Oft regarded as an apex of patriotism, the pinnacle of enlightenment, a reverential moment for the ages, the emancipation of enslaved-African Americans in 1863 — to be made official in 1865 — was, in reality, a time of extreme turmoil for newly freed men and women. “They ended up entering into a world that was plagued by disease and suffering,” says Dr. Jim Downs. “Let us understand what was really at stake — yes you’re free, you’re liberated, you can dance in the street. But where did you sleep that night, where did you eat? What about when you entered into the Union camp and there was an outbreak of measles?”

Downs, an associate professor of history and American Studies at Connecticut College, is the author of Sick from Freedom: African American Illness and Suffering during the Civil War and Reconstruction, a 178 page (not including 56 pages of footnotes) deep-dive into the health of freedpeople during the late 19th century. He will be speaking on the topic at the MUSC Waring Historical Library’s Joseph I. Waring Jr. lecture this Thurs. April 19 at 5:30 p.m.

Waring library curator Susan Hoffius says Downs fits the bill as far as the annual lecture series goes, “We like to bring in a speaker who looks at the history of something, who brings in this moment in time and gives us an opportunity to understand where we are today.”

Downs is certainly of the former moment, living and breathing research, mired in historical documents — Sick From Freedom includes, in great detail, records from the Freedmen’s Bureau, negotiations between Bureau doctors and municipal officials, even an 1868 petition from emancipated slaves in Summerville, asking that the Bureau hospital be in place for another year. But he is also firmly placed in the present, writing in his conclusion (and nodding to a current hot debate topic), “The Medical Division [of the Freedmen’s Bureau] illustrates that freed slaves were the first advocates of federal health care.”


Sick From Freedom came came out in 2012, in advance of the 150th anniversary of the Civil War, but it was percolating in Downs’ mind for some time before then. “My project developed over two decades ago,” he says. “I was coming across all this stuff in popular media about stereotypes of black health and about them being ‘inherently inferior.’ All these silly arguments about being affected by different diseases. I was in grad school and started to do research about the Civil War.”

As most former high school students could answer correctly on Jeopardy, more soldiers died of disease in the Civil War than from battle or battle wounds. But, queries Downs, “what happened to the hundreds of thousands of slaves who were freed and entered into that same environment? The same patterns we see today about black health about ‘what black people did to themselves’ we see in the 19th century.”

The records and statistics which Downs finds and includes in Sick From Freedom paint a very different picture of the epic, glorious end to the Civil War and the subsequent freeing of enslaved human beings than the one the public may be used to reading. The accepted narrative of the end of the Civil War is that “it’s this the story of freedom, of Lincoln as this great hero. But that’s not true,” says Downs.

The idea that the approximately four million freedpeople could go and exist in a healthy, successful fashion perpendicular to their white neighbors after Emancipation falls in line with the modern day theses, posited by some, that certain health issues are particular to a race, or that particular crises or epidemics are the fault of a certain race. In reality, as Downs so expertly lays out in Sick From Freedom, freedom from slavery was not the end of slavery. It wasn’t even close.

When the Freedmen’s Bureau was established in the South in 1865, its mission was to transfer care of disabled and “indigent sick” freedpeople to state and local authorities or charitable organizations. But the state and local governments refused to acknowledge freed people as citizens, which meant they were not eligible for medical services. Free men and women, lacking the official title of “citizen” would starve, suffer from untreated smallpox (a disease with a known cure at the time), and other infectious diseases. The 1866 Civil Rights Act, a precursor to the 14th amendment, defined freedpeople as citizens, but as Downs writes, state and local government “operated according to their own political agendas.”

When the Freedmen’s Bureau, often through “piecemeal arrangements,” was able to finally secure freedpeople proper or close to proper medical care, the freedmen and women often had to deal with the stigmas propagated by the Bureau. Downs writes, “Bureau physicians would have to convince medical authorities that the freedpeople were paupers or they would manipulate communities by inciting fear and danger…the tactic may have relied on racist perceptions, but it worked.” Even when freedpeople were admitted to hospitals, asylums, or almshouses, it was often based on fear of otherness, not charity for humankind.

Similar to the media that inspired Downs to research the history of black healthcare in the first place, the newspapers of the 1860s-70s would “propagate the medical fiction that smallpox only infected black people.” The Bureau was not a total wash — by the 1870s, a pension system was established that allowed freedpeople to document specific medical histories — they were no longer “just quantified.”

Downs wants to continue to seek out these specific medical histories, to track the freedmen and freedwomen, some with names, some deemed “anonymous” in the records, to further flesh out the full story of Emancipation, of the struggle after, of the disparities and the tensions and the unanswered questions of today.

“Historians have focused a lot, and for good reason, on the politics of the period,” says Downs. “Politics are important…that led to citizenship and suffrage. But it’s important to recognize that there’s another story that happens alongside this — the social realities of how freedom unfolded. There’s so much more to learn about the day-to-day. Health is one way to see people’s lives. It shows the moment that was supposed to hold the most promise was riddled with serious crises.”

Dying to be Free: African-American Sickness and Suffering during the Civil War and Reconstruction. Thurs. April 19 at 5:30 p.m. Free to attend, reservations required. Basic Science Building MUSC, 173 Ashley Ave. Downtown. waring.library.musc.edu. RSVP by calling (843) 792-2288 or emailing currinw@musc.edu.

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