Review: Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction

Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction by Jim Downs
My rating: 3 of 5 stars

The Emancipation Proclamation in 1863 was to be the defining moment for African Americans held in bondage. Slaves became freed people no longer forced into servitude. The Reconstruction era after the Civil War should have been a time for freed people to rebuild their lives on their terms. What many faced, however, were the vagaries of life, unknown challenges that would be life-altering and life-threatening. Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction by Jim Downs explores the medical issues that freed people faced during and after the Civil War. For people formerly held in bondage, life after the war led to sickness, disease, and death.

Downs explores the lives of freedpeople during and after the war years through the eyes of those that endured sickness, disease, and the death of loved ones. Downs also utilizes the experiences of medical caretakers and staff of the Freedmen’s Bureau, formally known as the Bureau of Refugees, Freedmen and Abandoned Lands, the agency employed to freed slaves and indigent whites in the aftermath of the Civil War. Down’s thesis suggests that the Civil War was the largest biological crisis of the nineteenth century. In their quest for freedom, former slaves endured diseases such as smallpox, cholera, dysentery, and yellow fever and received little help from doctors and staff of the Medical Division of the Freedmen’s Bureau. Children, women, and men often died before they could get the help they needed. These are the cases that Downs details along with data and statistics gleaned from physicians and hospitals that were underfunded and understaffed.
Downs supports his thesis by describing six areas that contributed to the devastating losses of freed people due to disease and sickness. Downs begins by looking at the political and social status of free people that led to unhealthy living environments. Downs posits that these conditions led to disease and outbreaks of illness and widespread epidemics. The second area that Downs details ask why disease broke out among unemployed freed people and why the bureau was unable to support a free labor system in the post-war south. In response to the labor crisis, The Freedmen’s Bureau establishes a Medical Division to handle the healthcare of freedpeople. Downs then transitions to a discussion on Freedmen Hospitals and the challenges faced within the structure and hierarchy of the Medical division of the Bureau. Downs feels that the hospital systems were unstructured and unable to handle the massive load of illness among freed people. Downs uses hospital records, and the lack thereof to support this discussion.

Downs then turns his attention to the smallpox epidemic of the late nineteenth century that left many dead in its wake. This discussion transitions into the fifth area that covers the outbreak of other diseases and sicknesses. Downs utilizes specific case studies of freed people and the challenges they faced in obtaining medical care.

Downs wraps up his thesis by highlighting the eventual downfall of the Medical Division of the Freedmen’s Bureau. Drawing on the autobiography of O. O. Howard, commissioner of the Medical division of the Bureau, Downs shows how the needs of the medical care of freed people transitions to state and local governments.

In the epilogue, Downs discusses the illnesses that affected Native Americans. Many of the same issues and concerns that freed people faced during Reconstruction, native Americans endured during the forced removal toward the west. Beginning with the Trail of Tears forced migration in the early 19th century through the Reconstruction, native people endured disease, illness, and death. Downs compares and contrasts the political, social, and medical issues that native Americans and freed people faced drawing parallels between the two groups.

Jim Down’s extensive research brought to life portraits of freed people who endured disease, sickness, and death in the aftermath of the Civil War and the staff and caretakers of the Medical Division of the Freedmen’s Bureau who were tasked to support free people during the Reconstruction era. Downs also reviews similar issues with poor white Americans and Native Americans and draws parallels to the issues faced by freedpeople. These case studies bring to light an area of the Reconstruction narrative often overlooked in Civil War scholarship. To truly understand how the war affected freedpeople during and after the war more attention and consideration needs more attention on all aspects of their lives, including sickness and death.


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