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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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Freedmen’s Hospitals

Freedmen’s Hospitals

The Medical Division of the Freedmen’s Bureau

(p.65) 3 Freedmen’s Hospitals
Sick from Freedom

Jim Downs

Oxford University Press

Abstract and Keywords

This chapter focuses on the bureaucracy and administrative hierarchy of the Medical Division of the Freedmen’s Bureau as well as Freedmen’s Hospitals, which were modeled on nineteenth-century asylums in the North. These hospitals were makeshift institutions that provided access to basic necessities, such as shelter, clothing, and food, after the Civil War. The chapter shows that Freedmen’s Hospitals were not systematically constructed throughout the South, and instead often established in response to a specific medical emergency. It also considers how the arrival of former slaves in almshouses and hospitals called into question the practices of these humanitarian institutions. Finally, it discusses the problem of medical care faced by the Bureau with respect to tending for freedpeople.

Keywords:   bureaucracy, administrative hierarchy, Freedmen’s Bureau, hospitals, Civil War, South, slaves, almshouses, medical care, freedpeople

He who has health, has hope. And he who has hope, has everything.

—Arabian Proverb

Let us begin with the basics. Nineteenth-century hospitals were deplorably dirty by modern standards. The number of unattended patients was often matched by the number of rats that scurried through the halls and appeared on the kitchen floors at nightfall. One representation of hospitals in a popular magazine of the time depicted rats climbing up a bedpost and onto the body of a female patient in the middle of the night.1 Medical advice books warned of the dangers that hospitals produced regarding “carbolic acid poisoning,” which, in the age before the current understanding of ventilation, was nineteenth-century parlance that referred to the hazards of breathing contaminated air.2

It is no wonder that in Charleston in 1868, Lizzie Vanderwhost refused to be admitted to a Freedmen’s Hospital despite a physician’s claim that she required medical assistance. Vanderwhost’s friends petitioned local authorities and wrote letters stating that they would find a physician to take care of her. Vanderwhost was admitted to Freedmen’s Hospital, which before the war was known as Roper’s Hospital—a municipal asylum for the poor and sick. The Medical Division subsequently took over Roper’s Hospital, yet the stigma of it as an asylum for the poor prompted Vanderwhost’s friends to hire a private doctor to treat her. Like many nineteenth-century Americans—black and white, rich and poor, newly emancipated and freeborn—Vanderwhost resisted the idea of being placed into an institution that housed the poor and dispossessed.

Many nineteenth-century Americans marked patients in hospitals as aberrant due to their lack of kin connections and their subsequent dependence on charity. Hospitals in this period oscillated between serving the basic medical needs of those who did not have families to care for them and providing shelter, clothing, and support to the indigent. Given a hospital’s dual objectives, an institution (p.66) often treated hundreds of patients. In some cases, the ratio of patients to doctors could be roughly 200:1, and in institutions that treated patients with mental disabilities, the ratio, at times, could be 1000:1.3 These discrepancies existed because, throughout the nineteenth century, there was minimal variation between institutions that provided shelter to the poor and to prostitutes and those that attempted to offer medical care and comfort to the sick and suffering. Hospitals, asylums, dispensaries, and almshouses all provided some form of relief and refuge for those who—unlike their middle- and upper-class contemporaries—could not afford to be treated by doctors in their own homes.4

Due to her friends’ pledges to provide care for her, Vanderwhost managed to avoid being admitted to the hospital.5 Yet, for many emancipated slaves in the immediate aftermath of the war, Freedmen’s Hospitals, despite their horrendous conditions, represented their only chance to survive the sickness, disease, and poverty that plagued the postwar South. They offered freedpeople the fundamentals: clean clothing, shelter, food, and basic medicine. In fact, so many freedpeople sought relief and medical care that the hospitals lacked the resources to provide support for all those who asked for it, let alone develop measures to search the postwar South for freedpeople who needed medical help. Further, the federal government did not have the capability to require emancipated slaves to be admitted.

The fact that the physician argued that Vanderwhost required assistance suggests that she may have been elderly or severely disabled, not simply sick. Sick ex-slaves were often provided with temporary medical assistance and then encouraged to recover on their own, usually with the help of family members, so that they could rejoin the labor force. Nineteenth-century doctors and federal officials carefully guarded against people taking advantage of the federal government’s “charity” and developed rigid guidelines for who qualified for federal assistance. Bureau officers and physicians placed elderly or disabled former slaves in a different category. Their age or disability marked them as unable to join the labor force and thereby worthy of institutional support. Since Vanderwhost’s discharge was based on her friends’ promise that they would find a doctor for her suggests that perhaps she could not find one on her own.

Lizzie Vanderwhost’s experience nevertheless reflects the broader history of almshouse and hospitals in nineteenth-century America, as well as the symbiotic, if vexed, relationship between labor and charity. From the late eighteenth century to the outbreak of the Civil War in 1861, municipal authorities supported the organization of these hospitals and almshouses since they facilitated the creation of a free labor economy. Early in the nineteenth century, as the rise of industrialization led to the collapse of individual proprietorship, many people who could not find employment in the burgeoning mills and workshops cropping up throughout the northeastern United States were left penniless. (p.67) Almshouses offered temporary charitable relief to these individuals as they attempted to find adequate work. Finding steady employment was not as easy as the administrations at these institutions had hoped. Superintendents became frustrated as the lines of people requesting relief grew longer and the number of patients at hospitals increased exponentially. Underlying the superintendents’ frustration were fears that dependency jeopardized the prospect of a free labor economy, threatened the success of industrialization, and contradicted the widely embraced American notion of “individualism.”6 Nonetheless, because the operation of these institutions developed in response to the changing organization of a labor force and the overall functioning of the economy, many nineteenth-century Americans tolerated almshouses and hospitals as temporary institutions that would ultimately improve the quality and character of American workers. Nineteenth-century hospitals, at least in theory, exemplified the efforts of many Northern reformers to offer charitable relief to those displaced by the unexpected disruptions of industrialization.

Unhelpful Charity

The arrival of former slaves on the doorsteps of almshouses and hospitals called into question the practices of these humanitarian institutions. Inundated with requests from poor white Southerners since the beginning of the war, many of these institutions, at first, did not have the resources to extend their services to former slaves.7 Moreover, among the dozens of dispensaries and almshouses in the postwar South that could potentially offer relief, these institutions explicitly denied freedpeople assistance. In Louisiana, the chief medical surgeon observed in October 1865: “In this city [Shreveport] the Civil Authorities made no provision whatsoever to relieve sick and destitute freedmen. They are not admitted to the Charity Hospital unless it is some exceptional cases of more than usual interest to the Medical profession. The same feeling is exhibited throughout the State generally.”8

Bureau officials assumed that since local governments had previously gathered afflicted white people from the rural parts of the state and then sent them to the state hospitals, freedpeople would also be admitted to these state-run hospitals under similar provisions. In Charleston, South Carolina, Bureau leaders demanded an explanation from the administration of Stewart City Hospital for the “delay and neglect” in removing black patients from rural areas to the Pest House in the outer regions of the town, but the local authorities argued that they never agreed to admit infected freedpeople.9 Physicians in Savannah, Georgia, claimed that there no sick people in the city ward, and in response to the growing number of black patients, particularly among the migrants in the surrounding (p.68) area, Bureau doctors asserted in 1866, “Those colored people that followed Sherman’s Army should be the responsibility of the City of Savannah.”10

Most almshouses refused admission to freedpeople because state and local governments failed to recognize newly emancipated slaves as citizens. State and local authorities further claimed that municipal officials designed asylums as temporary refuges for those who suffered from economic loss—in essence arguing that freed slaves were not former workers but indolent and unworthy dependents. Bureau officers initially challenged local governments’ refusals to assist freedpeople and attempted to coerce these institutions into extending relief to newly emancipated slaves. In the fall of 1866, a Bureau agent in Mobile, Alabama, appealed to the city, after the local government denied freedpeople admittance to an almshouse, by arguing that freedpeople were, in fact, entitled to aid because they were denied wages from their own labor. “I can only repeat that these people are the county poor and measures for their support and medicines must be their responsibility,” he wrote. “If you say they are not from households they are still destitute, simply because those have taken from them the net proceeds of their labor.”11 Beyond Mobile, civil authorities refused to provide medical assistance to freedpeople throughout the South in 1865–66.12

Compounding matters, when the war ended, there were fewer than six army medical units that provided assistance to former slaves. Treatment depended largely upon the availability of resources, the size of the ex-slave population in a Union camp, and the informal and often capricious decisions made by military officials in charge of a jurisdiction.13 As early as 1862, both Robert Reyburn, a Union surgeon in Washington, DC, and John Eaton, Union chaplain in the Mississippi Valley, allowed ex-slaves access to their camps and provided medical aid to them.14 Yet, in order to qualify for any form of assistance, freedpeople had to be willing to contribute their labor power to the federal government.

The few remaining military camps in the South offered the only institutional source of medical support for freedpeople after the war ended, which left hundreds of thousands of newly emancipated slaves without medical care.15 As the military folded their operations in parts of the postwar South, the wartime policy, which once afforded former slaves rations, clothing, and medicine, ended. Describing the fallout of this program, one military agent explained that “the great ingathering of freedmen at the first centres of military occupation, and the resultant outbreaks of disease, compelled immediate provision.” But, he continued, “Once these accumulations were dispelled, the number of patients was not so equally reduced … Victims of criminal assault, of accident and of disease continually came in as having plainly nowhere else to go, and often in moribund condition.”16 Arriving in North Carolina in the spring of 1865, a Bureau agent pointed to a specific case of freedpeople “left almost entirely without any medical care” for five months.17

(p.69) When the military had abandoned the freedpeople in the final months of the war at a Union camp in North Carolina in 1865, sickness and disease escalated; the military left no personnel or medical assistance for unemployed former slaves. According to the chief surgeon in North Carolina, General Sherman sent about 10,000 freedpeople “down the Cape Fear River to Wilmington” and established a camp for them at Fort Anderson on Cape Fear. However, sickness plagued this camp. The several doctors present could not prevent the rampant spread of disease. The chief surgeon in the camp claimed his subordinates, the acting surgeons, who worked in the jurisdiction “paid very little attention to the sick.”18 According to the chief surgeon’s report, an estimated 2,000 freedpeople died at Fort Anderson on Cape Fear between March 17 and May 31, 1865—an average of 30 ex-slaves a day. He concluded his report to a federal official in Washington by stating, “It is impossible to account for the cause or causes of this terrible mortality, as no record was ever kept of the camp, nor any report made of the sickness or death. There was no hospital accommodation at this camp.”19

There are things that we will never be able to recover or reconstruct. Who counted the dead? Was it the shocking discovery of their bodies or the questions of where they would be buried that led to this estimate? Since there was not, as the chief surgeon asserted, a hospital to care for them or even a mechanism to report on their sickness, there likely was no infrastructure in place to bury them. Why would there be? Their migration to Cape Fear resulted from Sherman’s order not from any formal plan for the emancipation of four million people.

What happened to those who lived? What did survival mean to people who endured slavery but witnessed the death of 30 people a day? Family members gone, parents buried, and children never given the chance to grow up as free. Indeed, the surgeon was right when he stated, “it is impossible to account for this terrible mortality,” but it is equally impossible to account for how the others survived.

Before the Civil War, many slaveholders provided medical assistance and even, in some cases, built hospitals for enslaved people on their plantations. After the war, they argued that it was the responsibility of the federal government to assume health expenses because the government freed the slaves. As one Louisiana planter crudely explained, “When I owned niggers, I used to pay medical bills and take care of them; I do not think I shall trouble myself much now.”20 A Bureau doctor from South Carolina, wrote, “We take care of those in the vicinity of towns and employers provide medical aid to those working on plantations.”21 Planters in northern Virginia refused to provide medical treatment and actually sent newly employed freedpeople who became infected with smallpox back to Washington, DC. The dispute between Bureau officials and planters escalated in Strawberry’s Ferry, South Carolina, when smallpox reappeared along the Cooper River in December 1865. “If planters vaccinated former (p.70) slaves the first time smallpox entered the region,” a physician argued, “many people would have been saved”; instead, “many have died.”22

On some plantations, former slaveholders and ex-slaves began the slow process of introducing the subject of health care as part of their contractual agreements in response to the epidemic outbreak of disease.23 Yet planters consistently deemed it the responsibility of the freedpeople to pay their own medical expenses. Similar to antebellum slaveholders, who hired out enslaved people to other plantations and shifted responsibility for medical care to those who were renting, postwar planters willingly contracted to provide former slaves with living arrangements but shifted the burden of medical expenses to those laborers.24 In his agreement with freedpeople on his plantation in Abbeville, South Carolina, in July 1865, Charles J. Haskell agreed to furnish food, clothing, and the usual supplies—including food to raise hogs and time off to cultivate gardens—but stipulated that freedpeople must pay for medicine and doctor’s visits.25

Many emancipated slaves, however, lacked the money to pay for medical expenses. Moreover, these agreements only applied to those who actually secured employment. Of course, many freedpeople, who avoided former slaveholders as employers and attempted to work independently, had no such arrangement. “We went begging,” remembered a former slave, about the days and weeks following his family’s emancipation. Only “finding berries to eat,” he lacked clothing and medical treatment to protect his wife and children from exposure.26

The Medical Fallout of Presidential Reconstruction

The creation of the Freedmen’s Bureau was an attempt to respond to the vacuum left by slaveholders, yet the Freedmen’s Bureau’s efforts were immediately thwarted. The federal government denied responsibility for ex-slaves’ medical care at the highest level. Andrew Johnson claimed that there was no precedent for establishing medical care in the South and that such a measure would violate his constitutional authority as president.27 As Radical Republicans, who served as the architects of the Bureau, developed plans for the operations of the Freedmen’s Bureau on Capitol Hill, blocks away at the White House, President Johnson attempted to derail the efforts of his own party by returning power to the planter elite. A firm believer in states’ rights, Johnson vigorously opposed the Freedmen’s Bureau as the institution that would rebuild the South. Johnson denounced the Bureau as unnecessary and expensive; he argued that former slaveholders could better reconstruct the South if given the necessary financial support and governmental authority. He contended that before the Civil War there were four million slaves and 320,000 slaveholders; after the Civil War, (p.71) there were four million slaves that cost the federal government 12 million dollars. In response to Johnson’s position on the Bureau, Republican Senator Lyman Trumbull of Illinois approached Johnson in the fall of 1865 to reach a compromise, explaining that asylums, among other forms of support, were desperately needed to assist former slaves in their transition to free labor.28

According to the Johnson administration, providing physicians, medicine, and hospitals for the freedpeople would only incite dependency. As a result, his policy limited the operations of the Freedmen’s Bureau and prevented military and Bureau officials on the ground from providing medical relief and support. While Johnson’s plan to rebuild the South has been judged an abysmal failure because he pardoned Confederate slaveholders and limited federal aid to reconstruct the South, his policies are even a greater failure when judged by their fatal health consequences for the freedpeople. By returning power to Confederate slaveholders and in essence prioritizing their demands over those of emancipated slaves, he prevented the creation of an infrastructure to stop the spread of disease or to address the abject poverty and prolonged starvation that beleaguered the South.

