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

In Jim Downs’s Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction, scholars of African American history, Civil War history, and American medical history will find a fresh account of African American death, suffering, and sickness during the Civil War and emancipation. Downs keeps his gaze trained on the denial of treatment, widespread illness and epidemic, and the generally callous hand that medical institutions and the U.S. government grudgingly extended to African American Union soldiers, former slaves, and their families.

Suffering and death haunt this book. Readers are privy to vivid accounts, mainly from reformers and Union Army personnel, about African Americans starving to death and dying of exposure, about smallpox sufferers literally turned out into the street. In Downs’s telling, racism combined with inept bureaucratic structures to create an environment of neglect and ill usage in which few were spared. Hardest hit were children, mothers, and the elderly who had scant potential for performing immediate physical labor for white supervisors. Readers of this journal will appreciate that reasons behind such misery are legion, but Downs has little patience for blaming the state of nineteenth-century medical technology. Although physicians were grossly misinformed about wide categories of illness and treatment, Downs argues forcefully that black people died of things they needn’t have.

Reading about nineteenth-century disease, epidemics, and sanitary conditions is always dreadful, and this book is no exception. Individual stories will stay with a sensitive reader for a long time—an African American Union soldier whose small son died of exposure on a cold Kentucky night after being turned out of a makeshift tent along with his mother and siblings, or a distraught freedwoman ordered to leave an encampment by boat so quickly that she could not bury her young child who had just died. Her fear of rats consuming her son’s small body drew little sympathy from a Union Army captain.

Downs usually meets the historical actors he is most concerned with in the days or hours immediately preceding their deaths, or in the throes of witnessing the suffering and deaths of loved ones. This, coupled with the widespread (nearly universal) illiteracy of the rank and file of former slaves and African American soldiers means that most of his sources come from white observers and actors. He draws creatively on reports from benevolent societies, memoirs from white reformers and aid workers, personal papers, and much Union Army and Freed-men’s Bureau material. Luckily, although he relies largely on these white-authored texts, his compassionate and indignant voice encourages readers to empathize and imagine what African American life and death.

Throughout the book, and woven into the stories that he retrieves out of a mass of paperwork, is a powerful argument about emancipation itself. Downs insists that understanding the scale of the medical crisis for African Americans during the war is critical to the idea of what freedom felt and looked like for those who were trying to experience it. Premature death and illnesses—both physical and mental—precluded thousands of African Americans from the very experiences we often understand to constitute freedom itself. Rather than learning to read, finding or even searching unsuccessfully for loved ones, legalizing marriages, earning wages, signing contracts, or voting, many thousands of African Americans experienced their emancipation from slavery briefly and miserably in dirty tents and shacks or abandoned outdoor spaces as they suffered and died from malaria, measles, smallpox, exposure, and malnutrition. This book reminds us that this grim portrait must be a part of any discussion of the years that messily separate African American slavery from freedom.

One small frustration with the book is the focus on African Americans who had things done to them or not, rather than on those who found ways to shape a successful or even meaningful emancipation. But...