Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction

by Jim Downs

Bondspeople who fled from slavery during and after the Civil War did not expect that their flight toward freedom would lead to sickness, disease, suffering, and death. But the war produced the largest biological crisis of the nineteenth century, and as historian Jim Downs reveals in this groundbreaking volume, it had deadly consequences for hundreds of thousands of freed people. In Sick from Freedom, Downs recovers the untold story of one of the bitterest ironies in American history--that the emancipation of the slaves, seen as one of the great turning points in U.S. history, had devastating consequences for innumerable freed people. Drawing on massive new research into the records of the Medical Division of the Freedmen's Bureau-a nascent national health system that cared for more than one million freed slaves-he shows how the collapse of the plantation economy released a plague of lethal diseases. With emancipation, African Americans seized the chance to move, migrating as never before. But in their journey to freedom, they also encountered yellow fever, smallpox, cholera, dysentery, malnutrition, and exposure. To address this crisis, the Medical Division hired more than 120 physicians, establishing some forty underfinanced and understaffed hospitals scattered throughout the South, largely in response to medical emergencies. Downs shows that the goal of the Medical Division was to promote a healthy workforce, an aim which often excluded a wide range of freedpeople, including women, the elderly, the physically disabled, and children. Downs concludes by tracing how the Reconstruction policy was then implemented in the American West, where it was disastrously applied to Native Americans. The widespread medical calamity sparked by emancipation is an overlooked episode of the Civil War and its aftermath, poignantly revealed in Sick from Freedom.

Genres: History, Nonfiction, Civil War, American History, African American, Health, Disability

280 pages, Kindle Edition

First published March 19, 2012

About the author

Jim Downs is Gilder Lehrman–National Endowment for the Humanities Professor of Civil War Era Studies and History at Gettysburg College. He is the editor of Civil War History and author and editor of six other books, including Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction.

Reviews

[Teri · Rating 3 out of 5]

The Emancipation Proclamation in 1863 was to be the defining moment for African Americans held in bondage. Slaves became freed people no longer forced into servitude. The Reconstruction era after the Civil War should have been a time for freed people to rebuild their lives on their terms. What many faced, however, were the vagaries of life, unknown challenges that would be life-altering and life-threatening. Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction by Jim Downs explores the medical issues that freed people faced during and after the Civil War. For people formerly held in bondage, life after the war led to sickness, disease, and death.

Downs explores the lives of freedpeople during and after the war years through the eyes of those that endured sickness, disease, and the death of loved ones. Downs also utilizes the experiences of medical caretakers and staff of the Freedmen’s Bureau, formally known as the Bureau of Refugees, Freedmen and Abandoned Lands, the agency employed to freed slaves and indigent whites in the aftermath of the Civil War. Down’s thesis suggests that the Civil War was the largest biological crisis of the nineteenth century. In their quest for freedom, former slaves endured diseases such as smallpox, cholera, dysentery, and yellow fever and received little help from doctors and staff of the Medical Division of the Freedmen’s Bureau. Children, women, and men often died before they could get the help they needed. These are the cases that Downs details along with data and statistics gleaned from physicians and hospitals that were underfunded and understaffed.

Downs supports his thesis by describing six areas that contributed to the devastating losses of freed people due to disease and sickness. Downs begins by looking at the political and social status of free people that led to unhealthy living environments. Downs posits that these conditions led to disease and outbreaks of illness and widespread epidemics. The second area that Downs details ask why disease broke out among unemployed freed people and why the bureau was unable to support a free labor system in the post-war south. In response to the labor crisis, The Freedmen’s Bureau establishes a Medical Division to handle the healthcare of freedpeople. Downs then transitions to a discussion on Freedmen Hospitals and the challenges faced within the structure and hierarchy of the Medical division of the Bureau. Downs feels that the hospital systems were unstructured and unable to handle the massive load of illness among freed people. Downs uses hospital records, and the lack thereof to support this discussion.

Downs then turns his attention to the smallpox epidemic of the late nineteenth century that left many dead in its wake. This discussion transitions into the fifth area that covers the outbreak of other diseases and sicknesses. Downs utilizes specific case studies of freed people and the challenges they faced in obtaining medical care.