As Johnson and members of Congress continued to debate the objective of the Freedmen’s Bureau, the emancipated slaves’ situation continued to deteriorate. Hungry, sick, and homeless, they rummaged through evacuated Union camps and salvaged worn, discarded uniforms, donned hats and scarves, and accepted, if available, blankets and food from Northern charitable groups. Meanwhile, former slaveholders, whom Johnson assumed would rebuild the South, ignored the thousands of newly emancipated slaves dying from exposure, malnutrition, and fever. As Bureau officials slowly arrived in Louisiana, southern Virginia, and the Carolinas in June of 1865, they discovered the bodies of dead freedpeople in the streets and learned of others left to die in the countryside—but only when townspeople complained about the stench. Bureau agents found elderly and feeble freedpeople in barns and hovels without food or clothing; on deserted plantations, they found scores of sick ex-slaves, huddling for warmth around fires.29 And in cities, military officials found emancipated slaves crowded in empty lots, begging for assistance outside of churches, and taking refuge in former Confederate prisons and slave pens.30 As one military official observed, the freedpeople “were crowded together, sickly, disheartened, dying on the streets … no physicians, no medicines, no hospitals.” Such scenes, he wrote, “were calculated to make one doubt the policy of emancipation.”31

As leader of the Bureau, O. O. Howard refused to wait for Congress to legislate an initiative to provide medical assistance. Howard created the Medical Division of the Freedmen’s Bureau on June 1, 1865. He explained, “Soon after taking charge of the Bureau, I found it necessary to regulate hospitals and asylums … and to extend medical aid as far as practicable to the refugees and (p.72) freedmen who became sick and were unprovided for by any local supply from a private source.”32 Asserting that the establishment of hospitals throughout the South would reduce mortality rates among former slaves, Howard cited the success of hospitals in Washington, DC, under Robert Reyburn, and the Freedmen’s Hospital in the Mississippi Valley, supervised by John Eaton, where medical intervention led to mortality rates dropping from 30 percent to 4 percent.33

Using these hospitals as models, Howard developed the blueprints for hospitals throughout the South.34 On June 16, 1865, he appointed former Union surgeon Caleb Horner as the chief medical surgeon, who, along with a handful of doctors in the nation’s capital, began to design the organizational and bureaucratic structure of the Medical Division.35 In each state where the Freedmen’s Bureau established headquarters, an assistant commissioner oversaw the responsibilities of the various divisions and reported back to the main headquarters in Washington. Horner appointed a chief medical surgeon in each state to be in charge of the hospitals and physicians, to report any severe outbreaks of contagious disease, and to assess the overall health conditions in the state. Further down the bureaucratic ladder were assistant surgeons, who were in charge of particular regions and were required to make weekly and monthly reports to the assistant commissioner in charge of the state, who then made an annual report to the chief medical surgeon in Washington.

The establishment of Freedmen’s Hospitals was accompanied by fears that able-bodied individuals would become dependent on the government for support. This anxiety shaped every decision that federal authorities made about the construction, organization, and the management of medical care in the Reconstruction South. Freedmen’s Hospitals were not purely devoted to the comprehensive health and well-being of emancipated slaves but rather functioned as institutions that provided temporary care—namely, shelter, clothing, food, and basic medical treatment—to freed slaves so that they could join the labor force.

While the blueprints for the Medical Division seemed workable, the execution of these plans unfolded rather haphazardly because of conflicting economic and political agendas. Howard developed a medical system not only to lower the mortality rates of the ex-slave population but also to facilitate the creation of a free labor economy on Southern plantations. Each day, Howard received hundreds of reports from Bureau agents in the South about the struggles to create a labor force; to cultivate the land; and, in essence, to build an economy from the ground up. As he recalled years later in his autobiography, “The supervision and management of all subjects relating to refugees and freedmen gave a broad scope for planning and multitudinous duties. When I stepped into my office and began to examine the almost endless communication heaped on my desk, I was at first appalled.”36 “My first decision was that labor must be settled,” Howard wrote, “if we would avoid anarchy and starvation what we do must be done immediately.”37

(p.73) Similar to almshouses that isolated the sick in an effort to create social order in antebellum cities and towns, Howard devised the plans to create a medical system in the South in order to avoid “anarchy.”38 Sickness created chaos in the postwar South and jeopardized the building of an effective labor force. Constructing a hospital system, therefore, was Howard’s effort to create order. His creation of the system did not result purely from a benevolent concern about the health and well-being of former slaves but was firmly rooted in his broader campaign to establish social order.

Howard’s statement that “labor must be settled” evokes the formative wartime policies surrounding emancipation, which emphasized freedpeople’s labor power as contingent upon their emancipation. In the first circular that he authored as the leader of the Freedmen’s Bureau, which was widely published throughout the country, he wrote, “The negro should understand that he is really free but on no account, if able to work, should he harbor the thought that the Government will support him in idleness.”39 Here, Howard foregrounds his concern about the necessity of former slaves working. Moreover, like wartime army officials, Howard did not shy away from the idea that military compulsion would be needed in order to return former bondspeople to postbellum plantations. The mere suggestion of compulsory labor however caused the Northern press to rile against Howard’s proposal, charging that “that the negro had merely changed masters from the Southern slave owners to the United States.”40

In response of the Northern press’s allegations, Howard defended himself as a staunch proponent of free labor and a firm protector of the government’s charitable relief programs. That said, he later confessed in his Autobiography that he raised the issue of military compulsion to stave off the criticism of the Bureau as an institution that “would simply ‘feed niggers in idleness,’ as they expressed it … I wished to start right.” To prove that the Bureau would not encourage dependency, Howard furnished statistical proof to members of Congress that government relief would be temporary and limited. He posited that the number of freedpeople in Washington, DC, and “in different parts of the South” requesting relief from June to August 1865 grew from 144,000 to 148,120. Yet, once he tightened restrictions for those who qualified for aid by September of 1865, he proudly boasted, the number of those receiving relief dropped significantly, to 74,951.41

Much of the rationale behind the operations of Freedmen’s Hospitals can be gleaned from Howard’s statements. To begin with, Howard’s boastful proclamation that the number of people receiving relief declined rapidly reveals the federal government’s goal of reducing aid. This does not mean that the conditions in the South improved, that mortality rates decreased, or that ex-slaves were no longer hungry or sick. It simply means that the government had determined that the South no longer warranted federal intervention. It is unclear how officials reached this decision or how Howard calculated the reduced number of people worthy of relief.

(p.74) Howard’s statements further posit the temporary nature of federal intervention, and by temporary, he meant a nearly immediate cessation of support. The statistics for the distribution of aid from June to August were barely printed before Howard managed to halve the amount of relief. That the number of people requesting relief increased signaled to him that the ex-slave population was becoming permanently dependent on the federal government for relief. What this assessment fails to consider is that the ex-slave population in a particular region was not stagnant; in fact, freedpeople were constantly on the move—in search for food, lost family members, and employment. All of these factors led to changing population patterns and differences in the number of people in need of relief. More to the point, Howard does not provide specific geographic regions where people sought relief but vaguely states that dependency was increasing in “different parts of the South.” His failure to offer a more precise analysis exposes the often loose and imprecise language that federal leaders employed in their descriptions of the postwar South as well as the vagueness that characterized the prospect of rebuilding the South.

The Anatomy of Freedmen’s Hospitals

The project of creating a national system of medical care throughout the Reconstruction South did not attend to the specificities and variations of particular places, nor did it offer federal agents, stationed throughout the South, the textual space in reports to articulate nuance or variation of the medical problems that they confronted. Instead, federal reports generalized conditions, broadly summarized problems, and, most important, often kept an eye open for any sign of improvement to justify the federal government’s eventual withdrawal from the South. As Howard explained, “We were laboring hard to reduce the number of freedmen’s courts, hospitals, asylums,” as well as the charitable-relief efforts provided by the federal government.42

This ethos ultimately led to the mismanagement of Freedmen’s Hospitals and undermined the operations of the first-ever federal health care program. By working under the assumption that Freedmen’s Hospitals were temporary institutions, federal leaders failed to create a clear administrative protocol on how these institutions would run. Moreover, Bureau physicians stationed throughout the South, whose job was to treat the sick, struggled to do so, as they faced extreme pressures by federal leaders to reduce relief and medical aid. Without support to run functioning hospitals, Bureau doctors found it that much more difficult to stop the spread of disease or to address the consequences of poverty.

Given this predicament, Freedmen’s Hospitals functioned less effectively than Northern almshouses, which were dilapidated and poorly organized institutions. (p.75) Superintendents of Northern institutions at least recognized that almshouses would probably be permanent fixtures in the North, which facilitated their broader missions. Since the federal government was always looking for ways to cut medical aid, Freedmen’s Hospitals struggled against presumptions of their temporary status to operate effectively.

Moreover, federal authorities did not systematically construct hospitals throughout the South, the way they did schools or labor offices. Since most federal agents and military officials lacked medical experience or training, they built hospitals and contracted physicians only in response to need, usually presented in the form of a report to the Freedman’s Bureau that an area was “unhealthy” or where “mortality rates increased.” As the leader of the Bureau in Alabama explained, “The hospital system of the bureau is the result rather of past necessities than of a plan to furnish medical attendance to refugees and freedmen as a class.”43 This was also true beyond the Bureau; physicians often lamented that hospitals were constructed in response to demand, rather than established as permanent institutions that could prevent medical disasters. Many doctors across the country advocated for the state to take a more preventive approach to the treatment of disease and the construction of hospitals.44

The problem with establishing hospitals only in response to demand was that, in much of the rural South, no one was responsible for documenting health conditions and notifying federal authorities about the need for medical support. Rev. A. S. Fiske, a Bureau agent in the Mississippi, recommended to leaders in Washington that a doctor should be assigned to each area in the South where former slaves lived. “The proper care of the sick, and charge of sanitary affairs,” he explained, “requires that each provost-marshal district should have a medical officer, who should be in control of all sanitary affairs on the plantation.”45 In the fall of 1865, there were roughly 80 doctors and only a dozen hospitals in operation to treat well over four million slaves.

The lack of clear protocol on how to establish a hospital in a given region led to the federal government loosely assigning doctors to various Southern towns and cities where they assumed former slaves congregated after the war. Once arriving at these locations, Bureau doctors, who had little contact with treating black patients and had not been trained for the challenges of a postwar crisis, needed to assess the medical conditions. What they encountered and how they perceived the conditions of the South remains unclear, since the government did not solicit their impressions or observations.

Some Bureau doctors served in the military during the war, and others worked in private practices in the North or South before becoming employed by the federal government during the early years of Reconstruction. For other physicians, Freedmen’s Hospitals served as their training ground for the medical profession. Like Northern carpetbaggers who fled to the postwar South for (p.76) political advancement, some novice doctors recognized the opportunity to gain experience, treating scores of sick freedpeople.46 It is unclear how these doctors met their first patients or how they identified their mission to ex-slaves. Nor is it clear how freedpeople described their health to these mostly white men, some of whom wore military garb and other clothing similar to what their former masters wore. There were some doctors who traveled to the South with the best intentions of helping freed slaves. Committed to learning more about the medical problems that confronted freedwomen and their newborn babies, Dr. Rebecca Crumpler, one of the few African-American women physicians employed by the Bureau, traveled from Massachusetts to Richmond, Virginia, to have the opportunity to work with freedpeople. “I was enabled, through the agency of the Bureau under Gen. Brown, to have access each day to a very large number of indigent, and others of different classes, in a population of over 30,000 colored,” Crumpler stated.47

Once they arrived in their assigned jurisdictions, Bureau doctors’ first objective was to set up a hospital. This depended on assessing the medical condition of the freedpeople. Doctors had to determine whether the hospital would serve as a quarantine facility for those infected with a contagious viruses, like smallpox, or if it would function as a shelter for those that were homeless and vulnerable to exposure.48 Matters were more complicated when one institution had to serve both objectives.

