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CWBR Author Interview:
Empty Sleeves: Amputation in the Civil War South

by Miller, Brian Craig
Publisher: University of Georgia Press
Retail Price: $29.95
Issue: Summer 2015
ISBN: 9780820343327

Interview with Brian Craig Miller, Associate Professor of History at Emporia State University

Interviewed by Zach Isenhower

Click here for the audio version of the interview

Click here for the review

Civil War Book Review (CWBR): Today the Civil War Book Review is happy to speak with Brian Craig Miller, Associate Professor of History at Emporia State University. Professor Miller previously authored John Bell Hood and the Fight for Civil War Memory, and is Editor of the journal Civil War History. Today we get to discuss his most recent book, Empty Sleeves: Amputation in the Civil War South. Professor Miller, thank you for joining us today.

Brian Craig Miller (BCM) : Thank you very much for having me.

CWBR: Ok so I always ask to start about what drew you to this project, but I think in this case it’s a particularly important question, given how potentially relevant these veterans’ challenges, and their society’s reactions were, as you mentioned toward the end of your book.

BCM: Yeah, it sort of came by accident in some ways. In graduate school we were discussing new ways of thinking about Reconstruction, and at that time I was starting to think about John Bell Hood as a potential thesis and dissertation topic, and since he was a double amputee, I thought wouldn’t that be a really interesting way at getting at his particular life? In the midst of writing about Hood and his amputation and what that meant, ultimately, to his manhood and how it affected him in the postwar period, I started getting these letters in the mail that I mention in the epilogue, from these various veterans organizations, that showed amputees from Iraq and Afghanistan who had acquired prosthetic limbs and were looking for a financial donation to help them buy some sort of craft kit. It was usually around the holidays so they could assemble a model kit and then paint it to give them something to do with their functioning limb, which I thought was really fascinating, in terms of the way that these photographs were taken, of these particular veterans, that were sent with the mailing to acquire funds. To me, it became one of those things were the past of the Civil War and the present day crisis, that I think a lot of men and women who are returning from war are facing now, particularly with some issues with gaining the health care that they need quickly, and just simply being recognized. That they have extensive challenges both with issues of mobility as well as chronic pain they may be facing, as well as just simple recognition for their military service. So I think in many ways, the present day conflict, and the reverberations and aftermath of that conflict, bled into this particular project to think about, what does it actually mean in the Civil War era, to return home missing an arm or a leg, and how does Southern society, that has just been defeated in war, incorporate the damaged individual into the fold of society? I think that sort of matches where the Civil War historiography is going right now. I think the current trends of the issues veterans are facing in Iraq and Afghanistan are starting to appear in the Civil War era, with the work done recently by Brian Matthew Jordan, or James Martin, or I think you will see work here shortly from Diane Miller Sommerville, and Barbara Gannon, who are all talking about the challenges that veterans are facing, and I think that will continue on in the near future.

CWBR: A very interesting thing about this project is how it’s challenging in two different directions, because there is, as you mentioned, there’s real parallels with the challenges veterans face today and certainly, challenges that veterans from both sides of the Civil War faced, but then there are a lot of particularities to what Southern veterans experienced. I was wondering if you could explain why, specifically, you choose to look at Southern veterans?

