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Sick from FreedomAfrican-American Illness and Suffering during the Civil War and Reconstruction$

Jim Downs

Print publication date: 2012

Print ISBN-13: 9780199758722

Published to Oxford Scholarship Online: March 2015

DOI: 10.1093/acprof:osobl/9780199758722.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 18 October 2021

Reconstructing an Epidemic

Reconstructing an Epidemic

Smallpox among Former Slaves, 1862–1868

(p.95) 4 Reconstructing an Epidemic
Sick from Freedom

Jim Downs

Oxford University Press

Abstract and Keywords

This chapter focuses on the smallpox epidemic, the most devastating medical crisis that erupted throughout the South after the Civil War, and how it claimed the lives of thousands of freed slaves from 1862 to 1868. It argues that the epidemic resulted in large part from the inefficiencies of Freedmen’s Bureau hospitals to establish effective quarantines and conduct vaccinations as well as the federal government’s neglect of freedpeople’s health. It considers the high mortality rates caused by the smallpox epidemic, and how they were interpreted by federal officials, Southern planters, and both the Northern and Southern press as signs of the extinction of the black race. The chapter also cites the federal government’s lack of effort in addressing the outbreak of the virus throughout the South.

Keywords:   smallpox, epidemic, South, Freedmen’s Bureau, hospitals, quarantines, vaccinations, federal government, freedpeople, mortality

That was the end of the optimism epidemic.

—Salman Rushdie, Midnight’s Children (1981)

“You must provide buildings or tents to meet the emergency at once,” wrote the Chief Medical Officer in North Carolina to a Bureau doctor stationed in New Bern, North Carolina. “You must go out vigorously with vaccination and if necessary make applications with other physicians,” he exclaimed. Smallpox had threatened the black residents of the small coastal town, and the only Bureau doctor remaining in New Bern stood defenseless as he read orders from Bureau headquarters. The Freedmen’s Hospital that had been built a few months ago had since been disbanded due to federal regulations to reduce the number of hospitals in the South. Due to the massive migrations of people in and out of New Bern, smallpox entered the town, and to compound matters, Bureau administrators feared an impending outbreak of cholera.1 At the same time, former Union surgeon Dr. Thomas Knox discovered “smallpox in almost every dwelling” that he visited in South Carolina and the surrounding area. The incessant presence of the virus overwhelmed Northern teachers, who instead of reporting to their benevolent agencies about their work with freed children, consistently documented the harm and “terrible havoc” that the virus inflicted among newly emancipated slaves.2 “We should soon have a pitted or pock aristocracy,” penned a Southern journalist in New Orleans in 1865. “It is almost unfashionable,” he quipped, “not to have about on the face the scars and blotches of that most loathsome disorder … Wherever we go, on the street, in the cars, in the market, at the places of amusement and at church—everywhere and at all times we meet with the irrepressible pock.”3

These are the scattered pieces of evidence referring to communities of freedpeople falling victim to a smallpox epidemic that began in Washington, DC, in (p.96) the winter of 1862, spread to the Upper South in 1863–64, culminated in the Lower South and Mississippi Valley in 1865, and eventually seeped into the Western territories in 1867–68, infecting Native Americans. Physicians did not record freedpeople’s names or details about their condition, but tallied their illness under the heading “number infected” In the millions of documents that chronicle the battles of the Civil War and the coming of Reconstruction, there is not one photograph of those suffering from a smallpox epidemic. Instead, the dominant images of Reconstruction show hard-fought political battles won: large groups gathering under a banner of citizenship, and freedwomen singing liberty. There are virtually no sources that describe what the epidemic meant for freedpeople during emancipation.4

On the federally occupied plantations and in the so-called freedmen’s villages, where the federal government boasted about their experiment with free labor, how did freedpeople cope with the outbreak of the epidemic? When did they recognize that they were infected with what some nineteenth-century doctors referred to as a “pestilence” or the “deadly scourge”? Did they awaken at night with a hot sweat and a fever, the first symptoms of the virus? How did they react when their skin broke with tiny pustules erupting on their face, arms, and chest? Had they witnessed the effects of smallpox on the body of a friend or family member before the war or had they seen a case among the Union troops?5

Freedpeople, like many other nineteenth-century Americans, may have purposely hidden those infected with smallpox from public view. Akin to those with leprosy, people infected with smallpox may have been ostracized, exiled to the remote corners of a town, forced to live out their lives in a rural, unknown place, quarantined by local authorities to prevent the spread of disease. Even if they managed to survive the virus, the scars that it left on their bodies would invariably serve as a reminder that they were once carriers of the “deadly scourge.” Moreover, in nineteenth-century America, evidence of a past infection of smallpox on one’s body could have connoted immorality, poverty, and/or promiscuity.6 Any of these reasons would have further marginalized those infected with the virus.7

Even though there were medical reasons to justify isolating afflicted freedpeople, the economic, political, and social pressures more than likely codified these practices. Bodies covered with a sickness that produced pustules should not be seen by Northern journalists touring the South, who wanted to write about the “South that will rise again.” Radical Republicans may have reconsidered their campaign to expand their party’s base in the postwar South if they were forced to shake hands with someone infected with “the pox.”8 Southern planters, who were already reluctant to engage in contract negotiations with people they considered their property, certainly did not want to see the effects of an epidemic that could potentially decimate their labor force.

(p.97) Maybe those suffering with smallpox were also hidden because freedpeople feared that Northern and Southern doctors would visit sick former slaves in the name of a so-called cure, but were actually motivated by a prurient fascination to observe how smallpox erupted on black skin. While former abolitionists wrapped the bodies of those infected with smallpox in clean blankets and then wrote passionate letters to their sponsoring organizations for money and resources to combat the epidemic, some of those reformers may have questioned whether their Southern adversaries were right—that the “negroes would go extinct.” Finally, religion may have figured into freedpeople’s calculations for hiding those infected with smallpox. Nineteenth-century Americans often understood catastrophes that claimed the lives of so many people as rooted in spiritual causes—God’s will or demonic power—not as the result of physical, natural, or medical causes. No freed person would have wanted to provide a white observer with possible evidence of God’s disapproval of emancipation.9

This absence of evidence of freedpeople’s feelings as they cared for and lost loved ones in this epidemic is not a mere coincidence but reflects a larger effort by many in the Freedmen’s Bureau and in Congress to conceal an episode that, if fully exposed, could have jeopardized the rebuilding of a region that before the war was deemed by many in the North as “backwards” and “peculiar.”10 Only signs of progress or hope could be displayed to the rest of the country in order for them to economically invest in the South. Only visions of free labor and land-ownership could be propagandized to apprehensive Northerners and white Southerners whose support of Reconstruction was essential to achieve national reunion.

All of this was exacerbated by how the military defined smallpox, how the federal government responded to the outbreak, how doctors treated it, and how the press reported on it. When smallpox first broke out in 1862, military and federal officials in the North followed health protocols to stop the spread of the virus among soldiers, but justified the outbreak among freedpeople as a “natural outcome” of emancipation. The outbreak reinforced theories that newly freed black people were on the verge of extinction, which provided little incentive for federal agents to try to stop its spread. Additionally, even when various doctors and federal officials rejected that theory and committed themselves to stopping the spread of the virus, the massive dislocation that emancipation caused thwarted their efforts: smallpox spread with the formerly enslaved people and the armies that moved throughout the South. Freedmen’s Hospitals also proved unable to defend freedpeople from attacks of the virus, because doctors lacked the resources, personnel, and support to establish adequate quarantines and conduct inoculations and vaccinations. In contrast, when cholera broke out in 1866, the federal government established efficacious health regulations and measures that prevented the expansion of that epidemic. Believing that cholera (p.98) threatened the entire population, federal officials employed efficient measures to stop the disease. During the nineteenth century, cholera produced enormous fear among federal officials because it was a relatively new epidemic and local governments and doctors had little experience treating it, yet federal officials managed to disseminate protocols to local governments on how to prevent the spread of the bacteria. Ironically, smallpox was a virus that local governments and doctors had battled since the eighteenth century, yet when it broke out among emancipated slaves, federal officials failed to follow the protocols and procedures that doctors and communities had implemented for decades. Instead, these officials propagated a medical fiction that smallpox was a disease limited to former slaves—despite advances in nineteenth-century medicine that underscored environmental factors as the cause of the virus’s transmission.11

Known for centuries as a fatal virus, smallpox attacked communities around the globe. It struck both Union and Confederate camps during the Civil War and turned battlegrounds into makeshift hospital stations.12 After both sides laid down their weapons, the virus continued its assault on freedpeople.13 Military authorities often responded to the outbreak of smallpox in their camps by placing afflicted soldiers in pest houses to isolate the virus, or vaccinating and sometimes revaccinating vulnerable troops. Due to the unsanitary conditions of the camps and the constant movement of soldiers and prisoners, the military’s efforts at preventing the virus from spreading often failed.14 The two viruses that cause smallpox can be spread by inhaling the expelled air of an infected person or through contact with contaminated bedding or clothing.

Former slaves who entered Union camps during the war were susceptible to both strains of the virus and were disproportionately infected.15 Once infected, they developed slight fevers. By the second week, flat reddish spots erupted on their faces, which then spread to their arms, chest, back, and legs. After a few days, the fever intensified and the reddish spots turned into pimples and then blisters.16 Depending on the severity of the infection, patients either survived or succumbed to the virus. If they could survive the fever for two weeks, they had a good chance of living.

Both during and after the war, the military and the Medical Division of the Freedmen’s Bureau struggled to protect freedpeople from smallpox despite policies that encouraged ex-slaves to be in motion. When smallpox exploded in the South, the migratory patterns of former slaves traveling to plantations in search of work worsened the spread of the virus. The federal government did not stop or redirect freed slaves from returning to plantations, but instead increased the number of ex-slaves descending on a particular region or restricted them to overcrowded and unsanitary refugee camps.17

(p.99) The Initial Outbreak

At the same time that freed slaves arrived at the nation’s capital in 1862, smallpox broke out in the city.18 Horse-and-buggies were converted into ambulances to transport afflicted soldiers from one camp to the next. While wealthy Washingtonians were vaccinated two to three times in fear of being infected with the full-blown deadly virus, city officials scrambled to develop a procedure to vaccinate school-age children. Some freed slaves dosed their bodies with tar to ward off possible infections.19 Newspapers reported incidents of hysteria that ensued after the mere mention of the “distemper.” Letter-writers from the capital warned travelers and passersby to avoid the area at all costs, and yellow flags were hung throughout the city to signal the presence of the “deadly scourge.”20

One Washingtonian diarist recorded in January 1862 “that smallpox prevailed among the Negroes.”21 The metropolitan police requested that the army remove the bodies of former slaves who died of smallpox and were left on city streets.22 As the virus spread throughout city, military and municipal officials, as well as city residents and newspaper reporters, blamed the virus on the arrival of freedpeople to the area. After visiting the Old Capitol Prison in Washington, DC, where he saw many “Negroes confined there as contraband,” Brigade Surgeon Stewart informed his subordinate, B. B. French, that in every case in which “small pox had come under his notice it originated among the Negroes.” He then ordered that former slaves “should be removed to some place where they can be kept more apart from the respectable white people, and where, if possible constant employment can be given to them.”23

While military officials ordered some former slaves to recross the Potomac to live in prisons and former slave pens in Alexandria and Fortress Monroe, others were left on their own. Meanwhile, a sudden snowstorm fell upon the city, followed by rain and icy cold temperatures, forcing former slaves to find shelter on frozen, or muddy, uninhabitable streets. With few options, many former slaves congregated in overcrowded tents in the center of Washington, DC, leaving them more susceptible to a smallpox outbreak.24

Although Union officials claimed smallpox “originated among the Negroes,” medical authorities in Washington realized that the outbreak resulted from the Union army forcing former slaves to live in unsanitary camps. According to the Medical Society of Washington, building barracks to house former slaves would have prevented the rampant outbreak of smallpox in the first place. In their report on heath conditions during the war published in 1864, local physicians condemned military officials for not building barracks for freedpeople on the outskirts of town or in the city’s vacant lots, forcing them instead to congregate in overcrowded camps in the center of town, which was filled with trash, excrement, and rotten food. The Medical Society did not blame the former slaves for (p.100) the proliferation of smallpox, but instead recognized the environmental factors at its root. “It is generally admitted,” the physicians posited, “that small-pox is one of the diseases due to domiciliary circumstances, and is at all times a preventable disease. It has been stated over and over again by eminent authorities, that there need not be a single case of small-pox in any city; if the authorities will but take the proper steps to check it.”25 Sadly, the authorities in Washington were too late. By 1864, the virus had managed to cross the Potomac River and make its way into Alexandria and to other parts of the Upper South.26