In the midst of confronting these questions, physicians also devised the actual blueprints to construct hospitals. Due to their limited budgets and the temporary nature of Freedmen’s Hospitals, they converted schools, hotels, municipal buildings, and almshouses into hospitals. None of these plans could be formally executed until doctors received permission from leaders in Washington.49 One local doctor asked Bureau officials for permission to use a recently constructed school building as a hospital. “It is absolutely necessary,” he explained in September 1865, “that some provision be made at once for these people, as they are sure suffering very much and the shanties at present occupied are utterly unfit for human beings.”50 Bureau doctors in Savannah, Georgia, consequently turned “the city poorhouse” into a hospital that was also used as a school.51

The type of medical care that hospitals could offer freedpeople and the number of patients that they could treat depended upon the availability and resources that federal authorities provided local Bureau doctors. “We have labored under great inconvenience for a suitable building for a hospital purposes which the sick could be suitably nursed and cared for as well as a suitable place to bestow and care for the old and the infirm,” explained a doctor on the outskirts of Washington, DC, in 1865.52 Freedmen’s Hospitals in Washington, DC, New Orleans, and Charleston housed as many as two hundred beds in one hospital, treating those infected with typhoid fever as well as offering shelter to the (p.77) orphans and elderly. But the vast majority of Freedmen’s Hospitals, like those in rural parts of North Carolina and Georgia, could treat no more than twenty patients, due to lack of funding.53

Additionally, Bureau doctors struggled to find available land to construct hospitals. Johnson’s return of land to former slaveholders thwarted the efforts of those who attempted to establish hospitals on abandoned land or plots of land the Union army had used as campgrounds and refugee places for newly emancipated slaves. In Orangeburg, South Carolina, Bureau doctors turned a former quartermaster store for the Union army into a supplies post for the Freedmen’s Hospital, but a local townsman demanded its return and the doctors were ultimately forced to give up the land and the hospital on it.54 Similarly, in Roanoke, North Carolina, the government ordered Bureau officials to move the hundreds of freed slaves who migrated to the island during the war to another location, so that the land could “be restored to its original owners.”55 As Southern slaveholders scrambled to reclaim their property lost in the war, the land available for Bureau doctors’ use shrank. Bureau physicians required land for a number of functions from providing shelter to those, who Harriet Jacobs described, as “living with nothing but the bushes over their heads” to offering refuge for those afflicted with chronic dysentery and were subsequently unable to work.56

Freedmen’s Cemeteries

Bureau doctors required plots of land to bury the freedpeople who died during and after the war. In their haste to cut the Bureau’s funding in the winter of 1866, the Johnson administration failed to consider the cost of coffins and the need for cemeteries to bury dead freedpeople. When Bureau physicians first alerted federal officials of the need for burial grounds, they commanded the Bureau doctors to work out arrangements with local governments.57

Local authorities, in turn, often rejected such requests, opposing the mere suggestion that freedpeople be buried near the same lot used for white Southern residents. In Raleigh, North Carolina, sparks flew when municipal officials informed Bureau agents in April 1866 that “the cemetery is a resting for those remains of Union soldiers and not an indiscriminate burying ground for freedmen.” Bureau officials responded by asking for an appropriate place to bury the freedpeople, but municipal authorities failed to provide an adequate solution, all the while demanding that the bodies be removed.58 Debates about where to bury freedpeople reignited the issue of who was in charge of the Reconstruction South: the federal government or local authorities.

On an emotional level, the turmoil of not being able to properly bury loved ones must have been unbearable for former slaves. On a public health level, the (p.78) lack of cemeteries for freedpeople created dangerous health problems. In April 1865 in Charleston, South Carolina, freedpeople infected with typhoid fever were left to die in isolation and not properly buried. As a city official there explained, “The health of this institution and the city requires that dead bodies by typhoid fever should be removed with as little delay as possible.”59

Without a sanctioned area for burial, the bodies of many dead freedpeople were left exposed. If the local medical staff could secure an ambulance, they could transport some of the bodies of freedpeople to remote locations in the countryside.60 But ambulances were a new invention and few existed around the South. The idea of transporting dead bodies from one location to the next via an ambulance gained momentum after the Battle of Bull Run, but such a program demanded funding, manpower, and, most of all, a designated area to bring the bodies—which ultimately made this relatively easy task difficult to accomplish. In many parts of the South, the failure of both the federal and local governments to create cemeteries rendered such transportation moot. As a result, members of the local medical school in Montgomery, Alabama, scavenged the town for the bodies of dead freedpeople to be used—without the permission of family members—for medical experimentation. Reports from freedpeople in Washington, DC, and other parts of the South, told of similar situations in which medical practitioners snatched the bodies of dead former slaves for experiments.61 Bureau doctors frantically wrote to officials in Washington for allotments to their budgets to stop these practices from continuing and for the money to pay local carpenters to build coffins. “I need three coffins immediately,” wrote a doctor in Charleston, South Carolina, in 1868; “I have no time to make a special requisition.”62 But like other requests placed by local doctors, these orders were left unanswered.

Help Wanted

As Bureau doctors struggled to acquire land and funding, they were also overwhelmed by running a bureaucracy. Paperwork piled up on physicians’ desks: weekly and monthly medical reports, pharmacy inventories, employee contracts, and various other administrative forms competed with actually treating patients. After waiting months for officials in Washington to respond to a call for medical assistance for over 3,000 freedpeople in Roanoke, North Carolina, a Freedmen’s Bureau agent, in September of 1865, wrote again, explaining that, “much suffering will endure if supplies are not provided.”63 As an institution reliant entirely upon federal administrators for funding, supplies, and manpower, each Bureau doctor needed to have a steward on staff to maintain accurate records and to handle the correspondence between local doctors and federal administrators.64

(p.79) Bureau doctors, however, struggled to find competent stewards to assist them with hospital management. Local military authorities assigned Union soldiers, who were still stationed in the South, to serve as hospital stewards. While this provided a temporary solution to the problem, as more Union camps folded their operations and soldiers left the South, the number of available soldiers that could read and write dramatically decreased.65 When the Union army left Memphis, Tennessee, in September 1865, a local Bureau doctor panicked for fear of not having an assistant who could handle the overwhelming paperwork that the hospital amassed. He wrote, “I feel that I cannot overstate or exaggerate our wants in this particular hospital … in a hospital with over 100 patients, where the convalescents are alike ignorant and untaught or rather inteachable, the service of a good steward are indispensable … all the white troops here are being mustered out.”66

Initially, Howard planned to simply extend Union army stewards’ and physicians’ contracts. In an order from General Tillson in Georgia, for instance, army surgeons were required to continue to stay in the region and “to treat those in need” until sickness and disease dissipated.67 But Georgia was the exception; many soldiers refused to stay on duty. “We are now needing additional help of that kind,” wrote a Bureau doctor to his supervising officer in September 1865.68 Like many members of the army, medical personnel also refused to remain in the South after the war, and, consequently, many former slaves suffered because of lack of medical treatment.69 As one Union physician described the situation in September 1865, “There are upwards of three hundred sick and but two surgeons to minister to them; and the result is that the former are overworked and yet the latter have not the care that humanity demands.”70 Thus numerous doctors simply left the South, refusing to provide medical care, even if it meant breaking the Hippocratic oath. As John Eaton, stationed in the Mississippi Valley, later explained in his autobiography, “the soldiers in the Army were a good deal opposed to serving the Negro in any matter.”71

Without consistent and reliable support from the Medical Division, Bureau doctors had no choice but to turn to local, white Southern physicians for assistance—often to no avail. As former slaves migrated from the sugar and cotton plantations of Louisiana to Shreveport and New Orleans for employment and medical assistance, local white doctors—despite prodding from the Bureau—declined to provide treatment to the migrants.72 Similarly, in Greensboro, North Carolina, a local doctor unapologetically refused to provide medical treatment to a group of sickly freed slaves.73

Although some white doctors agreed to assist Bureau physicians, federal authorities only permitted such hires on a short-term basis. In many cases, the Bureau would only hire a physician for three to six months, refusing to extend beyond a nine-month period. Short-term doctors’ contracts made it difficult for (p.80) chief surgeons to run a hospital; as soon as an assistant physician was trained to treat patients and carry out administrative duties, his contract would expire. That said, many doctors were unwilling to stay on staff beyond the initial three-month period. The long hours, combined with the responsibilities of managing the hospital, resulted in many physicians declining to extend their contract. A Bureau official in Mississippi remarked in 1866, “When any of these gentlemen do not renew contracts, much inconvenience, to say the least, is the result, and generally there is danger that patients will suffer before a new contract will be accepted.”74

On the other hand, when local doctors did agree to renew their contracts, Bureau leaders doubted their intentions. As the assistant surgeon in charge of medical operations in South Carolina said in December 1865, it was very difficult to find Southern white physicians who were “faithful friends to the colored race.”75 Bureau officials on the ground suspected eager doctors who were willing to open Bureau hospitals of being charlatans, only interested in treating freedpeople to gain experience, a common practice among novice doctors in the nineteenth century.76 As one Bureau official lamented in October 1865, “It’s too difficult to find a honest, good doctor that won’t abuse the poor.”77 In an attempt to prevent disingenuous physicians from filling their ranks, the Bureau required applicants to provide verification of their medical training and experience, as well as letters of recommendation testifying to their sincere commitment to providing medical care to the freedpeople. But sometimes due to freedpeople’s immediate need for medical care, this process was not carried out. In some cases, local doctors, who did not have contracts with the Bureau, provided immediate, free medical assistance to former slaves but later charged the Bureau for their services—which created problems for Bureau administrators, who did not have the funds or authority to pay these doctors.78

In addition to hiring additional Bureau doctors, local physicians also struggled to hire competent and committed nurses, attendees, and cooks to staff Freedmen’s Hospitals. Federal restrictions, however, often thwarted these efforts. Federal authorities required Bureau doctors to wait until they received permission from the national Bureau office before they initiated employment contracts with hospital staff.79 But Bureau doctors immediately and desperately needed nurses to distribute rations, change sheets, wrap bandages, and bathe the patients. Physicians also needed cooks to prepare the meals, and, even—in some hospitals—guards to protect the rations and supplies.

After physicians, attendees proved to be the second most challenging and important positions to fill. Attendees were responsible for ensuring that hospitals were sanitary to guard against sickness. Beginning in the late eighteenth-century, several military leaders, doctors, and ordinary citizens began to theorize about how dirt caused the spread of disease. Bureau doctors desperately needed (p.81) attendees to sweep and mop floors, wash tables, desks, and walls with lime; and launder clothes to keep toxic smells away.80 In some cases, attendees also provided medicine to patients. At the Freedmen’s Hospital in Arlington, Virginia, in 1867, the supervising physician complained to federal authorities that attendees had given patients the wrong medicine. The doctor blamed the attendees’ “blunder” on the cramped conditions of the hospital and claimed that if attendees could properly number each bed, such mistakes would be prevented in the future. The doctor also emphasized the role of attendees to maintain “more perfect cleanliness,” which, he argued, could be achieved by proper inspection and preservation of the bedding.81

But without funds allotted from the federal government to hire the proper personnel, Bureau medical officials were unable to maintain efficient hospitals. Although federal officials eventually approved contracts to hire hospital staff and allowed Bureau agents to contract local physicians to serve in the hospital, they did not provide the necessary funds to pay the medical staff. As one frustrated doctor dryly remarked in September 1865, “The Bureau seems to me imperfect as it provides for the employment of surgeons but makes not appropriations for their pay.”82 Throughout the South, Bureau offices and medical authorities could not consistently pay their staff, to the point that many employees often quit and the Bureau could not replace them.

Freedmen’s Hospitals Bureaucracy

Within the broader framework of the Freedmen’s Bureau, the communication to the federal level came at a greater cost to the Medical Division than to other divisions of the Bureau. Officials who supervised schools, legal matters, and employment contracts also needed to funnel their requests through a federal bureaucracy, but the time that elapsed waiting for a response about hiring another teacher, approving the terms of an employment contract, or resolving a legal conflict did not have the same repercussions for doctors, forced to wait for medical queries to be answered. As a result of the slowness of federal bureaucracy health conditions worsened, and, in many situations, freedpeople died while waiting for treatment. Throughout North Carolina, from Raleigh to Wilmington, agents and doctors produced reports about the dire and unhealthy conditions of the state in 1865, but calls for assistance were not answered. By January 1866, physicians stationed in various districts were still waiting for additional doctors to arrive and supplies to be delivered. Not surprisingly, a physician in Salisbury reported on January 24, 1866, “that several had died from want of great attention.”83 Not until March, six months after the initial requests were made, were doctors’ calls for more assistance finally answered.