Downs wraps up his thesis by highlighting the eventual downfall of the Medical Division of the Freedmen’s Bureau. Drawing on the autobiography of O. O. Howard, commissioner of the Medical division of the Bureau, Downs shows how the needs of the medical care of freed people transitions to state and local governments.

In the epilogue, Downs discusses the illnesses that affected Native Americans. Many of the same issues and concerns that freed people faced during Reconstruction, native Americans endured during the forced removal toward the west. Beginning with the Trail of Tears forced migration in the early 19th century through the Reconstruction, native people endured disease, illness, and death. Downs compares and contrasts the political, social, and medical issues that native Americans and freed people faced drawing parallels between the two groups.

Jim Down’s extensive research brought to life portraits of freed people who endured disease, sickness, and death in the aftermath of the Civil War and the staff and caretakers of the Medical Division of the Freedmen’s Bureau who were tasked to support free people during the Reconstruction era. Downs also reviews similar issues with poor white Americans and Native Americans and draws parallels to the issues faced by freedpeople. These case studies bring to light an area of the Reconstruction narrative often overlooked in Civil War scholarship. To truly understand how the war affected freedpeople during and after the war more attention and consideration needs more attention on all aspects of their lives, including sickness and death.

[Ashley · Rating 3 out of 5]

Downs had me until the "epilogue." His points about "reconstruction moving west" are valid and interesting, but I felt like he played way too fast and way too loose with Native American health history. That said, the rest of the book is a thought-provoking exploration of freed slaves' health in the years immediately following the Civil War-- the bulk of the text focuses on the years 1864-1872. Health and poverty are important and often overlooked aspects of Reconstruction. While "Sick From Freedom" foregrounds these themes, the analysis offered failed to explain why it's overlooked and/or why this is such a critical dynamic shaping the politics/progress of Reconstruction.

It's an important first step and I sincerely hope future scholars expand on the ideas Downs puts forward in "Sick from Freedom."

[Maxie · Rating 5 out of 5]

Sick from Freedom by Jim Downs

Jim Down's book Sick from Freedom is well written and quite enlightening from the standpoint that many Americans have no real knowledge of regarding the realities of life after slavery. Sick from Freedom paints a vivid picture of how life as freedmen was like on a day to day basis. Sick from Freedom not only focuses on the freed slaves regarding the racial divide but that lack of humane living conditions resulting in the lost of thousands of lives. The men women and children now freed have to contend with where to go, can they find work and provide for their families and loved ones. Their accounts how the rampant illnesses and diseases impacted the families of freed people.

I have read several books about the freedom of slaves and how it meant hardships that were unexpected by all individuals from the former slaves to U.S. Government officials due to the lack of foresight and the constant battle to end cruelty inflicted on the Freedman. This is the first account that directs the reader to explore another critical reality which was the health of newly freed slaves. One of the key issues were living conditions, medical concerns after escaping the cruelties of being held captivate and force to perform duties or suffer often dire circumstances.
The book Sick from Freedom provides a clearer insight on areas of abuse I believe has been grossly overlooked and not pursued as deeply as the social, racial, political ramifications of freed slaves. Mr. Downs account of freedmen comes from a different vantage point; the day to day survival of the freedmen as a result of the illnesses, diseases, lack of basic living conditions, clothing and no medical supplies and care. Mr. Downs provides the reader with clear and substantiated documentation regarding the horrific conditions men, women and children had to endure to simply make it from one day to the next. Most readers are aware that the Civil War produced the largest biological/ health crisis on military lives and the newly freed.

Sick from Freedom is a fascinating account that I believe history enthusiasts should investigate. Surviving the brutality of being a slave to acquiring freedom that literally cost thousands upon thousands of freed slaves their lives after becoming sick and dying from freedom. I know I will be talking about Sick from Freedom with my colleagues and friends. I highly recommend this book as a must read for American History and African American History majors. It definitely addresses different issues surrounding life after slavery.

[Naomi · Rating 5 out of 5]

Although I felt the author had some biases pop up periodically, I didn't hold that against him because I found this book fascinating. Not only for the illnesses which are rarely talked about following the civil war of freed slaves, but also life, in general, following the Civil War across many sectors. I must add, if the book was not so interesting to me, I really would have nailed the author on what could have been interpreted as "snarky". I feel it has absolutely no place in history books which, in my opinion, should be "just the facts ma'am!"