The vast population movements, orchestrated largely by the Bureau to develop a labor force, spurred massive migrations across the South that enabled the virus to pick up momentum.27 Additionally, many former slaves defined the meaning of freedom as an ability to be mobile—whether that mobility resulted from a desire to relocate to the North, or to find lost relatives, or to seek land ownership and opportunity. In response to the arrival of freedpeople to Orangeburg, South Carolina, in November 1865, a Bureau agent requested that military officials prohibit freedpeople from visiting neighboring plantations. While the agent recognized that such a request would restrict former slaves’ newly won freedom, he promised that the mandate would only last until smallpox disappeared, noting that this was the only the way to prevent the further spread of the virus.28

Traveling from place to place, freed slaves could not protect themselves from unexpected contact with the virus. Describing his experience in Hilton Head, South Carolina, in 1864, a freedman recounted the initial symptoms of a smallpox infection, “We tuck down wid feber … ’case we hasn’t got nuttin’ for keep warm.” In one colony in Hilton Head, where former slaves took refuge, smallpox killed freedpeople by “tens and twenties.” A benevolent society worker from Boston stationed on Hilton Head informed her sponsoring agency, the New England Freedmen’s Aid Association, that there was “no hospital on the island except for wounded soldiers and white invalids.” Without a government-sponsored hospital, she explained, “we have scarcely any shelter for the hundreds fleeing from slavery and ending their weary march here.”29

Despite the medical and public knowledge that smallpox could be easily transmitted through contact with an infected person, medical and governmental officials interpreted the growing number of cases of smallpox as consequences of the “dirty habits” and immoral behavior of former slaves, much as they had attributed epidemic disease to the vices of working-class and immigrant New Yorkers in 1832 and 1848.30 Some Bureau officials and Northern newspapers claimed that freedpeople were responsible for their high mortality rates. A correspondent for the New York Times wrote in 1866, “The mortality of the Negroes in and near large towns and cities still continues to be very great. The small-pox rages among them … dirt, debauchery, idleness, are the cases of this inordinate (p.101) mortality.”31 The New York Herald followed a similar course when a reporter reasoned that freedpeople continued to contract the virus because they lived in overcrowded “Negro cabins” and “dilapidated shanties.”32 While smallpox is an airborne, highly contagious virus that spreads simply by inhaling the air of a person infected with the virus, overcrowded conditions and unsanitary living dwellings certainly exacerbate the spread of smallpox. As one Bureau physician explained, unhealthy living conditions also led to other diseases that worsened smallpox infections. “While in tents many cases are reported to have been complicated with pneumonia, this being the cause assigned for most of the deaths … one third of all cases died.”33

Bureau authorities, nonetheless, repeatedly blamed the spread of smallpox particularly on freedpeople. “In view of the well-known filthy habits of the freedmen as a class,” a Bureau official in Louisiana remarked in 1866, “the small number of deaths among them this season is somewhat remarkable.”34 A black clergyman in Georgia agreed with this rationale, and took it a step further when he blamed the incessant spread of smallpox on freedpeople’s “immorality.”35 The notion that immorality led to the continual spread of the virus persisted throughout the duration of the epidemic. Military and religious officials in the Mississippi Valley led freed slaves to believe that “free love,” or unmarried freedpeople living together, was the cause of two “adulterers” contracting and then ultimately dying of smallpox.36

Bureau leaders also explained that the proliferation of smallpox among freedpeople was because black people and white people reacted differently to disease and sickness. When smallpox escalated in Augusta, Georgia, in 1867, the physician on duty frantically wrote to his supervisor expressing his fear of contracting the virus. Attempting to alleviate the physician’s fear, the supervisor assured him that his regional background and implicitly his race would prevent him from contracting the virus, “I trust you are frightened and not hurt by smallpox, keep cool and drink plenty of citric and lemonade … I don’t remember any Northerner having the disease though we all were excessively and consistently exposed last winter.”37

Moreover, the government’s reliance on a system of medical reports that quantified the number of freedpeople infected with the virus further underscored the medical fiction that only freed slaves were susceptible to smallpox. Federal authorities relied on a system of reporting that simply calculated the number of patients that were infected, the number under treatment, and then the number that died. This quantitative form of reporting on the virus provided federal officials in Washington with a largely statistical portrait of the smallpox epidemic, which, in turn, supplied federal officials with empirical proof that smallpox was an illness that only infected freed slaves. Due to these nosological interpretations of the virus, Bureau doctors continued to calculate the number (p.102) of infected freedpeople, and rarely, if ever, documented the number of white Southerners infected with the virus.

Although white Southerners contracted smallpox, there was no systematic bureaucratic structure that comprehensively tabulated the number of white people who were infected and subsequently treated in their homes by local doctors or by municipal institutions and charitable hospitals. Some white Southerners were dislocated and abandoned during the war and appear in the Bureau records as “white refugees.” According to the Bureau’s documentation, there were exponentially fewer white people than black people who were treated by Bureau doctors—which made it appear to federal authorities that smallpox disproportionately infected freedpeople. In Georgia doctors throughout the state reported 5,611 freedpeople admitted to the hospital compared to 143 white people.38 Similarly in Mississippi, an estimated 550 freedpeople contracted the virus in October of 1865, as opposed to 37 white refugees. In fact, from October 1865 to January 1866, the number of infected freedpeople, as reported by Bureau doctors in the field, far outweighed the number of white people on an average of 100 to 1.39

After a few months of treating fewer than five to seven white people, Bureau doctors began crossing out the column of white refugees on their annual reports and would only tally the number of infected freedpeople. When the chief medical surgeon in Louisiana noted a decrease in the number of white patients treated in early 1866, he crossed out the word “refugees” on the forms, and only treated freedpeople infected with smallpox (or any sickness).40 Describing the prevalence of smallpox in Savannah, Georgia, the New York Herald assured readers that while “whites have not entirely escaped, the number of cases yet developed is quite small and of a mild type.” But among the freedpeople, the paper reported, “the disease travels almost with the speed of an epidemic.”41 The New York Times reported that in 1866 and again 1867, the number of freedpeople far outweighed the number of white people infected with the virus.42


Despite the arguments made by some, such as the Medical Society in Washington, DC, many federal leaders and writers for the Northern press understood the smallpox epidemic as a consequence of emancipation.43 The fact that medical reports coming from the South stated that the epidemic affected mostly, if not exclusively, freedpeople only buttressed this perception. A reporter for the Nation in 1866 corroborated the claim when he wrote, “There has been considerable speculation as to the effect of freedom upon the physical condition of the former slave. By many it is thought that his ultimate fate will be that of the Indian, (p.103) and for this opinion there seems to be some ground. That mortality and disease are largely on the increase cannot be doubted: of this fact I am assured by leading physicians, and the statistics would seem to confirm this statement.”44 A religious leader echoed the assertion in 1863 when he stated, “Like his brother the Indian of the forest, he must melt away and disappear forever from the midst of us.”45 Medical authorities, journalists, and even researchers who later studied the high rates of mortality during the postwar period, consistently used arguments about biological differences between the races as an explanation for the large number of freedpeople’s deaths caused by smallpox.46 “The emancipation was a starting point in more ways than one. Here began, not only his career as a freedman and struggle for elevation, but his physical decline,” stated one physician. “It is certain this death rate is uniformly double that of the whites and in many cases three or four times as large.”47

The leaders of the Medical Division of the Freedmen’s Bureau also expected the extinction of the black race and consequently did not provide Bureau physicians in the South with adequate money and resources to build pest houses to quarantine infected former slaves or to conduct vaccination campaigns to protect freedpeople from the virus. Congressman Samuel Cox, a Democrat from Illinois, argued that former slaves were, in fact, “dying out.” He also compared the high rate of mortality among emancipated slaves to that of Native Americans, and thereby cautioned members of Congress to not violate the Constitution and provide federal assistance to freedpeople since their death was inevitable.48 Since many in Congress, particularly in 1865, believed that freed slaves were meant to go extinct, they did not allocate money toward government programs designed to provide them with medical assistance.

That said, once the word extinction was used, it shifted attention away from the corporeal reality of freedpeople dying, as well as the effects of an epidemic spreading throughout the South. By comparing the high death rate among emancipated slaves to that of Native Americans, these officials placed more of an emphasis on explaining the epidemic than responding to it, which morphed this biological crisis into a discourse.49 The use of the term extinction asserted that the demise of former slaves was a foregone conclusion.50 As the Alabama Independent in Birmingham warned in 1866, “Unless some organized effort is made to arrest its progress it will become atmospheric and sweep over the land.”51

Because they viewed the smallpox epidemic in the context of extinction, federal officials saw no need to follow the standard protocols that health authorities in both the North and the South had followed for decades. Since the eighteenth century, outbreaks of smallpox, sometimes as few as two to three cases, constituted an “epidemic.”52 Definitions of epidemics did not always trace back to a particular number of infected people or to a mortality rate.53 The decision of eighteenth-century medical and municipal officials to implore communities to (p.104) isolate those infected with smallpox to quarantined areas or for doctors to provide a range of treatments represents the community’s enactment of rituals mobilized for an epidemic.54

When government leaders declared an epidemic, local physicians started to inoculate townspeople. The process of inoculation involved infecting a healthy person with a strain of the virus with the hope that the healthy patient would develop a mild case of smallpox, and, after a few weeks, gain an immunity toward it.55 The problem with this procedure was that the inoculated person, with even a mild strain of the virus, could inadvertently spread smallpox. Although the discovery of vaccination in the late eighteenth century, which involved cowpox, promised a lifetime of immunity, any announcement of a smallpox epidemic by local and state governmental officials ignited political and medical debates surrounding vaccination.56 Doctors published studies ranging from the history of smallpox to pamphlets on medical treatment, while city and state government officials argued over the civil procedures surrounding the enforcement of vaccination. In 1832, the federal government even established a campaign to vaccinate susceptible Native Americans to an outbreak of the virus.57 The outbreaks of smallpox throughout the seventeenth and eighteenth centuries, in short, did not go unnoticed.58

In 1862, the appearance of “two or three cases of smallpox among the men” prompted Brigadier-General Ulysses S. Grant to assure federal supervisors that “every effort has been made to prevent the spread of the virus.”59 Both Grant and Lee understood the danger of a few cases of the disease; they both immediately reported these incidents to their headquarters, as part of the standard protocol in combating the virus, and issued mandatory vaccinations of all troops.60

Yet, in the fall of 1865, when Bureau physicians began to report the increasing cases of smallpox, neither the Freedmen’s Bureau nor the medical profession classified smallpox as an epidemic, unlike the first outbreak among Union troops. James E. Yeatman, president of the Sanitary Commission, recognized the need for the government to declare an epidemic when he arrived at Camp Benton, Missouri. He explained to military authorities, “Small-pox has had its appearance at several posts and in one of our hospitals; every precaution has been taken to prevent it from spreading, but, in order to arrest and mitigate the horrors of this dreaded disease it is necessary that some obligatory order be issued to colonels of regiments, holding them responsible for the prompt execution of the same.”61 Military and government leaders failed to enact a similar order for the freedpeople.62

Some officers in the field wrote suggestions to their supervisors on how to prevent the virus from spreading further among the freedpeople. A military official in Greensboro, North Carolina, in the spring of 1866 hoped that there would be “no unnecessary delay” to build a smallpox house a quarter mile from the (p.105) freedmen’s camp in order “to arrest the fearful disease which is increasing every day.”63 A Union officer stationed in Louisiana that same spring “respectfully suggested that an order declaring vaccination to be a military necessity,” which, he argued, “would save many lives among these poor people.”64 The New York Times echoed the need for vaccinations in 1866: “The Freedmen’s Bureau could do as much good in seeing to the vaccination of the blacks as in any other way. Unless something is done for them, the Negro population of the South will begin to melt away in freedom.”65