BCM: The reason for the Southern veteran, if you will, being the center of this project is because in some ways I thought it would be more challenging to do the Southern side of the story, which certainly is not something that we traditionally see in Civil War scholarship. A lot of times when volumes are produced on veterans, in particular, I would say that a vast majority of the source material and the stories within those books are mostly focused on Northern veterans, and for good reason. The paper trail is much greater, the United States medical records are more extensive and easily accessible, so I wanted to focus on the South and especially in its connection to manhood. We think of how Southerners defined their manhood before the American Civil War, with honor, or this internalization that men actually had to go through to realize they were a man, and how they outwardly showed that through how they physically appeared, how they interacted with the public, how they controlled their drinking or their horses and so forth. And also their ability to master or control their wives, their slaves, their children, and their own personal behaviors. The Civil War in many ways alters a lot of those particular facets of defining manhood. For example, honor is shattered in many ways because Southern men are going off to war to fight to prove their manhood and they’re returning as military failures. Their concept of mastery has been completely overturned because of emancipation and women taking a much more prominent role in literally running many Southern households while their men were away fighting the war itself. So it seems that in some ways when men are returning home, and society was once again looking to them as men, it seems that the male physique, which had been so important in the prewar era, would in some ways naturally rise back to the top again. However, because now the male physique has been battered in many ways, not just through amputation but because of physical scarring or emotional scarring that has made these men more dependent on their wives, on their children, on their society in general to care for them, which certainly would have been a mark of feminization in the prewar period. What I was struck with, was I found some isolated cases of amputees in the South before the American Civil War, in the 1840s and ‘50s, many of them amputees from the Mexican-American War or from the Texas independence conflict, and what I found is that Southern society didn’t necessarily embrace them. Even though they would be considered military heroes, they were still viewed in a negative light because their physical being, if you will—their body—had been battered, broken or damaged in some way, which was seen as a marker of feminization, or certainly not pristine manhood. That sense seems to carry its way through the Civil War and into the postwar period, creating what historian LeaAnn Whites calls, and others have echoed, a “crisis in manhood.” I think it’s a crisis that was deeper and more profound than historians have been willing to acknowledge, particularly because of this newfound dependent place in which Southern men find themselves, returning home, needing assistance to survive, coming back to a society that isn’t necessarily thrilled that their military prospects turned out so poorly.

CWBR: It’s that return of damaged physiques that seems to offer the starkest contrast between Southern and Northern veterans. The Union guys can expect limb replacement programs from the government, they have Federal pensions, and of course they won, so there’s this outpouring of public gratitude for having won. For Confederate veterans there are already steeper obstacles because of the shattered economy in the South, but then there are all these notions of Southern male honor, the pall of defeat, and these hinder the support that these guys can expect. Since we’re already on that topic, could you talk about the ways in which those notions of honor hindered the support that they could expect?

BCM: Yeah, it seems in particular that because these men would not get any Federal benefits at all, that they would have to be reliant on benevolent societies, local communities, or state governments to step up and take action. The benevolent societies were completely overwhelmed. I think they had great intentions early on, particularly the local groups that were gathering supplies or raising funds to buy prosthetic limbs, but they simply could not handle hundreds of men who needed their assistance, particularly when they were working based on donations. The eye then focused on state governments, where you only see seven Southern states start prosthetic limb programs—North Carolina, Mississippi, etc., some of these deeper South states—start a limb program, starting with legs, then eventually arms. But the programs are mixed. They take some time, and require that the amputee themselves travel to usually the state capital or another other major city in that state to acquire the limb. It would require some measurements and you’d have to wait for the limb to be constructed and then fitted. Some men found them very useful, others did not, they found them painful. States started to revise some of those programs by offering men a choice between a limb or a cash payment. I discovered that as those programs advanced a few years, that men wanted the cash payment. It was more important for them to have seventy-five or one hundred dollars up front rather than a prosthetic limb that may increase mobility or may hide the fact that they received a catastrophic injury during the war, but it seems that their dire straits of poverty required them to take the cash payment.

Those programs fizzled out and you started to see other programs like land grant programs. Louisiana and Texas particularly gave large tracts of land to amputees. In west Texas and more rural areas of Louisiana, but those programs weren’t as successful as the state governments hoped them to be, because many of these amputated men didn’t know what to do with such large parcels of land unless they had family members who could help them farm these plots of land. So ultimately it comes down to the pension programs. Because of Unionist governments, because of Constitutional questions within state governments themselves, you have legislators, particularly in Texas, wondering if they should actually, if Confederate veterans should be seen as wards of the state, if this dependency that they’re going to have on a government handout payment in the form of four times a year—is that appropriate, is that an honorable endeavor to take place? The governor of Florida actually questioned if this is a manly enterprise. If Southern veterans were true men [the governor reasoned], then they shouldn’t have to rely on state governments in order to survive. So the pension programs are very slow coming. By the 1880s, some of the states started to buy into these programs, and they started to pop up from time to time all the way through Kentucky, which was one of the last to start its program, in the nineteen-teens, which was almost fifty years after the conflict itself. Many of these veterans have started fade away, and haven’t even survived to the point where they could actually collect a pension. That I think was most striking to me. The Lost Cause, in many ways, has allowed us to think that these veterans returned home, were completely embraced by Southern communities, the women took care of them, they lifted them up, they constructed monuments in their honor, they praised them, and cared for them. But the reality is that these men came home, they had no financial prospects, they ended up begging on the streets in some cases, or trying to find odd work here and there, but the doors were closed to them. In fact, one veteran famously noted the sign that appears when he looks for work everywhere, “no maimed veteran need apply.” These men were not being recognized by society as men, let alone men who could be productive in a postwar Southern economy.

