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Among the numerous tragedies of the Civil War and Reconstruction was the suffering and death of thousands of former slaves due to displacement, confinement, sickness and disease. Even before Union armies advanced into the Southern states, enslaved men, women, and children - especially those in the upper South - fled toward freedom. The number involved raised drastically as invasion occurred and as word spread from town to town, farm to farm, and plantation to plantation. Many of these freed people ended up in contraband camps and were at the mercy of either the Union army or Northern benevolent societies to provide employment, clothing, shelter, food, and medical care. Too often all were lacking.

With the establishment of the Freedmen's Bureau in the spring of 1865 a concerted effort was put in place to attempt to alleviate some of the suffering  Unfortunately, the problem was larger than the resources committed to solve it.

As freed slaves hit the road to experience freedom, find relatives that were sold in previous years, or to search for jobs, they unexpectedly experienced suffering, and inadvertently contracted and spread diseases. Unhealthy conditions such as living in crowded, leaky, dirty tents led to afflictions such as small pox, yellow fever, typhoid, and measles, which plagued efforts to make new lives. In Sick From Freedom: African American Illness and Suffering during the Civil War and Reconstruction, historian Jim Downs digs into the records of the Medical Division of the Freedmen's Bureau to tell this unpleasant but important story.

Downs contends that much of the effort and expense put into the Medical Division was made to keep a healthy workforce in the Southern states on the abandoned farms and plantations that the federal government confiscated, and for black soldiers that were enlisted in the Union army. Women, children, the elderly, and disabled were too frequently of secondary consideration.

The level of disease experienced by the freed people was unexpected by both they and the government. Downs explains that freedmen hospitals were established in the former slave states, but that they usually popped up in response to an outbreak or epidemic. Most of the freedmen hospitals were very inefficient in operation and lacked success. One of the terrible epidemics experienced by freed people was small pox. The outbreak was wrongly perceived by many as problem unique to the African American former slaves and thus the treatment became understood in terms of race - that blacks were more susceptible than whites - and therefore treatment was not administered as it should have been.

Of special interest was the epilogue in Sick From Freedom. Here, Down's explains that Reconstruction's heath measures were often applied to American Indians in the West, who experienced many of the same problems with disease when placed in reservations.

A few irritating error were noticed in the text.  When Downs covered a particularly heartbreaking instance that happened at Camp Nelson in Kentucky he incorrectly named the camp commander as Pry instead of Fry. It was incorrect in more than one place and also in the index. Downs also wrote "When soldiers in the North reached for the rifles that hung above the mantles of their front doors and marched off to war, they did so in the name of ending slavery." I would argue that ending slavery was far from being a representative motivation for Union soldiers, especially early in the war.  Most Northern soldiers fought for preserving the Union, not freeing slaves. Additionally, most did not take their rifles off their mantles - Union soldiers were well armed by the federal government and fought with standardized rifled muskets, not their own from home.

Despite the above mentioned minor quibbles, I enjoyed reading Sick From Freedom. It is a sad story of the Civil War and Reconstruction that more people need to know and understand. On a scale of 1 to 5, I give it a 4.5.