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

It is an eerie coincidence that the letters of “emaciation” can be found within the word “emancipation.” Both of these concepts are at the heart of Jim Downs’s Sick from Freedom, which is as much about the relocation and institutionalization of African Americans in the post-Emancipation era as it is about the intersections of race and health. Margaret Humphrey’s 2008 Intensely Human zeroed in on the health of black soldiers. With the publication of Sick from Freedom, readers have a second study that, in considering a broader swath of humanity, offers a differential diagnosis on African Americans caught in the transition between slavery and freedom. Downs’s book explores how the development of government programs to manage the ex-slave population—particularly the Medical Division of the Freedmen’s Bureau created in 1866, almost as an afterthought to the Bureau’s mission of economic aid—exploited that population under the rhetorical guise of putting new citizens to work. So concerned was the federal government to claim success with its Reconstruction of the South that it scarcely kept data on the inmates of the forty freed people’s hospitals the Medical Division established in the postwar period, choosing instead to utilize nosological reporting which eschewed clinical details. Even a sidelong glance into containment facilities for the newly freed would have revealed the horrendous fallout of thousands who were dying of starvation and exposure.

In its conviction to put black men to work, the Bureau sponsored initiatives that helped freedmen find jobs as manual laborers, but which had unintended consequences for women and children. This putative gendering of the African American work force meant that freedwomen, whose expertise in agricultural and domestic work had been well documented during slavery, were now left without sponsored employment and thus a means of sustenance, which imperiled their families’ survival. The shattering of kinship networks during slavery indeed only hastened the deterioration of black health after it. The insupportable conditions in the winter of 1864 faced by the Joseph Miller family, for example, when all but Miller himself were ordered away from Camp Nelson, Kentucky, resulted first in the death of Miller’s seven-year-old son from exposure, and then in the death of every other family member, including ultimately, Miller himself. Downs notes poignantly that their emancipation was no “jubilee, but rather . . . a continuous process of displacement, deprivation, and . . . death” (21).

Caught between the political agenda of Bureau officials, who sought to demonstrate improvement in black health outcomes by closing down hospitals prematurely, and former Confederates, who read the declining health prospects of the black population as the inevitable result of removing black bodies from white planter protection, the African American ex-slave community was ripe for exploitation. Public fears about black dependency understood as the likely result of institutional help put the Bureau in a defensive position. Bureau leader and Civil War general Oliver Otis Howard saw the ameliorative potential of limiting the number of freed people with access to the Bureau’s largesse as an opportunity to appease legislators anxious to prove to constituents that ex-slaves were becoming self-sufficient citizens rather than a drag on scarce federal resources. Not only did political posturing fail to address black needs, but also did misconceptions about the resilience and medical mysteries of black bodies, such as physicians’ belief that blacks were immune to malaria—a misguided assumption that led in fact to higher mortality.

Downs’s commentary about the smallpox epidemic of 1866 and 1867 is scathing. In the fall of 1865, 800 blacks were dying of the disease every week, and by 1867, nearly 50,000 had perished—an estimate that is probably too low, given federal officials’ circulation of the “medical fiction” that only blacks were likely to contract smallpox and that the race would go extinct in a short time. Such propaganda, according to Downs, fueled the...