Jim Downs: Civil War and Emancipation the "Greatest Biological Catastrophe of the Nineteenth Century."

Contraband during the Civil War. Credit: Wiki Commons.

January 1, 2013 will mark the one hundred fiftieth anniversary of the effective date of the Emancipation Proclamation.

We tend to think of the emancipation of African American slaves in the South as a celebratory moment of jubilation and ecstasy. But there is a darker, bitterly ironic side to this triumphant story -- a grim story of neglect and indifference to a vulnerable population of uprooted men, women and children left to negotiate their freedom in a hostile, war-torn, disease-plagued land.

Historian Dr. Jim Downs in his unprecedented new book Sick From Freedom: African-American Illness and Suffering During the Civil War and Reconstruction (Oxford), now chronicles the medical consequences of emancipation: horrific deprivation and mass illness and death. His original research reveals that, of a population of four million former slaves, at least more than one million became ill or died in the aftermath of their liberation in what he calls “the greatest biological catastrophe of the nineteenth century.”

In ten years of research, Dr. Downs studied more than 500,000 previously ignored records from doctors, abolitionist groups, military pension archives, and the Medical Division of the Freedman’s Bureau -- the first effort at a system of national health care in response to advocacy by freed slaves. He is the first to document the lethal threats to the health and survival of the emancipated slaves such as severe smallpox epidemics that killed tens of thousands of newly freed people, as well as cholera, yellow fever, starvation, dysentery, and exposure.

Sick from Freedom has been praised for its original research and its contribution to a growing re-examination of how emancipation and Reconstruction affected freed people. Acclaimed bioethicist Harriet Washington, author of Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present, wrote: "Sick from Freedom by Jim Downs traces a shrouded chapter of American history: the mass death and medical devastation that visited African Americans in the immediate wake of legal emancipation. Downs compellingly reveals how the confluence of racial slander, government indifference, and medical malign neglect proved widely fatal, and in doing so he paints a detailed and disheartening portrait of man's inhumanity to man."

Former slave children, circa 1870. Credit: New York Public Library

Dr. Downs is assistant professor of history and American studies at Connecticut College, and he specializes in the history of race, politics and medicine in the nineteenth century. He has written numerous articles and edited two previous books: Why We Write: The Politics and History of Writing for Social Change, and Taking Back the Academy!: History of Activism, History as Activism (co-edited with Jennifer Manion).

Dr. Downs recently discussed his new book and research by telephone from the East Coast.

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Robin Lindley: You call the medical consequences of the emancipation of the slaves “the greatest biological catastrophe of the nineteenth century.” What does that mean?

Jim Downs: The first part of it is that the war itself produces massive mortality and that mortality leads to outbreaks of disease. We know that more soldiers died from disease than from battle. That’s only exacerbated by the fact of massive dislocation during this period and massive migration. There’s movement of civilians from farms to cities. There’s movement of troops throughout the Confederacy, from the western theater and onto the Atlantic seaboard. And on top of that, you have massive dislocation sparked by emancipation.

When we talk about emancipation, we think about triumph and slaves finally free and dancing jubilantly, and running from southern plantations. That’s true, but we don’t think about where they go and how emancipation produced this dislocation and how that dislocation made former slaves vulnerable to the diseases that were destroying the military ranks.

Why I call it biological is that I found evidence all over, even about the death of animals. In chapter one, I footnoted glanders disease, which affected horses. What happened to horses that died? The [army] just left them. When they tried to respond to the dead horses, they would throw them in the waterways and pollute them. This was an era before microbiology and germ theory, so the same water that was used for waste and the dead bodies of animals was used for drinking water, and that further exacerbated the spread of illness. It’s not just diseases like typhus, pneumonia, and dysentery that affect the troops, but they’re also affecting the freed slave population. And there are major environmental crises that are taking place [as part of] this biological catastrophe.

What was the attitude of the Lincoln administration toward the freed slaves during the war?

On one level, in looking at the record, what I see the most is not Lincoln being the Great Emancipator and contributing to this liberation discourse, but instead everything is connected at that moment to the labor struggle. Even Lincoln says the Emancipation Declaration -- as many historians have noted -- is [issued] for [its] military necessity. That idea formed that template that shaped many of the policies that surround emancipation before and after formal liberation. Even before the formal liberation, you have the second Confiscation Act, that’s embedded with the labor power of freed slaves.