Although Union officials in the South continued to report on the devastation and deaths that smallpox caused among the freedpeople, federal authorities in Washington failed to react. The federal government’s neglect of the initial outbreaks of smallpox among the freedpeople in Washington, DC, Mississippi, and Louisiana allowed the virus to expand rapidly. By early autumn of 1865, the virus reached Washington, North Carolina, and infected well over 300 freedpeople in one week. In the Sea Islands, where former Confederate doctors joined the fight to halt the virus, it killed roughly 800 freedpeople a week in November and December.66

Doctors across the South reported an increase in the number of smallpox cases in their communities. In Augusta, Georgia, doctors reported 40 patients infected with the virus in October 1865. Less than four months later, the number of infected freedpeople there tripled, totaling 135. Throughout the winter and early spring months, Freedmen’s Bureau doctors and freedpeople remained defenseless against the epidemic. Not until May of 1866 did the outbreak begin to show signs of slowly dissipating. Bureau records indicate that the number of infected freedpeople dropped from 135 cases a week to about 40 cases.67

While such numbers may suggest the demise of the virus, it could also potentially indicate its strength as well. Smallpox invariably reached populations of former slaves who had already been infected with the virus during slavery or the war, and who would be immune. Yet, smallpox continued to proliferate. Although it is not possible to provide a better assessment of the population of Augusta and the percentage of people infected with smallpox, the mere fact that Bureau medical officials established a presence there and remained for eight months suggests that it was considered a medical crisis. The Bureau only established hospitals and contracted doctors across the postwar South in response to medical disasters and after quelling the crises; it often sought justifications to dismantle these systems swiftly to prevent dependence. When the surgeon-in-chief attempted to close the Freedmen’s Hospital in North Carolina in February 1867, local doctors refused “to entertain” the order, arguing that it was essential for a certain number of beds “to be kept up” at all times. Officials in Washington, however, ignored these rebuttals and shut down the hospital.68 Since smallpox can remain dormant in a person for three weeks before showing symptoms, the reports that (p.106) document a decrease in the number of cases only indicate the number of patients that the physician encountered at the time of the report. These reports did not take into account those who could have contracted the virus within the past week. Six to seven weeks after federal officials ordered a hospital to be closed in western North Carolina, the virus returned in February of 1867 infecting more people than it did the first time.69

By 1869, the chairman of the Committee of Freedmen’s Affairs estimated that smallpox had infected roughly 49,000 freedpeople throughout the postwar South from June of 1865 to December of 1867.70 This statistic tells only part of the story. Records of Bureau physicians in the field suggest that the numbers in their specific jurisdictions were, in fact, much higher. In the Carolinas roughly 30,000 freedpeople succumbed to the virus in less than a six-month period in 1865.71 From December of 1865 to October of 1866, when the epidemic reached its peak, Bureau physicians in Georgia, Louisiana, North Carolina, and Virginia estimated that hundreds of freedpeople a month became infected with the virus.72 Due to the countless freedpeople in need of medical assistance, many Bureau doctors claimed to be unable to keep accurate records. “I am unable to forward the consolidated reports of the sick freedmen for the month of February,” wrote a Bureau doctor from North Carolina.73 As mentioned, the statistics regarding the number of afflicted freedpeople only represent those that Bureau doctors encountered. In rural regions and in places where the Bureau did not establish a medical presence, cases went unreported. When the smallpox epidemic hit the area surrounding Raleigh, North Carolina, in February 1866, two freedwomen “walked twenty-two miles” in search of rations and support. The unexpected cold weather combined with the outbreak of smallpox in the state capital, however, depleted the Bureau’s supply reserve. After discovering that even the benevolent office had “only empty barrels and boxes,” and “nothing of real service to offer,” the women wept.74

Statistics fail to convey the great emotion and fear that the so-called pestilence incited among those living in the postwar South.75 A Bureau official in Kentucky described smallpox as a “monster that needed to be checked”; another agent witnessing the “severity and almost malignancy of the epidemic” believed that the virus was on the rise and predicted that “before the coming summer is over it will decimate the colored population.”76 Although some freedmen and freedwomen had been vaccinated during slavery or previously infected, many freedpeople feared the virus would attack their children.77 Children succumbed to smallpox at a higher rate than any other age group. As one Bureau official noted in 1864, “In country parishes where vaccination is not the custom, with no physician near, where the colored children are poorly fed and clad, and much exposed, they sicken, die, and are buried, without a record of their numbers.”78 The Christian Recorder added, “You may see a child well and hearty this morning, and in the evening you will hear of its death.”79

(p.107) Most doctors responded to the sudden and dramatic outbreak of smallpox by writing letters to their supervising officials about the need to hire more doctors and staff.80 “Smallpox is spreading among the freedpeople,” wrote a physician in Orangeburg, South Carolina, in November 1865. “I have but one surgeon and he is unable to attend to each place, besides taking care of the hospital. Could you send me a surgeon?”81 Bureau doctors requested money and permission to build hospitals, asked questions about medical treatment and hospital management, and informed authorities in Washington that smallpox plagued the postwar South.82 “A report has reached me,” wrote a physician in 1865 in Georgetown, South Carolina, “that smallpox is raging to an alarming extent in a place about fifteen miles from here.”83 When word got to a Bureau physician that smallpox lurked in the outer perimeters of the hospital’s jurisdiction, the doctor immediately vaccinated those around the hospital and then made his way on horseback to those who lived in rural areas. “Disease is coming under my notice and great affliction and suffering evidently exists among the freedmen,” wrote a Bureau doctor in December 1865, “much if necessarily beyond the reach of relief from my efforts as my duties are so numerous and onerous as to make it simply and plainly an impossibility for me to visit all the sick on the surrounding plantations besides I have no horse that I can rely for use at all times when I need him.”84 Bureau doctors traveling to freedmen’s communities surrounding Charleston, South Carolina, to treat the epidemic requested two separate ambulances—one to transport smallpox patients, the other for those suffering from noncontagious diseases. When supervising Bureau authorities did not send a separate wagon to carry the infected freedpeople, Bureau physicians complained that they were unable—for the past year—to contain the virus because they lacked the necessary means to remove infected patients to the smallpox ward in Charleston.85

Despite these letters, federal authorities failed to perceive smallpox as a problem that demanded immediate action. Chief of the Medical Division Caleb Horner issued numerous circulars to physicians on other medical issues relating to the treatment of the freedpeople and the operations of the Bureau hospitals, but neglected to inform Bureau physicians of the protocol on how to respond to the smallpox epidemic. O. O. Howard, the leader of the Freedmen’s Bureau, who consistently sympathized with the plight of the freedpeople, omitted the mention of the outbreak in his reports to Congress.86 Reports from assistant commissioners, who forwarded statements from Bureau doctors in the South to the secretary of war, also ignored the epidemic.87 As a reporter for the New York Herald observed in Savannah, Georgia, in May 1866, “limited precautions against contagious disease” have yet to be taken in the South.88

Since federal authorities failed to mobilize a national, “organized effort,” to arrest the spread of smallpox, many Bureau physicians, most of whom lacked the support of their colleagues in neighboring districts, independently attempted to (p.108) slow down the proliferation of the virus through quarantine. Taking money from their meager hospital budgets, Bureau doctors rented or built temporary smallpox asylums to quarantine afflicted freedpeople. In many freedmen’s communities, they used former army tents as pest houses or as quarantine facilities.89 These makeshift provisions, however, failed. The army tents, according to Bureau doctors, “were in a miserable condition,” and only aided the spread of the virus. Physicians during this period did not attempt to provide elaborate forms of medical treatment, but only to remove infected bedding, blankets, and clothing to a quarantined area. In Charlotte, North Carolina, physicians feared the virus so terribly that immediately after discovering a smallpox-infected patient in the hospital, Bureau officials ordered the hospital to be burned to the ground—destroying the only site of medical intervention in the region.90

Without a workable, efficient, and general medical system, Bureau doctors were unable to monitor the changing health conditions in their regions. As one doctor explained in Georgetown, South Carolina, “The visiting of patients steadily on the increase and the prescribing for others at my office requires no small amount of time daily. Add to these my charge of the smallpox patients is now numbering fifteen, and you will perceive that my duties are not very light.”91 As the responsibilities of doctors increased, the virus continued to spread in the Carolinas, Georgia, and Louisiana, infecting well over 30 to 40 people a week.92 Bureau physicians frequently distributed clean clothing, blankets, and even bedding to freedpeople but many Bureau hospitals lacked these rudimentary supplies. “We are indeed ‘roughing it,’ this winter,” wrote a benevolent reformer stationed in Norfolk, Virginia, in 1866. “The poor blacks will suffer during this hard winter. They can hardly feed, much less clothe themselves. Government deserting us makes this time hard.”93 “I am entirely confident,” wrote a Bureau physician in Charleston, South Carolina, in January 1866, “that the fatality among my smallpox patients is greatly increased by the lack of necessary bedding to protect them from the cold … There is no bedding of any kind at my command and all that the patients have is such as they take with them from their homes, and some of them have none to take.”94

Without a federal protocol to follow, Bureau doctors were left on their own to determine how to combat the outbreak of smallpox in their particular jurisdictions. As a result, some virtually ignored outbreaks of smallpox and were even unwittingly responsible for the virus’s continued spread. Other Bureau officials failed to respond or even to report the presence of the smallpox in their regions. One Bureau physician mentioned the appearance of smallpox in his district because “smallpox got in the way of the planting” in South Carolina in 1866.95 The chief surgeon in Georgia did not respond to the outbreak of smallpox in 1865, because he did not view the reported cases of the virus in his jurisdiction as his part of his responsibility.96

(p.109) Smallpox erupted in a settlement on the south bank of the Trent River near New Bern, North Carolina, in 1866, according to military authorities, because the superintendent in charge of the region “exercised arbitrary and despotic power.” A delegation of freedmen from the settlement approached military officials and charged that the superintendent inflicted “oppression and outrages” among those living in the community. The military subsequently investigated the charges and discovered that freedpeople became infected with smallpox because of the superintendent’s corrupt behavior. In one case, the military authorities learned, the superintendent “arrested a man for debt, shut him up in the black house—the prison—for months, while his wife and children, reduced to abject destitution, died with the smallpox, and took him from the prison under guard and compelled him to bury his last child in the cradle in which it died.”97

The neglect of infected freedpeople by some Bureau officials and doctors contributed to the spread of smallpox throughout 1866 and early 1867. Neighboring doctors, agents from other Bureau divisions, and freedpeople in the community wrote letters of complaint to supervising officials about how some Bureau doctors left patients unattended or allowed their hospitals to become filthy and vulnerable to the virus. The unsanitary conditions of the smallpox hospital in Columbia, South Carolina, in the fall of 1866, prompted a group of former slaves to inform military officials of the indifferent and inhumane treatment of sick patients. The delegation of freedpeople stated:

Twenty-nine colored persons, men, women, and children, suffering from the smallpox, were crowded into one room, about twenty feet by twenty-four in size, and placed on the bare floor, with no bedding, while their only covering was the blankets that they had bought with them. These poor creatures were left in this condition several days, some of them delirious, with only one black woman to attend them, and without any nourishment but meat and bread. A number of respectable old colored people, attacked with smallpox, were thus taken from their comfortable homes and placed in this room to die of neglect.98

By the winter of 1866–1867, smallpox had seeped into southern Arkansas, Northern Louisiana, Texas, and other parts of the South, affecting populations that had not been exposed to the virus during the war, but had become vulnerable due to the lack of a standard policy on how to prevent the disease.99 Even when the federal government began to receive reports from areas of the South that had not yet been hit with the virus, it had ignored these accounts.100 Meanwhile, most Bureau officials learned of the extent to which smallpox pervaded throughout the South when schoolteachers submitted their annual records, indicating the large decrease in the number of pupils in attendance due to the (p.110) epidemic.101 Benevolent organizations established headquarters throughout the rural South—particularly in areas where there was no Bureau hospital—and, as a result, were, on many occasions, first to report on the appearance of smallpox among freedpeople in the countryside.102 Many of these organizations arrived in the South in the final months of the war to set up schools for newly emancipated slaves but quickly discovered that medical services were desperately required. In Tennessee, for instance, benevolent associations in Chattanooga and Murfreesboro contributed supplies and medicine to establish hospitals in these regions.103 Since benevolent organizations typically founded headquarters in all parts of the South, they would often notify either neighboring military or Bureau officials, or their sponsoring agencies, about the outbreak of smallpox among former slaves.