(p.82) Despite the dire situation, Bureau doctors were required to follow the bureaucratic regulations. In order for Bureau physicians to receive supplies—whether it was secondhand tents, clothing, or medicine—the chief medical surgeon of the Bureau required local doctors to provide comprehensive reports ranging from the number of patients treated to detailed accounts of inventories. If they did not follow the prescribed guidelines, they would not be provided with funding, supplies, or staff. Bureau doctors struggled to comply with these federal mandates.84 In less than a three-month period in 1866 in South Carolina, for example, local Bureau doctors throughout the state were unable to provide reports to the chief medical surgeon. Their reasons for failing to do so ranged from being sick themselves to a sudden outbreak of fever that turned their “district into a hospital,” which left no time for sending reports.85 A doctor serving in the outskirts of South Carolina waited months to receive his shipment and when he did get part of the requested material it was “broken and spoiled.”86 Supervising officials justified such a tedious process because they claimed some doctors stole supplies and embezzled money.87

Those doctors who attempted to abide by the headquarters’ command often found themselves in a bureaucratic mess. Obtaining the correct request forms or knowing how to calculate number of patients seen versus the number of patients remaining under their care from the previous week posed problems for Bureau physicians. Once they filled out the correct reports, they invariably did not know to whom the request should be sent. A doctor in Georgia wondered if the form should be dispatched to the Commissary office, since that office dealt with clothing, or sent to the Medical Purveyor, who dealt largely with the freedpeople’s relief.88 A similarly flummoxed physician, who was stationed at the Freedmen’s Hospital in Shreveport, Louisiana, made repeated requests for bandages but “heard nothing” from the main headquarters. “I have to use bandages every day and it is impossible for me to procure them, there was no one to even get them in any other way,” he wrote in September 1865. Not only did this doctor struggle with the lack of supplies, he also lacked the correct forms to make his requests and had to use “army blanks” instead. A doctor stationed in Louisiana expressed a similar frustration about how to organize the federal forms in September 1865, “I have no date from which to make correct weekly reports for the whole time I have been in charge.”89

The directives established by the Bureau in Washington made sense to a group of former military leaders, but to doctors, many of whom did not serve in the Union army and worked in private practices, the constant change of orders, issuance of circulars, and delivery of memos was simply confusing. “Enclosed are your monthly reports AGAIN for corrections, separate monthly reports from consolidated reports,” wrote a Bureau supervisor to a doctor in New Berne, North Carolina, in 1866.90 “Your statements of funds due at the Freedmen’s (p.83) Hospital,” wrote one supervising official in 1867, “is returned for your signature. Your attention is directed to form 57, p. 95 of the Officer’s Manual.”91

Uncertainty over how to file the correct federal reports was a particular problem for doctors in rural regions, who had a difficult time accurately assessing the number of patients they would visit at a freedmen’s camp or on a plantation. Traveling on horseback through the outskirts of South Carolina, Dr. Smith informed his supervising officer in October 1865 that it was impossible for him to provide weekly reports of the sick and wounded for the past three months, since he was unable to follow-up on his “outdoor patients.” Unlike local doctors in hospitals who had the opportunity to check on a patient’s daily progress and provide status updates in weekly reports, doctors in rural regions were unable to keep accurate accounts, which hindered them from getting the necessary medical supplies, or providing an accurate representation of health conditions in the Reconstruction South.92

The likelihood of getting their requests answered, or even received, partly depended upon doctors’ proximity to the nation’s capital. Those in Alexandria, Virginia, found it easier to send word to officials about the health conditions of the freedpeople in the region; also, there were over eight hospitals in a 20-mile radius of the small suburban town, so the ratio of doctors to patients was relatively low.93 In the Deep South, it was more difficult to manage a reliable and effective correspondence to the national headquarters, and there were, as a result, fewer hospitals. Those that were in operation in this part of the country were often understaffed and without ample supplies.94 When cholera began to appear among newly emancipated slaves in the summer of 1866, a physician in Georgia wrote to the quartermaster for supplies but was then sent on a wild goose chase, contacting various officials in the Bureau before ultimately being denied the medicine. “I inquired of the Quartermaster about the middle of last month,” he wrote, “if he could assume a bill for medicines that I had contracted in the emergency of the Cholera breaking out. He said he could but subsequently informed me that according to General Howard’s field order 4, he cannot pay for the medicine without an order from General Tillson.” In the two months the doctor waited for an order of quinine, bismuth, and chloroform, many patients succumbed to the cholera.95

Situations like this erupted throughout the South largely because of the complicated bureaucracy that Bureau doctors needed to follow in reporting health issues. Even when Bureau officials received doctors’ reports, bureaucratic problems nonetheless surfaced. On a weekly and monthly basis, Bureau physicians often sent medical reports to assistant commissioners, who were the liaisons to federal authorities, detailing the number of sick patients under their charge and the fluctuations in mortality rates. Bureau doctors had hoped that such statistical reports would lead to additional resources and support. Yet, when assistant (p.84) commissioners gathered this information from various doctors in a given state, they often did not include notes about the medical condition in the state under their supervision and instead focused on economic issues relating to the distribution of abandoned land, contract disputes between former slaves and planters, or the progress of the Education Division.96

If assistant commissioners did discuss health conditions, they often stated “that health was improving” or “death rates decreased” over the past month, ignoring the comprehensive evidence presented by physicians on the ground.97 In Georgia, for example, the assistant commissioner described the success of the Bureau’s efforts in a number of areas but failed to emphasize the dire health needs of the former slaves. After not receiving a response from the national headquarters regarding their immediate request for medical assistance, local freedpeople in Savannah, Georgia, took matters into their own hands in the fall of 1865. The freedpeople in Savannah approached several “prominent citizens” and asked them to write letters to the Freedmen’s Bureau on their behalf. Even after this intervention, the Bureau did not respond. Not until a group of “colored patrons” approached a local physician, Dr. Caulfield, did the freedpeople receive medical treatment. Although Caulfield was willing to treat them, he was uncertain how to establish a suitable hospital for them. He wrote to officials in Washington several times for instruction, but his letters went unanswered.98 Throughout the postwar South, freedpeople frequently sought medical care independently, but their experiences were often not included in the Bureau’s documentation, because it was not required that the Bureau record on all freedpeople’s health, just those who they directly supported.99

Freedmen’s Hospitals as Almshouses

As freedpeople, local doctors, and Bureau agents struggled to negotiate the tangled web of federal bureaucracy in the Reconstruction South, President Johnson vetoed a bill in February 1866 that would have increased funding to the Medical Division.100 This funding was not requested for expensive medications or to hire experienced doctors, but rather to cover the rudimentary expenses of the hospitals to keep them in operation. In view of the fact that many hospitals simply operated as almshouses, Bureau doctors only needed Congress to provide meager financial support in order for medical staffs to afford basic necessities, such as candles, kerosene, soap, fresh beef, bread, squash, molasses, and other staple foods.101 Many local physicians requested funding for large kitchens, stoves, and sleeping areas to accommodate the destitute and sick freedpeople. In Savannah, for example, the Freedmen’s Hospital included “three large coal stoves for each of the five largest wards and two for each of the smaller, and for the kitchen it (p.85) required to coal cooking stoves.” In this particular hospital, there was also a laundry and a stove used for heating the iron in case of a “long wet spell.”102 In Alabama, Bureau doctors requested a “kitchen to accommodate over 200 freedpeople … to ensure that only cooked rations should be issued,” and “to provide comfort for those who cannot cook for themselves.”103

The need for kitchens was of particular importance, since Bureau physicians understood proper nutrition as the cure for illness. A proper diet, medical officials contended, not only staved off the symptoms of dysentery but also improved the freedpeople’s general health. By providing freedpeople with fresh vegetables and well-cooked meat, medical staffs attempted to wean newly emancipated slaves off the allegedly poor diets that they had grown accustomed to during slavery and which, Bureau officials claimed, was the cause of the alarming death rates among them. Describing the need for adequate nutrition, the chief medical officer in Louisiana explained in 1866, “Great difficulty has been experienced in the hospital from inability to furnish a proper diet for the sick, and a fair proportion of the deaths reported can be readily traced to a lack of proper nourishment.” To remedy this problem, he recommended “an addition to and increase of the hospital stores in the shape of farinaceous articles of diet, would be of great benefit to the sick, reduce the mortuary report of the hospitals, and greatly assist the medical officers in the treatment of patients under their charge.”104

In addition to proper nourishment, doctors also requested clean clothing and bedding to protect freedpeople from exposure. By providing freedpeople with proper nutrition, adequate bedding, clean clothing, and suitable shelter, they had a good chance of defending freedpeople against an onslaught of disease and sickness. Many of the illnesses that infected freedpeople—intestinal viruses and smallpox—resulted from the mere fact that they were forced to live in crowded, unsanitary conditions, where they lacked access to the basic necessities.

One of the ways that doctors hoped to create healthier environments was to construct hospitals that had proper ventilation. Providing adequate ventilation in hospitals, in large part due to the influence of the U.S. Sanitary Commission’s efforts to reform army medicine, was one of the crowning achievements of Civil War medicine. Medical army historians boasted to their European contemporaries that U.S. Army doctors had managed to limit the amount of sickness and disease during the war by establishing proper ventilation measures. Therefore, some Bureau physicians paid particular attention to the architecture and design of Freedmen’s Hospitals, noting the need for open windows and less crowded spaces. In Arlington, Virginia, in 1867, the doctor in charge of the hospital advocated “tearing down the partitions” between the private rooms so that the “whole building can be more thoroughly warmed in the cold weather and better ventilation can be obtained in warm weather.”105

(p.86) Yet on the Bureau’s constrained budgets, constructing or even renting buildings that offered proper ventilation proved difficult. Understanding the necessity of fresh air and principles of ventilation, Bureau doctors improvised and used former army tents to house patients. Modeled after the Indian tepee, the Sibley tent, invented by a U.S. Army official, had a circular opening at the top that facilitated ventilation. While tents may not have provided the most ideal shelter for emancipated slaves, doctors were, nevertheless, able to use them for quarantined patients and to house overflow patients when hospitals were full.106

The Cost of Medical Care

One of the major problems that Bureau doctors faced was the question of payment. Should federal authorities provide free medical aid to formerly enslaved people? Or should former slaveholders in their new role as employers be responsible for medical expenses? Or should freedpeople themselves pay for doctor’s visits? These questions were not just about medical care but reflected the power struggle over who was responsible for reconstructing the South. As a result, there were no direct and easy answers. Problems like these continued to crop up in the Education and Labor divisions, but when these conundrums surfaced in the Medical Division the consequences were much more severe. As a Bureau physician in North Carolina explained, “The majority of the freedpeople who are overtaken by disease are in most cases totally unable to pay the smallest charge for medical attention and unless public charity is extended to them, they die in some excluded place uncared for.”107

Far removed from the suffering, many federal officials easily dismissed doctors’ requests for increases in their budget to pay the staff by writing back that freedpeople should be charged for medical services. Bureau doctors boldly rejected such suggestions because they realized that freedpeople were in no position to pay for medical treatment. The federal government’s proposition fundamentally contradicted the entire purpose of the Medical Division as an almshouse for freedpeople that provided free medical care.108

Even if freed slaves may have wanted to pay for such expenses, they usually could not afford to do so, due to the financial problems they confronted as the South slowly and clumsily transitioned from a slave to a free labor economy. On many plantations freedpeople were denied their wages. In his report on the condition of freedmen in the Mississippi Valley, James Yeatman, president of the Western Sanitary Commission, noted, “The poor Negroes are everywhere greatly depressed at their condition. They all testify that if they were only paid their little wages as they earn them, so that they could purchase clothing, and (p.87) were furnished with the provisions promised they could stand it; but to work and get poorly paid, poorly fed, and not doctored when sick, is more than they can endure.”109

Federal authorities continued to ignore these requests for medical aid because President Johnson, as well as many of his staff, opposed the Bureau and wanted the operations of the Medical Division to be terminated immediately.110 In a circular issued to assistant commissioners on May 30, 1865, Howard stated, “Relief establishments will be discontinued as speedily as the cessation of hostilities and the return of industrial pursuits will permit. Great discrimination will be observed in administering relief, so as to include none that are not absolutely necessitous and destitute.”111 Increasing funds for the Medical Division only, according to federal authorities, encouraged freedpeople to be dependent on the national government for their livelihood. These officials continued to contend, “that the charity of the government must be guarded.”112

For many federal authorities, the answer to doctors’ pleas for medical support often was either to simply find employment for those freedpeople out of work or to transport afflicted freed slaves to another location. Members of Johnson’s administration rejected requests for increased medical assistance by arguing that those in need of support should be removed to areas in need of laborers. The rationale that employment could prevent and even cure sickness grew out of the wartime policies that insisted on freedpeople returning to the South as plantation laborers. After touring plantations throughout the South to check on the status of the Bureau, two U.S. army generals argued, “A majority of the freedmen to whom this subsistence has been furnished are undoubtedly able to earn a living if they were removed to localities where labor could be procured.”113 Once freedmen were gainfully employed, federal officials speculated, they would not be destitute and, therefore, not vulnerable to sickness and disease. In Washington, DC, in 1865–66, the federal government offered free transportation to ex-slaves to enable them to move to areas in need of workers. The problem, of course, was that freed slaves had migrated to the Upper South during and after the war in order to escape from the suffering, disorder, and disease of the Deep South.114

According to the Johnson administration, federally sponsored hospitals were not a necessary and critical part of rehabilitating the postwar South. They served as a constant reminder that the freedpeople relied on the government for support. Leaders of the Bureau stationed in Texas assured the Johnson administration in October 1865 that they had done everything “to prevent the necessity of establishing hospitals.”115 The hospital constructed in Houston, the assistant commissioner further explained, would only be temporary. For this Bureau agent, and many others like him, hospitals represented failure and had the potential to lead to “systemized pauperism.”116

(p.88) While the Bureau’s leader, O. O. Howard, expressed similar fears when the government first began the process of disseminating relief and establishing hospitals in 1865, by 1867, many local and federal Bureau officers grew increasingly intolerant of freedpeople’s needs and repeatedly denied them assistance. The goodwill that they had reluctantly bestowed upon the freedpeople in the immediate aftermath of war dissipated and was replaced with the pitiless conviction that federal relief invariably produced dependency. After surveying a freedmen’s community in Washington, DC, in the spring of 1867, a military agent recognized the suffering condition of the newly emancipated slaves. Yet when the question of constructing a hospital to protect freedpeople from disease was raised, he advised “the colored people to be persuaded to leave” since a hospital “attracts a community of dependents.”117

Unlike federal leaders, Bureau doctors viewed hospitals as important and necessary sites of medical intervention. Without Freedmen’s Hospitals, wrote a physician from Montgomery, Alabama, in January 1865, many freedpeople “would have greatly suffered, perhaps perished.”118 Beginning as early as the summer of 1866, Bureau doctors along with a handful of sympathetic federal agents fought to keep their hospitals in operation, despite aggressive federal efforts to shut down these institutions.119 Bureau doctors responded to staff shortages by ignoring federal regulations and independently employing local freedpeople to work as attendees, cooks, and nurses. As the assistant commissioner in North Carolina explained, “If medical attendance cannot be procured without [contracts] I will take the responsibility of making such contracts.”120 Without federal support, Bureau doctors, in many cases, paid these employees in food rations.

