Abstract
Until recently, historians of slavery in the United States have understood emancipation in the United States within the framework of American exceptionalism. Contrasted with the gradual processes that finally ended human bondage in Latin American and the Caribbean, emancipation in the United States was long understood as a discrete event, precipitated by the crisis of the Civil War and enforced by the armed power of the American military. Not only does Jim Downs’s Sick from Freedom contribute to a growing literature challenging this traditional narrative, but its focus on the widespread illness and suffering of former slaves during and after the war also illuminates the tragic limitations of federal and state responses to physical displacement that accompanied emancipation. Overlooked or avoided by historians of slavery whose recent emphasis has been on African American agency and autonomy, the chilling evidence in Sick from Freedom is an important reminder that disease and physical illness often confronted former slaves with obstacles ‘that could not have been defeated no matter how willing or independent they may have been’ (p. 6).
Downs argues that the American Civil War was the ‘largest biological crisis of the nineteenth century’, and his evidence is quite compelling (p. 168). The mobilization of huge armies and the population movements that accompanied their deployment in various parts of the South not only created unhygienic conditions in the camps and surrounding regions, but also introduced pathogens to populations with little previous exposure to them. Totally unprepared for the size and scope of the epidemics that swept through the army, the Union military’s medical staff had little time or inclination to respond to the terrible conditions that refugee former slaves faced in hastily constructed ‘contraband camps’ which Downs accurately describes as holding pens. Setting an important precedent that defined medical policy for the next decade, military authorities evaluated the health or illness of black refugees mainly in relation to their ability to labour. Black men who appeared well enough to work were conscripted for labour with the army or in ‘free labour’ colonies such as Port Royal Island, South Carolina, while those deemed physic-ally unfit were relegated to camps where freedom was sharply limited and where the lack of adequate food and shelter caused disease and death. Following these practices into the post-war period, Downs shows that medical officials generally refused medical care to those deemed healthy enough to work, while consigning the elderly, orphans, and the permanently disabled to poorly funded asylums or almshouses.
While historians of Reconstruction have generally celebrated the assertiveness of former slaves in demanding political rights in the aftermath of the Civil War, Downs refuses to avert his gaze from the persistence of illness and suffering among the freedpeople. He also offers a sharp indictment of the ways in which both racism and the capitalist free labour ideology vitiated state and federal responses to it. The creation of a Medical Division of the Bureau of Refugees, Freedmen and Abandoned Lands was a landmark event in the history of federal responsibility for the health of American citizens, but Downs demonstrates that its ability to alleviate the physical plight of freedpeople was compromised by extreme underfunding and a belief that consistent medical care for former slaves would reinforce their supposed inclination toward chronic dependency. During the periodic outbreaks of smallpox, moreover, medical officials were also hampered by a widespread notion that African Americans were inherently more susceptible to the disease and that its prevalence among them presaged their ultimate extinction. Despite growing knowledge among medical scientists about the environmental causes of disease, the government failed to respond effect-ively to the outbreak of the disease among blacks because they attributed it to ‘biological differences among the races’ (p. 103). Although Downs found that white activists with abolitionist backgrounds often acted as advocates for sick and suffering freedpeople, they were unable to dislodge the basic assumptions about race or labour that guided federal policy.
Downs successfully places physical suffering at the centre of how former slaves ex-perienced emancipation, but he is less effective in his attempt to show how the persistent demands of former slaves for assistance and medical treatment promoted their claims to citizenship in the post-war nation. While he does provide evidence that federal author-ities used the threat of diseased or mentally ill African Americans to force state institutions to reverse their policy of excluding black patients, there is no direct discussion of medical care as a formal political issue during Congressional Reconstruction. If medical claims upon the state were, as Downs suggests, an element of grass-roots activism in the South, how were those claims translated into policy debates at the state level by black leaders? Indeed, there is very little discussion of Southern black political leaders or their formal discourse of rights in Sick from Freedom, a curious omission given the book’s concluding contention that ‘health formed a central part of freedpeople’s campaign for rights’ (p. 166).
But this observation should not detract from the fact that Sick from Freedom is an important book that illuminates a long-neglected aspect of emancipation in the United States. In the midst of reflections on the sesquicentennial of the Emancipation Proclamation, Downs’s work is a stark reminder that slavery did not end in a shining moment of wartime liberation, but in a long struggle against racism, violence, and physical suffering.