As smallpox continued to spread, assistant commissioners ordered Bureau doctors to return to the 1864 practice of mandatory vaccination, which was instituted by the Union army. “You must go out vigorously and vaccinate,” commanded the chief surgeon in North Carolina in 1866.104 Bureau doctors complained that mandatory vaccinating was difficult.105 They explained that they had to “re-vaccinate” and conduct second and sometimes even third vaccinations because the initial procedure failed, or because the vaccination was administered improperly. In Tennessee, of the 1,200 vaccinations administered from December 1865 to May 1866, over 830 proved unsuccessful.106 Yet, in many districts, Bureau doctors were without adequate supplies or the necessary staff to perform follow-up vaccinations. “I received your request,” wrote the chief medical surgeon in Georgia in January 1867, “I can not furnish you any vaccine virus it is furnished by the medical purveyor but all that I have seen from that source has been useless.”107 Even after waiting weeks for small vials filled with vaccine to arrive from the North, it was often damaged or insufficient to provide for all members of a community.108 A doctor from South Carolina lamented:

The smallpox in this community is spreading, it can receive at my hands no check. I regret to say that the great scientific protective influence of vaccination has not yet reached me, and as a consequence I am without vaccine matter … The private physicians have none, the surgeon in charge of troops have none … I have therefore been powerless to prevent smallpox.109

When a shipment of medicine arrived in Christ’s Church, South Carolina, the medical purveyor failed to include vaccine, “not even a scab,” the physician grumbled in May 1866. The lack of vaccine forced the physician to return to the century-old practice of inoculation. Because the Bureau doctor was responsible for vaccinating well over 150 freedpeople, whom the supervising military officer only allowed the doctor to vaccinate on Saturdays when “the Negroes were idle,” (p.111) the physician was compelled to inoculate the freedmen as their only protection against the virus. “I am obliged to wait until tomorrow Saturday,” the physician explained, and then, “I expect to take with me one of the school children whom I vaccinated a few days ago, and to transfer the fresh lymph from the mature pustule on her arm to the others on the George White plantation.”110 A procedure that likely proved to be ineffective, given the number of people in need of inoculation and only one pustule to use.

Freedpeople’s Resistance

In some regions, physicians offered vaccination, but many freedpeople resisted such invasive medical treatment. When the military was in charge of the health and welfare of former slaves during the war, the Union army required mandatory vaccination in 1864. This policy failed because of freedpeople’s resistance to the measure and the military’s failure to enforce mandatory vaccination.111 Describing the inability of Bureau physicians in Louisiana to implement vaccinations in 1864, one official noted, “Our efforts to induce the general vaccination have failed, in consequence of the fears of the children and the superstition of many of the parents.”112

Although many enslaved people had been vaccinated before the war, many freedpeople during the war resisted mandatory vaccination because they resented the Union army for interfering in their health matters or considered vaccination a harmful procedure. Describing an attempt to provide vaccination to bondspeople in North Carolina in 1864, the superintendent of Negro Affairs explained that freedpeople “frequently conceal those attacked with it [smallpox] under blankets and beds, and hide them in their houses, even after dissolution had taken places, so gregarious are they, as they burrow together in their filthy cabins, so ignorant are they of the value of skillful medical treatment. This is the sum of a negro’s ailments—he has a ‘right smart misery’ somewhere; and his materia medica consists of roots, herbs, and castor oil!”113 The superintendent’s assertion that freedpeople avoided vaccination and the intervention of Union doctors placed the blame on former slaves for the epidemic.

Due to the military’s inability to conduct vaccinations in freedpeople’s homes, some Bureau doctors went into schools and instituted mandatory vaccinations for children.114 Doctors also required freedpeople to register at the local Bureau hospital and either get vaccinated or prove that they were vaccinated by showing their scar, but many freedpeople refused to go to the hospitals for vaccinations. With the help of the local police and other Bureau authorities, some Bureau physicians, particularly in rural regions, broke into freedpeople’s homes and required immediate vaccination. In Cooke County, Georgia, former slaves—according to (p.112) city officials—“refused any attention from the Doctor saying that they would manage their own affairs.”115 Due to the continual outbreak of smallpox in the state, authorities recommended that Bureau agents compel freedpeople to go to the hospital or else arrest them. When freedpeople in Orangeburg, South Carolina, resisted vaccination, Bureau authorities and local doctors arrested the former slaves. Once they were released from jail, they reported their story to the local newspaper and argued that the Bureau limited their mandatory vaccination campaign to “coloreds only.” When the story reached leading Bureau administrators in the state, the Bureau officials responsible for the arrest realized that they had made a mistake by imposing such strict penalties for those who resisted vaccination.116

The arrests were, in many respects, an exception. Since many Bureau doctors, particularly those stationed in rural areas, lacked the resources to treat and to vaccinate all the former slaves residing in a particular area, it was feasible for freedpeople to avoid the Bureau physicians conducting mandatory vaccinations. Moreover, many local governments resented the Bureau’s presence and refused to provide police support even if it meant not ending the epidemic. As a Bureau physician in Georgia explained to Caleb Horner in 1866, the head of the Medical Division, “they [local governments] refuse to take care of smallpox cases and as it appears would rather the disease spread over the city than do something.”117

Smallpox in the North

The federal government’s failure to immediately respond to the outbreak of smallpox among freedpeople starkly contrasted with the ways in which health officials in the North handled the outbreak. As the virus spread in the South, eruptions of the virus simultaneously exploded in the North, particularly in New York City.118 From accounts of the so-called distemper in Staten Island to reports that Irish immigrants and working-class city residents infected tenement buildings, health officials continually provided residents of the city with guidelines on how to avoid infection.119 Northern health officials required physicians, hotelkeepers, and officers of vessels to report within 24 hours every case of smallpox or other contagious disease that came to their knowledge. They also warned against overcrowded living quarters, in particular stressing that cellars, boarding houses, and closets should not be rented to strangers who might carry the virus. Municipal authorities, as well as local citizens, policed neighborhoods and streets for signs of the virus and worked tirelessly to prevent smallpox from spreading.120

New York City health officials attempted to determine the cause for the rapid dissemination of the virus; whereas, in the South, officials did not attempt to explore the origins of the virus. Although the surveillance measures that (p.113) Northerners employed to detect the origin of the virus and to find infected residents remains controversial, the New York City case nevertheless reveals the extent to which nineteenth-century Americans understood disease causation.121 New York health officials recognized that smallpox could cross racial, ethnic, and class lines, whereas, the federal government operated under the outdated premise that smallpox would remain isolated among the newly freed population.

Had federal officials—like city authorities in New York in 1865–66 and even in Washington, DC, in 1862—investigated the social factors that contributed to the spread of smallpox among freedpeople, they might have found that the experience of emancipation led to dislocation and abject poverty, which facilitated the spread of smallpox among former slaves. Instead, they attributed the outbreak among former slaves to their racial background and the notion that, when freed, black people would go extinct.

Federal authorities insisted they were unable to respond to the smallpox epidemic because they lacked the manpower, resources, and facilities to do so. While the Medical Division was certainly beleaguered, the federal government did, in fact, manage to establish the necessary protocols, elicit adequate manpower, and extend their authority into the postwar South when they feared that an outbreak of cholera would infect white people and plague the nation.

An Epidemic within an Epidemic

In the midst of the smallpox epidemic in 1866, federal authorities declared a state of emergency due to the mere possibility of an attack of cholera in the postwar South. Referred to as “Asiatic Cholera” throughout the world, the federal government tracked the epidemic as originating in Asia, traveling to Russia, and spreading into Europe. They documented it making its way across the Atlantic, first appearing in Cuba and then possibly entering seaports in the Carolinas and Louisiana. Having just won the Civil War, the federal government felt empowered to take on this epidemic—despite the difficulties other governments had in preventing cholera from spreading.122 While army doctors complained that they were unable to offer adequate care and treatment to emancipated slaves, when cholera threatened both white Northerners and Southerners federal officials managed to develop the necessary protocol and amass resources and manpower to stop the spread of the epidemic.

Stationed in the postwar South, as part of the federal government’s occupation of the former Confederacy, army physicians typically avoided addressing freedpeople’s health concerns. Yet fearing a possible cholera outbreak, the surgeon general assigned army doctors to work more closely with Bureau (p.114) physicians to monitor the health conditions of the South. Because cholera had proven a threat to Europeans and Asians, the surgeon general took more seriously its threat to all Americans.

Although U.S. Surgeon General Joseph Barnes, who oversaw medical affairs throughout the country, failed to declare the hundreds of reported cases of smallpox as an epidemic, he took seriously the entrance of cholera into U.S. ports because it posed a greater threat to white people’s health and the national economy. Once he announced the possible arrival of “Asiatic cholera” in the United States in 1866, assistant commissioners warned Bureau doctors of the epidemic and provided them with detailed instructions on how to prevent it from entering their communities.123 Federal authorities informed army doctors stationed throughout the South that overcrowded and unsanitary living quarters exacerbated the spread of cholera.124 They ordered homes and public streets to be whitewashed with lime, privies to be emptied, living quarters limited to no more than five to seven people per dwelling, proper ventilation to be maintained, and clean clothing to be distributed.

The news that cholera had entered the South and other parts of the country provoked the U.S. surgeon general to publish and circulate letters that he received regarding the appearance of the disease. His Report on Epidemic Cholera in the Army of the United States, During the Year 1866 not only contained information on how to prevent the disease from invading one’s territory and spreading, but, more critically, it also informed Bureau doctors and administrators that an epidemic had erupted. Nothing this sophisticated was disseminated when smallpox epidemic erupted. The mere publication of this book illustrates how organized and systematic the federal government could be in response to an epidemic. It also powerfully indicates that the surgeon general recognized the need to synthesize doctors’ experience in the field and the federal government’s protocol on how to respond to an epidemic in order for them to be used in future campaigns against epidemics. The report codified federal authority as it expanded efficaciously in response to the cholera epidemic.

Armed with this compilation of directives and observations, medical officials could protect their communities from an epidemic. Once federal authorities informed local doctors that cholera had entered the water supply, Bureau doctors could more carefully monitor the sanitary conditions around major waterways and exercise particular caution in the receipt of goods from other seaports, particularly Cuba, where federal officials assumed “the pestilence” had arrived.125

The outbreak of cholera proved that the federal government understood how to counteract disease transmission but ignored these protocols when the victims were former slaves. “In order to reduce the great amount of disease prevailing among the inmates of the camp and to prevent the appearance and spread of an epidemic,” wrote a military official in Mobile, Alabama, in 1866, “the strictest (p.115) sanitary regulations should be enforced by the officers every day.”126 Once the outbreak entered a region, federal authorities warned, hospitals should release their destitute patients to make room for those affected by cholera.127 Further, Bureau authorities feared that freedpeople would spread the virus. O. O. Howard, leader of the Bureau, stated, “Bureau surveillance of the blacks were prompt and constant.”128 This statement reveals the federal government’s ability to respond to black health issues, despite its later claims to be unable to prevent the spread of smallpox.