As a way to reduce the hospitals expenses, Bureau doctors also adopted a popular practice commonly used in Northern almshouses, assigning menial tasks to patients rather than hire attendees. “We must at all times have some of the labor in the hospitals done by convalescents,” explained a Bureau official to a doctor in North Carolina in the winter of 1866.121 In Louisiana, the chief medical officer reported that patients assisted nurses since “paid help has been reduced to the minimum.”122 These efforts served a dual purpose: they helped reduce the hospitals’ expenses, and they facilitated the broader goal of free labor. Similar to those who ran Northern almshouses, Bureau doctors believed that asylums could provide freed slaves with basic training to enter the workforce, with the byproduct of lowering the operating costs of their hospitals.123

Hiring local freedpeople and patients and paying them in rations offered one way of lowering a hospitals’ expenses; but as Alexander Augusta, an assistant surgeon in Savannah, Georgia, and one of the few black doctors employed by the Bureau, explained in May 1867, even with patients assisting the laundress with the washing, his hospital still required an increase in the monthly budget.124 (p.89) The cost of rations, in particular, drained a hospital’s monthly budgets since the prices for fresh vegetables, chicken, and meat varied according to the market. “Prices are double the cost of the Raleigh Market,” asserted a doctor in New Bern, North Carolina. “Eight chickens bought at the rate of sixty-cents each and four bushels of sweet potatoes at $1.25 a bushel” was far too expensive for the hospital to afford, he reported in January 1867.125

Bureau physicians found the answer to their financial worries in their own backyards. Instead of waiting for shipments of rations to arrive or worrying if they had enough money to buy supplies, they converted plots of land at the outer perimeters of their hospitals into vegetable gardens. Growing corn, squash, and beans provided doctors in Arkansas, Georgia, and Louisiana with nourishment for the sick. Creating their own vegetable gardens also enabled Bureau doctors to lower the expenses of the hospital by assigning patients to sell and barter the vegetables to members of the surrounding community. In his annual report to federal authorities in 1866, the assistant commissioner in Little Rock, Arkansas, boasted about the success of his vegetable garden. “It has not only paid for the rent of the land and other expenses, but the estimated value of the products over all expenses is $108.25. To say nothing of the sanitary effect upon the hospital and asylum,” he continued, “it has enabled the hospital to save and accumulate a fund of $160.81 for use during the winter when the garden will not be available.”126

When federal leaders learned that a cadre of local doctors had discovered their green thumbs, O. O. Howard, to the chagrin of most doctors, required all medical staff to plant vegetable gardens to lower their hospitals’ expenses.127 While in theory this seemed feasible, it nonetheless created even more problems and work for hospital staffs. Some doctors waited for seed; others lacked fertile land.128 Dr. Augusta, the assistant surgeon who spearheaded the garden project in Georgia, actually faced a number of obstacles at harvest time. After planting his seeds and not seeing results, he discovered that Sherman’s army had occupied the land and had left it in a condition that made it unfavorable for growing vegetables. Compounding matters, a herd of cattle decided to graze on the field. The physician’s requests for fences to prevent the cattle from destroying his garden were left unanswered.129

Benevolent Assistance

The continual neglect by the federal government to provide Bureau doctors with adequate support prompted many physicians in the postwar South to approach benevolent associations for assistance. Since many Northern benevolent groups who were stationed in the South from the war had begun the process of (p.90) providing relief and support to freedpeople, mostly in regard to education efforts, these organizations willingly formed alliances with Bureau officials. After being commissioned to Augusta, Georgia, the supervising Bureau agent told the local doctor that he should obtain the assistance of the teachers there to help provide clothing and in organizing the hospital.130 Despite ideological conflicts between the benevolent organizations and the Freedmen’s Bureau, in many places, these associations helped to lower the expenses at the hospital.131

The Western Sanitary Commission and the North Western Freedmen’s Aid Commission provided supplies to hospitals in Arkansas and Mississippi, while the National Freedmen’s Aid Society contributed $1,000 to the construction of a hospital in Tennessee. In Alabama, the Cleveland Freedmen’s Union Commission, along with the North Western Freedmen’s Aid Society, provided much-needed support and clothing to freedpeople in Mobile and the surrounding area.132 In Washington, DC, the citizens in Georgetown organized the National Association for the Relief of Destitute Colored Women and Children.133 Meanwhile, the members of the New England Freedmen’s Aid Society, the American Missionary Association, and the New York Society of Friends supported Bureau doctors in the Carolinas, Georgia, and northern Virginia.134

Of particular support to the Freedmen’s Hospitals were the “Colored Benevolent Societies.” In fact, one physician suggested to Caleb Horner, the Surgeon-in-Chief in Washington, that his work with the “Colored Benevolent Societies” was so successful that he recommended Bureau officials encourage local physicians to approach these organizations. He wrote in September 1865 of a strategy “that I have adopted, which works well and you might find worth suggesting to other surgeons. In all these large towns are Colored Benevolent Societies. I have talked with committees and in some cases gone before the meetings to explain my mission and purpose and have them to contribute … we work together and I have a pledge of $75–$2100 or more a month for the hospital.”135 With the help of Northern free black women, Harriet Jacobs organized a “fancy fair” in order to raise money for the hospitals in Alexandria.136

While benevolent associations provided a formal network of relief, there were also a number of other informal responses to the predicament of sick freedpeople that did not get captured in traditional archival documentation. There were invariably thousands of freedpeople who suffered from sickness or were impoverished but never appeared before a Bureau doctor or requested relief from a federal asylum. Based on the expansive notion of what constituted kin within the postwar black community, there were surely freedpeople who offered a member of their community temporary shelter, food, and clothing.137 When a reformer in Beaufort asked a “young man who broke his leg a month ago” and was “lying destitute and helpless” why he did not go to the Bureau doctor for assistance for his leg, he replied, “I have learned by experience that it is direct (p.91) cruelty to the race for the government to assist the people with rations in any form, and in this I am happy to state I am sustained by the best friends of the freedmen in this place.”138 This particular incident reveals the extent to which many freedpeople purposely did not turn to the federal government for support since it could have, according to this freedman, have negative consequences for freedpeople to seek federal charity. Yet, receiving assistance from “the best friends of the freedmen,” that is the Northern reformers who published the report, endorses the claim that former abolitionists should serve in the postwar South. This was part of the rationale for publishing such intimate stories in the Northern press: to garner more financial support for the critical work, which reformers performed. Freedpeople may have received a combination of relief—some drawn from federal sources and other support provided by kin networks. In sum, there is no single algorithm to calculate how relief was disseminated during this period or who provided it.

That said, Northern teachers, who lived and worked within freedpeople’s communities, witnessed the extent to which kin networks provided fellow emancipated slaves with medical assistance and support. C. E. McKay, a Northern teacher stationed in Baltimore, Maryland, discovered a boardinghouse operated by a freedwoman in 1868, “when a young colored boy” approached her, announcing that “Miss Downs wants you to come see her.” Located in an alley in a deserted part of the city, Downs opened her home to destitute children and freedwomen. She also rented out rooms in her home to local boarders and used the money, along with some cash she earned as a washerwoman, to buy medicine for the orphans in need. After visiting the boardinghouse, McKay wrote to her Northern association urging it to send funds to support Downs’s efforts. “A part of this [Downs’s income] has to be expended in medicines for one of the little orphans, who is dropsical, her head and neck swelled to an unnatural size, and her arms and legs slender as pipes.”139 Downs’s boardinghouse represents one of the many efforts within the black community to provide support and medical assistance for those in need, even if their ailments were not contagious.

The Bureau recognized these kin connections within freedpeople’s communities, which is the reason why military officials throughout the postwar South advocated for families to take over the responsibilities of caring for those who were sick or impoverished. Moreover, by late 1866, some groups of freedpeople had been able to regain their footing and were, as a result, able to establish boardinghouses, like the one Downs started in Baltimore, or were in a position to establish colored benevolent societies. Given that Northern middle- and upper-class black people in places like Philadelphia and New York provided charitable relief to manumitted and poorer blacks in the decades before the war, it is likely that these groups either directly provided relief to emancipated slaves or pooled (p.92) their resources and donated money, clothing, and food through the organizational efforts arranged by Northern Freedmen’s Aid Societies.140

This piecemeal relief signaled to federal officials that they could reduce the amount of aid allotted to freedpeople despite the fact that sick freed slaves’ continued to need assistance. Even with the Republicans’ control of Congress in 1867 and the efforts made by many in the House and Senate to extend the Bureau’s contract until 1868, the guidelines set forth by officials during Johnson’s administration to terminate the Bureau after a few years remained intact. When Johnson first began to evaluate the Bureau’s operations in the South, he assigned former military officials to serve as inspectors. Basing their reports on cleanliness, the health conditions of the patients, and the staff, they determined whether hospitals should remain open.141

On one level, assigning officials to inspect hospitals built on wartime practices, initiated by the Sanitary Commission, to ensure that hospitals were healthy, clean environments that could adequately treat patients and prevent the spread of disease. On another level, the deployment of inspectors throughout the postwar South became a way for Johnson and other federal critics of the Bureau to marshal evidence about the conditions in the South that justified their decision to reduce federal aid. In the overwhelming majority of the reports, the inspectors unanimously determined to close down hospitals. Either the health conditions in the region were, according to their estimation, “improving” and therefore, no longer required federal intervention, or the hospital was in abysmal condition and thus needed to be closed since it was unable to provide adequate medical care. There was rarely, if ever, any middle ground or a call to keep the hospital in operation. In many of the inspectors’ reports, contradictory and ambiguous descriptions of health conditions of the community were recorded, which reflected the tensions between doctors, who fought to maintain hospitals, and Bureau agents and inspectors, who attempted to disband them. When the local doctor in St. John’s Parish, Louisiana, in September of 1866 reported that cholera “was raging fearfully” in his region, the supervising officer claimed that the doctor “exaggerated the violence” that the disease inflicted.142

The difference of opinion between Bureau doctors and federal leaders regarding the health conditions in the postwar South partly resulted from the failure of both groups to provide a clear definition of sickness. Instead, they continually relied on adjectives such as “suffering,” “sickly,” and “destitute” to describe the medical conditions of newly emancipated slaves. Or in their assessment of freedmen’s communities, they described the general, overall health status as “dependent,” “idle,” or, “self supporting.”143 While, on the surface, the terms and their meanings varied, concerns about labor underpinned each of these definitions. The meaning of sickness among federal leaders and Bureau agents was intimately tied with concerns relating to freedpeople’s labor power. (p.93) In Plymouth, North Carolina, in 1866, for example, a local doctor offered to provide medical services free of charge to newly emancipated slaves in response to their ill health and lack of medical treatment. When military officials contacted authorities in Washington in July 1866, so that this doctor could be compensated and “that some plan could be adopted” to provide permanent medical care to the former slaves, government leaders in Washington sent an inspector to the region. After he “conversed with a number of citizens of the places as to the condition of the freedmen in that subdistrict,” he concluded that he saw “no reason why any action should be taken to procure medical aid as they are generally self supporting.”144 The inspector’s choice of the term “self supporting” ignores the freedpeople’s poor health conditions that prompted the unsolicited assistance of the local doctor and instead evaluates freedpeople’s health status within a labor context. Self-supporting connotes economic independence and self-reliance and has nothing do with health. Moreover, the use of this term contains a judgment about freedpeople’s labor power not their medical needs.

