Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction by Jim Downs (review)

In Sick from Freedom, Jim Downs argues that the Civil War and the emancipation of four million slaves brought about the “largest biological crisis of the nineteenth century,” one the federal government was both unwilling and ill-equipped to handle (168). In doing so, Downs complicates the celebratory narrative of emancipation that has been dominant in the scholarship for the past thirty years, resurrecting an argument that had been common (although poorly documented) among the Dunning school of Reconstruction historians. While thousands of slaves obtained freedom in contraband (refugee) camps, cramped and unsanitary conditions there contributed to the spread of epidemic disease and an untold number of deaths. The health crisis among newly freed African Americans continued, according to Downs, for years after the end of the Civil War, as the Freedmen’s Bureau proved ineffective in stemming its effects. Building on the scholarship of Sharla Fett, Margaret Humphreys, and Todd Savitt, Downs carefully and skillfully demonstrates how African Americans struggled with both heartbreaking health problems and a federal government unwilling to recognize the severity of the crisis.

Downs’s understanding of the emancipation health crisis draws heavily on records from the Freedmen’s Bureau Medical Division, a largely untapped resource for understanding Reconstruction and emancipation. These sources indicate that the federal government was grossly unprepared to deal with African Americans’ dire health issues during and after emancipation. Fears that African Americans would become dependent on the government pushed Freedmen’s Bureau officials to limit freedpeople’s access to health care. Downs readily admits that his sources do not allow us to hear how African Americans understood their illnesses and the sufferings of their loved ones. Sick black refugees are almost entirely nameless and faceless in the Medical Division reports, and they barely emerge as individuals in other records Downs uses, such as pension records and personal reminiscences. Nevertheless, the text is replete with dramatic examples of African Americans who suffered with disease during and after the Civil War.

Sick from Freedom examines the health consequences of emancipation in six chapters. The book begins with an exploration of how the nebulous political status of African Americans and unhealthy living conditions during the Civil War contributed to the outbreak of disease, culminating in the formation of the Medical Division of the Freedmen’s Bureau. Downs then examines the creation of Freedmen’s Hospitals and their ineffectiveness during a smallpox outbreak that killed thousands of freed slaves between 1862 and 1868. Final chapters detail how black women, the elderly, and children suffered particular hardship during Reconstruction and explain the decisions behind and the repercussions of the closure of the Medical Division of the Freedman’s Bureau. In the epilogue, Downs explores how the health problems African Americans experienced in contraband camps replicated themselves in the American West, where Native Americans suffered from similar mistreatment at the hands of the federal government.

This innovative text deserves a wide readership, and future scholarship on emancipation will have to take Downs’s work into account. Sick from Freedom fundamentally complicates the familiar narrative of emancipation established by Eric Foner’s Reconstruction (1988). While Foner emphasizes African Americans’ agency during Reconstruction, Sick from Freedom argues that whatever agency freedpeople had was limited by their health. However, the book is not without its missteps. Downs could have done more to contextualize African Americans’ health problems within the broader context of illness in the Civil War. While he occasionally touches on illnesses among white soldiers and civilians in the South, without more evidence it is difficult to assess his claim that African Americans’ health issues differed significantly from those of other disadvantaged groups such as white Unionist refugees, who also died in significant numbers from disease. Downs’s repeated comparisons between contraband camps and slave trading pens is unpersuasive. While both were undoubtedly cramped, unhealthy places, the comparison does not do justice...