CWBR: Talking about how overwhelmed these benevolent societies were, about how this question eventually had to go to the states and to politicians because there’s just no other institution that’s capable of supporting them. In a general sense, I’m curious about numbers, and if there are numbers available, for Southern veterans. Looking at some of the tables in the book, the number of amputees seems a little lower than one might expect, especially once you divide them up among the states. But at the same time, this controversial subset of veterans becomes a symbol for veterans, especially aged veterans, writ large. So I was wondering first about the numbers, and second how they became such a powerful symbol.

BCM: The numbers are a tricky prospect for anyone working on Southern medical history. A lot of the records for medical hospitals and medical care were not standardized until several months into the war itself, so you didn’t have appropriate record keeping. A lot of it was just doctors writing things down in ledger books, which of course were scattered all over the South. Then as the Confederate government starts to centralize these medical records, and a lot of them were destroyed when the Confederate capital of Richmond was evacuated in 1865. So we don’t have an exact count of how many Confederate amputees there were. I think most medical historians have estimated it’s probably close to the Union figure, which was around 29,000, but it’s really difficult to pinpoint that exact number. The pension files themselves may be useful in counting that number, but in some states they’re still medically sealed, because they contain medical information so historians are not actually able to go and look at that information. This is actually applicable in the state of Texas, for instance. The medical portion of pension files in Texas is not available for historians because it contains sensitive medical details, so again, so that would maybe be one way of counting these amputees, but we’re certainly not able to do so in a physical sense. I can tell you that what medical there is does show that the number of amputees did decline during the course of the Civil War, which I think may surprise many readers with general Civil War knowledge, which sees this as a continued medical crisis throughout the war, but it seems that by 1864, Southern surgeons and hospitals have become very regulated, with very strict cleanliness policies, and doctors themselves had access by that time not just to practice but to medical journals and surgical manuals which had been updated. These went step-by-step on when and when not you should amputate, and it became so standardized in practice that surgeons, particularly by the last year of the war, were able to treat thousands of gunshot wounds, but weren’t necessarily amputating at the same rate that they had done at Manassas or Shiloh, in the early part of the war, where you saw surgeons completely overwhelmed, without extensive experience , and they were cutting off limbs left and right.

I think in some ways we can see the amputee, particularly because he became such a prominent physical being in many Southern communities, to be elevated to a different stature amongst other Southern veterans. But it struck me again, particularly with these benevolent groups, that the amputees themselves aren’t always easily recognized in Southern society. You could have instances in some Southern communities where veterans and amputees begging on the streets were told that they were no longer allowed to do this. They would be rounded up—particularly in the city New Orleans—and they would be rounded up and dumped into the Shakespeare Alms House. So the city actually went back and revised that statute to say that actual Confederate veterans could remain begging on the streets, but what happens is some men are able to acquire Confederate uniforms by buying them or stealing them, and get through that loophole and beg for money as an amputee that would not have been caused by a war-related injury.

I thought that the United Confederate Veterans, which becomes the largest Confederate veteran organization by the 1890s, would be a great place for amputees in order to be positioned and heralded, but what I found was that not a lot of amputated men were joining this organization, let alone being recognized by the organization. The UCV does have in their mantra that benevolence is part of who they are, and they want donations to be solicited so they can help take care of aging veterans and infirm veterans, particularly in veterans’ homes across the South, but once state governments started to get involved and take over those veterans’ homes, it seems a lot of the financial resources the UCV would have put into taking care of veterans now goes to other endeavors, particularly textbook writing. The UCV becomes very, very concentrated on making sure that the narrative of the war is written from a Southern point of view, and that Southern point-of-view textbooks are being used in classrooms across the South, rather than in lifting up and caring for these amputated men. Maybe it’s because amputated veterans aren’t interested in joining a veterans’ organization, or they simply don’t have the financial resources to pay dues or to travel due to mobility issues, to go to camp meetings, or even to the national reunions that the UCV is holding from place-to-place. Or they simply don’t want to return to locations where that injury actually took place. A lot of times UCV reunions are taking place at or near battlefields where veterans can go and see where the action took place and maybe that’s something they’re simply not interested in reliving.

