit.

Yellow fever patient in military hospital, 1898Yellow fever patient, 1898
National Library of Medicine
Louisiana has endured centuries of epidemics, outbreaks, and endemic diseases, chiefly in its most populace city, New Orleans. The city is known worldwide for its revelry and rich culture—the pentimento for the various flags that have flown over her since the French first began colonizing the region in the late seventeenth century. In the early nineteenth century, the city became the third largest city in the United States and one of the wealthiest because its bustling port at the mouth of the Mississippi River was the intersection of trade between the nation’s interior and the Caribbean, South America, Europe, and beyond. Here, we highlight diseases and institutions that have shaped the medical, public health, and social history of the state.


Louisiana, because of its subtropical climate and home, near the mouth of the “Mighty Mississippi,” to the premier southeastern port in the United States, has been the site of many lethal and chronic communicable diseases, including yellow fever, malaria, hookworm, Hansen’s disease, and bubonic plague. The presence of these diseases has channeled the current of biomedical research in the state.

Epidemics and Outbreaks

Yellow Fever. An acute infection caused by an RNA virus spread, primarily by the female Aedes aegypti mosquito, Fumigation of sheds in New Orleans, yellow fever campaign, 1905Yellow fever fumigation campaign, 1905
National Library of Medicine
yellow fever was one of Louisiana’s deadliest diseases before the early twentieth century. The mosquitoes carrying the disease typically hitchhiked to Louisiana aboard trading ships from their native Caribbean habitat. Mortality rates climbed as high as 60 percent during some epidemics, and in the New Orleans region, the disease was responsible for more than 41,000 deaths between 1817 and 1905. An epidemic in 1878 began in the port of New Orleans and spread up the Mississippi River to the American Midwest, infecting more than 110,000 and killing at least 20,000. An occurrence in 1905 marked the last yellow fever epidemic in the United States. By this time, the transmission cycle was understood, and public health campaigns, including mosquito prevention and eradication, limited spread of the disease before the first successful vaccine was developed in the 1930s.

ALT TITLEPlague epidemic in New Orleans
National Library of Medicine
Bubonic Plague. In late June 1914, a bubonic plague outbreak in New Orleans was caused by rats from a cargo ship at the New Orleans Stuyvesant Docks. In August, at the height of the outbreak, cases were reported at a rate of one every three days. A coordinated response by health officials, led by the U.S. Public Health Service, suppressed the outbreak by year’s end through a combination of medical intervention and rat-reduction programs, which included “rat-proofing” or destroying hundreds of buildings and enacting new housing codes. The 1914–1915 outbreak resulted in 31 reported cases, of which 10 were fatal. New Orleans continued to have infections until the city was declared free of the disease in the late 1920s.

Endemic Diseases

Malaria. Although malaria never reached epidemic levels, it was a constant presence in the state, Map, “Malaria in the United States,” [undated]“Malaria in the United States,”
National Library of Medicine
with a peak rate of 57 cases per 100,000 in 1944. In 1947, the National Malaria Eradication Program began in the United States, focusing on 13 southeastern states. The program successfully eradicated the disease in the United States in 1951 through the reduction of mosquito-breeding sites and the application of insecticides. An important breakthrough in malaria research was made at Tulane University School of Medicine in 1911, when Charles C. Bass (AAI 1916) successfully cultivated plasmodia in vitro, using human blood. Bass’s technique allowed other researchers to better understand and devise new treatments for the disease.

Head of the hookworm <em>Necator americanus</em>Head of a hookworm
Centers for Disease Control and Prevention
Hookworm Infections. Bass was also responsible for calling attention to the impact of hookworm infections in Louisiana, especially in rural children with continuous infection. He recognized growth and developmental problems resulting from the infected children’s loss of iron and protein. Through a series of studies in 1910 at Tulane, Bass, who was previously a country doctor, determined that the high rate of infection in rural communities was attributable to the geology of central and northern Louisiana, specifically the sandy soil; poor access to privies; and the “habit among children…of going barefoot.” That same year, a Rockefeller Foundation report found that nearly 40 percent of the population in the South was infected with hookworms, validating Bass’s assertions. Within a few years, a public health and education campaign eliminated these occurrences.

