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Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction 1st Edition
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In Sick from Freedom, Downs recovers the untold story of one of the bitterest ironies in American history--that the emancipation of the slaves, seen as one of the great turning points in U.S. history, had devastating consequences for innumerable freed people. Drawing on massive new research into the records of the Medical Division of the Freedmen's Bureau-a nascent national health system that cared for more than one million freed slaves-he shows how the collapse of the plantation economy released a plague of lethal diseases. With emancipation, African Americans seized the chance to move, migrating as never before. But in their journey to freedom, they also encountered yellow fever, smallpox, cholera, dysentery, malnutrition, and exposure. To address this crisis, the Medical Division hired more than 120 physicians, establishing some forty underfinanced and understaffed hospitals scattered throughout the South, largely in response to medical emergencies. Downs shows that the goal of the
Medical Division was to promote a healthy workforce, an aim which often excluded a wide range of freedpeople, including women, the elderly, the physically disabled, and children. Downs concludes by tracing how the Reconstruction policy was then implemented in the American West, where it was disastrously applied to Native Americans.
The widespread medical calamity sparked by emancipation is an overlooked episode of the Civil War and its aftermath, poignantly revealed in Sick from Freedom.
- ISBN-100199758727
- ISBN-13978-0199758722
- Edition1st
- PublisherOxford University Press
- Publication dateMay 14, 2012
- LanguageEnglish
- Dimensions9.3 x 1.1 x 6.4 inches
- Print length280 pages
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Editorial Reviews
Review
"An important challenge to our understanding of an event that scholars and laypeople alike have preferred to see as an uplifting story of newly liberated people vigorously claiming their long-denied rights." - The New York Times
"Downs has written a scholarly book about emancipation that should open a whole new discussion about how it was achieved. If there is any doubt about his assertions, he has included 56 pages of footnotes." -- The Washington Post
"Jim Downs' exceptional research has resulted in a major study ... Highly recommended." --Civil War News
"As Jim Downs makes clear in this carefully documented work, the Union leadership, domestic and military, was wholly unprepared to deal with the breakdown of the system of slavery that followed the Union army with every foray into southern soil. ... However one may 'spin' the story, one comes away from this book with no doubt that the path out of slavery was a minefield of death and disease that needs its proper acknowledgment in histories of reconstruction." -- Journal of the History of Medicine and Allied Sciences
"James Downs' Sick from Freedom is a signal contribution to the vastly understudied question of freedpeople's health and a formidable challenge to the dominant analytical framework that has heretofore framed our understanding both of the transition from slavery to freedom in the American South and the meaning of death and dying in the era of the Civil War. It, quite simply, remaps a field. Against an archival record of statistics--of so many bodies sick or dying and denied access to local and state hospitals and asylums--Downs gives us the story of a people, of individual men, women and children 'dying to be free.'" -- Thavolia Glymph, Duke University
"A fresh and ambitious account of the Civil War era that not only interrogates the transition from slavery to freedom in new and unsettling ways but also invites us to rethink the geographical dimensions of Reconstruction." --Steven Hahn, University of Pennsylvania
"Jim Downs's Sick from Freedom charts new, darker, and profoundly revealing paths into the history of the American emancipation in the Civil War. In a work of medical, social, labor, and military history all at once, Downs shows that achieving freedom for American slaves was a signal triumph, but only through a horrible passage of disease, suffering and death. A 'new' history of emancipation is emerging, and Downs is one of its most talented and innovative craftsmen. This book demonstrates that emancipation is real history and not mere sentimental celebration." --David W. Blight, author of American Oracle: The Civil War in the Civil Rights Era
"In Sick from Freedom, Jim Downs paints a startling and little known portrait of African American emancipation in which struggles for health and survival must be factored alongside the political and economic history of the period." --Sharla Fett, Occidental College
"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." --Harriet Washington, author of Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present
About the Author
Jim Downs is Associate Professor of History and American Studies at Connecticut College. He is the editor of Taking Back the Academy: History of Activism, History as Activism and Why We Write: The Politics and Practice of Writing for Social Change.
Product details
- Publisher : Oxford University Press; 1st edition (May 14, 2012)
- Language : English
- Hardcover : 280 pages
- ISBN-10 : 0199758727
- ISBN-13 : 978-0199758722
- Item Weight : 1.1 pounds
- Dimensions : 9.3 x 1.1 x 6.4 inches
- Best Sellers Rank: #1,155,387 in Books (See Top 100 in Books)
- #313 in U.S. Abolition of Slavery History
- #1,237 in History of Medicine (Books)
- #4,777 in African American Demographic Studies (Books)
- Customer Reviews:
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About the author

Jim Downs is the Gilder Lehrman-National Endowment for the Humanities Professor of Civil War Studies and History at Gettysburg College.
