Contextualizing the United States Government’s Legacy of Combating Infectious Diseases: Examining the Marginalization of Formerly Enslaved Africans Amid the Smallpox Epidemic

Joseph Bonjawo

In modern society, each individual possesses a presumed desire to achieve longevity. Unfortunately, however, such an aspiration may prove infeasible due to the existence of infectious diseases. In 2017, the Centers for Disease Control and Prevention (CDC) reported that respiratory illnesses such as influenza and pneumonia were among the ten leading sources of mortality in the United States. These diseases collectively accounted for 2% of the total fatalities of that year. Depending upon the prevalence of infection, the World Health Organization (WHO) may classify an infectious disease as either an epidemic or a pandemic. So long as a disease invades a specific region, it is customary for the governments of affected territories to impose preventive measures. For instance, the WHO’s 2007 interim guidelines for acute infectious respiratory diseases contain protocols such as early detection, isolation and reporting, and the erection of preventive infrastructure.

Seeing as these procedures are intended to mitigate the transmission of infectious diseases, one may perceive them as serving society’s interest. However, proponents of such measures are often oblivious towards the disproportionate infection and mortality amongst African American demographics. This essay will contain three segments, each of which will satisfy the following objectives:

  1. Examine the responses of federal officials during the Civil War era’s smallpox epidemic.
  2. Explore the contemporary reality of COVID-19 in the United States. 
  3. Begin generating uncertainty regarding the United States government’s proposed resolutions to the pandemic.

According to an article authored by journalist Guy Gugliotta, the 19th-century Civil War claimed the lives of approximately 750,000 soldiers. This particular figure, calculated by demographic historian David Hacker, serves as a replacement to the original estimate of 618,222. Historical sources often convey that the enormous casualties during the war were primarily a result of infectious diseases. However, there is seldom any mention of the catastrophic fate of formerly enslaved Africans. In his publication titled Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction, Jim Downs, Professor Of Civil War Era Studies, recounts the dreadful events of the American Civil War. He emphasizes that numerous former slaves succumbed to infectious diseases in the years following their emancipation. One such disease, known as smallpox, developed in Washington D.C. in 1862 and pervaded the Upper South in 1863–64, the Lower South and Mississippi Valley in 1865, and the Western territories in 1867–68 (p. 96). Downs describes it as the most lethal disease that plagued the postwar South (p. 15).  

As he examines the events of the smallpox epidemic, Downs introduces an organization known as the Freedmen’s Bureau. As mentioned in the Encyclopædia Britannica, the United States Congress established the Freedmen’s Bureau in 1865 to assist the formerly enslaved population of four million. Upon examining the article, one may perceive the Freedmen’s Bureau’s contributions as invaluable. As stated in the text, the Bureau provided hospitals for more than 1,000,000 freedmen, distributed nearly 21,000,000 rations to impoverished African Americans and Caucasians, and erected more than 1,000 African American academic institutions. However, the Encyclopædia Britannica’s editors overlooked the Freedmen’s Bureau’s involvement in the management of the smallpox epidemic.

In his publication, Downs provides estimates of infected freedmen reported by Freedmen’s Bureau physicians and the chairman of an organization known as the Committee of Freedmen’s Affairs. The chairman, known as Thomas D. Eliot, estimated that approximately 49,000 formerly enslaved Africans contracted smallpox in the postwar South between June of 1865 and December of 1867. Additionally, Freedmen’s Bureau physicians in Georgia, Louisiana, North Carolina, and Virginia approximated that smallpox infected hundreds of formerly enslaved Africans per month between December of 1865 and October of 1866. In particular, the North and South Carolina estimate amounted to 30,000 casualties in less than a six-month period in 1865 (p. 106). Downs specifies that the Freedmen’s Bureau rarely documented the quantity of infected Caucasian Southerners. Nonetheless, Bureau physicians reported that infected freedmen between October of 1865 and January of 1866 outnumbered infected Caucasians by an average ratio of 100 to 1 (p. 102).

As initially conveyed, the WHO’s preventive measures may include early detection, isolation and reporting, and providing infrastructure. However, the 19th-century Union army deemed such precautions as inapplicable to the formerly enslaved. According to Downs, the Union army refused to station formerly enslaved Africans in barracks. As a result, a significant proportion remained in noxious contraband camps composed of discarded matter and excrement (p. 99). Downs reveals specific objections provided by an organization known as the Medical Society of Washington. They contended that the smallpox epidemic was largely preventable and that the gesture of assembling the formerly enslaved in barracks may have impeded its transmission (p. 99-100). Nonetheless, federal officials unwittingly dismissed the smallpox epidemic as a crisis exclusive to formerly enslaved Africans (p. 98). Perhaps such negligence at the onset of the outbreak may have contributed to the immense casualties reported by Freedmen’s Bureau physicians and the Committee chairman.  

Downs introduces a notable preconception perpetuated by Northern authorities: the unsubstantiated belief that the extinction of the formerly enslaved was imminent. As he mentions, officials of the Freedmen’s Bureau’s Medical Division perceived their survival as an impossibility. Consequently, they refused to provide the necessary resources to enable Southern Bureau physicians to quarantine infected freedmen. Moreover, Congress members in 1865 neglected to allocate their investments towards initiatives intended to provide medical assistance to the formerly enslaved (p. 103). Seeing as federal officials perceived the extinction of the formerly enslaved as the probable consequence of the smallpox epidemic, preventive procedures were not of the slightest concern. However, this does not imply that officials were unable to enforce efficient measures. In 1862, Brigadier-General Ulysses S. Grant detected two or three cases of smallpox amongst his men. As a result, he immediately reported his observations to his headquarters and supplied mandatory vaccinations to all soldiers. Additionally, president of the United States Sanitary Commission (USSC) James E. Yeatman alerted military authorities of the smallpox epidemic’s arrival and encouraged swift precautions. On the contrary, the Freedmen’s Bureau in 1865 refused to classify smallpox as an epidemic despite the frequency of cases in the formerly enslaved population (p. 104). Considering that physicians and local governments have encountered smallpox since the 18th century, they were bound to have received sufficient exposure towards the necessary protocols (p. 98). As such, the Freedmen’s Bureau’s inaction during the Civil War era’s smallpox epidemic is undeniably inexcusable. 