Furthermore, Radical Republicans and members of Johnson’s administration—who otherwise disagreed on the objectives of the Bureau—shared a view of ill-health as it related to one’s ability to perform arduous field labor. In their view, sickness was avoidable, and employment would protect freedpeople from sickness. In the proposed bill that attempted to extend the duration of the Freedmen’s Bill to 1866, the Radical Republicans took a rather Johnsonian stance and claimed that afflicted freedpeople who qualified for employment would be ineligible for medical assistance or relief. They posited “that no person shall be deemed ‘destitute,’ ‘suffering,’ or ‘dependent upon the Government for support,’ within the meaning of this act, who, being able to find employment, could by proper industry and exertion avoid such destitution, suffering or dependence.”145 According to the bill, if freedpeople were capable of “being able to find employment,” the government would not provide medical assistance to them if they became sick—revealing the extent to which federal officials and Bureau authorities, regardless of party affiliation, understood health in relation to labor.146

The understanding that one’s employment opportunities determined access to medical relief impelled assistant commissioners and planters to enforce regulations that would cut off medical services to those who could work. In North Carolina, the assistant commissioner, after touring much of the state, reprimanded the doctors in his jurisdiction for providing medical assistance to freed slaves who could easily be employed. Meanwhile, in Shreveport, Louisiana, in 1866, the assistant commissioner ordered the hospital closed because of the great demand for laborers.147

The failure of the Medical Division to provide adequate medical assistance resulted from the federal government’s understanding that ill-health was connected to freedpeople’s alleged unwillingness to work. According to Johnson (p.94) and his staff, the more money, resources, and funds that federal officials pumped into the fledgling Bureau hospitals, the more dependence would increase in the South. And according to their logic, such dependence would prevent former slaves from returning to the plantation as laborers. Johnson and his administration continued, as a result, to ignore the ways in which the effects of the war and dislocation exacerbated the spread of sickness, particularly the explosive spread of smallpox among former slaves in 1865–1866.


(1.) Harper’s Weekly, May 5, 1860.

(2.) As president of the New York State Medical Society, D. B. St. John Roosa bemoaned the lack of attention paid to ventilation and proper sanitation in nineteenth-century hospitals. He further argued that hospital boards of directors, who designed hospitals, often excluded doctors from taking part in conversations about the organization and construction of hospitals. See D. B. St. John Roosa, M.D., President of the Society, “The Relations of the Medical Profession to the State” (New York: Published by the Order of the Society, 1879), 16. Also see Kathleen M. Brown, Foul Bodies: Cleanliness in Early America (New Haven, CT: Yale University Press, 2009), 234–37. On the disastrous and deadly conditions of army hospitals, see Paul E. Steiner, Disease in the Civil War: Natural Biological Warfare in 1861–1865 (Springfield, IL: Charles C. Thomas, 1968); Frank R. Freemon, Gangrene and Glory: Medical Care During the American Civil War (Madison, NJ: Fairleigh Dickinson University Press, 1998).

(3.) Edwin M. Knights Jr., M.D., “The History of Bellevue Hospital,” History Magazine, December–January 2000; W. Gill Wylie, M.D., Hospitals: Their History, Organization, and Construction (New York: D. Appleton, 1877), 180; Charles Rosenberg, “From Almshouse to Hospital: The Shaping of Philadelphia General Hospital,” Milbank Memorial Fund Quarterly 60, no. 1 (1982): 108–54.

(4.) David Rothman’s The Discovery of the Asylum was one of the first and most important books on the history of the asylum as an institution that imposed social order. Seth Rockman’s Scraping By moves beyond the discourse of social control, and instead offers a more complicated and nuanced interpretation of the ways in which workers at various times used the asylum to their benefit. See Rothman, The Discovery of the Asylum: Social Order And Disorder in the New Republic (New York: Little, Brown, 1971); Seth Rockman, Scraping By: Wage Labor, Slavery, and Survival in Early Baltimore (Baltimore: Johns Hopkins University Press, 2008).

(5.) On Vanderwhost, see Robert Lebby to Asst. Surgeon T. Turner, August 9, 1865, Charleston, South Carolina, e. 3135, LS, RG 105, NARA.

(7.) On relief in the Civil War South, see W. Martin Hope and Jason H. Silverman, Relief and Recovery in Post-Civil War South Carolina: A Death by Inches (Lewiston, NY: Edwin Mellen Press, 1997). Furthermore, Stephanie McCurry reveals the extent to which relief was not even available to many Southerners, particularly poor white women. Lacking basic necessities, many of these women engaged in bread riots in order to feed their families and mounted political campaigns as soldiers’ wives to gain support. Stephanie McCurry, Confederate Reckoning: Power and Politics in the Civil War South (Cambridge, MA: Harvard University Press, 2010).

(8.) Griswold to Hayden, October 31, 1865, Chief Medical Officer, Annual Report, e. 1393, Chief Medical Officer (Misc), Box 40, RG 105, NARA. New York Times, January 27, 1866; U.S. War Department, BRFAL, Laws in Relation to Freedmen, U.S. Senate 39th Cong., 2nd sess., Senate Executive Document, no. 6 (Washington, DC: GPO, 1866–67), 79–81.

(9.) Pelzer to Mr. A. Fairly, March 13, 1866, Charleston, SC; Pelzer to H. Baer, March 15, 1866; Pelzer to Circular Letter, all in e. 3132, LS, vol. 1, RG 105, NARA. Local authorities did not agree to take infected freedpeople to Stewart City Hospital until September, six months after the initial letter from the Bureau.

(10.) Augusta to Lawton, May 17, 1866, Georgia, Savannah Lincoln Hospital, LS, vol. 1, December 1865–January 1868, M1903, Roll 85, RG 105, NARA.

(11.) Williams to D. B. M. Wilson, September 7, 1866, Mobile, AL, Offices of Staff Officers, Surgeon, LS, vol. 1 (31), September 7, 1865–July 21, 1865, M1901, Roll 8, RG 105, NARA.

(12.) For South Carolina, see J. S. Caulfield to W. R. Dewitt, September 10, 1865, South Carolina, Chief Medical Officer, e. 2979, LR. For Georgia, see Augusta to Caleb Horner, June 2, 1866, Georgia, Savannah Lincoln Hospital, LS, vol. 1, December 1865–January 1868, M1901, Roll 85. For Alabama, A. M. Ryan to Shrokly, April 30, 1868, Alabama, Records of (p.201) the Assistant Commissioner for the State of Alabama, Reports of the Operation of the Subdistrict, M809, Roll 18, Frame 67–68. For North Carolina, see Hillebrandt to Kinston, June 18, 1866, North Carolina, e. 2535, LS, Box 37, all in RG 105, NARA. For Arkansas, Missouri, and Indian Territory, see War Dept., Laws in Relation to Freedmen, 28.

(13.) Hill to Thomas, December 3, 1864, Surgeon General’s Office, Washington, DC, e. 2040, LR, Box 35, RG 105, NARA.

(14.) 39th Cong., 1st sess., House of Representatives, House Executive Documents, no. 11; See also John Eaton, Grant, Lincoln and the Freedmen (New York: Longmans, Green, 1907).

(15.) The six army medical units were established in New Orleans, Charleston, Sea Islands, Alexandria, Mississippi Valley, and New Berne, North Carolina. M. K. Hogan to C. W. Horner, November 23, 1865, New Berne, NC, e. 2468, Box 14, RG 105, NARA.

(17.) M.K. Hogan to C.W. Horner, November 23, 1865, Raleigh, N.C., e. 2535, L.S., RG 105, NARA.

(18.) Ibid.

(19.) Ibid.

(20.) Testimony of Col. Geo. H. Hanks before the American Freedmen’s Inquiry Commission, quoted in Ira Berlin et al., The Wartime Genesis of Free Labor: The Lower South (Cambridge: Cambridge University Press, 1990), 520.

(21.) Second Report of a Committee of Representatives of New York Yearly Meeting of Friends Upon the Conditions and Wants of the Colored Refugees, 1863, From Slavery to Freedom: The African-American Pamphlet Collection, 1824–1909, Abraham Lincoln Papers, LOC.

(22.) F. M. Minteur to W. W. Smith, December 18, 1865, e. 2979, Chief Medical Officer, LR, 1865–1866, RG 105, NARA. While Strawberry Ferry is not rural, the plantation remained outside of the purview of the Medical Division in Charleston. Emancipated slaves, who did not live near Bureau hospitals, were left on their own to combat the epidemic.

(24.) “Agreement between Baskerville and Betty, a Negro Family,” December 25, 1865, “Agreement between Mason and Baskerville, December 25, 1865,” “Agreement of Hands with R. Baskerville for the year 1866” Signed November 24, 1865, Mss1B2924a 1669–1685, “Agreement, 1867 & 1868,” “Hands Agreement, 1868,” Baskerville Family Papers; “Contracts,” Allen Family Papers, Buckingham Country, VA, January 1866–January 1868, Mss1AL546c, microfilm; “Isaac Claiborne, January 17, 1866, Amelia County,” Harvie Family Papers, Mss1H2636c2844, “Amelia Burton,” Harvie Family Papers, Mss1H2636a2841, all VHS.

(25.) “Agreement Between Charles J. Haskell and Freedmen and Freedwomen on Alston Plantation,” July 21, 1865, Section 24, Mssic1118a 731–32, and January 1, 1866, Section 43, Mss1c1118a8881, Cabell Family Papers, VHS.

(26.) Grady McWhiney, ed., Reconstruction and the Freedmen (Chicago: McNally, 1963), 52.

(27.) Johnson ignored the fact that Marine Hospitals were the precedent to Bureau hospitals. More to the point, Johnson denied the effort to increase the roll of the Bureau, See “Bills and Resolutions,” Cong. Globe, 39th Cong., 1st Sess. 129 (1866).

(28.) For more on Johnson’s response to the Bureau, see Hans L. Trefousse, “Andrew Johnson and the Freedmen’s Bureau,” in The Freedmen’s Bureau and Reconstruction: Reconsiderations, ed. Paul A. Cimbala and Randall M. Miller (New York: Fordham University Press, 1999), 29–45.

(29.) For military reports on the condition of freedpeople, see, M. K. Hogan to C. W. Horner, November 23, 1865, North Carolina, e. 2468, Box 14; A.A. Lawrence to H. N. Howard, October 31, 1866, Freedmen’s Village, Washington, DC, Subordinate Field Officers, Annual Reports 1865–1868, 6; C. Tripp to S. Helenaville, September 23, 1865, South Carolina, e. 2979, LR, Box 37; Augusta to Lawton, May 17, 1866, Georgia, Savannah Lincoln Hospital, LS, vol. 1, December 1865–January 1868, all in RG 105, NARA. Eaton, Grant, Lincoln and the Freedmen, 30–33. For civilian reports, W. C. Adams to Robert Burns, April 6, 1866, Georgia, Mss1B9468a17, Burrus Family Papers, VHS; L. P. Brockett, Heroines of the Rebellion: or, Woman’s Work in the Civil War; A Record of Heroism, Patriotism and Patience (Philadelphia: Hubbard, 1888), 140, 159, 164, 186. J. T. Trowbridge, South: A Tour of Its (p.202) Battlefields and Ruined Cities, A Journey Through the Desolated States, and Talks with the People (Hartford, CT: L. Stebbins, 1866), Lois Bryan Adams, Letter from Washington, 1863–1865, edited and with an introduction by Evelyn Leasher (Detroit: Wayne State University Press, 1999). Eliza Frances Andrews, The Wartime Journal of a Georgia Girl, 1864–1865 (New York: D. Appleton, 1908); Spencer Bidwell King, Jr., ed. (Macon, GA: Ardivan Press, 1960); Grady McWhiney, ed., Reconstruction and the Freedmen (Chicago: McNally, 1963), 29–32.

(30.) S. N.Clark to W. W. Rogerts, October 6, 1866, Washington, DC, A-9931, DC A/G 520, LS, v. 53, pp. 22–23, letter 49, FSSP.

(32.) On May 12, 1865, Maj. Gen. Oliver Otis Howard was assigned as the Commissioner. 39th Cong., 1st sess. House of Representatives, House Executive Documents, no. 11, 11–12.

(33.) Ibid.

(34.) For John Eaton’s role in assisting Howard organize the Bureau, see Eaton, Grant, Lincoln and the Freedmen, 236–51.

(35.) Hill to Thomas, December 3, 1864, Surgeon General’s Office, Washington, DC, e. 2040, LR, Box 35, RG 105, NARA.; 39th Cong., 1st sess., House of Representatives, House Executive Documents, No. 11; Eaton, Grant, Lincoln and the Freedmen, 237; Howard, Autobiography, 258–59.

(38.) David Rothman makes the connection between the creation of asylums and social order in his classic study, The Discovery of the Asylum: Social Order and Disorder in the New Republic (New York: Little, Brown, 1971), For a more theoretical discussion on the relationship between institutions and surveillance, see Foucault’s discussion of panopticism. Michel Foucault: The Birth of the Clinic: An Archeology of Medical Perception (New York: Vintage, 1994).

(39.) Howard quoted his first circular verbatim in his autobiography. See Howard, Autobiography, 212–13.

