Empty Sleeves: Amputation in the Civil War South by Brian Craig Miller (review)

Empty Sleeves belongs to a growing body of Civil War writing that goes beyond analysis of military campaigns, political machinations, unit histories, and soldiers’ biographies, to look at the conflict’s lasting impact upon cultural development, broadly defined. Brian Craig Miller, who teaches at Emporia State University, addresses a subject that until recently was consigned to the special category of medical history. Now, the author shows how the huge number of amputations profoundly shook to its foundations the structure of southern society.

The book is well researched, clearly written, and logically organized. After a cogent introduction, Miller considers the surgeons and their tough choices over procedures to follow regarding specific cases of limb or organ trauma. He defends physicians against the charge of being quick to cut, arguing their appraisals were generally cautious, and he commends their frequent selection of resection to remove damaged bone. However, he may overstate the effectiveness of this operation, which often distorted the limb and failed to heal.

Next, the book looks at the patients and how they reacted to their situation. Some refused amputation, fearing they would be blocked from a normal life, with poor prospects for work or marriage. Some took their own lives, but a majority became resigned to their loss, even seeing their mutilation as a noble sacrifice for the cause, akin to that of Christ suffering for humanity. Those who did not have to make a living with their hands might face the future with the most optimism. But all amputees faced years of acute discomfort from stumps and shattered nerve endings, the torture including “phantom pain” from missing body parts.

Women played a vital role through nursing damaged men and helping them adjust to their altered reality, bolstering the confidence of crippled veterans. Naturally, this was not true of all women. Some were repulsed by the monstrous disfigurement of shattered faces and bodies. Many faced a tough choice in sticking with radically damaged males: how was it possible to provide full-time nursing while perhaps looking after children and striving to be the bread winner? Women harnessed themselves to plows, took in washing or sewing, or found clerking jobs to make ends meet.

Ultimately, many amputees were dependent on the charity of local communities and state governments to provide for their needs, which included prosthetic limbs, re-education for employment, a modest pension, even bed and board as they aged without means of support. State and local agencies did an uneven job of providing for the damaged veterans’ needs. In the victorious North, the federal government quickly passed legislation providing medical aid and pensions for wounded soldiers. Local communities that had not been ravaged by war also helped. In the ex-Confederate states, ruined financially and destroyed by invasion, cobbling together aid for veterans proved much harder. In the border states, many Unionists questioned why any help should be given to Rebels.

The most original aspect of the book is the analysis of how mutilation damaged the antebellum image of the white man as a paragon of commanding strength, towering above cowed blacks and dependent women. The defeat of the white male was revealed in the empty sleeve, echoing his shattered cause. Distinguished public service mitigated the image of impotence, but the sense of invulnerability was gone.

This important and provocative study joins others in the UnCivil Wars series from the University of Georgia Press, which also comprises volumes on the ruin wrought by war, including its environmental impact.