CWBR: Yeah I thought it was telling in the section you had on allocations of funds from Mississippi and, at the same time that some $2,600-2,700 was allocated for amputees, there was some $20,000 allocated for the defense of Jefferson Davis. There seems to have been quite a mismatch between the rhetoric of supporting veterans, compared to when it actually came time to pay for such things.

BCM: The thing that’s fascinating about that Mississippi number with historians is that it grows. I’ve actually seen some popular Civil War books, looking at the darker crisis of the Civil War, which are now taking that number and saying that Mississippi spent fifty percent of its state budget. It was twenty percent, then it was forty percent, now it’s fifty percent. That’s simply just not true. Mississippi actually spent about what everybody else did, which was a small portion of their budget, partially because there were such large hurdles for these men to actually go through and apply—because they had to be counted, they had to be verified. In order to get you prosthetic limb, you had to prove that you were an honorable man, that you didn’t desert from the war, that you honorably left the war, that you surrendered or were discharged in an appropriate way, and you had to get medical guys to step forward, your physicians, surgeons had to say that this guy’s amputation took place during the Civil War. So it became a very large burden of proof on these men just to actually fill out the paperwork and then swear and affidavit before a judge to actually get the prosthetic limb to begin with. So Mississippi’s budget figure, I hope, will actually return back to normal here. It continues to be one of the great myths of the Civil War, that Mississippi had to spend all this money on prosthetic limbs when the reality was very similar to what the few other state who even created the programs actually spent.

CWBR: There’s one group I want to make sure we talk about, because the whole time these guys are doing all of this, trying to get their paperwork filled out and, of course, they don’t make a whole lot of headway until almost the turn of the century, and in the interim in many cases they’re basically dependent on women at home. You mentioned the disruption of prewar gender expectations. Some of it seems to have come down just to numbers, with some twenty percent of the marriageable male population no longer available. So women have to make adjustments, but they make a whole range of adjustments. Would you say that overall Southern women formed a crucial bridge to the more formalized institutional support for veterans after they returned?

BCM: Absolutely, I would definitely agree with that. We think for these amputees themselves, the very first person that they’re going to interact with once they wake up from their amputation is probably a female nurse who has been assigned to give them medical care, change their dressings, and watch over them for a few weeks while they recover, before their return back to battle or the front lines or sent back home. In some ways these nurses serve as the psychological gatekeepers for preparing these men for some of the challenges that they may face. As these amputees are recovering, they take a lot of time to think about what an injury means to them in the future. They begin worrying, in particular, about how their fiancées, or potential spouses back home, or their current spouse, are going to react to this injury. It seems time and time again that the nurses themselves are telling these men, “everything is going to be ok, show your fiancée, your wife, your empty sleeve, show them your wound. They will embrace you, they will love you all the more.” In some cases as these men are recovering in the hospital, they’re getting mail, so we have nurses having to break the news that their fiancée or spouse has actually sustained a major injury, one that will alter their ability to maybe be a breadwinner for the household itself.

The Lost Cause has this thing that every single Southern woman rose to the challenge and accepted these men. I actually found it to be a mixed bag early on. You have some women who were very enthusiastic, very excited about taking care of amputated men. There are others who are not so interested, particularly those who want a fully able-bodied man, because that is how they see their ability to care, to survive in the future. Other women simply become physically repulsed by the sight of men who have been physically altered by the war. I don’t think we can blame those particular women because they are part of a culture and a society in the mid-nineteenth century that was in many ways Barnham’s world, where those were physically altered or handicapped became sideshow attractions. They were individuals who were gawked at or stared at or ridiculed by the general public, so it shouldn’t surprise us as historians that these men now, who are veterans, happened to be viewed in the same way by some of their potential spouses.

