An Interview with Professor Jim Downs

The editors of the Oxford African American Studies Center spoke to Professor Jim Downs, author of Sick From Freedom: African-American Illness and Suffering during the Civil War and Reconstruction (Oxford University Press, 2012), about the legacy of the Emancipation Proclamation 150 years after it was first issued.

Jim Downs is an Associate Professor of History at Connecticut College, where he specializes in Nineteenth-century American history, the history of public health, and African American studies. In the Fall of 2012, he was a visiting researcher in the Department of the History of Science and the W.E.B DuBois Institute for African and African American Research at Harvard University.

An edited version of this interview appeared on the appeared on the OUP blog in January 2013.


Your book goes into great detail to describe the ways in which emancipation was problematic, indeed disastrous, for so many freedpeople, particularly in terms of their health. What was the connection between newfound freedom and health?

JD: I would not say that emancipation was problematic—it was a critical and necessary step in ending slavery. I would first argue that emancipation was not an ending point but part of a protracted process that began with the collapse of slavery. By examining freedpeople's health conditions, we can see how that process unfolded—we can see how enslaved people liberated themselves from the shackles of Southern plantations but then were confronted with a number of questions: How would they survive? Where would they get their next meal? Where were they to live? How would they survive in a country torn apart by war and disease?

Due to the fact that freedpeople lacked many of these basic necessities, hundreds of thousands of former slaves became sick and died.

The traditional narrative of emancipation begins with liberation from slavery in 1862-63 and follows freedpeople returning to Southern plantations after the war for employment in 1865 and then culminates with grassroots political mobilization that led to the Reconstruction Amendments in the late 1860s. This story places formal politics as the central organizing principle in the destruction of slavery and the movement toward citizenship without considering the realities of freedpeople's lives during this seven- to eight- year period. By investigating freedpeople's health conditions, we first notice that many formerly enslaved people died during this period and did not live to see the amendments that granted citizenship and suffrage. They survived slavery but perished during emancipation—a fact that few historians have considered. Additionally, for those that did survive both slavery and emancipation, it was not such a triumphant story; without food, clothing, shelter, and medicine, emancipation unleashed a number of insurmountable challenges for the newly freed.

Was the health crisis that befell freedpeople after emancipation any person, government, or organization's fault? Was the lack of a sufficient social support system a product of ignorance or, rather, a lack of concern?

JD: The health crises that befell freedpeople after emancipation resulted largely from the mere fact that no one considered how freedpeople would survive the war and emancipation; no one was prepared for the human realities of emancipation. Congress and the President focused on the political question that emancipation raised: what was the status of formerly enslaved people in the Republic?

When the federal government did consider freedpeople's condition in the final years of the war, they thought the solution was to simply return freedpeople to Southern plantations as laborers. Yet, no one in Washington thought through the process of agricultural production: Where was the fertile land? (Much of it was destroyed during the war; and countless acres were depleted before the war, which was why Southern planters wanted to move west.) How long would crops grow? How would freedpeople survive in the meantime?

Meanwhile, a drought erupted in the immediate aftermath of the war that thwarted even the most earnest attempts to develop a free labor economy in the South. Therefore, as a historian, I am less invested in arguing that someone is at fault, and more committed to understanding the various economic and political forces that led to the outbreak of sickness and suffering. Creating a new economic system in the South required time and planning; it could not be accomplished simply by sending freedpeople back to Southern plantations and farms. And in the interim of this process, which seemed like a good plan by federal leaders in Washington, a different reality unfolded on the ground in the postwar South. Land and labor did not offer an immediate panacea to the war's destruction, the process of emancipation, and the ultimate rebuilding of the South. Consequently, freedpeople suffered during this period.

When the federal government did establish the Medical Division of the Freedmen's Bureau, an agency that established over 40 hospitals in the South, employed over 120 physicians and treated an estimated one million freedpeople, the institution often lacked the finances, personnel, and resources to stop the spread of disease. In sum, the government did not create this division with a humanitarian, or to use 19th century parlance, "benevolence," mission, but rather designed this institution with the hope of creating a healthy labor force.

