# 068
Before Citizenship: Smallpox Among Former Slaves During and After the Civil War, 1863-1867
Blood still stains the report that a doctor in New Berne, North Carolina wrote in a panic to officials in Washington, D.C., about the outbreak of smallpox in the winter of 1865. Smallpox, he exclaimed, had taken the lives of 300 freedpeople in less than a week and had continued its assault by threatening the residents of the small coastal town.[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 continual 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 pitied or pock aristocracy, penned a Southern journalist. “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]
Known for centuries as a fatal disease, smallpox has terrorized communities from Asia to Mexico.[4] Throughout the war, both Union and Confederate military officials documented the destruction that smallpox caused in their camps as it killed more soldiers than combat, and turned battlegrounds into makeshift hospital stations.[5] In the aftermath of the Civil War, the virus continued its assault on freedpeople.
Military authorities often responded to the outbreak of smallpox in their camps by placing afflicted soldiers in pest houses in order to isolate the virus, or vaccinating, and sometimes, revaccinating vulnerable troops, particularly new recruits who had never been exposed to the virus. Due to the unsanitary conditions of the camps and the constant movement of soldiers and prisoners, the military’s efforts in preventing the virus from spreading often failed.[6]
Since variola, the scientific name for the virus that causes smallpox, easily spreads from face-to-face contact by inhaling the contaminated air of an infected person, former slaves who entered Union camps during the war became open targets for the deadly scourge, and were disproportionately infected with the virus from 1865-1866. [7] Once infected, freedpeople developed a slight fever. By the second week, they developed flat reddish spots on their face, 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.[8] Depending on the severity of the infection, patients either survived or succumbed to the pestilence. If they could survive the fever after a two-week period, they had a good chance to live. Beating the virus, however, demanded immediate medical attention.
Both during and after the war, the military and the Freedmen’s Bureau—the institution designed by the War Department to assist former slaves in their transition from slavery to freedom—struggled to protect freedpeople from smallpox. Throughout the postwar South, Bureau doctors attempted to provide medical treatment, but the federal government’s failure to recognize the outbreak of smallpox as a problem that demanded immediate attention resulted in the continual spread of the virus in the winter of 1865-66. As the Alabama Independent reported “unless some organized effort is made to arrest its progress it will become atmospheric and sweep over the land.”[9] By failing to quickly address the first reported cases of smallpox, federal officials ignored not only a historical precedent on how to stop the virus from spreading, but they also failed to follow the standard protocol that health officials in the North successfully employed when the virus erupted. Even when federal leaders in the Medical Division allotted funds for the construction of hospitals and appointed doctors to serve in the South to treat the virus, the Bureau focused its campaigns largely in cities and major towns, ignoring the continual spread of the virus in the rural South. When Bureau doctors attempted to treat smallpox in the countryside in 1866, lack of resources, manpower, and vaccine prevented doctors from stopping its continual spread.
While the failure to respond adequately to the virus certainly resulted from the Bureau’s limited scope and lack of organization, the Medical Division by and large did not perceive smallpox as a problem or even a health risk because of the way in which Bureau officials reported on the outbreak of the virus. Bureau officials, local doctors, and even newspapers argued that smallpox overwhelmingly infected freedpeople because of their unhealthy living habits and inherent vulnerability to disease. Furthermore, charitable hospitals and state asylums offered medical support to infected white Southerners, who they considered to be citizens, while municipal authorities simultaneously refused to admit freedpeople, who they considered to be contraband of war in 1865-1868. Due to the state government’s uncompromising attitude that freedpeople were not citizens and therefore not entitled to access to medical assistance, Bureau doctors treated mostly, if not exclusively, freedpeople. The Bureau along with members of Congress, in turn, created specific laws in order to address the political, economic, and health conditions of former slaves. Known as “The Laws in Relation to the Freedmen,” this body of rules and regulation responded to the political transitions and economic transformations of the Reconstruction period.
Despite the creation of such laws, which recognized the tenuous political status of newly emancipated slaves, federal leaders in Washington, D.C. continued to understand the outbreak of smallpox as a natural consequence of emancipation; these leaders did not perceive smallpox as an epidemic that resulted from the failure of state and local governments to recognize freedpeople as citizens eligible for medical assistance. As a reporter for The Nation observed, “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, 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.”[10] Since federal leaders, Bureau doctors, and even the press considered smallpox to be an outcome of the “filthy habits and physiological inferiority of former slaves,” the Medical Division of the Freedmen’s Bureau did not adopt the necessary measures to prevent the virus from further spreading.