Moreover, the tenor of the federal government’s reaction to the outbreak of an epidemic had dramatically changed. When describing smallpox, they used words that emphasized how overworked and limited Bureau doctors were in their arduous campaign against the virus. Yet, when discussing cholera, the surgeon general described how efficient and capable army doctors were. He wrote, “These reports were made with commendable diligence by the medical officers brought in contact with cholera during the year.”129

By the summer of 1866, cholera had entered the port of New Orleans. Bureau physicians stationed in the region penned letters to their supervising officials in Washington, alerting them of the situation. Two weeks later, Bureau doctors in Shreveport, Louisiana, roughly 300 miles from New Orleans, diagnosed 20 freedpeople infected with the disease. And by the fall of 1866, Bureau doctors and agents in the Carolinas and Georgia were reporting on the appearance of cholera in their states.130 Following the Bureau protocol, local doctors reported the cases to the assistant commissioner, who then forwarded their reports to Washington.131

By November of 1866, cholera had subsided. Federal authorities received monthly reports from Bureau doctors and assistant commissioners throughout the South documenting a decrease in the number of cases, indicating that the Bureau’s precautions and warnings had prevented the virus from further spreading throughout the postwar South. An Arkansas doctor recounted in 1866, “During that portion of this period, in which the cholera has prevailed, the various hospitals and asylums under the care of the Bureau have suffered but little. Only twenty-five cases of cholera were reported.”132 Alert to the potential danger of cholera, the Freedmen’s Bureau effectively helped halt the spread of the bacterial epidemic.133

In the winter of 1867, a year after cholera first entered the New Orleans harbor, Bureau officials continued to warn local doctors on a monthly basis about the possible threat of its return in the summer months. Federal authorities provided detailed instructions on ordering essential supplies, particularly sulfuric acid as a disinfectant; maintaining sanitary living conditions; and warding off the disease. Officials directed doctors to keep a watch for cases of cholera in their districts and to immediately contact their supervising officers at the first discovery of the bacteria.134

(p.116) The measures adopted to counteract cholera in 1866 and again in 1867 far exceeded what federal officials provided to local doctors in their campaigns against smallpox. The assistant commissioner from New Orleans summed it up best when he stated in 1866 that Louisiana had not been entirely free from smallpox for several years, but of cholera “so much dreaded during this spring and summer, there has not been a single case.”135 A Bureau agent from Tennessee echoed this sentiment when he said in 1866, “this county has done little for the sick and poor, except provide medicines during the cholera epidemic.”136

The Problematic Reports on Smallpox

Adding to this confusion, newspapers had reported that smallpox dissipated in the South and the health conditions of freedpeople in rural regions improved since the war. In the winter of 1865 and spring of 1866—when the virus claimed the most number of lives—reports from the New York Times and the Nation stated that the health of the “South was good.” In 1865, the New York Times reported, “Smallpox is on the wane,” in New Orleans.137 In another article in the Times published in 1866, the journalist described high mortality rates among former slaves in cities and then argued that health on plantations “was as good as usual.”138 By claiming that the conditions were “good,” the Times not only kept with the federal policy of denying the presence of disease in the South until it became undeniable, but they also perpetuated a conventional myth that the city was disease-ridden and the countryside was healthy. Bureau authorities made similar statements to migrating freedpeople. When Bureau officials met with a group of former slaves leaving Kentucky in 1865, the Bureau warned against “flocking into the towns and cities … Hundreds, unless they speedily move to the country,” Bureau authorities stated, “will fall victims of pestilence. The smallpox is now prevalent … By all means seek healthy homes in the country.”139

A few months later the Nation contributed to this mischaracterization by incorrectly reporting that “the sanitary condition of the freed people has far improved,” and, as a result, “all Bureau hospitals have been abolished, medical attendance being part of the labor contracts of the employers.”140 Although the federal government did not “abolish all Bureau hospitals” until 1868, many assumed that employers provided medical care, and even worse, that the health of the postwar South was improving.

In the end, the smallpox epidemic reflected a number of contradictions. On the one hand, the federal government established hospitals in the South and employed physicians to respond to the medical crises that plagued emancipated slaves. On the other hand, when it came to the outbreak of smallpox, the Medical Division of the Freedmen’s Bureau failed to offer adequate support. In part, (p.117) the failure resulted from the inefficiencies of the system, the inability of physicians to maintain sufficient communication with federal officials, the problems of transporting supplies, the dislocation and destruction that overwhelmed the South, and the difficulty in establishing adequate quarantine measures and administering proper vaccinations. Yet, the outbreak of cholera suggests that despite the fact the federal government’s headquarters was hundreds of miles away from the Deep South, the federal government with the help of the army, the support of local citizens, and the work of Bureau doctors managed to quell an epidemic that quite literally plagued the rest of the world.

Federal officials did not respond so effectively to the smallpox epidemic, because they believed that it was an epidemic confined to emancipated slaves. Statistical reports that they received from physicians stationed throughout the postwar South only buttressed this claim. The idea that only freedpeople became infected with smallpox fueled the extinction thesis—which explains the Bureau’s failure to follow decades-long protocol on how to stop the spread of the virus. That said, to subscribe to a theory about extinction, but at the same time conduct the operation of Bureau hospitals in the South, is inherently a contradiction. In other words, if government officials thought that freedpeople were really going extinct, then why establish Bureau hospitals in the first place?

The reason for this contradiction lies in the fact that federal authorities understood smallpox differently from other illnesses that plagued freedpeople. The Medical Division viewed its mission in terms of providing basic relief to freedpeople. By distributing clothing and food to emancipated slaves in response to exposure and starvation, the Medical Division, like Northern antebellum almshouses, could facilitate the goals of free labor. Moreover, by employing physicians and building hospitals, the federal government through the aegis of the Medical Division could fill the gap left by former slaveholders and local governments and react to outbreaks of dysentery, yellow fever, and, most of all, cholera. But federal leaders understood smallpox differently; they narrated this epidemic both as a result of emancipation and as a result of the inherent physiological differences between white and black people—which explains why they did not mobilize an aggressive campaign to prevent it from spreading.

Both during the epidemic and in the decades following it, a few physicians, who had served in Freedmen’s Hospitals, published reports on the medical conditions of the period that sharply contradicted the propaganda that the South was a healthy locale for freedpeople, and more closely investigated why smallpox and other illnesses spread in the region. Alexander T. Augusta, one of the few black physicians who practiced in the Medical Division of the Freedmen Bureau, constantly explained to supervisors in his monthly reports and letters of 1865–67 that disease spread among the freedpeople due to lack of medical resources and the unhealthy environments where they were forced to live. When disease (p.118) escalated in Savannah, Georgia, in 1865, where Augusta served as the assistant medical surgeon, he informed military and municipal officials that the sickness developed among the freedpeople due to the proximity in which freedpeople lived to the privy. He advocated for the privy to not only be emptied, but also fought to have the hospital and the freedpeople’s living areas relocated to a more sanitary area in the city. Augusta also explained to his supervisors that smallpox continued to spread in Savannah, not because of the dirty habits of former slaves or innate physiological difference, but because municipal officials “refuse to bury dead freedmen lying in the streets and in some cases when they have died of smallpox.”141 By submitting detailed and investigative correspondence, Augusta attempted to promote and expand knowledge of why and how disease continued to infect freedpeople. His analyses and conclusions suggest his understanding of how environmental factors contributed to the onslaught of smallpox.

That roughly a hundred other Bureau physicians served in the South and failed to offer reports that investigated the conditions of the freedpeople or the causes of the virus—even those who were sympathetic to the health conditions of the freedpeople—indicates that they understood the incessant spread of smallpox, disproportionately among freedpeople, as a result of innate physiological differences, the extinction thesis, and/or the “dirty and unhealthy habits of former slaves.” That Augusta continued to investigate why disease spread among freedpeople strongly suggests that he rejected the assumption that black people were inherently vulnerable to smallpox. In his reports, Augusta challenged the accuracy of the conventional wisdom of the day by considering how people—black and white—were more susceptible to disease when they were part of a dense population restricted to a confined area.

In 1888, years after serving as the director of medical affairs in Washington, DC, Robert Reyburn, one of the chief architects of Freedmen’s Hospital in Washington, also debunked contemporary conventional wisdom when he published an article titled, “Types of Diseases among the Freedpeople.”142 Drawing on his experiences as a physician in Freedmen’s Hospitals, Reyburn contended that sickness resulted from environmental causes. In particular, he made clear that black soldiers were not—as many assumed—inherently immune to fevers, and that the high rates of illness among former slaves resulted from lack of proper medical care. He further argued that if poor white people were in a similar situation they too would have contracted similar viruses. Reyburn desperately attempted to discredit what was considered common knowledge by emphasizing the relationship between environmental factors and disease.

Similarly, Rebecca Crumpler, the only known black female doctor employed by the Bureau, argued that the factors that caused disease could have been prevented. “There is no doubt that thousands of little ones annually die at our very doors, from diseases which could have been prevented, or cut short by timely aid. (p.119) People do not wish to feel that death ensues through neglect on their part.”143 Based on her experience at a Freedmen’s Hospital in Virginia, where she encountered hundreds of freed slaves, Crumpler recognized that the most fatal threat to freedpeople’s health was the lack of shelter, clothing, and nutrition. Without the fundamentals, many freedpeople, particularly freedwomen and children, became susceptible to smallpox and infected by it. Her book, Medical Discourses, served as a rebuttal to the prevailing idea that black people were physiologically different from white people and thereby more likely to be infected by contagious diseases, such as smallpox and cholera.

By analyzing the factors that cause illness and by advocating a prevention discourse, Crumpler’s book represented a sophisticated analysis of disease causation, which was at odds with the Bureau’s reaction to the smallpox epidemic. “They seem to forget there is a cause for every ailment, and that it may be in their power to remove it. My chief desire in presenting this book is to impress upon someone’s mind the possibilities of prevention.” Since prevention remained her main motivation for writing the book, Crumpler aimed to reach a broad reading audience beyond medical professionals “I desire that my book shall be as a primary reader in the hands of every woman.”144 By writing directly to freedwomen and their children, Crumpler identified a segment of the freed slave population that had been marked as dependent and thereby had become more vulnerable to sickness and disease.


(1.) Hogan to J. K. Fleming, February 12, 1866, Scrapbook of Letters Received; Fleming to Hogan, April 4, 1866; Horner to Hogan, April 11, 1866, all in e. 2788, Scrapbook of LR, RG 105, NARA.

(2.) Second Report of a Committee of Representatives of New York Yearly Meeting of Friends Upon the Conditions and Wants of the Colored Refugees, From Slavery to Freedom: The African- American Pamphlet Collection, 1824–1909, LOC; Jean Fagan Yellin et al., The Harriet Jacobs Family Papers, Volume Two (Chapel Hill: University of North Carolina Press, 2008), 642–63; L. P. Brockett, Woman’s Work in the Civil War: A Record of Heroism, Patriotism and Patience, 1820–1893 (Philadelphia: Hubbard Brothers, 1888), 193–94.

(3.) New York Times, March 26, 1865.

(4.) I have examined thousands of records regarding the smallpox epidemic and have found few sources that comment on what the epidemic meant for freedpeople.

(5.) Historian of science David S. Jones insightfully warns that historians cannot witness how historical actors experienced epidemics. David S. Jones, Rationalizing Epidemics: Meanings and Uses of American Indian Mortality since 1600 (Cambridge, MA: Harvard University Press, 2004), 12–13.

(6.) According to historian Charles Rosenberg, despite the fact that smallpox had been known as a contagious disease for centuries, many people nevertheless subscribed to the idea that personal behavior made one susceptible to smallpox infection. See Charles E. Rosenberg, “What Is an Epidemic: AIDS in Historical Perspective” Daedalus 118, no. 2, Living with AIDS (Spring 1989): 6–7.

(7.) Beyond the de facto measures, there was also a public health rationale for these practices. Since the eighteenth century in the United States (and even earlier in Europe), townspeople, medical authorities, and municipal officials often quarantined smallpox patients to isolated regions to prevent the further spread of the disease. Donald R. Hopkins, Princes and Peasants: Smallpox in History (Chicago: University of Chicago Press, 1983).

(8.) Xi Wang cogently argues that Republicans supported black enfranchisement in order to expand their party’s base in the South. See Xi Wang, The Trial of Democracy: Black Suffrage and Northern Republicans, 1860–1910 (Athens: University of Georgia Press, 1997).

(9.) Sharia Fett, Working Cures: Health, Healing, and Power on Southern Slave Plantations (Chapel Hill: University of North Carolina Press, 2002), 40. Also see, for example, John Thornton, (p.209) Africa and Africans in the Making of the Atlantic World, 1400–1800 (Cambridge: Cambridge University Press, 1998), 243, 265, 267.

(10.) In his autobiography, O. O. Howard brushes over the devastation and death caused by the smallpox epidemic by claiming that the government promptly responded to epidemic outbreaks and quelled them—which was unfortunately not the case. See Howard, Autobiography, 295–96.

(11.) Despite the current medical understanding that smallpox is a virus and not a disease, throughout the nineteenth-century Bureau records, doctors and other military officials refer to it as a “disease.” They also use the terms “scourge,” “distemper,” and “affliction.” I often use the term “virus” when I am trying to explain a particular point about smallpox transmission. When I describe it as a “disease,” it is often due to the sources that I am drawing from or the historical context that I am attempting to develop.