(40.) Ibid. For a penetrating analysis of compulsive labor among the freedpeople during this period, see Amy Dru Stanley, “Beggars Can’t Be Choosers: Compulsion and Contract in Postbellum America,” The Journal of American History 78, no. 4 (March 1992): 1265–93.

(44.) It is also important to note that throughout the nineteenth century, the notion of preventive medicine was not widely accepted. Physicians were called in response to a problem instead of being consulted before a potential medical crisis could erupt. For more on physicians’ frustration with the state not adopting preventive measures, see D. B. St. John Roosa, M.D., President of the Society “The Relations of the Medical Profession to the State” (New York: Published by the Order of the Society, 1879), 16.

(46.) On almshouses as training grounds for physicians, see Charles Rosenberg, “From Almshouse to Hospital,” 108–54.

(47.) Rebecca Crumpler, A Book of Medical Discourses (Boston: Cashman, Keating, 1883), 2.

(48.) On smallpox, see 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 can be found in e. 2979, LR, RG 105, NARA. On clean water, see A. T. Augusta to R. O. Abbott, June 17, 1863, Quartermaster Correspondence Consolidated Files, Contraband Camps 1863 File, Box 99, RG 92, NARA.

(49.) W. F. Spurgin to C. H. Howard, April 9, 1866, District of Columbia, A-9753, 456 Letter, Box 2, #1232, FSSP; Hogan to Cilley, January 17, 1866, North Carolina, e. 2535, LS, p. 18, RG 105, NARA; War Dept., Laws in Relation to Freedmen, 12.

(50.) Lawton to O. O. Kinsman, September 19, 1865, Offices of Staff Officers, Surgeon-in-Chief, LS and Register of LR, vol. 52, September 1865–July 1867, M1903, Roll 26, RG 105, NARA.

(p.203) (51.) Freedmen’s Record, January 1866, 3–4.

(52.) Wilcox to Capt. Newtown Flagg, June 26, 1865, Quartermaster Report, December 1864–1865, Quartermaster Consolidated Collection, Negroes File, Box 720, RG 82, NARA.

(53.) Griswold to Hayden, October 31, 1865, Chief Medical Officer, Annual Report, e. 1393, Chief Medical Officer (Misc), Box 40, RG 105, NARA; War Dept., Laws in Relation to Freedmen, 109.

(54.) Emmanuel Ezekiel to Radzinsky, September 10, 1866, Orangeburg, SC, e. 3314, LS and Special Orders Received, RG 105, NARA. In February 1866, Congress passed a bill that enabled the federal government to occupy no more than 3 million acres of land in Florida, Mississippi, and Arkansas for the use of hospitals and asylums, but in South Carolina, it seems such a policy was not adopted. See Harper’s Weekly, “Domestic Intelligence,” February 10, 1866, 83.

(56.) Freedmen’s Record, January 1866, 3–4.

(57.) For more on the Johnson’s first presidential veto and the extension of the Freedmen’s Bureau, see LaWanda Cox and John H. Cox, eds., Reconstruction, the Negro, and the New South (Columbia: University of South Carolina Press, 1973), 31–32. Unlike the massive project undertaken by the federal government to properly bury Union soldiers, a similar program did not exist for freedpeople. Instead, burials and the creation of cemeteries depended upon the decisions made by individual Bureau leaders. Moreover, there is little archival data about where freedpeople were buried during the Reconstruction era. A recent archival excavation of a plot of land in Alexandria, Virginia, on which a gas station was built in the late twentieth century, led to the discovery of a Freedmen’s Cemetery. As a result of this finding, I was then able to locate some of the burial records of the freedpeople in Alexandria from the Civil War years. See Gladwin, “Book of Records Containing Marriage and Deaths That Have Occurred within the Official Jurisdiction of Rev. A. Gladwin together with any Biographical and other Reminisces that may be Collected” (microfilm), Barrett Library, VHS. For more on the federal government’s efforts to bury enlisted men, see Drew Gilpin Faust, This Republic of Suffering: Death and the American Civil War (New York: Vintage, 2009).

(58.) Gardner to Campbell, April 30, 1866, and Campbell to Whittlesey, April 30, 1866, both in Raleigh, NC, e. 2536, LS, RG 105, NARA.

(59.) Robert Lebby to W. R. Dewitt, Chief Surgeon, November 4, 1865, Charleston, SC, Roper Hospital, e. 3135, LS, RG 105, NARA.

(60.) Ibid. Edward Pierce, Atlantic Monthly, “The Freedmen at Port Royal,” September 1863, 291–315. Also see Jim Downs, “The Other Side of Freedom: Destitution, Disease, and Dependency among Freedwomen and Their Children during and after the Civil War,” in Battle Scars: Gender and Sexuality in the American Civil War, ed. Catherine Clinton and Nina Silber (New York: Oxford University Press, 2006), 78–103.

(61.) On postmortem in Alabama, see Kipp to R. H. Beumty, H. Hood (in Selma), J. Schetz (Montgomery), C. Miller (Demopolis), November 28, 1865, Alabama, Officers of the State Offices, Surgeon, LS, vol. 1 (31), 50, September 7, 1865–July 21, 1865, M1900, Roll 8, RG 105, NARA. On the need for freedpeople’s burials to be entirely separate from the other citizens in North Carolina, see Campbell to Whittlesey, April 30, 1866, North Carolina, e. 2535, LS, RG 105, NARA. H. N. Hubbard to Mayor Eldridge. April 28, 1868, Washington, DC, M1902, Roll 20, RG 105, NARA. On body snatching, see A. A. Lawrence to H. N. Howard, January 11, 1866, Washington, DC, M1902, Roll 20, RG 105, NARA.

(62.) Pelzer to E. L. Deanes, February 19, 1868, Charleston, SC, e. 3162, LS, RG 105, NARA.

(63.) Holman to C. A. Cilley, September 4, 1865, North Carolina, e. 2535, LS, p. 114 (ledger), RG 105, NARA; M. K. Hogan to C. W. Horner, November 23, 1865, North Carolina, e. 2468, Box 14, RG 105, NARA.

(64.) W. F. Spurgin to Torrey Turner, September 1, 1865, Local Superintendent for Washington and Georgetown Correspondence, vol. 1 (77), LS, July 15, 1865–September 10, 1867, M1902, Roll 13, RG 105, NARA. Henry Saunders to Griswold, February 12, 1866, Louisiana, e. 1393, LR, Box 40, RG 105, NARA.

(p.204) (65.) Lawton to Tillson, September 29, 1865, Georgia, Endorsements, Chief Medical Officer; and Lawton to C. W. Horner, September 29, 1865, Georgia, Offices of the Staff Officers, Surgeon in Chief, vol. 52, LS and Register of LR, September 1865–July 1867, M1903, Roll 26, RG 105, NARA.

(66.) A. J. Swartzwelden to Major Grove, September 11, 1865, Memphis, TN, e. 3556, LS, Box 73, RG 105, NARA.

(67.) Dewitt to Lt. Col. A. K. Smith, January 20, 1866, South Carolina, Chief Medical Surgeon, e. 2979, LR, Box 37, RG 105, NARA; John David Smith, “‘The Work It Did Not Do Because It Could Not’: Georgia and the ‘New’ Freedmen’s Bureau Historiography,” Georgia Historical Quarterly 352, no. 2 (Summer 1998): 343–44.

(68.) Barnes to Hogan, September 29, 1865, North Carolina, e. 2536, p. 8, LS, RG 105, NARA.

(69.) Swartzwelden to Grove, September 11, 1865, Tennessee, e. 3556, LR, Box 73; J. V. De Hanne to Clement, June 21, 1867, Atlanta, GA, Offices of the Staff Officers, Surgeon-in-Chief, LS and Register of LR, vol. 52, September 1865–July 1867, M1903, Roll 26; Kipps to Horner, November 15, 1865, Mobile, AL, Offices of the Staff Officers, Surgeon-in-Chief, LS, vol. 1 (31), 41–46, September 7, 1865–July 21, 1865, all in RG 105, NARA.

(70.) Swartzwelden to J. E. Smith, September 4, 1865, Memphis, TN, e. 3556, LS, Box 73, RG 105, NARA.

(72.) D. Markay to Lieut. J. M. Lee, September 30, 1867, Louisiana, e. 1393, Annual Report, Chief Medical Report, p. 10, (Misc.), Box 40, RG 105, NARA.

(73.) Asa Teal to Eliphalet Whittlesey, October 6, 1865, Reports of Operation, N.C., Assistant Commissioner Records, quoted in Reggie Pearson, “‘There Are Many Sick, Feeble, And Suffering Freedmen’: The Freedmen’s Bureau’s Health-Care Activities During Reconstruction In North Carolina, 1865–1868,” North Carolina Historical Review 79, no. 2 (2002): 147.

(75.) DeWitt to Caleb Horner, December 11, 1865, South Carolina, e. 2977, LS, vol. 1, 106–07, RG 105, NARA.

(76.) Charles Rosenberg, “Social Class and Medical Care in Nineteenth-Century America: The Rise and Fall of the Dispensary,” Journal of the History of Medicine and Allied Sciences 29, no. 1 (1974): 32–54.

(77.) Lawton to Lewis, October 4, 1865, Georgia, Offices of the Staff Officers, Surgeon-in-Chief, LS and Register of LR, vol. 52, September 1865–July 1867, M1903, Roll 26, RG 105, NARA.

(78.) Higgs to Corner, April 8, 1867, Offices of the Staff Officers, Surgeon-in-Chief, Endorsements Sent and Received, p. 29, M1902, Roll 13, RG 105 NARA. Ibid., April 20, 1867, p. 30.

(80.) On toxic smells, see Brown, Foul Bodies, 183–89.

(81.) G. A. Wheeler, A.A. Surgeon to Captain A.A. Lawrence, February 14, 1867, Freedmen’s Village, LR, M1902, Roll 20, Frame 349–50, RG 105, NARA. For a brilliant discussion on the relationship between laundering and cleanliness, see Brown, Foul Bodies.

(82.) J. W. Lawton to Surgeon B. McClin, September 15, 1865, Offices of Staff Officers, Surgeon-in-Chief, LS and Register of LR, vol. 52, September 1865–July 1867, M1903, Roll 26, RG 105, NARA.

(83.) C. A. Ciley to Hogan, January 24, 1866, Salisbury, NC, e. 2535, LS, p. 18; ibid., January 13, 1866 both in RG 105, NARA.

(84.) W. F. Spurgin to Torrey Turner, September 1, 1865, Local Superintendent for Washington and Georgetown Correspondence, LS, vol. 1 (77), July 15, 1865–September 10, 1867, M1902, Roll 13, RG 105, NARA. Henry Saunders to Griswold, Louisiana, February 12, 1866, e. 1393, LR, Box 40, RG 105, NARA.

(85.) S. D. Radzinksky to Happersett, October 6, 1866, Orangeburg, SC, Hogendabler to Happersett, December 24, 1866, Hogendabler to Happersett, Hamburg, SC, Chief Medical Surgeon, all in e. 2979, LR, Box 37, RG 105, NARA.

(86.) B. Burgh Smith to W. R. DeWitt, October 14, 1865, Charleston, SC, e. 3249, LS, vol. 1; ibid., November 4, 1865; ibid., March 13, 1865; Beckett to George Wright, March 22, 1867; (p.205) Beckett to Hogan, May 21, 1867; Beckett to Wright, August 29, 1867, all in e.3249, LS, vol. 1, RG 105, NARA.

(87.) List of Employees in the Refugees and Freedmen’s Hospital at Atlanta For the Year Ending January 1866, Reports of the Surgeon in Charge, Atlanta, GA, e. 745, Folder 26, RG 105, NARA; DeHanne to T. R. Clement, June 9, 1867, Office of Staff Officers, Surgeon-in-Chief, LS and Register of LR, vol. 52, September 1865–July 1867, M1903, Roll 26, RG 105, NARA.

(88.) Lawton to Horner, September 29, 1865, Offices of the Staff Officers, LS and Received, vol., 52, M1902, Roll 26, RG 105, NARA.

(89.) Pease to Griswold, September 9, 1865, Louisiana, Chief Medical Officer, e. 1393, LR, Box 40, RG 105, NARA.

(90.) Hogan to Yeomans, November 30, 1866, New Berne, NC, e.2536, LS, vol. 2, RG 105, NARA.

(91.) Hogan to R. B. Matlock, March 9, 1867, North Carolina, e. 2536, LS, vol. 2, RG 105, NARA.

(92.) B. Burgh Smith to W. R. DeWitt, October 14, 1865, Charleston, SC, e. 3249, LS, vol. 1, RG 105, NARA; I. L. Beckett to R. K. Scott, January 15, 1867, e. 3249, LS, vol. 1, RG 105, NARA.

(93.) Alexandria had well over 13 hospitals, whereas, in the entire state of Louisiana, there were less than a dozen. Hospitals Vertical File, AHS; E. Griswold to Hayden, October 31, 1865, Chief Medical Officer, Annual Report, e. 1393, Chief Medical Officer (Misc), Box 40, RG 105, NARA.

(94.) C. H. Howard to O. O. Howard, October 22, 1866, Annual Reports, e. 9926, DC AC, 449 LS, Vol. 7, p. 112–22. FSSP.