After the war, the government creates the Freedman’s Bureau, and all four divisions are invested in questions about labor, and even the medical division is concerned about how to take a population of people and make them into workers who can adjust to free labor when they’ve been stuck in a slave economy. As a result, the Medical Division of the Freedman’s Bureau is not a benevolent effort and it’s not about humanitarian concern for the health of freed slaves. It’s about how the federal government can develop a labor force, and it’s used as a way to discipline the population, to separate those who can work from those who, in nineteenth-century parlance, were not able-bodied -- those who could not work. So they’d take the disabled, the elderly, female former slaves and children and place them in hospitals and orphanages to separate them from those who could work. There’s always a concern among federal officials about freed people’s labor.

I read through Benjamin Butler, a leading official who is credited with using the term “contraband” to refer ex-slaves who were allowed to join Union camps in exchange for their labor. In his early writing at the time, he discusses the labor power that freed slaves could provide to the Union cause. It’s not until 1890 in his autobiography that he actually sees the policy he developed as a prelude to the Emancipation Proclamation. There’s a forty-year gap until he realizes what happened during the war and the consequences. That’s when the notion of emancipation as a liberating, revolutionary act begins to take shape, and the labor part of it begins to disintegrate and fall aside.

We remember this moment [of emancipation] more from a late nineteenth-century view as this revolutionary transformation, but at the time it’s seems much more invested in the question of labor from the vantage point of the government. Of course, from the vantage point of the freed slaves, it’s always connected to liberation.

The government’s fear of dependency of freed slaves seems to tie into all of its decisions, and that has resonance now too as we look at how any government aid to people is discussed.

Yes. So many discussions today on the Affordable Healthcare Act, etc., all get to the welfare state, the welfare queens. All of these policy terms hearken back to the moment of Reconstruction, which is when the notion of the state begins to develop. In tandem with the creation of the nation and the state is also the development of this rhetoric, this nomenclature used to describe these people who could, in the imagination of policymakers, depend on the federal government for support. They say “the charity of the government must be guarded.” That became a way that they articulated a fear of dependency on charity and that fear comes down to the present in discussions of welfare and other policies.

This fear that freed people would come to depend on the government was shared by Lincoln’s successor after the war, President Andrew Johnson. What was Johnson’s attitude toward the freed people?

One of the things I tried to do as a social historian was focus on what was happening on the ground and the records I looked at don’t always reflect the larger political decisions at first glance.

In terms of Reconstruction and President Johnson’s policies, those policies aren’t articulated in a clear way when it comes down to what’s happening in Shreveport, Louisiana, in 1865. But what I started to notice when I’d look at the records and step back from that, the biggest epidemic that hit was the smallpox epidemic that hit in the summer and fall of 1865. When you place that epidemic as exploding in the Sea Islands, then into the low country South, and then into the Mississippi Valley, you notice this is the moment of Presidential Reconstruction when Johnson is limiting federal agents, limiting the capacity of the Freedman’s Bureau, shutting down the intervention of bureau officials to actually do any kind of work. It’s because of that that this epidemic explodes in epic proportions. When Radical Republicans capture Congress by 1866 and 1867, you begin to see the epidemic slowing down because the doctors are given funding. It’s not a lot of funding, but just enough to have people in the South who can quarantine infected people.

There are efforts to vaccinate and inoculate these people, and the efficacy of that remains unclear. What you can see is that, when you have Johnson ousted and the opportunity for radical members of the Republican Party to take over, then they can allot money to the Bureau, which can then give the money to the doctors to arrest the spread of disease of the South.

There is not an understanding of germ theory at that time, but there is an understanding of how to treat smallpox. And there’s a lot of racist rhetoric and blaming of African Americans for spreading smallpox.

Right. And it’s an interesting moment in medical history at the nexus of old ideas of the eighteenth and nineteenth century, where disease causation is associated with one’s social or moral status or their appearance. In the mid-nineteenth century doctors begin to investigate physical surroundings -- the environment -- as a cause of the spread of disease. All of this is happening at the moment when this epidemic breaks out. In many respects, the medical profession is challenged by how to respond to this.