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Escaping from slavery involved the loss of a means of livelihood, the loss of the medical care masters had provided, often the loss of shelter. The Union government was unprepared to deal with this crisis, and, as Downs tells it, wasn't much inclined to do so. During the war the army herded many freed slaves into filthy "contraband" camps that were sometimes literal death camps on a par with Andersonville and Elmira.
After the war the freedpersons faced enormous challenges in trying to adjust to the new free labor economy. Partly because of race prejudice, partly because of the 19th century's aversion to the poor being maintained at government expense, the federal authorities made little effort to provide relief. The Freedmen's Bureau did make a serious effort to provide education, but this was a long term solution, and a short term one was needed.
Again and again, Downs records instances of malign neglect of freedperson's needs on the part of the government. Although he regards the Freedmen's Bureau's Medical Division as a historic innovation--the federal government's first incursion into health care--he still gives the Division poor marks for how it did its job. About the only Yankees who come off well in this book are the non-governmental philanthropic associations, which did their best, but didn't have the resources needed to handle the crisis.
Downs says that his book is intended as a corrective to the "triumphant" narrative of emancipation. Such a corrective may be needed, but at times he writes as though emancipation was an almost entirely negative experience, although perhaps that isn't the intended message. I think he is overly critical of the Union for its policy of putting freed slaves to work on plantations. It was essential to procure employment for the freedpersons, and most of them had no skills but farming. There were abuses, but I think the policy goal was sound.
The thing I most want to address is Downs contention that "hundreds of thousands" of African-Americans died as a result of emancipation. If true, it casts serious doubt on the morality of emancipation and the war. But I think there are grounds for challenging it.
The mortality in the contraband camps was dire, ranging from a low of 5-6 percent to a high of 25 percent. But since less than a quarter of a million passed through the camps, this toll could not mean hundreds of thousands of deaths.1
As for the ex-slaves who remained outside of the camps,--the vast majority-- it is impossible to say if their mortality was greater than it would have been without emancipation. Downs actually acknowledges this on pg. 54. But almost everywhere else, he attributes nearly all deaths to the war and emancipation.
The Bureau's Medical Division may have been inefficient, but nothing like it had existed before. It may have saved some lives that would have been lost if slavery had continued. Despite the dollar value of their slaves, many masters provided them medical care that was sub par even by mid-19th century standards. Conditions in some slave hospitals were worse than anything Downs reports for the Bureau's hospitals.2
Also on pg. 54, Downs cites an account of ex-slaves reduced to sleeping on a bare floor. They might not have had it better before; on the plantation where Frederick Douglass was born, the slaves habitually slept on the earth floor.
Downs reckons as part of the cost of the war the smallpox epidemic of 1862-67, whose 50,000 dead were overwhelmingly African-American. He attributes much of the mortality to the federal government's failure to take serious preventive measures, because it did not regard the epidemic as a threat to white people. But would an independent Confederate government have behaved any differently? It probably would have left the health situation to individual masters to deal with, and they could not have coped.
It may be that in the long run the war saved more African-American lives than it cost, or even more than than it cost among white and black civilians together. There was a substantial reduction in African-American mortality in 1900-1940. It is doubtful if the improvement would have been as marked if those people had remained in slavery, or had only recently been freed.
Despite these objections, I would strongly recommend this book.
1. "Camp Life of Contrabands and Freedmen", Joel W. Shinault, digitalcommons.auctr.edu James Oakes, Freedom National, pg. 421
2. Todd L. Savitt, Medicine and Slavery, Diseases and Healthcare of Blacks in Antebellum Virginia, pg. 219-226, Kenneth Stampp, The Peculiar Institution, pg. 317-318
I was angered at some of the Federal programs that caused more harm than good, but I was happy to hear of all the charity afforded to the freed people by various organizations and individuals from the North. The author, through snippets of information, was able to bring to life stories of real individuals beyond the statistics. He could achieve this feat only by a painstaking review of voluminous records, which can be seen through his 55 pages of notes and 16 pages of a bibliography.
I was cheered to see the valiant efforts of a young and struggling medical establishment dealing, not only with the expected consequences of war, but also with the unforeseen consequences of the largest biological crisis of the nineteenth century.
In the end, Mr. Downs's book is a tribute to the indefatigable human spirit of the freed people who survived all these crises and made our country so much the better for it. In the current debates about health care for the needy and safety nets for the poor, one need only read Downs's book to obtain a unique perspective, as these issues were very much in the forefront during the Civil War and its aftermath.
The book's epilogue gives a glimpse of Native American suffering in the West and the Southwest. I hope that Downs's future books can paint for us a more detailed picture and appreciation of the Native American plight as this book so vividly has given us a gripping picture of African-American illness and suffering during the Civil War and Reconstruction. Kudos to Downs for a job well done on this book.