[Stephanie · Rating 4 out of 5]

I really appreciated how well and how often
Downs incorporated quotes from primary sources.

[Samuel · Rating 3 out of 5]

While Jim Downs makes a fairly intuitive argument that just hadn't been explicitly made before, he does so in such a way that does indeed yield some interesting thoughts. By looking at a new cache of records assembled by the Freedmen's Bureau in the nineteenth century, Downs demonstrates how Emancipation had some unanticipated, detrimental outcomes for many African-Americans--many of whom died from a Smallpox epidemic and other diseases. Without a well-thought out plan for how to provide for the healthcare of freedmen, as well as an over emphasis on transforming former slaves into laboring freedmen without any dependency during the transitional phase, many former slaves crossing into Union camps and thereafter migrating to the North suffered under extremely meager and dangerous conditions. These substandard conditions left tens of thousands vulnerable to death by common illnesses and later epidemics.

While there were efforts in the postbellum Reconstruction era to administer a form of healthcare and other basic necessities to former slaves, these efforts were insufficient and largely curtailed by politicians who feared that any investment by the government to assist freedmen with basic necessities would lead to dependency and idleness. Thus, the agencies created were temporary and under-staffed and under-equipped. Furthermore, politicians were still considering sending former slaves back to Africa and still others were anticipating "the extinction" of Africans in ways that paralleled the demise of Native American populations. Many racist notions from Northern politicians muddy the waters for a clear plan of action that never fully materialized. In this sad and painful truth, freedom from slavery was not only a process rather than a seamless transition but a painful process at that. Environmentally (as well as socially and politically), emancipation and reconstruction proved to be painfully limited in scope and breadth which led to many deaths early on and a legacy of racial neglect for African-Americans by the federal government.

As an interesting after thought (this argument surfaces in the Epilogue), Downs points out how the Reconstruction infrastructure migrated West in the 1880s and 90s to transition Native Americans into sedentary living on reservations.

[Cherisse]

Black emancipation, a process circumscribed by "illness and suffering." A simple but often overlooked concept, in particular Downs' argument that health became a critical part of African Americans' campaign for rights. He refers to Helene, Arkansas in a couple of places. It's Helena. I wondered about the author's repeated use of the terms "freed" and "emancipated," "slaves." Preachy in parts but an interesting and important contribution to the historiography of African Americans during the Civil War and Reconstruction.

[Bridget · Rating 4 out of 5]

This is a much needed and overdue treatment of African-Americans during and immediately after the Civil War. Arguing against historiographical and factual claims of previous historians, Downs describes the medical challenges facing freed slaves and the failure of the American government to meet them. He makes a convincing case that the war's causalities were much higher than previously established and that you can no longer talk about emancipation without considering the history of medicine.

[H. Dair Brown · Rating 5 out of 5]

Full disclosure: I used this book for research for a story I am writing, and did not read it from beginning to end. The material I found was well-researched, thoughtfully presented, and eye-opening. Recommended.

[Doug · Rating 2 out of 5]

Didn't finish this book. While there was interesting info on the post slavery world, it was essentially that things for the most part got even worse for ex slaves. Death from disease and malnutrition, following Union armies en mass, being refuge was all bad.

[Frederick · Rating 4 out of 5]

This book chronicles the struggle that former slaves had under Reconstruction to survive medically. Many starved to death and died of diseases caused by malnourishment and the conditions of being forced to move from war zones and not being able to return to the surroundings they knew and, if they were able to, not having the resources to survive. Tens of thousands of former slaves died of disease and starvation upon being set free from slavery. The federal government’s efforts were uneven at best and the southern state governments balked at providing assistance to their former chattel. The book is a very good appraisal of the first calls for national healthcare and of the dire situation former slaves were in. It got so bad that some federal officials declared that the black race would be extinct in America, all dying from epidemics that raged through their desperate populations and there was little these former dependents of the slaveholder could do about it. You had to grow food to have food and that takes time and a place where your crops can be cared for and be unmolested. If you are refugee running from war and of no settled place of residence you are forced to depend on the kindness of charity and the resolution of governmental authorities who are ambivalent about your survival. The fact is that black women were the most neglected segment of that population because they weren’t valued as laborers like men were. It was a very helpful and informative book. I recommend it to fill out your understanding of the Civil War and Reconstruction.