Despite this debate, there is an understanding of contagion. Even though germ theory had yet to be named in any clear way, but people understood contagion long before the eighteenth century. Here the question is why are they allowing people who are obviously infected to mingle and associate with those who aren’t. That’s when they fall back on a number of different discourses that were often unarticulated, [such as] ideas that black people are more vulnerable, or black people are sick because of their immorality, or black people can’t handle the challenges of freedom. All of these ideas come together to rationalize why this epidemic is breaking out.

This was a challenge of writing this book. These doctors aren’t providing copious notes on their understanding of disease causation and spread because they’re working during war or in a postwar environment. The challenge for me is to understand the medical ideas circulating at this time, and how these doctors are drawing on that, often without articulating that in their records.

During [the] period, there was a lot of blaming of former slaves for their conditions and health, and even Andrew Johnson embraced a racist view of their plight.

Right. His policy is returning power and authority to former Confederates and giving land back to them. That has a disastrous effect for the freed people. His policy is also aimed at getting blacks to return to the plantation South as agricultural workers. He might have a particular attitude, but I’m less interested in his attitude and more interested in the ways his policies led to the development of a labor force and how that abrupt and chaotic organization of a labor force accelerates the spread of disease.

The archival work on this project must have been extremely challenging and time-consuming.

It was. This project took more than ten years. I had to think about not having presentist notions about the intersection of race and medicine that came to a head in the early twentieth century, such as the discourses about black inferiority and eugenics. All of these discourses are twentieth-century phenomena for which there are copious records that detail what doctors thought.

In the nineteenth century doctors rarely articulate the relationship between race and medicine, and it seems as if they share a common set of beliefs that do not need to be articulated. It's only when those ideas are challenged that they get articulated. In the research, I had to compile any references I could find to help. I started at the National Archives, but most of the doctor’s letters didn’t provide much of a clue.

Where I ended up finding a lot of great detail was when I left the National Archives and I went to local historical societies in the North -- places that sent former abolitionists to the South to serve as teachers. But when these teachers arrived they realized they couldn’t set up schools, and they instead had to respond to the sick and suffering freed slaves. That gave me information about where disease was in the South, and that’s when I started honing in on the Sea Islands and Alexandria, Virginia. With that in mind, I could go back to statistical charts or areas where the Freedman’s Bureau was, and I could go to Alexandria and the Sea Islands, and I could contextualize the record in a richer way.

Most of this material follows nineteenth-century convention. “Did you receive my letter?” “I received your letter. When will I get your next report?” “I will send it.” You can spend a day in the archives not finding anything. But if you know that a teacher said in October 1865 that smallpox ravages in Ladies Island, then you can go to the Charleston records for October 1865 and see if there’s any reference.

It was a constant process of placing different archives and dialogues together in order to find something.

And weren’t you the first person to review many of the records of the Medical Division of the Freedman’s Bureau?

In the 1970s, before the publication of Eric Foner’s Reconstruction, [researchers] were doing shorter studies of the activities of the activities of the Medical Division in various places. There’s a study on what happened in Alabama, and another study about what happened in Georgia. They range from a focus on the doctors to working with the Bureau in particular areas.

Foner comes out with his magisterial and synthetic history of the Reconstruction in 1987. Instead of generating more questions, Foner’s book unwittingly shut down the field of Reconstruction and it became the defining book for the field. As a result, these studies of the Medical Division receded to the margins.

My book is the first to look at the Freedman’s Bureau at the national level. I do draw on some of the state studies, but I’m trying to do a history of public health and those studies were on the administrative works of the Bureau.

I was asking about the health conditions and the diseases. That’s why, for example, my book is the first to chart the smallpox epidemic and use that as evidence on Reconstruction.

Wasn’t Eric Foner your mentor? And he hadn’t looked at these health issues?

He was my dissertation advisor and his generation of historians was invested in another set of questions. He was interested in black political mobilization and thinking about how did black people actually got the rights of citizenship and how that movement began on the ground and escalated into the Fourteenth and Fifteenth Amendments. It was a different set of questions that wouldn’t lead him into the Medical Division’s record.