It seems that as time passes and these men come home, that for the most part they are embraced by women who have no choice other than to sort of help pick up the pieces. They heed, in some ways, Jefferson Davis’ call near the end of the war to help build up the amputee as the “new aristocracy,” mostly out of sheer desperation to readjust to society. If you fell in love with a man when he went off to war, you certainly understood the risks and when he returned missing an arm or leg, for the most part women, again, accepted that man in that new position. We see cases of women who were very vigilant in caring for their amputated spouses, others who took them out every morning and tied them to the plow so they could actually do the fieldwork for the day. Others found this prospect to be slightly exciting and beneficial for their own relationships, because they felt that their husbands or fiancées would not leave them. “Who else could love an amputated man better than myself,” these women would start to argue. In fact, some relished this newfound dependency that their husbands would now have on them, in many ways, as they had been dependent on their husbands prior to the Civil War. It’s from those efforts in particular that we see women in that familial role of lifting these men back up or at least providing them medical care. They become the stand-ins for the state governments that are slow to react, or the lack of healthcare system that’s readily available for these veterans as they return home and adjust to their newfound disabilities.

CWBR: Of course there’s one more group that undergoes a massive transformation over the course of the war, and that’s the surgeons. It was really striking to me that you have these soldiers and also the untrained nurses, maybe from rural Arkansas or Mississippi or Louisiana or wherever, and they think so little of the surgeons that they feel that their own opinions on whether amputation is necessary or not hold more weight, even as the surgeons themselves are very carefully developing and documenting and standardizing best practices. Although it does seem like there were certainly cases where the worst perceptions of wartime medicine were accurate, that actually instances of really saw-happy surgeons, and utter disregard for cleanliness, and incompetent post-operation care, those don’t really represent the typical standard of Civil War medicine. So how is that our impression still today, has become so skewed? Because of all of these groups that undergo real transformations, surgeons’ reputations don’t seem to come out of the other end of the war much better than they went in.

BCM: I think there are a few reasons for that. First of all, popular culture has done some damage to Civil War surgeons. Think of any major Civil War film, going all the way back to Gone with the Wind, where the surgeon is sort of viewed in this negative light. He’s more Sweeney Todd than a skilled individual, hacking away at the bodies, calling for the next patient/victim, hacking off the limb, tossing it, and then just screaming “next!” as they wipe the saw or knife on their blood-spattered apron. That, I think, also parallels with some of the very negative impressions early on in the war. If you look at any sort of general narrative history of the American Civil War, these big one-volume narratives that have been written, usually when you get to the section on medicine, or the medical crisis, a lot of the quotes pertaining to doctors, both Union and Confederacy, usually are lifted from 1861-1862. We can’t blame those diary writers and letter writers because that is the horror that they’re seeing for the very first time. They don’t have much of a frame of reference. We’re talking about men and women who probably have never seen an operation before. They certainly had not experienced any sort of major medical surgery in their life or been into a location where that had taken place, so when they walk by a battlefield hospital or they’re serving as a nurse in a battlefield hospital, they’re going to hear people screaming, they’re going to hear cries, they’re going to see limbs being cut off. The only thing they can think of is to use the term “butcher.” Now we think of the term butcher as back in those days as requiring some skill. Even today, when you go to Whole Foods or Kroger and you go talk to your butcher behind the counter, you’re going to have him cut a piece of meat in a very skilled manner so it looks great, and so butchers themselves back then were doing very skilled work, but observers had no other frame of reference, so that was the term. It comes up again and again and again, particularly in ’61 and ’62, and these accounts were written about these surgeons or the hospital experience in general. It has been cast, when combined with popular culture, in a very negative light.