[Courtney · Rating 4 out of 5]

4.5 stars: This was a really tightly written and emotionally powerful read. There's one section in the conclusion that I think best summarizes some of the deeper questions of this book: "The narrative of American freedom implies triumph, celebration, and progress, but these terms leave little rhetorical room to tell the history of the thousands of freedpeople who were displaced from their homes, became sick, and died during the Civil War and Reconstruction. What does freedom mean if many people failed to survive the war and emancipation? If freedom cannot adequately articulate the ending of slavery, what can?" (168). The intense focus on small-scale administrative functioning and actual lived experiences bolsters these questions and provided so much to think about.

[Greg Parrott · Rating 3 out of 5]

This book describes how the end of slavery was not the end of suffering. The nation was not prepared for the 4 million freed-people and the freed-people paid for it in poor conditions and in death. Groups were shoved into camps if they were not "able-bodied" or worse, left to roam and fend for themselves.

[Ms211 · Rating 5 out of 5]

History of medicine in parts with the corresponding burdens placed on physicians due to bureaucracy. Surprised by the quotes that could be literally written by a physician today. The moral injury from the demands placed on them for large medical recording to receive funding for the freedmen and women.

[Rowland Hill · Rating 4 out of 5]

The Untold Story Of Reconstruction

Eye-opening book on the massive displacement of African-Americans during and after the Civil War and the deleterious effects on health and social structure. Even if you are familiar with the literature on Reconstruction this is a very worthwhile read offering a new perspective of the effects of the Civil War on the African-American population.

[Aubrey Hill · Rating 5 out of 5]

It really makes you understand how poorly things were managed during the civil war and after. Zero attempt at reconciliation led to a giant mess and mistreatment … and even continued enslavement of “formerly enslaved.” This book was the most honest look at how the institution of slavery continued after the emancipation proclamation, and should be required reading.

[Jennifer M. · Rating 3 out of 5]

Fascinating material but drawn out and dull. It felt like the author was repeating himself and I lost patience with it. I haven't finished it yet and I'm not sure if I will. I normally push through but I can't with this one.

[Sophie Nye · Rating 2 out of 5]

This was a book for a class I am taking. Definitely learned a lot of important information about freedpeople in a post Emancipation America. However, the book in general just didn't hold my attention very well.

[Tommy Rutherford · Rating 4 out of 5]

So much makes sense now

[Rachel · Rating 3 out of 5]

An interesting study on how freedom from slavery hurt the emancipated peoples health. I liked the overall conclusion and I thought it was argued well but found the writing to be a bit dry.

[Emily Rajner · Rating 3 out of 5]

narratives of illness!

[Emily Brown · Rating 2 out of 5]

Though I really wanted to like this book, it was more padding than fact. The padding was unfortunately quite a bit of introspective questioning and opinions about suffering. While I by no means want to demean the suffering of freed slaves during and after the Civil War, what I was expecting out of this book was medicine, while it offered psychology. If that interests you, this book is for you, as there is a good deal about the social treatment of freed slaves after emancipation. That itself was interesting, but not enough for me to finish this book, as I was hoping for medical treatments to be covered.

[Kevin Mcdougall · Rating 4 out of 5]

This book is unique in that it analyzes Reconstruction from a different lens. Downs argues that freed slaves did not have the opportunity to obtain freedom in the wake of the Civil War and emancipation because their poor health was a barrier. The Freedman's Bureau and the U.S. government, in general, were not prepared to take care of the 4 million freed slaves and this, along with racist ideologies, kept them from achieving their goal of transitioning ex-slaves into free citizens. Downs' evidence is plentiful and makes a compelling argument. It is a very interesting and powerful read.

[Scottsdale Public Library]

If you are interested in African-American history this is a good book to read. It gives you an insight on the treatment and suffering of the freed people after the Emancipation Proclamation was issued. It goes into smallpox outbreaks, organization of the Freedmen's bureau and other moments in civil war history (mostly heartbreaking) that most people are unaware of.

[Kirk · Rating 3 out of 5]

Grim, very grim.

[Ron Stafford · Rating 5 out of 5]

Very interesting monograph. It is about time, we start to focus on the horrors of Reconstruction.

[Mills College Library]

613.089 D7516 2015