By Curtis Price

May 9, 2021

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Sick From Freedom: African-American Illness and Suffering During the Civil War and Reconstruction by Jim Downs (Oxford University Press, 2015

According to popular image, the end of slavery was an era of liberation, a happy ending to a bitter war, with jubilant ex-slaves embracing and flourishing under new freedoms denied in the regime of Southern chattel slavery. In this absorbing and well-documented book, Jim Downs questions this interpretation.

 The same troops that sung “John Brown’s Body” on marches, when confronted first-hand with disease and illness among slaves, closed down the informal settlements that had formed on the perimeter of Union camps, forcing newly free slaves away from Army bases.  Sometimes Union soldiers kidnapped escaped slaves and sold them back to their former masters. This continued after the war ended with military and Freedmen’s Bureau officials, obsessed with black bodies only as a source of labor, entering freedmen camps and communities, removing able-bodied men and shipping them to work on distant plantations.  (1)

As Downs notes, “many free slaves died once they secured refuge behind Union camps. Even after the war ended, they continually struggled to survive in a region torn apart by disease and destruction.”  (2) To Harriet Jacobs, a northern aid worker comforting sick freewomen surrounded by the dead and dying in Washington, D.C., wrote how their eyes seemed to cry: “is this freedom?” (3)

These conditions continued in the post-war period, when the Freedmen’s Bureau set up by Northern authorities, prioritized ex-slave health only as a means to get ex-slaves to return to the fields they had just fled. The objective of the Freedmen’s Bureau Medical Division was to support the emerging free labor system in the South and, by restoring workers’ health, return the region to productivity while avoiding “dependency” on government largesse.

***

Toward the end of the Civil War, thousands of slaves abandoned plantations and escaped behind Union lines, what W.E.B. DuBois famously labeled “a general strike” against the plantation system. But they arrived sick and famished, having trekked great distances, and at considerable personal cost. Their forced mobility, always on the run, meant that freedmen lost community ties, ties that had nourished slaves throughout slavery’s harsh regimens.

As the collapse of the Confederacy accelerated, in large part because of a refusal – the second, yet unacknowledged general strike of the Civil War – by Confederate draftees to fight “a rich man’s war,” kinship bonds among slaves further eroded and families were thrown on their own resources. Medical care that slaves had gotten on plantations or through informal systems of folk medicine within the slave community vanished.

Although a sense of personal and collective agency had helped slaves flee bondage, the other side of the coin that hasn’t gotten attention, as Downs points out, is that ex-slaves faced obstacles “that could not be defeated, no matter how willing or independent they may have been.” Ex-slaves confronted multiple biological crises – the need of bodies for nourishment, shelter, and respite from illness – that even the keenest sense of autonomy could not vanquish. (4)

The Union army had neither the resources nor the political will to address this onslaught of mass suffering. To Union commanders, the presence of so many sick and debilitated slaves hindered war efforts. The Emancipation Proclamation carried no clauses governing Northern armies’ responsibilities towards escapees nor any funding to address their plight, in large part because the Emancipation Proclamation was conceived in narrow strategic terms as an economic weapon undermining the South’s plantation work force, not as a measure promoting social or human rights for African-Americans. (5)

The Union army saw escaped slaves only as a potential source of extra man-power for the war, to relieve grunt work falling on white Northern soldiers. Able-bodied male slaves either signed on voluntarily or were forced to enlist for rations and shelter. Sometimes raids were conducted in camps and freedmen’s communities (a practice that continued, although reduced, during the post-war period with a few local representatives of the Freedmen’s Bureau.)

