This impressively researched and well written book seeks to fill a glaring hole in Civil War historiography. As historian Brian Craig Miller[1] (Emporia State Univ.) notes, even with the recent emphasis on the darkest aspects of the war, "the consequences of amputation on Civil War soldiers and civilians, both during and after the war, have remained largely unexplored" (3). Empty Sleeves breaks new ground by exploring those consequences specifically for Confederate soldiers[2] and Southern society writ large, with particular attention to the gendered nature of the surgery. Miller argues that amputation not only physically disabled the soldier, but dealt a blow to his masculinity, since Southern men often defined themselves as men by a whole healthy body. Was a man still a man if he was missing an arm or a leg or both? After the war, "Confederate amputees relied solely on themselves, their communities, and eventually their (often dysfunctional) state governments" (4), and asserted their masculinity in a variety of ways.

Some of the wounded demonstrated their manhood by refusing an amputation to begin with, often with lethal consequences. Others submitted to it and limped home to lives of dependence on their wives, families, and communities, while still clinging to the notion that they remained men. How did Southern society respond? Disabled veterans were difficult to employ. Private charitable organizations fundraised for the poverty stricken, but it was seldom enough. State governments jump-started prosthetic limb and paltry pension programs.

Empty Sleeves comprises five discrete, roughly chronological chapters on Confederate amputees during and after the war, loosely tied together by the shared topic. Chapter 1, "The Surgeons: Gray Anatomy," focuses on Confederate surgeons, adding to a recent spate of works seeking to rehabilitate the reputation of Civil War surgeons.[3] Miller contends that Confederate doctors were neither heartless butchers nor hapless incompetents, but often skilled and compassionate operators who gained expertise as the war went on. In its later stages, mortality rates declined, as surgeons increasingly practiced safe alternatives to amputation. But growing competence and a will to improve could not overcome the horrific images of their early mistakes.

In chapter 2, "The Patients: Enduring the 'Fearfulest Test' of Manhood," Miller, in the same vein as the work of Kathryn Shively Meier,[4] argues that wounded Confederate soldiers practiced their own form of self-care by choosing whether or not to undergo amputation. Officers tended to reject the procedure more than common soldiers did. Many did so in order to return more quickly to the battlefield; others feared the emasculating effects of the surgery or sought to prove their manliness by facing death. Many soldiers willingly underwent the grisly operation as their own red badge of courage.

Chapter 3, "The Women: Reconstructing Confederate Manhood,"[5] is the most interesting and valuable in the book. In it, the author shows that Southern women reacted variously to the return of their disabled menfolk. Some were disgusted by their deformities, while others worried about the financial implications of marriage to an amputee, who struggled financially to provide for his family. But many embraced the damaged men with sympathy or patriotism in their hearts. Most interestingly, Miller identifies a shift in the dynamics of family relationships:

Chapter 4, "The Return: Adjusting to Dependency and Disability," describes the difficulties faced by disabled veterans in rejoining Southern civil society. Miller stresses that they came back home—unlike their Union counterparts—under a cloud of defeat, enjoying no Grand Review, generously subsidized prosthetic limbs, or adequate pension programs. Simply working was their first challenge. "Prior to the extension of prosthetics and pensions from state governments, amputated men struggled first to find meaningful employment. Ramshackle veterans tied themselves to a plow in order to prepare their farmland; they begged for money and sold items on street corners, hoping that their missing limb would elicit sympathy and sales" (118). Their deformity prevented many Confederate veterans from resuming their prewar occupations. Some turned to teaching, others went back to school and earned degrees in law or medicine. Sadly, some amputees ended up in an almshouse, insane asylum, or prison. Others became homeless street beggars. Some amputees, however, found success in politics, where their "empty sleeves" became a powerful symbol, much as the "bloody shirt" did for Northern politicians.

Chapter 5, "The State: The Politics of Paying Damages," concerns the aid eventually provided to disabled soldiers by state governments in the postwar years. Miller argues that such assistance was often too little too late. His discussion of prosthetic limb programs is particularly instructive. Providing aid for disabled veterans could be a potentially thorny business, varying from state to state. North Carolina was the first Southern state to enact a prosthetic limb program that became a model for other states to emulate. Six other southern states followed suit, but two, South Carolina and Louisiana, did so only after redemption,[6] since benighted Republicans for a time thwarted any program to support men they considered traitors. Texas never did create a program because of budget constraints. In Arkansas, the legislature approved a program, but the Unionist governor vetoed it. Miller corrects a longstanding story that Mississippi spent 20 percent of its budget on artificial limbs in the postwar years. In fact, he shows, it spent more on Jefferson Davis's legal defense than on artificial limbs.

The thorough research for Empty Sleeves took Miller to major universities and archives throughout the South, as well as the National Archives and the National Library of Medicine in Washington. He is also fully conversant with the published primary sources and the pertinent secondary literature on his subject. I do, however, have a few quibbles. While the experience of Union veterans lies outside his purview, the author often paints a too rosy contrasting picture of their postwar lives, no doubt to spotlight the unenviable position of Confederate veterans.[7] In addition, the book sometimes reads like an encyclopedia of Confederate amputees. The flood of case studies at times overwhelms the argument.

This extremely valuable study of the lives of Confederate amputees, the gender implications of their disabilities, and the societal responses to the war wounded is very timely in our own day, when, as Miller notes in his epilogue, more amputees are coming home from America's wars in the Middle East than have since the war in Vietnam. As a fine installment in the "dark turn" trend in Civil War historiography, Empty Sleeves places a salutary emphasis on the lasting, dire physical and psychological effects of war. It is a book that deserves close reading and reflection by academics and general readers concerned with the Civil War, the postwar South, or the history of war-inflicted disability more generally.