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

Wounds, and the work required to treat them, should be at the heart of all effective military medical history. Nowhere is this more clearly demonstrated than in Brian Craig Miller’s absorbing and compassionate history of limb loss and its many meanings for casualties on the losing side of the American Civil War. For European medical historians engaged in making new representations of Great War injuries as part of the centenary commemorations, America’s own dreadful reckoning with itself fifty years earlier is often seen as not much more than a coda to the Crimean War. Miller’s work is an important corrective, demonstrating both the distinct social context of America’s limbless but also the remarkable continuity of injury and treatment from the mid-nineteenth century into the early twentieth and, regrettably, on into our own times and wars.

Miller opens by describing the problems posed for medical historians, which limited documentation, archives and statistics to be found in the former Confederate South (12). This is not a dilemma created by an exclusionary “history written by winners” tendency. British historians of the Great War know this problem all too well. Most official archives were destroyed in the mid-1920s, with only representative samples of hospital admission books retained for scholars to study and nothing from the field hospitals that operated so effectively on the western front of the Great War. So Miller faced the same problem: no definitive statistical analysis, but a great need to account for injuries that might otherwise become invisible without the conventional infrastructure of scholarly study. Instead he has tackled an extraordinarily wide range of primary sources to provide a coherent, well-grounded alternative, among them casualties’ own diaries and letters, poetry, newspapers, as well as pension records and legislative material.

The use of photographs and sketches is a powerful component of the book, allowing the reader to appreciate the severity of the injuries and the efficacy of the surgery performed on the limb stumps (the photograph of Pvt. William Stubblefield on page 74 is illuminating for today’s orthopedists). Accounts by doctors and surgeons are also instructive, although here the specific context of the Civil War places a limitation not found in Great War histories. Confederate medics had little ability to report and publish their experiences and findings for their peers to study. Instead, transmission of their growing expertise in treating limb loss must have taken place informally if at all, relying on the few surgical manuals that existed (26). Publications by Union medics, such as Gurdon Buck’s Contribution to Reparative Surgery, found their way to Britain and were read as part of medical preparations for the new century’s conflicts, although the political affiliations of their authors, and therefore their access to publishing resources, have not generally been considered (including by this reviewer, who won’t make that mistake again).

Of particular interest in Miller’s work is his detailed account of this growing expertise by southern doctors and surgeons in treating their amputee patients, both at the point of wounding and at a later point in their reconstruction (39). The process Miller describes with useful technical detail matches similar improvements by surgeons at the Great War where by 1916 survival rates for injuries requiring amputation were reduced from 50 percent for femoral fracture to less than 10 percent. Much about the circumstances of the work of both sets of professionals is the same. Constrained by crude anesthetics, rampant infection, sudden overwhelming patient numbers, and sometimes real physical danger as they worked, surgeons saved thousands of lives that might otherwise have been lost, learning and improving as they went along. Flanders or Chancellorsville, the profession rose to the challenge.

There are of course significant elements in this history unique to the Civil War context, and fascinating to readers outside the United States. Without ever losing sight of the essential elements of the injury, Miller carefully...