Women, children, the elderly, sick and disabled presented a special problem. In the eyes of Union commanders, sick slaves, women and children hindered mobility and used up scarce resources.  At times, escaped slaves were viewed only for their monetary value as chattel, such as when General Benjamin Butler wrote that “… more than $60,000 worth of them had come in” in describing an influx of escaped slaves behind Union lines.  Old slave pens from chattel days were re-opened by Northern troops as holding areas for escaped “contraband.” (6)

Without warning, Army officials sometimes suddenly broke up slave encampments, even after promising safety, and scattered escaped slaves elsewhere, even if this meant their risk of death from starvation or the spread of infectious diseases. Slaves, as Downs points out in his description of one slave family’s ordeals, “did not die from complicated medical illnesses or unknown diseases, they died because they did not have basic necessities.” (7)

The Army and, later, Freedmen’s Bureau officials wanted local authorities to take on responsibility for the welfare of ex-slaves, but local officials refused. Hostile to Emancipation, local officials in the South saw slaves as traitors getting their just deserts for abandoning the plantation. Ex-slaves were taunted over what they had lost from rejecting “benevolent” masters.  Many Southern officials found an opt-out by declaring since former slaves were never legally constituted as citizens, they were ineligible for local aid. (8)

This resistance to treating the medical conditions or providing basic social services of ex-slaves was a permanent feature of Southern official response from the end of the Civil War through Reconstruction – and beyond. To make matters worse, crop failures and drought swept through a South destroyed by war in the years after war’s end, making slaves’ survival even more precarious as available resources went to whites first.

Reacting to ground-level reports of the growing plight of emancipated slaves, the Federal government felt forced to act, setting up the Freedmen’s Bureau as a temporary stop-gap to assist desperate slaves’ entry into the new world of free labor. The Medical Division of the Freedmen’s Bureau, one of several sub-departments of the Bureau, each tackling an aspect of ex-slave welfare, was established by the War Department. The Medical Division built over 40 hospitals to tend to freemen’s health and hired over a hundred doctors. But these measures were just a drop in the bucket in proportion to the growing need. Very quickly, the hospitals became de facto poor houses, providing housing, food and clothing to emaciated ex-slaves.

Contributing to high death rates among ex-slaves were the racialized concepts of African health that dominated U.S. medicine in the Civil War era. Because slaves were wrongly seen as immune to malaria because of their African heritage, malaria cases among black troops, for instance, were ignored. Northern doctors sent to practice in Medical Division hospitals thought people of African ancestry had weaker constitutions than whites and thus when fell sick were either under-treated or outright ignored.  Some Northern Medical Division doctors, even when sent, refused to treat freedmen. Charles Cox, an Illinois Democrat congressman speaking in opposition to the Freedmen’s Bureau legislation, no doubt spoke for many in the North when he said, “no government farming system, no charitable black scheme can wash out the color of the negro, change his inferior nature or save him from his inevitable fate.” (9 )

The passage of the Freedmen’s Bureau bill led to a drop-off in involvement of Abolitionist Benevolent groups as former activists felt – wrongly, as it turns out – that the Federal government was now taking over work that had previously been done voluntarily by Northern abolitionist groups. Aid workers remained, but were sidelined and their observations ignored. At no point was any opportunity given by Northern authorities to freedmen to define their own needs. The anecdotes of suffering supplied by abolitionists were quickly replaced by the cold, impersonal calculus of raw numbers with no names attached.

The newly changed status from slave to freedmen needing to making their way as workers in a free labor economy meant that health benefits that were formerly provided on the plantation now had to be introduced into individual labor contracts – if offered at all. Often the costs were too high for freedmen to pay from their meager wages, so health benefits stayed unused as new employers – often the same slave owners as before – now transferred the costs of reproduction to workers in accordance with the principles of the free labor system.

President Andrew Johnson, hostile to the Freedmen’s Bureau from the start, was determined to reinstate the old system of labor control inherited from slavery with power now shunted to employers. To Johnson, all Bureau activities cultivated a culture of “dependency” that had to be tenaciously fought.

 Instead of taking up care of freedmen, however, the ex-slave owners ignored their plight, leaving the stench of rotting bodies hanging in the air as corpses piled up in city streets. In Chattanooga, for instance, one Army official wrote that freed slaves were “dying by scores – that sometimes thirty per day dies & are carried out by wagon loads, without coffins, and thrown promiscuously, like brutes, into a trench.” (10)

O.O. Howard, then head of the Bureau, ignored Johnson and set up medical facilities anyway. But even Howard bucking the system was done with a commitment to the same goals. As Howard wrote, “the negro should understand that he is really free, but on no account, if able to work, should he harbor the thought that the Government will support him in idleness.” (11) When confronted with rising numbers demanding help, Howard concluded the problem was not unmet needs but instead a dangerous trend toward permanent dependence on state intervention.