What sparked your interest in emancipation and its medical consequences for freed people?

I was working as a research assistant on the Harriet Jacobs Letters Project out of Pace University under the tutelage of Jean Yellin, and was assigned to annotate Jacobs's life while she was in Alexandria during the Civil War and Reconstruction. I began noticing many of Jacobs' references to the sick and suffering conditions of former slaves.  When I consulted the historiography on this subject, there were no references to it, so I began to do the preliminary research in my first few years of graduate school, and it later became my dissertation, and now a book.

I realize you can only estimate how many freed slaves became ill and how many died. What’s your sense of this terrible toll following emancipation?

It doesn’t ever lend itself to a clear figure or a pure statistic. There’s no balance sheet with an accurate number in large part because, during the war, there was no federal policy or protocol to count the number of dead free slaves. There was no accounting system. On one level, it’s completely unknowable.

Even during the postwar era, when the Freedman’s Bureau [keeps some records], we only see the number of people who are sick or die based on the number of people physicians come in contact with and were hospitalized. For example, a doctor in Orangeburg, South Carolina worked with forty-three people a week, and then one day a week would take a ferry to a rural location, and he’d actually write in a note, “I don’t know how many I’ve seen.” Or they would lose the record. They would send the number to Washington, and Washington would say we never got the number. So the numbers were jumbled and lost in the administrative workings even when there was counting.

So the numbers are hard to get at. I’m confident that over a million people were treated in this period (1862-1870) and that’s a low estimate. I know also that, according to one annual report, that 60,000 freed slaves died in the smallpox epidemic, but again that’s a really low number because, on the ground, I’m seeing local reports from the Sea Islands, for example, that nearly a quarter of that population died. And I saw records from doctors saying that they can’t keep accurate records.

The 600,000 figure for the number of people who died in the Civil War has been revised [recently] to 720,000, but that’s counting only soldiers. I’m saying that these [additional] soldiers that you’re counting are not dying from battle [but] from disease. If disease becomes the criteria to count mortality, why are we not counting the thousands and thousands of black freed people who died of similar diseases during this war?

We in the twenty-first century need to expand the categories of who is [counted as a casualty]. We’ve been using categories of the nineteenth century. The whole point of African-American history of the last century is that we can’t use those categories. We have to be more interpretive and more creative in the way we ask certain questions. Of course, when you ask a question based on nineteenth-century criteria, you’ll never get a number on black people, so you need to ask different kinds of questions to get to that number.

And weren’t there about four million emancipated slaves?

Yes. On the eve of the Civil War, there were four million slaves. Five hundred thousand were emancipated during the war. Slaves in the border states were not emancipated at first. That was a gradual process.

After reading your book, it’s surprising in a way that the morbidity and mortality were as low as about a million of these freed people suffering and at times dying of illness.

I think it was actually much higher. These are only people who turned to the Medical Division for support. Surely there were tens of thousands of other freed slaves who were doubtful about going to the Bureau for support or who relied on the support of their family or kin networks or who were in areas without the presence of federal officials to help them or who were getting support of former abolitionists so they wouldn’t have to turn to the government. Again, this number is really low.

I think some readers will ask why didn’t these freed people just go north where the conditions may have been healthier and more tolerable.

There were many issues. First, the Freedman’s Bureau was organized by the military. What I saw in the records, particularly between the end of 1864 and the beginning of 1865, were questions about military compulsion. Should they force freed slaves to move them from the upper South and into the North? They are moving from the lower into the upper South, but the government wants them to return to the plantation South as agricultural workers, but they can’t incentivize that and the [freed people] don’t want to go. So the question in 1864 was should the government use military force to return them? That’s what ultimately happens. The federal government rounds the men up and sends them back to the South.

That’s another notion I’m trying to emphasize in the book: the idea that freedom is the ability to be completely mobile is not the case. They are rounded up into labor gangs and forced to return to the South. There’s a gravity that’s pushing them back into the South.

