This book by Jim Downs tells about what happened to African-Americans after they gained freedom. Professor Downs, in introducing his subject, tells us, “The Civil War, however, produced the largest biological crisis of the nineteenth century, claiming more soldiers’ lives and resulting in more casualties than battle or warfare and wreaking havoc on the population of the newly freed. The causes of the high rates of illness and mortality during the Civil War resulted from various factors, including the unsanitary conditions of army camps, polluted waterways, unburied bodies of animals and soldiers, overcrowding, dislocation, and the medical profession’s uncertainty about how to respond to the massive epidemics that plagued the South, among other issues. Disease and sickness had a more devastating and fatal effect on emancipated slaves than on soldiers, since ex-slaves often lacked the basic necessities to survive. Emancipation liberated bondspeople from slavery, but they often lacked clean clothing, adequate shelter, proper food, and access to medicine in their escape toward Union lines. Even after the war ended, they continually struggled to survive in a region torn apart by disease and destruction.” [p. 4]
The fate of the freed people illustrates the comparative ignorance of nineteenth century medicine and its inadequate understanding of diseases and their causes. “Sick from Freedom reveals that tens of thousands of freed slaves became sick and died due to the unexpected problems caused by the exigencies of war and the massive dislocation triggered by emancipation. The distress and medical crises that freed slaves experienced were a hidden cost of war and an unintended outcome of emancipation. While sickness and epidemics certainly existed in the South before, the Civil War, like many major wars throughout the nineteenth century, gave rise to explosive epidemic outbreaks and inordinate mortality and suffering. … Military officials on both sides of the Mason-Dixon Line scrambled to develop effective medical corps and sanitary commissions, but the rapid spread of disease compounded by the lack of understanding of microbiology and germ theory during the mid-nineteenth century often thwarted their efforts. Furthermore, the destruction of slavery and the gradual erosion of the plantation economy, combined with the federal government’s initial ambivalence and often ambiguous plans on how to rebuild the South, left former slaves without an institutional structure to help them survive the biological crises that the war generated. The ending of slavery led to the abrupt dismantling of antebellum systems of medical care (both those organized by enslaved people and by individual slaveholders on local plantations), and it exhausted the networks of support provided by municipal almshouses and state hospitals.” [pp. 7-8]
Exacerbating the problems was the way the Union Army offered employment to the former enslaved people. “Economically, freedpeople’s health was often connected to their employment status. Without gainful employment, many freed slaves became sick during the early transition to the free labor economy. Military officials rigorously evaluated freedpeople’s bodies, determining who could work and in what capacity. … Unlike slaveholders, the military privileged the employment of men, which left thousands of freedwomen, elderly, orphaned, and disabled freed slaves without formal opportunities to earn incomes. Living under such uncertain economic conditions left many freedpeople vulnerable physically as well as economically. Compounding matters, both during and after the war, freedpeople suffered from limited employment opportunities in agriculture, the industry for which the government considered them most suitable. The war destroyed much of the land for cultivation, while drought and the crop failures of 1866-67 further devastated large parts of the South–leaving thousands of emancipated slaves penniless. The onset of famine in 1867 led to chilling mortality rates among newly freed slaves.” [p. 8]
Unlike state officials and local organizations, the Federal Government did attempt to respond to this situation. “The federal government responded to these appeals by arguing that state and municipal authorities in the South should assume responsibility for freedpeople’s health. These institutions, which had historically offered universal support to the poor and dispossessed, began to claim that they would only assist ‘citizens,’ who, according to their definition, referred to white Southerners; they summarily refused to provide assistance to formerly enslaved people. The federal government thus created the Freedmen’s Bureau to serve as a temporary institution to facilitate freedpeople’s quests for access to the benefits of citizenship. Under the auspices of the War Department, the federal created the Medical Division of the Freedmen’s Bureau, which included the construction of more than 40 hospitals and almshouses, and the employment of over 100 doctors and countless nurses, stewards, and aides to provide medical treatment to over one million freed slaves.” [p. 9]
Wrapped up in this was the training and attitudes of the physicians of the day. “At the beginning of the nineteenth century, American society questioned the efficacy of ‘regular’ physicians as healers who employed aggressive forms of treatment, which included bloodletting, purging, and vomiting, and turned to ‘irregular’ physicians or sectarians who practiced less aggressive forms of medical care, such as hydrotherapy and homeophathy. By the 1830s, a number of American physicians began to travel to France for medical education. there they learned to investigate the causes of illness and value science in medical diagnosis and treatment. When they returned to the United States, older generations of physicians were impressed with their scientific knowledge, but questioned their efficacy as healers. Consequently, a divide developed between doctors who valued the practical, experiential methods of healing and those who were formally trained and emphasized scientifically based medical treatment. Despite this intense debate, the architect of the Medical Division of the Freedmen’s Bureau did not take a direct stand on this issue; they neither committed themselves to a scientific approach that investigated the cause of illness and relied on new ideas about science to treat freedpeople nor did they identify themselves with healers while seeking to cure freedpeople from the many diseases that plagued them in the postwar years. Instead, Bureau doctors stationed throughout the South often provided treatment based on their own assessments, training, and understandings of medicine. Some Bureau physicians did attempt to investigate how the placement of privies led to outbreaks of dysentery among the freedpeople, while some hoped to prevent smallpox among freedpeople with rudimentary forms of vaccination. By and large, however, the majority of Bureau physicians simply responded to emergency medical crises and provided former slaves with basic necessities, such as food, clothing, and shelter. The distribution of these supplies indirectly suggests that Bureau doctors understood disease causation as rooted in the physical world, yet the Medical Division’s administration never formally issued a detailed protocol on medical treatment that Bureau physicians should follow. the common practice that unified Bureau doctors across the South was their use of nosological reports, which they sent to their supervisors in Washington, DC. That said, many Bureau physicians seemed to harbor beliefs that black people were inherently inferior and susceptible to certain illnesses and immune to others. Compounding matters, Freedmen’s Bureau doctors also interpreted freedpeople’s health through the highly charged ideological prism of the South as a distinct region with its own particular etiology. Consequently, their diagnoses often reflected stereotypes about the South and black people.” [pp. 10-11]
Eventually, the Federal officials were able to convince state agencies to take over care of the freedpeople by playing on racial fears of officials in those agencies, and what happened with freedpeople became a model for the West and dealings with Native Americans. “By late 1869, the federal government turned responsibility for freedpeople’s health over to state authorities, which had been their plan since arriving in the postwar South. Many military officials did not return home to the North, but were assigned to the Western territories, where they facilitated Native Americans’ transition from so-called nomadic life to federally organized reservations. The infrastructure that developed during Reconstruction for new black citizens was transplanted in the West and became a national strategy for Native American. Reformers who worked as teachers for the freedpeople also traveled west and established schools for Native Americans.” [p. 11]
This is an excellent, well-researched study of a topic that heretofore has been largely unknown. Professor Downs did an admirable job in placing all these actions in context and providing connections as well as giving us the full story of how freedpeople were medically treated and what happened to them. I can highly recommend this book.