(DuBois, in Black Reconstruction only mentions the Medical Division in passing but cites success stories such as the death rate among ex-slaves being reduced from 30% to 2.03%. Dubois couldn’t have been aware that the Medical Division’s statistics should be treated as suspect, inflated to make the Division’s work appear more successful than it was.)

This, of course, was done to justify winding-down services and proving to Congress that the war against “dependency” had been won.  Federal Reconstruction officials as a whole needed to paint for Northern public opinion optimistic pictures of a booming South. To this end, Northern journalists were given tours touting the South’s rebirth under Northern tutelage, tours that showed happy freedmen working in fields and masked mounting black suffering offstage.) (12)

In many rural areas, where need was the greatest, overworked Division doctors lacked both time and resources to comply with the Division’s onerous bureaucratic reporting standards, leading to case undercounts. In the countryside, many ex-slaves died anonymous, unrecorded deaths from illness and starvation in bushes and forests without ever encountering a Medical Division doctor.

Yet even at their height, Medical Division hospitals could only treat an average of 20 patients at a time. Sometimes, hospitals and aid programs were forced off their sites so the land could be returned to former slave-owners.  Howard at first hoped to recruit doctors from the military to staff medical programs. But most Northern Army doctors left the South, with many openly expressing their lack of interest in treating black patients. (13)

Starved of funding, pressured by Northern officials to shut down as soon as possible, local hospitals were forced to improvise. Some Doctors hired patients to do menial work and were paid in food rations. Hospitals were told by Howard to grow their own vegetables on scraps of unused land to lower costs, A few defied Federal authorities and hired local workers anyway. Outside associations such as the Colored Benevolent Societies raised funds and provided food and clothing.

But Federal officials used this outside support as an excuse to further cut funding. The primary objective was to get fields back running again. As Downs notes, “ . . . Radical Republicans and members of Johnson’s administration who otherwise disagreed on the objectives of the Bureau – shared a view of ill-health as it related to one’s ability to perform arduous field labor.” (14) Later, in 1866, the Radical Republicans argued for able-bodied freedmen to be denied health care or assistance if they didn’t go back to the fields – a position indistinguishable from Johnson’s.

Left out in both Johnson and Radical Republican calculus was any acknowledgement of the role of war and internal displacement in stoking illness. Everything was narrowed to simplistic ideas of a “will to work” that was either present or not. The larger structural impediments to employment such as a ruined economy and infrastructure were never considered

During this period, dating roughly from 1862-1865, smallpox raged throughout the South, undoubtedly aided by freedmens forced dispersion. Smallpox carried a stigma of affecting the immoral, poor and promiscuous and carriers avoided public attention, making it harder to practice quarantine. Ex-slaves, for instance, hid evidence of infection from white eyes because they feared being told infection was God’s disproval of Emancipation. As smallpox spread up the Atlantic coast, military officials in D.C. pressured many freedmen to go back over the Potomac River, where they were warehoused in former slave pens in Alexandria; others were just abandoned to die. (15)

Smallpox was spread by large movements of freedmen, often forced out by local Freedmen’s Bureau to seek services elsewhere. Tragically, many freedmen viewed freedom as the right to go wherever they pleased and thus unwittingly carried smallpox with them.

Susceptibility to illnesses such as smallpox for both Northern and Southern officials became one more sign confirming Africans’ inherent racial inferiority. The role of overcrowding and lack of housing escaped notice as a cause, even as both factors were acknowledged as exacerbating conditions when applied to whites. Instead, smallpox offered “proof” that blacks and whites had different biologies. Widely accepted as fact was the theory that African slaves were inherently doomed to die out, like Native Americans, and treatment was futile in stopping this inevitable outcome. As one religious leader spoke in 1863 about Africans, “Like his brother the Indian of the forest, he must melt away and disappear forever among the midst of us.”  (16)

These views were also held in the top leadership of the Freedmen’s Bureau Medical Division and officials refused to provide adequate funds to build separate facilities – pest houses – to house the infected. The logic was since freedmen were inevitably slated to become extinct, efforts to stem the spread of smallpox through basic sanitation measures and vaccination were futile. Thus, Federal officials refused to follow long-known strategies for containing smallpox that had been standard practices for decades.