In some ways I think surgeons rightfully earned that label, but only early in the war, because they were so overwhelmed, they were understaffed. You’re talking about hundred of gunshot wounds, thousands when you’re looking at the aftermath of Shiloh, with a limited number of medical personnel, a limited amount of time, and in many cases they simply did not know what to do with that many wounded. Once that storm calms a bit in the early part of the war, we start to see more standardization of practices, more medical literature readily available, and there it seems the medical practice really makes profound steps forward. We have cases of surgeons who are clearly understanding germ theory well before we have given them credit for in the historical community. Doctors are employing cleanliness standards in battlefield hospitals or in recovery units. Nurses themselves are starting to understand the necessity for cleanliness and regularly changing dressings or following protocol where floors have to be scrubbed and cleaned in a certain way after a certain amount of time has passed. In some ways when we negatively castigate these surgeons or hospital workers, we’re actually shredding their credibility, their honor, where they had taken up very honorable profession and did their best. While we have a lot of source material negatively blaming these surgeons in 1861-62, I was able to find quite a bit of praise-worthy material, particularly of patients who ran into their surgeon later in life, and thanked them for saving their life. Those are the stories that don’t necessarily get into those grand narratives of the Civil War, and they certainly don’t make it into the Hollywood, pop culture views of the medical practice.

CWBR: So by the time we turn the clock again and get back up to the turn of the [twentieth] century, and women caregivers have been stand-ins for quite some time. There have been the benevolent societies and we’re starting to get some incipient state programs. But the foundation of support is really still too small, especially as these veterans get older. By contrast, Northern veterans, by the 1890s, support for Northern veterans I think accounted for something in the neighborhood of forty percent of spending. At the same time, Southern states are still debating whether individual support is undignified and maybe they should all go into these underfunded veterans’ homes. So while there is some emerging systematic support, it’s coming after a lot of the veterans have died, and it’s really kind of, as you mentioned earlier, a very mixed actual result for the veterans. What do you think was the legacy of their efforts, and the efforts of the women and of the benevolent societies, who championed on the veterans’ behalf?

BCM: I would say it’s a very mixed legacy. Unfortunately, I think this is a mixed legacy after every major American conflict. I don’t think that the Civil War stands alone here. If we look at recent events, you know, a few years ago with the issues at Walter Reed Medical Center or with the backlog of paperwork that veterans are having to wait to see a doctor at the V.A. This seems to be a sad, persistent theme in American history, that after every major conflict, we sort of turn the page in the textbook, I like to say. The war ends, we turn the page, and we move on to the next chapter in history, not really taking the time to understand the complexity of what these veterans, and those who were directly connected to them, have to deal with on a daily basis. The benevolent organizations themselves, in the South, try their best, are overwhelmed, then sort of turn their attention elsewhere, such that caring for the wounded may not have been in their minds the larger legacy, as opposed to decorating graves and constructing monuments and writing textbooks. That telling the story of the war becomes more a pertinent issue for these benevolent groups than taking care of the human beings who survived the war itself. The state governments drag their feet. Some of them take a long time to actually get to a place where they put up a financial commitment for these veterans, by which time many have passed away or are no longer interested in seeking out financial support. A lot of them will just write in that they are in a place where they simply need help, and when the government was unable to do so, we’re left as historians to wonder what happens to them, if that’s the only paper trail that they leave behind.

I think that the story of the veterans themselves becomes a problematic one in the sense that we don’t have enough material, if you will, to sort of glean what their experiences were really like, other than these sort of grand narratives that the benevolent organizations like the Daughters of the Confederacy, or the Ladies Memorial Association, or the United Confederate Veterans wrote. They wrote very grandiose things about these men, and they wrote very grandiose things about the nurses who cared for them, but that rhetoric doesn’t necessarily seem to match when you go to pension files and prosthetic limb applications that show injured men in such dire straits that they are begging state legislators, they are begging governors. You look at some of the governors’ files related to some of the prosthetic limb programs or pension programs, and there’s usually a folder full of letters written by the veterans saying, “I need help. I don’t need help next week or next month, I need help immediately because there’s nowhere for me to go,” and I think tragically that continues to be a legacy of American military conflicts where we have veterans today who are still begging for help, who are having to live under bridges or are homeless, who don’t have the medical care that they need. That sad mixed legacy I think for Confederate veterans, and even Union veterans as some historians have pointed out, even continues today.

CWBR: Well, an excellent look behind the grand narratives that certainly do need more complication. Professor Miller, I appreciate you taking the time to discuss your most recent work, Empty Sleeves: Amputation in the Civil War South.

BCM: Thank you very much.

Isenhower, Zach, review of CWBR Author Interview:
Empty Sleeves: Amputation in the Civil War South
, by Miller, Brian Craig, Civil War Book Review, (Summer 2015).