(12.) U.S. War Dept., Record and Pension Office, War Records Office, et al. The War of the Rebellion: A Compilation of the Official Records of the Union and Confederate Armies, series 1, vol. 7 (Washington, DC: GPO, 1894), 810. For a history of smallpox and its origins, see Hopkins, Princes and Peasants, 14. Hopkins argues that the first dated account of smallpox appears as early as 1570–1085 BCE. Also see, Elizabeth Fenn, Pox Americana: The Great Smallpox Epidemic of 1775–82 (New York: Hill and Wang, 2001).

(13.) My study offers the first analysis of the smallpox epidemic and the health conditions of exslaves after the war. In her study Intensely Human, Margaret Humphreys has convincingly documented the health conditions of black soldiers during this period, but her focus remains on the military experience—which represents a fraction of the ex-slave population. See Humphreys, Intensely Human: The Health of the Black Soldier in the American Civil (Baltimore: Johns Hopkins University Press, 2008).

(15.) Smallpox is caused by a virus known as variola. There is a distinction between major variola and minor variola. On contracting smallpox, see Hopkins, Princes and Peasants, 3, 7. On freedpeople contracting the virus, see War Dept., War of the Rebellion: A Compilation of the Official Records of the Union and Confederate Armies, series 1, vol. 17, 517; Elizabeth Leslie Rous Comstock, “Letter from Elizabeth Leslie Rous Comstock, October 12, 1862,” 132, The American Civil War: Letters and Diaries, database online (Alexander Street Press, 2003). Julia Ellen LeGrand Waitz, The Journal of Julia LeGrand, New Orleans, 1862–1863, ed. by Kate Mason Rowland and Agnes E. Croxall (Richmond, VA: Everett Waddey, 1911), 172.

(17.) Steedman and Fullerton, “The Freedmen’s Bureau: Reports of Generals Steedman and Fullerton on the Condition of the Freedmen’s Bureau in the Southern States,” May 8, 1866, p. 2, From Slavery to Freedom: The African-American Pamphlet Collection, 1824–1909, LOC.

(18.) While the epidemic in Washington, DC, marks the earliest reference that I have uncovered to smallpox during this period, the question remains how did smallpox even make it to Washington? I am not exactly sure if it was already present in DC or the mid-Atlantic region and then spread due to the movement of troops, the emancipation of slaves, or the displacement of civilians. My hunch is that it came from the West. Historian David S. Jones has meticulously documented the presence of smallpox in the West, particularly in the Ohio and Missouri River frontiers throughout the early nineteenth century. He also notes that traders along the Missouri River sent smallpox-infected furs to New York in 1837. While the traders claimed that smallpox did not break out in New York, this example, nevertheless, reveals the commercial traffic between the West and the East that would have provided pathways for the virus to travel during the Civil War. Moreover, the organization of troops from the West and the movement between the West and the Atlantic seaboard caused by the war could have further opened up pathways for smallpox outbreaks. See Jones, Rationalizing Epidemics, 1, 75.

(19.) During the nineteenth century, many Americans burned tar to clear the air and to ward off infection. The severity of the epidemic likely caused former slaves to take extreme measures and cover their bodies with tar. On nineteenth-century reactions to smallpox, (p.210) see Rosenberg, “What Is an Epidemic: AIDS in Historical Perspective,” 6–7. Frances Harding Casstevens, George W. Alexander and Castle Thunder: A Confederate Prison and its Commandant (Jefferson, NC: McFarland, 2004), 86.

(20.) Washington Evening Star, January 11, 1862; Weekly Anglo African, January 18, 1862 and February 1, 1862; Washington during the Civil War: The Diary of Horatio Nelson Taft, 1861–1865, January 8, 1862, January 9, 1862, January 15, 1862, LOC; Abby Woolsey to Gerogeanna Muiron Bacon and Elizabeth Newton Howland, January 7, 1862 in Letters of a Family during the War for the Union 1861–1865, vol. 1, 246, LOC. Jane Eliza Woolsey to Georgeanna Muirson Bacon and Eliza Newton Howland, January, 1862, ibid., 247. Clare Pierce Wood to Amos Wood, Wood Family Letters, South Hadley Historical Society, The American Civil War: Letters and Diaries online, University of Chicago Database, 2003.

(21.) Washington during the Civil War: The Diary of Horatio Nelson Taft, 1861–1865, January 8, 1862, January 9, 1862, January 15, 1862, LOC.

(22.) Various letters of Jno. Rogers, Sanitary Dept., Dept. of Metropolitan Police to Army, quoted in Kate Masur, “Reconstructing the Nation’s Capital: The Politics of Race and Citizenship, 1862–1878” (PhD diss., University of Michigan, 2001), 40.

(23.) B. B. French to Hon. Edwin M. Stanton, February 13, 1862, quoted in Berlin et al., Wartime Genesis of Free Labor: In the Upper South, 262–63.

(24.) Washington during the Civil War: The Diary of Horatio Nelson Taft, 1861–1865, January 15, 1862, LOC; Slave Pen Vertical File, AHS; Berlin et al., Wartime Genesis of Free Labor in the Upper South, 254–59; Alexandria Gazette, May 20, 1864; C. C. Bitting Memoir, December 30, 1865, AHS; Julia Wilbur Diary, November 10, 1862, AHS.

(25.) Medical Society of the District of Columbia, Report on the Sanitary Condition of the Cities of Washington and Georgetown (Washington, DC: Gibson Brothers, 1864), 4–6, NYPL.

(26.) Albert Gladwin, Book of Records Containing Marriage and Deaths that Occurred within the Official Jurisdiction of Rev. Albert Gladwin Together with Any Biographical or Other Reminisces, 1865, Barrett Library, AHS. Ibid., “Coffins and Other Funeral Expenses,” January 1, 1864. Due to the unevenness in the surviving record, it is impossible to provide an epidemiological map of the virus.

(27.) See, for example, the migrations of former slaves, who moved from the coast of South Carolina during the war, where the Bureau established hospitals, to the interior of the state, where the government lacked medical presence in 1865. Pelzer to Mr. A. Fairly, March 13, 1866, Charleston, SC, e. 3132, LS, vol. 1; Pelzer to H. Baer, March 15, 1866, e. 3132, LS, vol. 1; 17; Pelzer to Circular Letter, e. 3132, LS, vol. 1; South Carolina Chief Medical Report, LS, all in RG 105, NARA.

(28.) E. A. Klien to Major H. W. Smith, November 2, 1865, Orangeburg, SC, e. 2979, RG 105, NARA.

(29.) Daily Record, New England Freedmen’s Aid Society, “Mrs. Pillsbury’s Letter Concerning the ‘Freedmen’s Rest’ at Hilton Head,” MHS.

(30.) This is also common in discussions of the urban poor in the North. See, for example, John H. Griscom, The Sanitary Condition of the Laboring Population of New York (New York: Harper and Brothers, 1845). Also see Charles Rosenberg, The Cholera Years: The United States in 1832, 1849, and 1866 (Chicago: Chicago University Press, 1962).

(31.) New York Times, January 22, 1866.

(32.) New York Herald, February 16, 1864.

(33.) M. K. Hogan to C.W. Horner, November 23, 1865, Raleigh, N.C., e. 2535, L.S., RG 105, NARA. For a general overview on smallpox transmission, see Hopkins, Princes and Peasants, 14.

(34.) U.S. War Dept., BRFAL, Laws in Relation to Freedmen, 39th Cong., 2nd sess, Senate Executive Document, no. 6 (Washington, DC: GPO, 1866–67), 80.

(35.) Bishop M. F. Jamison, Autobiography and Work of Bishop M. F. Jamison, D.D. (“Uncle Joe”) Editor, Publisher, and Church Extension Secretary; a Narration of His Whole Career from the Cradle to the Bishopric of the Colored M. E. Church in America (Nashville, TN: Smith and Lamar, 1912).

(36.) John Eaton, Grant, Lincoln and the Freedmen (Longmans, Green, 1907), 35–36. Many nineteenth-century Americans often believed that sexually promiscuity predisposed (p.211) people to disease, a concept that has reemerged in the wake of the HIV epidemic. See Rosenberg, “What Is an Epidemic: AIDS in Historical Perspective,” 1–17.

(37.) J. V. DeHanne to M. F. Barres, February 23, 1867, Augusta, GA, LR October 1856–May 1868, M1903, Roll 49, RG 105, NARA. Also see M.K. Hogan to C.W. Horner, November 23, 1865, Raleigh, N.C., e. 2535, L.S., RG 105, NARA. I offer a more sustained analysis of how nineteenth-century Americans associated etiology with region in chapter 1.

(39.) Report of Sick and Wounded Refugees and Freedmen in Mississippi, for the week ending Saturday, October 21, 1865, 14 Refugees, 260 Freedmen; October 28, 1865, 3 Refugees, 201 Freedmen; November 11, 1865, 1 Refugee, 111 Freedmen; November 18, 1865, 0 Refugees, 79 Freedmen; November 25, 1865, 0 Refugees, 67 Freedmen; December 2, 1865, 4 Refugees, 149 Freedmen; December 9, 1865, 4 Refugees, 389 Freedmen, December 16, 1865, 4 Refugees, 371 Freedmen; December 23, 1865, 3 Refugees, 300 Freedmen; December 30, 1865, 2 Refugees, 325 Freedmen; Weekly Reports, Mississippi, e. 2018, box 32a, RG 105, NARA.

(40.) Report of the Sick and Wounded Refugees and Freedmen in Hospitals in District of Louisiana, for the week ending, May 4, 1867, e. 1396, Chief Medical Officer, Weekly Reports, Unentered, 1865–1866, RG 105, NARA.

(41.) New York Herald, February 16, 1865.

(42.) New York Times, “Mortality Among the Negro,” January 22, 1866.

(43.) I want to mark a critical distinction between the period of emancipation and the early nineteenth century. While ideas about black people as physiologically and mentally inferior circulated through medical and even political discourse in the early to mid-1800s, the process of emancipation provided a stage for this racist illogic to gain momentum and to take on new meaning. Unlike the early nineteenth century, when these ideas existed only in theory, buttressed by the medical fictions produced by loose and uninformed readings of the 1840 census, the 1860s, by direct contrast, did result with thousands of emancipated slaves dying from smallpox, starvation, exposure, among other ailments. Consequently, when journalists, scientists, doctors, politicians, and ordinary white Americans discussed black inferiority, they could then point to the problems that emancipation engendered. Yet, they did not consider structural poverty, medical neglect, and lack of basic necessities as the cause of illness and death among the ex-slave population. Instead, they rehearsed the skewed medical logic of the prewar years combined with their observations about the discontents resulting from emancipation in the 1860s in order to define black people as inferior. For an incisive analysis of early nineteenth-century ideas about black inferiority spanning from the writings of Dr. Josiah Nott to the publication of the 1840 census, see Harriet Washington, Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present (New York: Doubleday, 2006), pp. 143–56.

(44.) Nation, August 15, 1872.

(45.) J. M. Sturtevant, “The Destiny of the African Race in the United States,” Continental Monthly 2 (May 1863): 602, 605, 608–9, quoted in George Fredrickson, Black Image in the White Mind: The Debate on Afro-American Character and Destiny, 1817–1914 (New York: Harper and Row, 1971), 159.

(46.) J. R. Hayes, Negrophobia “On The Brain” In White Men, Or, An Essay Upon the Origin and Progress, Both Mental and Physical, of the Negro Race and the Use to Be Made of Him by the Politicians in the United States (Washington, DC: Powell, Ginck, 1869).

(47.) J. T. Walton, “The Comparative Mortality of the White and Colored Races in the South,” Charlotte Medical Journal 10 (1897): 291–94.

(48.) Cong., Globe, 38th Cong., 1st sess., 709. Samuel Cox, Eight Years in Congress, from 1857 to 1865 (New York: D. Appleton, 1865), 353. Historian David S. Jones argues that if the government had subscribed to the extinction thesis, they would not have felt obligated to develop federal policies for Native Americans or black people. See Jones, Rationalizing Epidemics, 139.