Occasionally, freedmen organized to demand better protection. In New Bern, North Carolina, a group of freedmen successfully approached a commander alleging the Freedmen’s Bureau superintendent committed “oppression and outrages.” In Columbia, SC, ex-slaves demanded an end to the unsanitary conditions at the local smallpox hospital. At other times, freedmen, not trusting the Northern military with their health and exercising what they felt was their new freedoms, refused to cooperate with Union army campaigns for mass vaccinations. (17) But such protests were rare.

By the time the Freedmen’s Bureau Medical Division was shut, few of its hospitals remained. Although a handful of dedicated doctors and Northern volunteers continued to provide health care to newly emancipated slaves, these scattered efforts could never meet the overwhelming need. From then on, freedmen would be at the mercy of employers or their own wits and the first experiment with government-sponsored health care consigned to history.

***

In many ways, the end days of the Confederacy saw a horizontal shift in suffering as Union troops and later Freedmens’ Bureau officials, confronted with the immense suffering of escaped slaves, refused to respond, leaving tens of thousands to die of hunger, exposure, and disease. Why are these circumstances unknown? As Downs points out,

“The few and scattered references of freedpeople suffering from the challenges of emancipation have been overlooked because these episodes do not fit into the patriotic narratives of the Civil War. Frozen feet and starvation complicate accounts dominated by heroic black soldiers or freedwomen in Union camps caring for both freed slaves and Northern troops. These carefully cast representations of freedpeople were often created by white authors in the late nineteenth century who strove to highlight the happy outcomes brought by emancipation. Recounting the hardships endured by former slaves during emancipation risked sending the erroneous message that the institution of slavery was no wholly cruel – inadvertently supporting the argument of antebellum pro-slavery advocates in response to the abolitionist movement” (18)

Alongside the exalted phrases of the Emancipation Proclamation and stirring accounts of black freedom during Reconstruction, we also need to center the experience of an anonymous freedwoman living in a dump cart in Montgomery who passed out while giving birth, only to find when she woke that hogs had devoured her baby. (19 130) She too is a face of Reconstruction and her baby’s death a case of social murder, perpetrated by the indifference of both Northern and Southern authorities alike, when confronted with the mass suffering of ex-slaves in the Civil War and Reconstruction eras.

Notes

1) Jim Downs, Sick From Freedom: African-American Illness and Suffering During the Civil War and Reconstruction (New York: Oxford University Press, 2012), 37, 123.

2) Downs, Sick From Freedom, 6.

3) Downs, Sick From Freedom, 162.

4) Downs, Sick From Freedom, 6.

5) Downs, Sick From Freedom, 38.

6) Ibid.

7) Downs, Sick From Freedom, 21.

8) Downs, Sick From Freedom, 68.

9) Downs, Sick From Freedom, 61.

10) Downs, Sick From Freedom, 27.

11) Downs, Sick From Freedom, 73.

12) Downs, Sick From Freedom, 144.

13) Downs, Sick From Freedom, 83.

14) Downs, Sick From Freedom, 93.

15) Downs, Sick From Freedom, 99.

16) Downs, Sick From Freedom, 103.

17) Downs, Sick From Freedom, 109.

18) Downs, Sick From Freedom, 6.

19) Downs, Sick From Freedom, 130.

Further Reading

Harris, Paul. “How the end of slavery led to starvation and death for millions of black Americans. “ The Guardian, January 16, 2012. Retrieved from https://www.theguardian.com/world/2012/jun/16/slavery-starvation-civil-war?fbclid=IwAR1Zv08337Uwv090IoP_RWnWTYcEWVt6F3hcsjwj-rADQR13hWGoQtaM6Sk