Doctoring Freedom: The Politics of African American Medical Care in Slavery and Emancipation

Conclusion

179 Conclusion For enslaved African Americans, the attainment of freedom and citizenship without health for themselves and their families would have been an empty victory. Even before emancipation, African Americans recognized that control of their bodies was a critical battleground in their struggle for autonomy, and they devised strategies to retain at least some of that control . The struggle of African Americans, since emancipation, for the right to health care and the right to become professional healers themselves is an essential part of the story of their struggle for freedom and autonomy. It also contains lessons for the present and future of freedom and health in the United States. Before the war, health and illness had appeared both as metaphors and as a vivid, ever-­present crisis in discussions of slavery, mastery, and racial hierarchy. Both abolitionists and advocates for slavery used the image of the wounded or healthy body of the slave in propaganda for their respective views. In literature by white abolitionists, references to the slaves’ scarred or sexually abused bodies provoked pity and outrage among readers . In slave narratives, physical abuse prompted the narrators to resist their owners, projecting an activist view of the slave. Proslavery writers used the image of a well-­ cared-­ for slave to support the system of slavery. Articles in agricultural and medical journals theorized that “African” bodies were biologically different from those of other Americans, making special medical treatment appropriate. Both before and long after emancipation , southerners and many northern army officers, Freedmen’s Bureau agents, reformers, and municipal authorities subscribed to the idea that African Americans were, by nature or as a result of slavery, dependent. Even reformers motivated by humanitarian concerns feared reinforcing dependency through provision of health care, including especially hospitalization. Both northerners and southerners theorized about the effect of emancipation on African Americans. Some saw wage labor as conducive to their 180 • Conclusion health; others worried that their health would suffer without close supervision by whites. Comparisons of slaves with free blacks and with workers in Europe and in the industrial North were used to warn against the dangers to white people if the slaves were freed and left without the paternal care of slave owners. During the war, the diverse experiences of African Americans as soldiers , laborers, domestic servants, and fugitives with masters in pursuit caused the meanings of their wounds and illnesses to shift radically according to each patient’s status and circumstances. While contrabands were often seen as lazy and as sources of contagion, those who volunteered for the Colored Troops were admired, their wounds considered marks of heroism. Once the war was over and Constitutional amendments ended slavery, bestowed citizenship on African Americans, and granted suffrage to African American men, ideas and beliefs formed in earlier years continued to affect African Americans’ experiences as patients. By turns, agricultural contracts after emancipation sometimes reflected the master-­ slave model of health care idealized by planters and sometimes the laborers’ yearning for autonomy. Even decades after emancipation, white authorities continued to imagine a threat of African American dependence and special vulnerability to disease, while African American patients at once struggled to overcome collective memories of slavery that made them suspicious of science and modern medicine and demanded quality care for themselves and their families. White medical journals continued to publish pseudoscientific studies contending that white and African American patients required different medical treatment, and white institutions continued to act on this ideology by rejecting African Americans as patients and students. The evolution of the actual medical care secured by African Americans during the early period of legal body ownership— ​ like their evolution from slaves to free people— ​ was neither straightforward nor predictable. As the former slaves gained ownership of their own bodies, their expectations of citizenship and freedom extended into the realms of sickness, health, and healing. Early hopes of freed slaves, both for a way of paying for medical care and for some control over care for themselves and their families, were only minimally realized. Provisions in agricultural contracts often resembled arrangements during slavery. Provision of medical care for people who were unable to work and who were not members of a worker’s immediate family was a thorny issue for laborers, planters, Freedmen’s Bureau agents, and local governments. During Reconstruc- Conclusion • 181 tion, when many African American men exercised the franchise, and in the early years of Jim Crow, when both the...