Hansen's disease researchHansen's disease research
National Library of Medicine
Hansen’s Disease (Leprosy). This disease was well established in Louisiana, particularly in southern Louisiana. By the late 1880s, high incidence rates (4.5/100,000) in the state, especially in South “French” Louisiana, led to the creation of the Louisiana Leper Home in Carville to treat patients and research the disease. Infection rates continued to rise until the late 1920s (12/100,000), with the highest rates still observed in French Louisiana. Antibiotic treatments beginning in the 1940s successfully brought incidence in the state to near zero by the 1970s.


Research institutions and medical schools in Louisiana were founded to address the public’s vulnerability to a rare confluence of public health threats. Here, we highlight six of the oldest institutions. All have contributed to the growth of immunology research in the state.

Hospitals and Public Health Institutions

Charity Hospital, c. 1939Charity Hospital, c. 1939
National Archives
Recognizing the need for a public hospital in New Orleans to serve the poor, a French ship builder residing in the city bequeathed money for what would become the city’s venerable Charity Hospital. The hospital was founded on May 10, 1739, and operated constantly until 2005, when Hurricane Katrina forced its closure. At that time, Charity Hospital was the second-oldest, continuously operating public hospital in the United States. Charity also served as a teaching hospital for Tulane University and Louisiana State University (LSU) medical schools, where many AAI members held appointments.

U.S. Marine Hospital/U.S. Public Health Service Hospital, New Orleans, LA, ca. 1950U.S. Marine Hospital/USPHS Hospital, New Orleans, c. 1950
National Library of Medicine
The United States Marine Hospital [later named the U.S. Public Health Service (USPHS) Hospital] in New Orleans was founded in 1801, three years after the creation of the U.S. Marine Hospital Service. The initial mission of these entities was to provide medical care to ill and disabled seamen, including those in the U.S. Merchant Marine and U.S. Coast Guard. The mission of the hospital and officers quickly expanded to assist the city as a leader in clinical research and public health, leading campaigns to control epidemics and outbreaks, especially for yellow fever and bubonic plague. The hospital was closed in 1981, following severe cuts in federal funding.

National Leprosarium, Carville, LA, c. 1950National Leprosarium, c. 1950
National Library of Medicine
The state opened the Louisiana Leper Home in Carville in 1894 and two years later, entered into a contract with the Daughters of Charity of St. Joseph, located in Emmitsburg, Maryland, to care for and treat its patients. In 1921, the USPHS took operational control of the institution and established it as the National Leprosarium, in accordance with a 1917 federal law mandating the founding of a hospital for leprosy patients. In addition to treating patients, the facility was updated to become a center for research into Hansen’s disease (leprosy) transmission and treatment. Researchers at Carville demonstrated the efficacy of sulfa drugs (1940s) and pioneered the use of Rifampin (1970s) in treating the disease. They also developed the first animal model using armadillos (1971) for studying the disease. In 1998, the National Hansen’s Disease Program was relocated to Baton Rouge, although patients were allowed to choose whether to remain at Carville, receive a lifetime medical stipend, or relocate with the program.

Alton Ochsner, c. 1953Alton Ochsner, c. 1953
National Library of Medicine
The Ochsner Clinic was opened in New Orleans in 1942, organized by Alton Ochsner and four other professors from Tulane. The clinic was modeled after the Mayo and Lahey Clinics, where specialists from different disciplines collaborated to diagnose and treat serious medical problems, while also emphasizing physician education. The Ochsner was the first of its kind in the South and enjoyed such rapid success that it was expanded to include a hospital, research facilities, and academic programs. The Ochsner Medical Center remains a cutting-edge clinical and research facility that garners international acclaim.

Medical Schools

Tulane University, c. 1900Tulane University, c. 1900
Library of Congress
Two of the state’s oldest medical schools are located in New Orleans. Tulane University School of Medicine was founded in 1834 as the Medical College of Louisiana, with the purpose of leading “the advancement of science and the rational treatment of disease.” Tulane issued Louisiana’s first medical degree in 1835 and was one of two southern institutions identified as “excellently situated in respect to medical education” by the Flexner Report in 1910. LSU School of Medicine was established and opened for Louisiana State University Medical School, c. 1939LSU Medical School, c. 1939
National Archives
classes in 1931. It has expanded over the years and still includes its original building next to Charity Hospital. As the preeminent private and public medical schools in New Orleans, Tulane and LSU have been leaders in clinical and basic research for more than one-half of a century.

Today, Tulane, LSU, and Ochsner are joined by Tulane National Primate Research Center, LSU Shreveport, Southeastern Louisiana University, and other smaller research institutions contributing to growth of immunology research in Louisiana.




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