(49.) Furthermore, it is critical to mark an important distinction between high mortality rates caused by an epidemic and the discourse about extinction. In other words, there is a discourse about an epidemic and then there are actual bodies that suffered from the epidemic, and at times, these phenomena overlap, but it is necessary to try to untangle their intricate (p.212) knots as the problems of language and of racial ideology can lead us to a place where we forget that people were actually dying. Within contemporary historiography, the use of the term “extinction” immediately sets off an alarm about racial inferiority based on a medical fiction that asserts hierarchies among the various races. The only reason why extinction even became a viable concept that punctuated observations about mortality rates in the nineteenth century (and earlier) was due to the fact that so many people were, in fact, dying. Of course, these claims about the large number of people dying could have been exaggerated, but the debate rarely questioned the fact that so many people were dying or doubted the extent to which smallpox plagued emancipated slaves. Those who wrote about the epidemic knew smallpox infected tens of thousands of freedpeople and left thousands more dead. What they debated was the meaning and the outcome of this high mortality, not the fact that people were actually dying. The extinction thesis thus developed in response to their anxiety and concerns about the outcome of the high death rates among emancipated slaves; this rhetoric should not undermine the material reality of the epidemic. After they developed the rationale that emancipation exacerbated the epidemic, they then used the rhetoric surrounding extinction to justify their political actions.

(50.) This move on the part of the federal government contradicts Charles Rosenberg’s analysis of the mid-nineteenth century as a turning point in medical knowledge and practice. Rosenberg cogently argues that in response to the cholera epidemics in 1866, the medical community turned to a more sophisticated analysis of disease causation. Rosenberg may, in fact, be absolutely correct in terms of white people, but when it came to the diagnosis and treatment of black people, the medical community seemed to fall back on earlier ideas about disease causation. See Rosenberg, The Cholera Years.

(51.) Republished in New York Times, February 3, 1866.

(52.) Benjamin Rush, “The New Method of Inoculating for the Small Pox,” delivered in a lecture at the University of Philadelphia, February 20, 1781 (Philadelphia: Charles Cist in Market-Street, 1781), microform, LCP; Philadelphia Dispensary, A Comparative View of the Natural Small-pox, Inoculated Small-Pox, and Vaccination in Their Effects of Individuals And Society (Philadelphia: Jane Aitken, 1803); Providence, RI, “At a town-council holden in and for the town of Providence, this second day of August, A.D. 1799 it is voted and resolved, that three hundred copies of the first five sections of the act, entitled, An act to prevent the spreading of the small-pox, and other contagious sickness in this state,’ be printed, and that all vessels coming from foreign ports, or from places where infectious diseases are prevalent, shall be immediately furnished, with one of said copies…” [Providence: s.n., 1799], microform, LCP.

(53.) As historian Charles Rosenberg astutely argues, an epidemic is “highly visible and, unlike some aspects of humankind’s biological history, does not proceed with imperceptible effect until retrospectively ‘discovered’ by historians and demographers”; “What Is an Epidemic: AIDS in Historical Perspective,” 1.

(54.) I profited enormously from what Charles Rosenberg eloquently summons as the “dramaturgic form” that epidemics take. Ibid., 2.

(55.) The history of inoculation can be traced to an African-born slave, Onesimus, who introduced this age-old African practice to his master, the famed Puritan minister Cotton Mather. Despite much controversy, Mather introduced inoculation to eighteenth-century Bostonians.

(56.) Later in the eighteenth century, Dr. Edward Jenner, a British physician, attempted to circumvent this problem by demonstrating the efficacy and safety of vaccination. Hopkins argues that recent studies indicate that Jenner’s vaccination was cowpox with a strain of smallpox included. Some scientists, Hopkins claims, suggest that the vaccine was actually horse pox. On Jenner, see Elizabeth Fenn, Pox Americana: The Great Smallpox Epidemic of 1775–82 (New York: Hill and Wang, 2001); and Hopkins, Princes and Peasants, 8. Also see Benjamin Waterhouse, “A Prospect of Exterminating the Small-pox: Being the History of the Variolæ Vaccinæ, or Kine-pox, Commonly Called the Cow-Pox; As It Has Appeared in England: With an Account of a Series of Inoculations Performed For The Kine-Pox, in Massachusetts” (London: Cambridge Press, 1800), LCP. One of the best-known controversies surrounding the inoculation crises is the smallpox epidemic in Boston in 1721. See Margot Minardi, “The Boston Inoculation Controversy of 1721–1722: An Incident in the History of Race,” The William and (p.213) Mary Quarterly (2004): 47–76; Maxine Van De Wetering, “A Reconsideration of the Inoculation Controversy,” The New England Quarterly 58, no. 1 (1985): 46–67. Also see Sarah Stidstone Gronim, “Imagining Inoculation: Smallpox, the Body, and Social Relations of Healing in the Eighteenth Century,” Bulletin of the History of Medicine 80 (2006): 247–68.

(57.) Historian David Jones explains that Congress passed an act that called for vaccination of the Indians on May 5, 1832. According to Jones, the program ultimately proved unsuccessful and there was a second effort in 1838. The point, however, is that the Indian vaccination campaign provided an antecedent to the outbreak among former slaves, but the federal government failed to adopt similar measures when Bureau authorities and the Northern press reported on the epidemic among the freedpeople. See Jones, Rationalizing Epidemics, 113–14.

(58.) J. M. Toner, M.D., “A Paper on the Propriety and Necessity of Compulsory Vaccination,” extracted from the Transactions of the American Medical Association (Philadelphia: Collins Printer, 1865) LCP; “A Series of Letters and Other Documents Relating to the Late Epidemic or Yellow Fever; Comprising The Correspondence of the Mayor of the City,” The Board of Health, the Executive of the State of Maryland, and the Reports of the Faculty and District Medical Society of Baltimore, Second Dispensary (Baltimore: William Warner, 1820), LCP. Also see Fenn, Pox Americana; James Colgrove, “Between Persuasion and Compulsion: Smallpox Control in Brooklyn and New York, 1894–1902,” Bulletin of the History of Medicine 78, no. 2 (2004): 349–78.

(60.) ibid., series 1, vol.19 (part II), 679.

(61.) ibid., series 1, vol. 8, 487.

(62.) ibid., series 1, vol. 19 (part II), 679.

(63.) S.A. Bell, March 18, 1866, e. 2535, LS, RG 105, NARA.

(64.) Report of the Board of Education for Freedmen, Department of the Gulf, for the year 1864, Daniel Murray Collection, LOC.

(65.) New York Times, February 12, 1866.

(66.) W. H. Elridge to DeWitt, September 25, 1865; I. M. Carr to C. W. Horner, September 28, 1865, Georgetown, SC; S. C. Brown to R. Libby, November 21, 1865, Charleston, SC; F. L. Frosh to Saxton, November 20, 1865, Charleston, SC; C. H. Brownley to DeWitt, December 11, 1865, James Island, SC, all in e. 2979, LR, RG 105, NARA.

(67.) For an increase in Georgia see Report of Refugees and Freedmen in Smallpox Hospital for Week Ending October 7, 1865, 38 patients; October 14, 1865, 40 patients; October 21, 1865, 43 patients; October 28, 1865, 48 patients; November 11, 1865, 53 patients; December 2, 1865, 65 patients; January 13, 1866, 73 patients; January 20, 1866, 93 patients; February 3, 1866, 109 patients; February 10, 1866, 121 patients; February 17, 1866, 137 patients; February 26, 1866, 139 patients; March 24, 1866, 89 patients; March 31, 1866, 64 patients, April 7, 1866, 45 patients; April 28, 1866, 37 patients. By May of 1866, the number of reported patients in Augusta, Georgia, drops to 31 patients. Register of Patients at Smallpox Hospital and Weekly Reports of Sick and Wounded, vol. 1. (163), Roll 49, RG 105, NARA. One of the major problems of obtaining an accurate population estimate for this region, or any region in the South, during the immediate aftermath of the war is the vast dislocation that emancipation engendered. Historians have not been as attentive to the changing demographics that the war and emancipation wrought. Therefore, it is quite difficult to obtain the number of freedpeople living in this region. Moreover, throughout this book, I emphasize that the numbers that have survived are often incomplete and inaccurate; as a result, I am reluctant to substantiate an argument based on empirical evidence alone.

(68.) F. Smith to Barholf, February 6, 1867; F. Smith to Yeamans, February 7, 1867; Smith to Fleming, February 11, 1867, all in North Carolina, e. 2536, LS, vol. 2, RG 105, NARA.

(69.) Hogan to Fleming, January 22, 1867; Hogan to O. O. Howard, J.K. Barnes, and S. Thomas, March 1, 1867, all in North Carolina, e. 2536, LS, vol. 2, RG 105, NARA. For other examples of a hospital closing in the midst of the epidemic, see Swartzwelden to Flood, January 3, 1868, Shreveport, LA, e. 1397, Box 46, RG 105, NARA; Edward Williams to A. F. Hayden, May 29, 1866, Shreveport, LA, e. 1393, L.R box 40, LR, RG 105.

(p.214) (70.) T. D. Eliot, Report of Hon. T. D. Elliot, Chairman of the Committee of Freedmen’s Affairs, The U.S. House of Representatives, March 10, 1868 (Washington, DC: GPO, 1869).

(71.) War Dept., Laws in Relation to Freedmen, 110–11; Georgia, Savannah Lincoln Hospital, LS, vol. 1, December 1865–January 1868, Roll 85, RG 105, NARA.

(72.) For Louisiana, see War Dept., Laws in Relation to Freedmen, 79–80: there were an estimated 10,000 freedpeople who received treatment; this does not include those in home colonies. In Virginia, 23,000 freedpeople were treated for smallpox, ibid., 37; in Georgia, an estimated 5,600 freedpeople received medical treatment, see Augusta to Horner, June 2, 1866, Savannah, Lincoln Hospital, LS, vol. 1 (354), December 1865–January 1868, M1903, Roll 85, RG 105 NARA. For North Carolina see, M.K. Hogan to C.W. Horner, November 23, 1865, Raleigh, N.C., e. 2535, L.S., RG 105, NARA.

(73.) Hogan to Edwards, March 19, 1867, North Carolina, e. 2536, vol. 2, RG 105, NARA.

(74.) Freedmen’s Journal, March 1866, 57.

(75.) This is to say nothing of the alienation that many of those infected with smallpox likely suffered. See Monroe A. Majors, Noted Negro Women: Their Triumphs and Activities (Chicago: Donohue & Henneberry, 1893), 53.

(77.) The fact that various slaveholders did, in fact, vaccinate or inoculate their slaves before the war, but the virus still managed to spread so violently across the South, reveals the strength and magnitude of the epidemic. On vaccination of enslaved people before the war, see Todd Lee Savitt, Medicine and Slavery: The Diseases and Health Care of Blacks in Antebellum Virginia (Urbana: University of Illinois Press, 1978), 220.

(79.) Christian Recorder, July 5, 1862.

(80.) Lawton to Col. Boucher, October 20, 1865, Hawkins View, GA, Office of Staff Officers, Surgeon in Chief, LS and Register of LR, September 1865–July 1867, vol. 52, M1903, Roll 26, RG 105, NARA; Clark to Dalton, April 13, 1867, and May 29, 1867, ibid.

(81.) E. A. Korlau to H. W. Smith, November 2, 1865, Orangeburg, SC, e. 2979, Chief Medical Officer, LR, 1865–1866, Box 38, RG 105, NARA.

(82.) A. P. Dolnizimple to W. R. DeWitt, September 7, 1865, Hilton Head, SC, e. 2979, Chief Medical Officer, Unregistered LR, 1865–1866, Box 38, RG 105, NARA. C. H. Brownley to W. R. DeWitt, September 28, 1865, James Island, SC, e. 2979, Chief Medical Officer, Unregistered LR, Box 38, 1865–1866, RG 105, NARA.

(83.) Clay to DeWitt, December 20, 1865, Georgetown, SC, e. 2979, Chief Medical Officer, LR, 1865–1866, Box 38, RG 105, NARA.