Now some do make it into the North, but even then, the North is not the promised land. Steve Hahn talks about it in an eloquent way, describing it as a “maroon community,” like some secret subversive place. Some Northerners favor colonization, sending blacks back to Africa. So it’s not as if the North is welcoming former slaves.

And it’s also important to know that free Northern black people don’t see Southern freedmen as their brothers. Some do, but that Pan-Africanist notion is primarily from the early twentieth century with few references in the mid-nineteenth century. You have a middle- and upper-class backlash looking down on freed slaves. You have this conduct again in the early twentieth century, where you have blacks moving out of the South in the Great Migration and urban free blacks are looking down on Southern blacks as different.

So the North is not a utopia.

It’s very complicated. For us in the West, it’s especially noteworthy that -- as you describe -- the policies toward the freed people became a template for the treatment of Native peoples in the West.

I was just following the military. I realized that many of the officers were redeployed to the West once the Bureau ended. By 1869 and 1870, Congress no longer invested in the Freedman’s Bureau and shut it down. Around 1871, [President] Grant puts forth an estimated 2.1 million dollars to deal with the increased number of reservations in the West. In my estimation, there was a connection. You have [Bureau] personnel moving from the South to the West and you have money being allocated to the West, and you have a government that feels emboldened by the war to respond to questions such as the decades-long concern about Native Americans.

Reservations existed long before emancipation, but this notion that reservations would be powered by free labor and this discourse of dependency again develops. There’s a concern about transitioning Natives from hunters and gatherers to agrarian workers.

That discourse is identical to the policy that developed in the Reconstruction South. That you had people like Oliver O. Howard, who had led the Bureau and then led one of the major campaigns in the West, begs the question. What are the connections between these two policies and how are they articulated? The archival record is there but it’s not articulated all the time -- but clearly these men are drawing on their experience in dealing with the freed population and the Native population. They have different associations and connotations about what they mean, but that experience shapes that interaction.

Why did it take almost one hundred fifty years to tell this story, which is important for the history of medicine as well as the history of how freed people were treated?

Because it’s a polemical story to tell. On one level, any time one makes a reference to black health, it’s always in a charged political context. One always risks falling into a stereotype that could suggest certain ideas about black inferiority.

In the nineteenth century, this was a problematic story because pro-slavery Southerners grasped the story. You could read the Richmond Dispatch or De Bow’s Review and they will talk about the high mortality of blacks and use it as proof that emancipation didn’t work and that black people were better off in slavery and that black people were going to die out.

At the same time, abolitionists and those supporting the Reconstruction effort were invested in the idea that these people can handle the challenges of freedom and that rebuild the South with their work. You can see this today in questions about [Hurricane] Katrina. “Our efforts to rebuild New Orleans are successful.” And then, “our efforts to rebuild the South after the war are successful.” They don’t want to point to the fact that emancipation led to high mortality. Then, in the early twentieth century, historians following the cues of pro-slavery advocates see these references and blame black people’s health on a notion of innate inferiority.

By the 1960s and 1970s, a cadre of historians inspired by the civil rights movement want to reach back into this past to find [the movement's ancestry]. They end up with a notion of black people as invincible, robust political actors who can handle citizenship, so they don’t want to write about disease. When they see it, they say it’s the result of bigoted historiography and of the racist illogic of nineteenth-century doctors. We can’t trust these [sources], so [let's] ignore it, and let’s focus on how black people created schools and how they got the right to vote and how they fought for land and how they were manipulated out of earning any profit for their land or their labor. The struggle should be narrated within the labor struggle and the unfairness and inequity in the labor struggle. These questions of health again dissipate.

Thank you for your thoughtful comments. Is there anything you’d like to add about what you hope your readers take from your book?

When you have a big history book 300 pages long, I ask how would this translate to a fifth-grade history textbook -- from the graduate level, the college level. The book has to boil down to something a fifth grader can learn. What I would say is that many freed slaves did not survive emancipation. That’s the main point. In the history textbook for the fifth grade you would say something about the Emancipation Proclamation, but you’d put a comma and add, “but many slaves did not survive and the war produced chaos and disease and many slaves died in the moment of freedom, which is a bitter irony.” In a nutshell, that is the crux of the book boiled down to a sound bite.