The misunderstanding about the presence of smallpox in the South compounded with the ongoing struggles among the Bureau, municipal authorities, and former slaveholders to determine who was responsible for providing medical assistance left thousands of freedpeople in rural regions without protection from smallpox and, without a system that monitored the presence of smallpox in the outlying areas. Describing the lack of protection from smallpox in Hilton Head, South Carolina during the war, a freedmen described the initial symptoms of a smallpox infection, we “tuck down wid feber…, ‘case we hasn’t got nuttin’ for keep warm.” A benevolent worker from Boston stationed in Hilton Head echoed this man’s concern, when she 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.” Even in Mitchellville, a colony established by the federal government as the first freedmen’s community on Hilton Head, the lack of medical protection from smallpox resulted in freedpeople dying by “tens and twenties.”[11]
By not immediately treating the first reported cases of smallpox as an epidemic, the Bureau administration, as the acting government in the South, disregarded a century of practice on how to treat the virus. Since the eighteenth century, in both the North and South, outbreaks of smallpox, sometimes as few as two to three cases, constituted an epidemic. Once medical or government officials diagnosed a patient with smallpox, local authorities circulated word of the disease to townspeople, imploring the community to isolate afflicted patients to quarantined areas; meanwhile, physicians provided a range of homeopathic treatments, most of which invariably proved unsuccessful.[12]
During the Civil War, this medical understanding of the virus persisted.[13] The mere 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.”[14] Both Grant and Lee understood the danger of a few cases of the virus; they both immediately reported these instances to their headquarters as part of the standard protocol in combating the virus, and issued mandatory vaccinations of all troops. [15]
Yet, when Bureau physicians began to report on the increasing cases of smallpox in the fall of 1865 in the postwar South, neither the Freedmen’s Bureau, serving as the replacement for local governments, nor the medical profession classified smallpox as an epidemic. This silence contradicted the response in 1862, when smallpox first broke out among the Union troops, James E. Yeatman, President of the Sanitary Commission, recognized the need for the government to declare an epidemic when he arrived to Camp Benton, Missouri. Aware that smallpox could spread unless the federal government intervened, 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.”[16] Union officials ultimately complied with this request by ordering the vaccination of all troops to ward off the virus. After the war, military and government leaders failed to enact a similar order for the freedpeople.[17]
Witnessing the fatalities that smallpox produced, some officers in the field did write to their supervisors with suggestions on how to prevent the virus from further spreading among the freedpeople. A military official in North Carolina recommended that a smallpox house resembling the solider house “should be built for the freedmen, while inspecting the state in the spring of 1865.”[18] A Union officer stationed in Louisiana, also during the late spring of 1865, “respectfully suggested that an order declaring vaccination to be a military necessity,” which, he argued, “would save many lives among these poor people.”[19] Meanwhile, The New York Times reported, “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.”[20]
Although Union officials in the South continued to report on the devastation and deaths that smallpox caused among the freedpeople, federal authorities in Washington did not perceive smallpox as a problem that demanded immediate attention.[21] By the winter of 1865-66, the federal government’s neglect to respond quickly to the initial outbreaks of smallpox among the freedpeople in Washington, D.C., Mississippi, and Louisiana allowed the virus to expand rapidly throughout the rest of the South. In Washington, North Carolina the virus infected well over 300 freedpeople in one week. In the Sea Islands, where former Confederate doctors joined the fight to stop the spread of smallpox, the virus killed roughly 800 freedpeople a week in November and December of 1865.[22] 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, and over a four-month period the number steadily climbed to well over 135 cases by February of 1866. Not until late March, 1866 did the number of infected freedpeople begin to decline. By May 1866—almost a year after officials first reported on the virus in Augusta—over 40 people a week were still being infected with the virus.[23] In 1869, the Chairman of the Committee of Freedmen’s Affairs estimated that smallpox infected 49,000 freedpeople from June of 1865 to December of 1867.[24]
These statistics only tell 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.[25] From December of 1865 to October of 1866, when the epidemic reached its peak, Bureau physicians in Louisiana, Georgia, and Virginia estimated that hundreds of freedpeople a month became infected with the virus. [26] Due to the countless freedpeople in need of medical assistance, many Bureau doctors claimed to be unable to keep accurate records. Furthermore, the statistics regarding the number of afflicted freedpeople only represent those Bureau doctors encountered. In rural regions, places in which the Bureau did not establish a medical presence, the number of those infected with the virus remained unreported.
Statistics fail to convey the sheer fear that the pestilence incited among those living in the postwar South.[27] A Bureau official in Kentucky described smallpox as a “monster that needed to be checked, while another agent witnessing the “severity and almost malignancy of the epidemic,” believed that the virus was on the increase and predicted that “before the coming summer is over it will decimate the colored population.”[28] Although many freedmen and freedwomen were immune because they were either vaccinated as slaves or previously infected, many freedpeople feared the virus would attack their children. Throughout the Bureau’s medical records, children succumbed to smallpox at a higher rate than any other age group. As one Bureau official noted, “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.”[29] The Christian Recorder added, “you may see a child well and hearty this morning, and in the evening you will hear of its death.”[30]