So, if an epidemic broke out, the Bureau would do its best to stop its spread. Yet, as soon as the number of patients declined, the Bureau shut down the hospital. The Bureau relied on a system of statistical reporting that dictated the lifespan of a hospital. When a physician reported a declining number of patients treated, admitted, or died in the hospital, Washington officials would order the hospital to be closed. However, the statistical report failed to capture the actual behavior of a virus, like smallpox. Just because the numbers declined in a given period did not mean that the virus stopped spreading among susceptible freedpeople. Often, it continued to infect formerly enslaved people, but because the initial symptoms of smallpox got confused with other illnesses it was overlooked. Or, as was often the case, the Bureau doctor in an isolated region noticed a decline among a handful of patients, but not too far away in a neighboring plantation or town, where the Bureau doctor did not visit, smallpox spread and remained unreported. Yet, according to the documentation at a particular moment the virus seemed to dissipate, which was not the case. So, even when the government, in the shape of Bureau doctors, tried to do its best to halt the spread of the disease, there were not enough doctors stationed throughout the South to monitor the virus, and their methods of reporting on smallpox were problematic.

You draw an interesting distinction between the terms "refugee" and "freedmen" as they were applied to emancipated slaves at different times. What did the term 'refugee' entail and how was it a problematic description?

JD: I actually think that "freedmen" or "freedpeople" could be a somewhat misleading term, because it defines formerly enslaved people purely in terms of their political status—the term "freed" places a polish on their condition and glosses over their experience during the war in which the military and federal government defined them as both "contraband" and "refugees." Often forced to live in "contraband camps," which were makeshift camps that surrounded the perimeter of Union camps, former slaves' experience resembled a condition more associated with that of refugees. More to the point, the term "freed" does not seem to jibe with what I uncovered in the records—the Union Army treats formerly enslaved people with contempt, they assign them to laborious work, they feed them scraps, they relegate them to muddy camps where they are lucky if they can use a discarded army tent to protect themselves against the cold and rain. The term "freedpeople" does not seem applicable to those conditions.

That said, I struggle with my usage of these terms, because on one level they are politically no longer enslaved, but they are not "freed" in the ways in which the prevailing history defines them as politically mobile and autonomous. And then on a simply rhetorical level, "freedpeople" is a less awkward and clumsy expression than constantly writing "formerly enslaved people".

Finally, during the war abolitionists and federal officials argued over these terms and classifications and in the records. During the war years, the Union army referred to the formerly enslaved as refugees, contraband, and even fugitives. When the war ended, the federal government classified formerly enslaved people as "freedmen," and used the term "refugee" to refer to white Southerners displaced by the war. This is fascinating because it implies that white people can be dislocated and strung out but that formerly enslaved people can't be—and if they are it does not matter, because they are "free."

Based on your understanding of the historical record, what were Lincoln's (and the federal government's) goals in issuing the Emancipation Proclamation? Do you see any differences between these goals and the way in which the Emancipation Proclamation is popularly understood?

JD: The EP was a military tactic to deplete the Southern labor force. This was Lincoln's main goal—it invariably, according to many historians, shifted the focus of the war from a war for the Union to a war of emancipation. I never really understood what that meant, or why there was such a fuss over this distinction, largely because enslaved people had already begun to free themselves before the EP and many continued to do so after it without always knowing about the formal proclamation.

The implicit claim historians make when explaining how the motivation for the war shifted seems to imply that the Union soldiers thusly cared about emancipation so that the idea that it was a military tactic fades from view and instead we are placed in a position of imagining Union soldiers entering the Confederacy to destroy slavery—that they were somehow concerned about black people. Yet, what I continue to find in the record is case after case of Union officials making no distinction about the objective of the war and rounding up formerly enslaved people and shuffling them into former slave pens, barricading them in refugee camps, sending them on death marches to regions in need of laborers. I begin to lose my patience when various historians prop up the image of the Union army (or even Lincoln) as great emancipators when on the ground they literally turned their backs on children who starved to death; children who froze to death; children whose bodies were covered with smallpox. So, from where I stand, I see the EP as a central, important, and critical document that served a valuable purpose, but the sources quickly divert my attention to the suffering and sickness that defined freedpeople's experience on the ground.

How has the federal government's attitude toward its own involvement in the physical health and welfare of the American people changed since the Civil War?

