Empty Sleeves

Amputation in the Civil War South

Brian Miller, Stephen Berry, Amy Taylor

• Publisher: University of Georgia Press
• Year: 2015
• ISBN:
  9780820343334
• Topic: History
• Subtopic: American Civil War History
• Index: History

The Civil War acted like a battering ram on human beings, shattering both flesh and psyche of thousands of soldiers. Despite popular perception that doctors recklessly erred on the side of amputation, surgeons labored mightily to adjust to the medical quagmire of war. And as Brian Craig Miller shows in Empty Sleeves, the hospital emerged as the first arena where southerners faced the stark reality of what amputation would mean for men and women and their respective positions in southern society after the war. Thus, southern women, through nursing and benevolent care, prepared men for the challenges of returning home defeated and disabled.

Still, amputation was a stark fact for many soldiers. On their return, southern amputees remained dependent on their spouses, peers, and dilapidated state governments to reconstruct their shattered manhood and meet the challenges brought on by their newfound disabilities. It was in this context that Confederate patients based their medical care decisions on how comrades, families, and society would view the empty sleeve. In this highly original and deeply researched work, Miller explores the ramifications of amputation on the Confederacy both during and after the Civil War and sheds light on how dependency and disability reshaped southern society.

ONE

The Surgeons

Gray Anatomy

The soldier is already dreaming of glory and renown, and, therefore, eagerly grasps the theories of war; but military tactics necessarily leave out of the question the ghastly field, its wounded, and the bed of suffering. There the province of the physician begins, and on the field of battle itself, his knowledge, and skill are put to the severest test.

—Dr. Moritz Schuppert, Treatise on Gun-Shot Wounds

Surgeons, be ready to give the best attention to our wounded; for doubt not, many a manly form shall bleed pure patriotism, ere another sunset!

—Rev. J. T. Clarke, Prepare for Battle

How many lives were lost through ignorance, want of experience, want of skill, want of suitable appliances will, of course, never be known.

—F. E. Daniel, M.D., Recollections of a Rebel Surgeon

Years after the close of hostilities, a surgeon remembered, in stunning detail, each specific moment of the amputation of a Confederate soldier in Atlanta. The doctor recalled, “I see a strong man stretched prone on the table. I see the aproned surgeons, stern of visage, kind and gentle of heart; I see the gleam of a long life; I see the warm life blood spur out as it cleaves the quivering white flesh.” The doctor still heard the sound of the saw as it grated through “the bleeding bone” and could envision that “ghastly wound, gaping gory; its flabby flaps weeping crimson tears.” As the “thirsty sponge” drank the bloody tears of the wound, the empty chasm quickly “dried” and the surgeon stitched the wound and placed a roller bandage “around the stump.” The patient next traveled to a cot beneath an oak tree where he found an attentive nurse sitting by his side, sweeping away the flies that tried to cohabitate with his newly forged stump.¹

This chapter explores the lives of surgeons in the Confederacy and their role in altering the image of the southern white male body during the Civil War. At the start of the conflict, a miniscule number of surgeons found themselves overwhelmed by limited supplies, a lack of training, and a plethora of patients. As a result, some doctors did perform ill-advised operations and produced an immense amount of suffering, chronic pain, and unnecessary death. But in underappreciated ways surgeons adapted as the war progressed. Despite persistent negative connotations as butchers, many surgeons received extensive training in a profession that gradually learned how to remove limbs only when medically necessary. Soon after the war started, surgeons had access to medical manuals that provided step-by-step instructions on how to deal with patients who had sustained even the most daunting injuries, and they tended to amputate only as a last resort, resulting in far fewer amputees than is usually suspected. Surgeons, as men, appeared to identify sympathetically with patients who were desperate to retain their manhood and, on numerous occasions, shunned amputation.

As we have seen, the inevitable hospital scene in numerous Hollywood films has shaped our impressions of Civil War surgeons as men who called for their next patient, swiped the saw or scalpel across a blood-stained apron, hacked and sawed away at an appendage of human flesh, then tossed the limb and called for their next victim. While films have a powerful ability to shape popular perception, historians have unfortunately added to the myth of the saw-happy surgeon. One historian, for instance, has called medical professionals “one of the Civil War’s most dismal failures” for their apparent addiction to amputation; another has wondered if “wounded soldiers often would have been better off without any treatment—even with a lead ball remaining in them, with its potential toxic effects.” One prominent Civil War historian has argued that Civil War surgeons “knew of few ways except amputation to stop gangrene” and has further noted that surgeons ended up divided between the radicals, who were only “probably right” in their belief that amputation “saved more lives than it threatened,” and the conservatives, who tried to save a limb. Another historian has claimed that medical personnel “operated in ignorance, and continued to make the same mistakes throughout the war, which often led to unnecessary suffering and death.” Others have criticized the overworked medical personnel as they “carelessly threw body parts everywhere.” Finally, one prominent historian has claimed in a recent narrative that “surgeons and doctors who were on hand were liable to make matters worse” as they established a hospital that resembled “nothing so much as a butcher’s shop on market-day.” Indeed, in many of the grand narratives of the Civil War era, medical personnel are universally lumped together and swiftly condemned as an inept and careless group who deserve blame for the war’s horrific level of casualties.²