Downs emphasizes that the smallpox epidemic’s prevalence may have been attributable to the Freedmen’s Hospitals’ inability to conduct inoculations and vaccinations (p. 97). However, there does not exist any indication that these measures were beneficial towards the formerly enslaved. As he mentions in his documentation, the process of inoculation entails the deliberate infection of patients in anticipation that they would manifest an immune response. Downs indicates that the subjects of such a precarious procedure could very well transmit the disease (p. 104). As the smallpox epidemic continued to escalate, assistant commissioners instructed Freedmen’s Bureau physicians to administer compulsory vaccinations. However, the medical supplies transported to Christ’s Church, South Carolina, did not include vaccines. As a result, the commanding Bureau physician resorted to inoculating the nearly 150 formerly enslaved Africans in the vicinity (p. 110). Seeing as reinfection was the inevitable consequence of 19th-century inoculation, such an operation was unlikely to have resulted in their protection. 

According to Downs, the discovery of vaccinations in the late 18th century served as the impetus for lifetime immunity (p. 104). However, Freedmen’s Bureau physicians often conducted multiple operations due to their failure to administer the vaccines. For instance, physicians in Tennessee failed in their administration of nearly 830 of 1,200 vaccinations between December of 1865 and May of 1866 (p. 110). Perhaps the insufficient supply of vaccines and medical equipment may have contributed to such a figure. Regardless, the victims of the failed procedures remained susceptible to infection. 

Upon examining this dilemma, one may evaluate that additional equipment and vaccines may have enabled Freedmen’s Bureau physicians to contain the smallpox epidemic. However, such a sentiment may not have been upheld by formerly enslaved Africans. As Downs mentions in his publication, the formerly enslaved perceived the vaccines as detrimental to their well-being and therefore resisted the Union army’s obligatory vaccinations of 1864 (p. 111). During that year, superintendent of Negro Affairs Horace James observed the behavior of formerly enslaved Africans in North Carolina. He specified that the formerly enslaved would often resist vaccination by concealing and remaining alongside infected freedmen beneath blankets and beds in their cabins. James believed that such evasion exemplified their ignorance of the ostensibly superior medical treatment of Union physicians. He then stated that the formerly enslaved would typically utilize traditional remedies such as roots, herbs, and castor oil to alleviate their illnesses (p. 111). 

James perceived their defiance as ludicrous. Regardless, formerly enslaved Africans possessed no desire to yield to the demands of the authorities. According to Downs, the formerly enslaved typically refused to register for vaccinations at Freedmen’s Bureau hospitals. Consequently, Bureau officials and local police often invaded their habitats and requested immediate vaccination. Additionally, Bureau authorities, agents, and physicians would arrest the non-compliant. Among the arrestees were formerly enslaved Africans in Orangeburg, South Carolina. Their duration of imprisonment remains a mystery. Upon their release from jail, they relayed their accounts to a local newspaper, asserting that the Freedmen’s Bureau’s vaccination initiative solely prioritized the formerly enslaved population (p. 111-112). This contention reveals the former prisoners’ distrust of the Freedmen’s Bureau’s intentions. In 1866, a Louisiana Union Officer claimed that the implementation of vaccinations “would save many lives among these poor people” (p. 105). Considering the Union army’s lack of compunction for the increased fatalities amongst the formerly enslaved, the credibility of such a suggestion is somewhat uncertain. Furthermore, the Freedmen’s Bureau’s refusal to diagnose smallpox in the Caucasian population may have served as an unforeseen source of infection. 

As a result of the Freedmen’s Bureau and Union Army’s discriminatory procedures, myriads of formerly enslaved Africans succumbed to the smallpox epidemic. By analyzing Downs’ writings, one may conclude that the reduced availability of medical resources primarily contributed to such a tragedy. Additionally, one may observe that the Freedmen’s Bureau’s minimal documentation of infected Caucasians resulted in a limited portrayal of the smallpox epidemic’s severity during the Civil War era. Regardless of these evaluations, Downs’ records clearly reveal that federal officials operated at the expense of the formerly enslaved population. Moreover, they introduce the possibility that such immorality may have served as a precedent for the contemporary management of infectious diseases in the United States. 


Downs, Jim. Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction. Oxford University Press, 2015.

“FastStats – Leading Causes of Death.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 30 Oct. 2020,

“Freedmen’s Bureau.” Encyclopædia Britannica, Encyclopædia Britannica, Inc.,

Gugliotta, Guy. “New Estimate Raises Civil War Death Toll.” The New York Times, The New York Times, 2 Apr. 2012,

“Image 3 of African American Pamphlet Collection Copy.” The Library of Congress,

“Infection Prevention and Control of Epidemic- and Pandemic-Prone Acute Respiratory Diseases in Health Care.” WHO Interim Guidelines , 2007,

States., United. “Bureau of Freedmen and Refugees. Report of Hon. T. D. Eliot, Chairman of the Committee on Freedmen’s Affairs, to the House of Representatives, March 10, …” HathiTrust, 

Horace James. Digital Image.

Easybib Citation: Thomas Dawes Eliot,