JD: That's a huge question that I really can't answer based on my research. I would instead argue that the Patient Protection and Affordable Health Care Act or Johnson's Great Society or even the New Deal were not the start of federal medical intervention; that the Civil War gave way to a period when federal authority expanded greatly and the government provided medical assistance to those who could not afford it.

Your book was released nearly six months ago. How would you describe the reactions that your book has provoked during this time? Have your readers and reviewers generally been supportive of your thesis?

JD: I have been very lucky that I have gotten a good deal of coverage by the mainstream press, and it is encouraging that non-academics are interested in a 19th century history topic. I did not anticipate this when I wrote my book. All of the mainstream press in the United States has been supportive, and I was happy to also get attention from the international press. The UK has been encouraging, particularly the BBC, The GuardianDaily Mail, and The Lancet, and I was also covered in New Zealand, Greece and the Czech Republic, which was all surprising and quite thrilling. For the past 150 years, the history of freedpeople's health has been relegated to the ledgers of 19th century books, narrated as statistics, and told in broken phrases and ellipses in reports and letters. For their experience to now become a part of news stories across the world signals an important turning point in U.S. History.

That said, in the comments to the various articles, op-eds, etc., some readers have misconstrued my main point, suggesting that I was arguing that black people were better off in slavery. I do my best to dispel this point in the introduction to my book, but for the most part, I simply argue that we can't compare slavery and freedom; it's like apples and oranges. I argue that we must examine emancipation on its own terms; once we do, we can see the struggles and the triumphs. If we try to examine it in comparison to slavery, then freedom is always good no matter what happened to the newly emancipated because they are no longer enslaved. In this formulation, there is no room rhetorically to talk about the struggle of freedom. Thusly, when and if we confront the image of starving, sick children in the record, the discursive reflex would be, "Well, it's still better than slavery."

So, I am trying to say that this starving child that we see mentioned in a phrase in a letter or as a number in an annual report is the result of the destruction of slavery, the dislocation caused by emancipation, and the abrupt and often chaotic effort to create a free labor system in the postwar South. I am trying to sketch out what the postwar world was like for those who were no longer enslaved.

Do you see any parallels between the situation of post-Civil War freedpeople and the plights of currently distressed populations in the United States and abroad? What can we learn (about public health crises, marginalized groups, etc.) from the events that you describe in your book?

JD: Yes, I do, but I would prefer to put this discussion on hold momentarily and simply say that we can see parallels today, right now. For example, there is a massive outbreak of the flu spreading across the country. Some are even referring to it as an epidemic. Yet in Harlem, New York, the pharmacies are currently operating with a policy that they cannot administer flu shots to children under the age of 17, which means that if a mother took time off from work and made it to Rite Aid, she can't get her children their necessary shots. Given that all pharmacies in that region follow a particular policy, she and her children are stuck. In Connecticut, Kathy Lee Gifford of NBC's Today Show relayed a similar problem, but she explained that she continued to travel throughout the state until she could find a pharmacy to administer her husband a flu shot. The mother in Harlem, who relies on the bus or subway, has to wait until Rite Aid revises its policy. Rite Aid is revising the policy now, as I write this response, but this means that every day that it takes for a well-intentioned, well-meaning pharmacy to amend its rules, the mother in Harlem or mother in any other impoverished area must continue to send her children to school without the flu shot, where they remain susceptible to the virus.

In my book, I saw a similar health crisis unfold: people were not dying from complicated, unknown illnesses, but they were dying from the failures of a bureaucracy; from the inability to provide basic medical relief to those in need; and from the fact that one's economic status greatly determined one's access to basic health care. Additionally, in the face of the flu epidemic, most doctors recommend that sick patients should simply rest. With the exception of the preventive flu shot, rest remains the most effective way to combat the flu. Newly emancipated enslaved people, on the other hand, were unable to rest. During the war, military officials forced them to move from one camp to the next, and after the war, Freedmen's Bureau officials compelled them to return to the plantation South to work as agricultural laborers. On a public health level, to be sick and to be forced to move from one location to the next further intensified the spread of sickness and disease; on a personal level, being unable to rest engendered enormous suffering and pain for freedpeople.