To be sure, there are some medical historians who have viewed surgeons in a more flattering light. H. H. Cunningham has argued, for instance, that scenes of butchery have been exaggerated, lamenting that “the most outrageous statements find credulous listeners.” Given the war-related shortages of proper instruments among Confederate surgeons, Cunningham has praised the medical officers for their ingenuity and skill that overcame supply deficiencies. Another medical historian has reminded historians of the primitive state of medical care in the nineteenth century and its successful evolution throughout the Civil War. Amputation, he claims, was “the most successful major operative procedure of the time.” Two other medical historians have come forward with similar arguments, praising surgeons for their “ingenuity, careful attention to detail, and humane interest in wounded soldiers.” Alfred Jay Bollet, in a recent article, notes that while negative characterizations about surgeons appeared in the newspapers in the early years of the war, no one has unpacked the significance of their disappearance in the later years. Surgeons were no longer written up in the press, Bollet concludes, because “competence” does not make headlines. Unfortunately, it is those early impressions that have wormed their way into most of the recent grand narratives written about the Civil War.³

Many surgeons, who defined their manhood by their medical reputation, would have been surprised by history’s negative characterization, especially as contemporary sources challenge both the arguments of prominent historians and the popular negative stigma. Jonathan Letterman, a surgeon with the Union Army of the Potomac, remembered in 1866 that surgeons, especially at Antietam, practiced “conservative surgery” and should have amputated more often than they did. William Keen, one of the leading surgeons in the United States during the war, remembered, “The popular opinion that the surgeons did a large amount of unnecessary amputation may have been justified in a few cases, but, taking the army as a whole, I have no hesitation in saying that far more lives were lost from refusal to amputate than by amputation.”⁴

The negative reputation of a Civil War surgeon eager to cut without sufficient sympathy or knowledge emanated from the very ghastliness of the act of amputation itself. We cannot deny the horrific nature of removing a limb. For thousands of soldiers, a battlefield injury prompted their very first visit to a doctor, a surgeon, or a hospital. Almost none had witnessed an amputation or a surgeon perform any sort of operation. Then there was the nature of the wounds. Lead- and shrapnel-crushed bones, shredded flesh, damaged blood vessels and vital organs produced a natural reaction to pain: cries, moans, screams, and groans. Without any prior exposure to such an environment, damaged soldiers quite naturally panicked and concluded that anyone who could do such things must be a monster. The process of amputation, we must remember, produced a high level of trauma not just to patients but to other observers as well. The recollections of sights and sounds associated with amputation often appear most vivid among those who were merely witnesses.

The sheer potential horror of the hospital experience prompted hundreds of soldiers and civilians to view the field hospital as ghoulish ground. A private soldier recalled his very first visit to a Civil War hospital as “the most painful thing of all.” “It resembles a butcher’s shamble,” he claimed, “with maimed and bloody men lying on all sides—some with their arms off; some with their legs off; some awaiting their time, while the doctors, with upturned cuffs and bloody hands, are flourishing their knives and saws.” The doctors stood among “piles of bloody-looking limbs” with dead bodies still lying “on the dissecting table.” He called it simply a “ghastly picture.” Charles Hutson, shot in the face at First Manassas, witnessed a crowded hospital scene in Charlottesville, Virginia, “with groaning men, some undergoing the agonies of amputation.” Following the Battle of Seven Pines, William R. Gorman, a member of the Fourth North Carolina, felt somehow that Mother Nature herself should be weeping. “Nature smiles sweetly and the birds sing as enchantingly as though no deeds of blood and carnage had been perpetrated near this now peaceful spot,” he noted. Gorman felt compelled to go to the local field hospital to “alleviate the horrible suffering” and saw a horrific scene: “piled in heaps lay [the] amputated arms and legs” stacked “like cord-wood,” and the “piercing cries” of patients broke through the chloroform and “the stillness of night” until “the very corpses trembled.”⁵

There is a reason the pile of amputated limbs makes it into every Hollywood movie: it made such a deep impression on everyone who saw it at the time. One soldier from Louisiana saw a huge box filled to the brim with hands, arms, and feet. He noted that the box “was so full that two horrible and bloody feet protruded out of the top.” Richard Henry Brooks, a member of the Fifty-First Georgia, casually commented in a letter to his wife on November 3, 1862, “The doctors cut off somebody’s leg, arm, hand, or foot or some other part nearly every day here [Lynchburg, Va.].” One southern woman, who found her home commandeered as a hospital, remarked, “Then came the amputating surgeon to finish what the bullet had failed to do. Arms and legs lay in a promiscuous heap on our back piazza.” Kate Cumming recalled that surgeons routinely at a hospital in Corinth, Mississippi, had “amputated limbs thrown into the yard,” where they remained after an operation.⁶

Figure 2. A pile of severed legs and feet at a Civil War hospital. Courtesy of Contributed Photographs Collection, Otis Historical Archives, National Museum of Health and Medicine.