(85.) Pelzer to Major H. W. Smith, February 15, 1866; Pelzer to Taylor, April 2, 1867; Charleston, SC, e. 3132, LS, RG 105, NARA. Also see, John E. Fallon to DeWitt, May 25, 1866, South Carolina, e.2979, Chief Medical Surgeon, LR, Box 37, RG 105, NA; Augusta to Lawton, January 26, 1866, Georgia, Savannah Lincoln Hospital, LS, vol. 1, December 1865–January 1868, M1903, Roll 85, RG 105, NARA; B. Burgh Smith to W. R. DeWitt, October 14, 1865, Charleston, SC, e. 3249, LS, vol. 1 of 1. RG 105, NARA. Sometimes even securing one horse was not enough. Due to the rural landscape, doctors often crossed deep rivers to reach freedpeople, but needed a horse on the other side because there were no ferries to carry horses over the river. Crossing the Stono River in South Carolina proved particularly challenging for one Bureau doctor, who requested that the federal government supply him, I. L. Beckett to R. K. Scott, January 15, 1867, e. 3249, LS, vol. 1, RG 105, NARA.

(86.) O. O. Howard, Report of Brevet Major General O. O. Howard to the Secretary of War (Washington: GPO, 1869).

(88.) New York Herald, March 18, 1865.

(89.) Fleming to Hogan, April 4, 1866, North Carolina, e. 2788, Scrapbook of LR, RG 105, NARA.

(p.215) (90.) Hogan to Matlock, March 25, 1867, Charlotte, NC, e. 2536, LS, vol. 2, RG 105, NARA. In South Carolina, the lack of bedding led to the further spread of the virus. A. Cay Roberts to W.R. DeWitt, January 15, 1865, Georgetown, South Carolina, e.2979, Chief Medical Surgeon, LR, RG 105, NARA.

(91.) Robert H. Clay to DeWitt, December 20, 1865, Georgetown, SC, e. 2979, Chief Medical Officer, LR, 1865–1866, Box 38, RG 105, NARA.

(92.) M. K. Hogan to C. W. Horner, November 23, 1865, North Carolina, LS, e. 2468, Box 14; Bishop to Griswold, September 9, 1865, Louisiana, e. 1393, Box 40, both in RG 105, NARA. War Dept., Laws in Relation to Freedmen.

(94.) Robert H. Clay to W. R. DeWitt, January 16, 1866, Georgetown, SC, e. 2979, Chief Medical Officer, LR, 1865–1866, Box 37, RG 105, NARA.

(95.) F. W. Liedtke to Major H. W. Smith, April 30, 1866, Moncks Corner, SC, Reports of Conditions and Operations, Records of the Assistant Commissioner for the State of South Carolina, July 1865–January 1866, M869, Roll 34, RG 105, NARA.

(96.) Lawton to Augusta, November 21, 1865, quoted in Todd Savitt, “Politics in Medicine: The Georgia Freedmen’s Bureau and the Organization of Health Care, 1865–1866,” Civil War History 28, no. 1 (1982): 45–64.

(98.) Beverly Nash, a black political leader during Reconstruction, published an article about the neglect of smallpox patients in South Carolina, which military officials mention in their report to federal leaders. See Reports of Generals Steedman and Fullerton on the Condition of the Freedmen’s Bureau in the Southern States,” LOC. On Nash, see Eric Foner, Freedom’s Lawmakers: A Directory of Black Officeholders During Reconstruction (New York: Oxford University Press, 1993). Also on Bureau doctors’ neglect of smallpox patients, see M. K. Hogan to C. W. Horner, November 23, 1865, Raleigh, NC, e. 2535, L.S., RG 105, NARA.

(99.) Subordinate Field Offices, Devalls Bluff, AR, LS and Received, October 1865–1868, M1901, Roll 8, RG 105, NARA; W. B. Pease to J. T. Kirkman, March 6, 1867, Houston, TX, Records of the Assistant Commissioner for the State of Texas, Reports of Operations of Conditions, M821, Frame 130, RG 105, NARA. For the further outbreak of smallpox in Louisiana in 1867, see “Weekly Reports of Sick and Wounded, 1867–1868,” January 5, 1867, January 12, 1867, January 19, 1867, January 26, 1867, February 2, 1867, February 9, 1867, February 16, 1867, February 23, 1867, March 2, 1867, March 9, 1867, March 16, 1867, March 23, 1867, March 30, 1867, April 6, 1867, April 13, 1867, April 20, 1867, April 27, 1867, May 4, 1867, May 11, 1867, May 18, 1867, May 25, 1867, June 1, 1867, June 8, 1867, June 15, 1867, June 22, 1867, June 29, 1867, July 6, 1867, July 13, 1867, July 20, 1867, July 27, 1867,” Shreveport, LA, all in e. 1396, Box 43, RG 105. For narrative descriptions of the epidemic in various Southern locales at the end of 1866, see War Dept., Laws in Relation to Freedmen.

(101.) Ibid., 105. Teachers reported the epidemic throughout reports to their sponsoring organizations. See, for example, Freedmen’s Record, February 1865, 19.

(102.) Freedmen’s Record, January 1866, 5.

(104.) Fleming to Hogan, February 12, 1866, North Carolina, e. 2788, Scrapbook of LR, RG 105, NARA.

(106.) In Tennessee, Bureau officials established hospitals in Chattanooga, Murfreesboro, Nashville, and Memphis in December 1865 and closed them by June 1866. See War Dept., Laws in Relation to Freedmen, 134.

(107.) J. V. Devanne to M. F. Barres, January 19, 1867, Augusta, GA, LR, October 1856–May 1868, M1903, Roll 49, Frame 649–50, RG 105, NARA.

(108.) Augusta to Lawton, March 14, 1866, Savannah Lincoln Hospital, LS, vol. 1, December 1865–January 1868, M1903, Roll 85, RG 105, NARA.

(p.216) (109.) Roberts to DeWitt, December 20, 1865, Georgetown, SC, e. 2979, Chief Medical Officer, LR, 1865–1866, Box 38, RG 105, NARA.

(110.) John E. Fallon to DeWitt, May 25, 1866, South Carolina, Chief Medical Surgeon, e.2979, LR, Box 37, RG 105, NARA.

(111.) Robert Reyburn to John Eaton, August 22, 1865, “Report on the Condition of the Government Farm at St. Mary’s County,” Maryland, A-9862, DC AC, 457 Un Rg LR, Box 22, FSSP. Also on some freedpeople’s resistance to go to hospitals, see M.K. Hogan to C.W. Horner, November 23, 1865, Raleigh, N.C., e. 2535, L.S., RG 105, NARA.

(114.) Report of the Board of Education for Freedmen, Department of the Gulf, for the Year 1864. Daniel Murray Collection, LOC. As early as 1813, Congress established the National Vaccine Agency as part of the Act to Encourage Vaccination, which predated federal efforts to vaccinate Indians in 1832. The act was repealed in 1822 because a shipment of smallpox, not cowpox, was sent to a region to vaccinate the vulnerable population and accidentally killed ten people. Not until the 1880 s or 1890s did state governments require mandatory vaccinations in schools. National Congress of Mothers, Report of the Proceedings of the Second Annual Convention of the National Congress of Mothers. Held in the City of Washington, D.C., May 2nd–7th, 1898, 243. Also see Hopkins, Princes and Peasants, 267–68.

(115.) R. S. Taylor to Gen. Davis Tillson, January 25, 1866, quoted in Savitt, “Politics in Medicine,” 57.

(116.) Henry Root to W.R. Dewitt, June 19, 1860, e. 2979, Chief Medical Surgeon, LR, RG 105, NARA.

(117.) Augusta to Horner, June 2, 1866, Georgia, Savannah Lincoln Hospital, LS, vol. 1 (354), December 1865–January 1868, M1903, Roll 85, RG 105, NARA.

(118.) New York Times, October 3, 1865.

(119.) New York Times, March 14, 1865, “The Senate Investigating Committee, Concerning the Duties of the Health Warden”; ibid., January 29, 1865; ibid., February 3, 1865.

(120.) New York Times, May 20, 1866, and April 29, 1865.

(121.) See Rosenberg, Cholera Years; Riley, Eighteenth-Century Campaign to Avoid Disease, 144. On medical surveillance in the late nineteenth century, see Colgrove, “Between Persuasion and Compulsion,” 349–78.

(122.) For recent scholarship on how European powers during the nineteenth century dealt with the spread of cholera into European colonies and the Continent by Muslim colonial subjects making the annual pilgrimage to Mecca see, for example, Daniel Brower, “Russian Roads to Mecca: Religious Tolerance and Muslim Pilgrimage in the Russian Empire,” Slavic Review 55, no. 3 (1996): 567–84; Michael Christopher Low, “Empire and the Hajj: Pilgrims, Plagues, and Pan-Islam under British Surveillance, 1865–1908,” International Journal of Middle East Studies 40 (2008): 269–90; and William R. Roff, “Sanitation and Security: The Imperial Powers and the Nineteenth Century Hajj,” Arabian Studies 6 (1982): 143–60. Also see C. A. Bayly, The Birth of the Modern World, 1780–1914: Global Connections and Comparison (New York: Oxford University Press, 2004).

(123.) Surgeon General’s Office, Report on Epidemic Cholera in the Army of the United States, During the Year 1866 (Washington, DC: GPO, 1867).

(124.) Ibid.; Surgeon General’s Office, Report on Epidemic Cholera and Yellow Fever in the Army of the United States, During the Year 1867 (Washington, DC: GPO, 1868); Surgeon General’s Office, Circular No. 3, vi, 17.

(125.) Surgeon General’s Office, Report on Epidemic Cholera in the Army of the United States, During the Year 1866 (Washington, DC: GPO, 1867); .Annual Report of the Resident Physician of the City of New York for 1865: Presented to the Board of Commissioners of Health at Their Meeting, January 4, 1866 (New York: Edmund Jones, 1866); John Chapman, “Diarrhea and Cholera: Their Origin, Proximate Cause, and Cure, Through the Agency of the Nervous System: By Means of Ice” (Philadelphia: J. B. Lippincott, 1866), LCP.

(p.217) (126.) Kipps to Robinson, October 12, 1866, Alabama, Office of Staff Officers, Surgeon, LS, vol. 1 (31), September 7, 1865–July 21, M1900, Roll 8, RG 105, NARA.

(130.) War Dept., Laws in Relation to Freedmen, 80; Augusta to Lawton, September 8, 1866, Georgia, Savannah Lincoln Hospital, LS, vol. 1, December 1865–January 1868, M1903, Roll 85, RG 105, NARA.

(133.) J. V. DeHanne to M. F. Barres, January 11, 1867, Augusta, GA, LR, October 1856–May 1868, M1903, Roll 49, RG 105, NARA; Kipps to Horner, June 16, 1866, Office of Staff Officers, Surgeon, Alabama, LS, vol. 1 (31), September 7, 1865–July 21, 1865, 1900, Roll 8, RG 105, NARA; Horner to Hogan, April 11, 1866, North Carolina, e. 2788, Scrapbook of LR, RG 105, NARA.

(134.) DeHanne to Barres, August 22, 1867, September 2, 1867, and January 11, 1867, Augusta, GA, LR, October 1856–May 1868, M1903, Roll 49, RG 105, NARA; DeHanne to Surgeon Edwards, May 28, 1867, and DeHanne to Sibley, May 27, 1867 both in Georgia, Office of Staff Officers, Surgeon in Chief, LS and Register of LR, September 1865–July 1867, vol. 52, 1903, Roll 26, RG 105, NARA.

(136.) Ibid., 134.

(137.) New York Times, March 26, 1865.

(138.) New York Times, January 22, 1866.

(139.) The push to “move to the country” was also a ploy to secure a labor force on cotton plantations. I. W. Brinckerhoff, Advice to Freedmen and J. B. Waterbury, Friendly Counsels for Freedmen (New York: AMS Press, 1980), reprint of freedmen’s textbooks, originally published by American Tract Society, NY [1864–1865?].

(140.) Nation, May 11, 1866.

(141.) A. T. Augusta to R. O. Abbott, June 17, 1863; Augusta to J. W. Lawton, August 9, August 14, August 21, 1866, all in Quartermaster Correspondence Consolidated Files, Contraband Camps 1863 File, Box 99, RG 92, NARA. Augusta to Asst. Surg. Schell, August 18, 1866; Augusta to Capt. Watson, August 21, 1866; Augusta to J. W. Lawton, September 1, 1866, all in Georgia, LS, M1903, Roll 85, RG 105, NARA.

(142.) Robert Reyburn, Types of Disease among Freed People of the United States (Washington, DC: Gibson Bros., 1891), NYAM.

(143.) Rebecca Crumpler, A Book of Medical Discourses (Boston: Cashman, Keating, 1883), 4.