(95.) A. T. Augusta to J. W. Lawton, August 9, 1866; August 14, 1866; August 21, 1866; September 1, 1866; A. T. Augusta to A.A. Schell, August 18, 1866; Augusta to Capt. Watson, August 21, 1866, all in Georgia, Savannah Lincoln Hospital, LS, M1903, Roll 85, RG 105, NARA.

(98.) J. S. Caulfield to W. R. Dewitt, September 10, 1865, South Carolina, Chief Medical Officer, e. 2979, LR, Box 37, RG 105, NARA. (Although this document is from Georgia, it was found in the South Carolina box—which could be the result of an error in the archival collection or it could be that the Bureau officer, at that moment, had authority over both regions.)

(99.) Wilcox to Capt. Newtown Flagg, June 26, 1865, Quartermaster Report, December 1864–1865, Quartermaster Consolidated Collection, Negroes File, Box 720, RG 82, NARA.

(100.) New York Herald, February 17, 1866. For an overview of the 1866 veto, see Cox and Cox, Reconstruction, the Negro, and the New South, 31–77

(101.) Monthly Statement of Hospital Funds and Rations Return, Augusta, GA, Freedmen’s Hospital, vol. 162, October 1865–May 1868, M1903, Roll 49; Clark to Howard, April 15, 1868, Washington DC, Subordinate Field Officers, Freedmen’s Village, M1902, Roll 21; J. C. O’Neal to Howard, December 31, 1867, Subordinate Field Officers, LR, vol. 85, M1902, Roll 20; Hogan to Day, January 8, 1867, North Carolina, e. 2536, LS, vol. 2. Diet tables—Caleb Horner to Griswold, September 20, 1865, Louisiana, e. 1393, LR, Box 40, all in RG 105, NARA.

(102.) Augusta to Sickles, January 5, 1866, Georgia, Savannah Lincoln Hospital, LS, vol. 1, December 1865–January 1868, M1903, Roll 85, RG 105, NARA.

(103.) Kipp to Sawyer, October 11, 1865, Alabama, Officers of the State Offices, Surgeon, LS, vol. 1 (31), September 7, 1865–July 21, 1865, M1900, Roll 8, RG 105, NARA.

(105.) G. A. Wheeler, A. A. Surgeon to Captain A. A. Lawrence, February 14, 1867, Freedmen’s Village, LR, M1902, Roll 20, Frame 349–50, RG 105, NARA.

(106.) Charles J. Stille, History of the United States Sanitary Commission: Being the General Report of its Work during the War of the Rebellion (Philadelphia: J. B. Lippincott, 1866); Jacob Gilbert Forman, The Western Sanitary Commission, “A Sketch of Its Origin, History, Labors for the Sick and Wounded of the Western Armies, and Aid Given to the Freedmen and Union (p.206) Refugees, with Incidents of Hospital Life” (St. Louis, MO: Published for the Mississippi Sanitary Fair), 14–15; P. M. Ashburn, A History of the Medical Department of the United States Army (Boston: Houghton Mifflin, 1929). Captain Louis C. Duncan, Medical Corps, U.S. Army, The Medical Department of the United States Army in the Civil War [Washington? n.d.], 20–1. On the subject of ventilation, I also profited enormously from a paper on ventilation that Margaret Humphreys presented at the Society of Civil War Historians, Second Biennial Meeting, June 2010, “Out of Harm’s Way? The Satterlee General Hospital of Philadelphia.” I also want to move beyond the strict idea that the principles underlying the subject of microbiology did not circulate until Pasteur’s discovery. Instead, I support Bruno Latour’s argument that Pasteur built on existing ideas and principles that were known among hygienists. See Bruno Latour, The Pasteurization of France (Cambridge, MA: Harvard University Press, 1988); Elan Daniel Lewis, Review of Pasteurization of France, Yale Journal of Biology and Medicine 62, no. 1 (January–February 1989): 47–48.

(107.) Ward to ?, July 11, 1866, North Carolina, e. 2535, LS, Box 37. Also see, Kipps to Robinson, October 12, 1866, Alabama, Office of Staff Officers, Surgeon, LS, vol. 1. (31), September 7, 1865–July 21, 1865, Roll 8; Hogan to Ward, July 11, 1866, North Carolina, e. 2535, LS, p. 55. Also see, C. A. Ciley to Hogan, January 24, 1866, Salisbury, NC, e. 2535, LS, p. 18, all in RG 105, NARA.

(108.) Historian David Rosner documents that it was not until the late nineteenth century that hospitals were forced to begin charging patients. See Rosner, A Once Charitable Enterprise: Hospitals and Health Care in Brooklyn and New York, 1885–1915 (New York: Cambridge University Press, 1982), 62.

(109.) James Yeatman, A Report on the Condition of the Freedmen of the Mississippi (St. Louis, MO: n.p., 1864), 7.

(110.) Thomas Conway, “The Freedmen of Louisiana: Final Report of the Bureau of Free Labor, Department of the Gulf. To Major General R.S. Canby” (Printed at the New Orleans Times Book and Job Office, 1865), 31.

(111.) Howard, Circular No. 5, quoted in Eaton, Grant, Lincoln and the Freedmen, 238–40.

(112.) W. F. Spurgin to Torrey Turner, September 1, 1865, Local Superintendent for Washington and Georgetown Correspondence, LS, vol. 1 (77), July 15, 1865–September 10, 1867, M1902, Roll 13, RG 105, NARA.

(113.) 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, 2. From Slavery to Freedom: The African-American Pamphlet Collection, 1824–1909, LOC.

(114.) Robert Harrison, “Welfare and Employment Policies of the Freedmen’s Bureau in the District of Columbia,” Journal of Southern History 72, no. 1 (February 2006): 75–110.

(115.) Headquarters, BRFAL, State of Texas, Office Surgeon in Chief, October 31, 1866, Senate Executive Documents for the Second Session of the 39th Congress of the U.S.A, 1866–67 (Washington, DC: GPO, 1867), 153–54.

(116.) Ibid., 153.

(117.) Report of C. H. Howard, April 1, 1867, Records of the Field and Officers for the District of Columbia, 1865–1870, p. 48, M1902, Roll 1, RG 105, NARA.

(118.) Charles J. Trips to Major General Wagner, January 5, 1867, Montgomery, AL, M1900, Roll 18, Frame 474, RG 105, NARA.

(119.) For example, see, George McComber to General Robinson, July 7, 1866, North Carolina, e. 2535, LS, RG 105, NARA.

(120.) Eliphalet Whittlesey to D. W. Hand, July 13, 1865, North Carolina, quoted in Pearson, “There Are Many Sick, Feeble, And Suffering Freedmen,” 148.

(121.) Hogan to Yeomans, December 8, 1866, New Berne, NC, e. 2536, LS, vol. 2, RG 105, NARA.

(122.) D. Markay to Lieut. J. M. Lee, September 30, 1867, Louisiana, e. 1393, Annual Report, Chief Medical Report, p. 10, (Misc), Box 40, RG 105, NARA.

(123.) For example, many freedpeople were employed to work at Freedmen’s Village in Arlington, VA. Superintendent Field Offices, Freedmen’s Village, Reports 1865–68, M1902, Roll 21, Frame 70, RG 105, NARA.

(124.) Augusta to J. V. DeHanne, May 2, 1867, Georgia, Savannah Lincoln Hospital, LS, December 1865–January 1868, M1903, Roll 85, Frame 961, RG 105, NARA.

(p.207) (125.) Hogan to Day, January 8, 1867, North Carolina, e.2536, LS, vol. 2, RG 105, NARA.

(127.) Howard commissioned the establishment of vegetable gardens in conjunction with hospitals in his order of March 15, 1866, See War Dept., Laws in Relation to Freedmen, 108.

(128.) Doctors in North Carolina, for example, struggled to implement the garden project. Hogan to Newtown, February 20, 1867, March 13, 1867, Raleigh, NC; Hogan to Barthoff, February 28, 1867, Raleigh, NC; Hogan to Day, Wilmington, NC; Hogan to Bell, March 13, 1867, Salisbury, NC; Hogan to Edwards, April 4, 1867, Wilmington, NC, all in e. 2536, LS, vol. 2, RG 105, NARA.

(129.) Augusta to Horner, July 1866, and August 7, 1866, Georgia, Savannah Lincoln Hospital, LS, vol. 1, December 1865–January 1868, M1903, Roll 85, RG 105. NARA.

(130.) J. V. DeHanne to M. F. Barres, January 19, 1867, Georgia, LR, M1903, Roll 49, RG 105, NARA.

(131.) For an insightful analysis of the conflict between Bureau agents and Northern benevolent associations, see Carol Faulkner, Women’s Radical Reconstruction (Philadelphia: University of Pennsylvania Press, 2004).

(133.) Second Annual Report of the New England Freedmen’s Aid Society (Boston: Published at the Office of the Society, 1864), 35, MHS.

(134.) Harriet Jacobs received aid from Northern reform organizations to support her work among the freedpeople. In many of her letters from 1865 to 1866, she describes providing assistance to Bureau hospitals. See Jean Fagan Yellin et al., The Harriet Jacobs Family Papers, Volume Two (Chapel Hill: University of North Carolina Press, 2008), 642–63. Throughout the benevolent records, there are numerous examples of Northern reformers supporting Bureau relief efforts. See Freedmen’s Record, volumes 1–4, 1863–1868; also see Henry Lee Swint, ed., Dear Ones At Home: Letters from Contraband Camps (Nashville, TN: Vanderbilt University Press, 1966).

(135.) Lawton to C. Horner, September 29, 1865, Offices of Staff Officers, Surgeon-in-Chief, LS and Register of LR, vol. 52, September 1865–July 1867, M1903, Roll 26, RG 105, NARA.

(136.) Abby Howland Woolsey to Harriet Gilman, March 9, 1865, in Letters of a Family During the War for the Union 1861–1865, vol. 2 (New Haven, CT: Tuttle, Morehouse & Taylor, 1899).

(137.) Historian Steven Hahn coherently charts how kin networks survived slavery, Reconstruction, and Jim Crow; Elsa Barkley Brown cogently explains how freedpeople conceptualized family units differently from white prevailing notions of family—these kin networks, Barkley Brown argues, fundamentally reconstituted the political and economic reconstruction of the South. Dylan Penningroth further advances the centrality of kin networks in his incisive analysis of how freedpeople relied on kin connections to claim property. Steven Hahn, A Nation Under Our Feet: Black Political Struggles in the Rural South from Slavery to the Great Migration (Cambridge, MA: Harvard University Press, 2005); Elsa Barkley Brown, “To Catch a Vision of Freedom: Reconstructing Southern Black Women’s Political History, 1865–1880,” in Unequal Sisters: A Multicultural Reader in U.S. Women’s History, 3rd ed., ed. Ellen DuBois and Vicki Ruiz (New York: Routledge, 2000), 124–46; Barkley Brown, “Womanist Consciousness: Maggie Lena Walker and the Independent Order of Saint Luke,” Signs: Journal of Women in Culture & Society 14, no. 3 (Spring 1989): 610–33; Dylan C. Penningroth, The Claims of Kinfolk: African-American Property and Community in the Nineteenth-Century South (Chapel Hill: University of North Carolina Press, 2003).

(138.) Freedmen’s Record, May 1868, 81.

(139.) Ibid., 78–9.

(140.) Julie Winch, Philadelphia’s Black Elite: Activism, Accommodation, and the Struggle for Autonomy, 1787–1848 (Philadelphia: Temple University Press, 1993). Leslie Harris, In the Shadow of Slavery: African-Americans in New York City, 1626–1863 (Chicago: University of Chicago Press, 2004).

(142.) Griswold to Hayden, October 31, 1865, Chief Medical Officer, Annual Report, e. 1393, Chief Medical Officer (Misc), Box 40, RG 105, NARA.

(144.) Ward to Fleming, July 11, 1866; Lt. C. M. Dodge to Fleming; July 11, 1866; and McComber to Maj. General Robinson, August 21, 1866, all in Plymouth, NC, e. 2536, LS, RG 105, NARA.

(145.) Second Freedmen’s Bureau Bill, Section 3, “An Act To Amend An Act Entitled ‘An act to establish a Bureau for the relief of Freedmen and Refugees,’ and for other purposes,” H.R. 613, 39th Cong., 1st Session, LOC.

(146.) In his study of the Republican Party’s support of black suffrage after the Civil War, Wang Xi suggests that Republicans aggressively fought for voting rights for freedpeople as a way to increase their own party membership in the South. See Wang Xi, The Trial of Democracy: Black Suffrage and Northern Republican, 1860–1910 (Athens: University of Georgia Press, 1997). Building on his argument, I attempt to reveal the ulterior motives of the Republican Party in their fight for the extension of the Bureau in the South. While on the surface, they argued it was for the relief and medical support of newly emancipated slaves, they also had an economic and political investment in freedpeople’s labor power.

(147.) Swartzwelden to Warren, March 31, 1868, Chief Medical Officer, e. 1385 LS, p. 317; Griswold to T. W. Conway, August 15, 1865, e. 1385, LS, p. 85; Griswold to T. W. Conway, October 18, 1865, e. 2536, all in e.1385, RG 105, NARA. Planters also cut down the amount of time for emancipated slaves to recover from illness and forced them to return to the fields. See F.M. Minter to W.W. Smith, December 1865, South Carolina, e. 2979, Box 38, Chief Medical Officer, LR, RG 105, NARA.