Obviously the very sight of a pile of limbs left a powerful and lasting impression on Confederate soldiers trying to make sense of the unprecedented level of carnage and destruction after a battle. Virginian artillerist Edmund Samuel Duffey witnessed lifeless limbs next to their former occupants all around the Second Manassas battlefield. Confederate soldier Berry Benson recalled during the Seven Days Campaign around Richmond in June 1862: “Before leaving the hospital, I went in the garden and was shocked to see lying about it, hands and arms and legs that had been amputated—a dreadful sight.” Following the battle at Perryville, Kentucky, a pile of legs and arms “rose like a pyramid to the floor of the second story gallery,” according to one soldier. Lieutenant Colonel William Owen, who served in the artillery with the Confederacy during the war, described hearing the “screams and groans” of men undergoing amputation and seeing piles of arms and legs, an image that he never forgot. He concluded, “No longer do the rush, roar and boom of the shot and shell, and the volleys of musketry bring fire to the soldier’s eye and make his blood tingle through his veins in glorious excitement; but now the saw and knife prove that all is not glory.”⁷

In addition to the sights and sounds of amputation, soldiers and civilians also smelled the aftermath of numerous field operations. Field hospitals, particularly the piles of corpses and rotting limbs, created a stench that engulfed nearby homes and areas. In Little Rock, Arkansas, one citizen noted the “nauseous aura overhanging” the city, especially as temperatures warmed and “just about everybody had the smell of putrification in his nostrils.” Men, women, and children across the city “suffered the shock of unsightly mangled bodies.” One civilian remembered, “Amputated arms, legs, as well as bodies, of the dead were buried as expeditiously as possible. But the odor of festering sores and of death could be detected whenever anyone went near any of the improvised hospitals.”⁸

Time and again, as soldiers, civilians, and nurses described amputation, the word “butcher” cropped up in letters and diaries as a descriptor for surgeons. The label, according to one historian, originates in the soldiers’ frame of reference: butchering back home. Most soldiers were farmers and had ample experience breaking down pigs, deer, cows, chickens, and other forms of livestock and game. Even Abraham Lincoln was comfortable enough with butchering to use it as a metaphor for Grant’s grand five-army campaign of 1864: “Those not skinning can hold a leg.” Thus, when soldiers saw the surgeon operating, they connected his performance to their own experiences dismembering an animal back home. Civilians and soldiers conveying their impressions of the first surgery they had probably ever seen would naturally adopt this metaphor. (And it is not necessarily as insulting as it might seem; butchering, in that day and age especially, was understood as a skill requiring a great deal of precision.) Even so, in referring to surgeons as butchers, Confederate soldiers butted up against the budding professionalism, not to mention the masculine honor, of medical men who were not keen on highlighting such comparisons. A butcher takes lives; a doctor preserves them.⁹

To be sure, errors were made, and some were quite costly. In one instance, a botched amputation resulted in a bone protruding from a leg; the patient could not bear the excruciating pain from any pressure on the limb. While fighting in Georgia in 1862, one Confederate soldier shuddered when he reflected on the image of a “surgeon sharpening his instruments and whetting his saw to take [from] them those necessary member[s] of our body that God has given us for our indispensable use.” Theodore Livingston, a clerk at the Fairgrounds Hospital in Atlanta, noted in 1863 that he would rather “take Yankee lead in the head” than be the subject of a “young swell head” doctor to perform experiments on during an operation. One Alabama soldier criticized the reputation of all medical professionals when he observed, “I believe the Doctors kill more than they cure. Doctors ain’t got half sense.”¹⁰

Occasionally, soldiers might be enlisted to assist in amputations, an assignment few relished, which provided an opportunity for them to assess the state of amputation within Civil War medicine. One private, J. W. Gibson, fervently believed that doctors made “many useless amputations.” His impression did not change when he was forced to hold the head of a Union soldier about to undergo amputation while chloroform was administered. Then Gibson dropped the head of the patient, due to “how they cut and slashed,” and thought he could give the Union man a chance to “wake up and fight.” Gibson informed the doctors that he did not enlist in order to be an accomplice to so much useless butchery. The doctors “laughed at me and said they would soon teach me to be a surgeon.”¹¹

The negative impressions of surgeons also stems from the overwhelming challenges Confederate medical personnel faced, especially in the early years of the war. The Confederacy suffered from a severe shortage of surgeons readily available to perform medical procedures, averaging about one surgeon for every 312 enlisted soldiers. Officially, the Confederate Medical Department consisted of 1,242 surgeons and 1,994 assistant surgeons. Yet the Union medical corps dwarfed its Confederate counterpart, eventually employing more than 11,000 doctors. The already limited number of Confederate medical personnel actually declined during the heat of battle, as some assistant surgeons headed off to fight. ...