JacksonMedical

This paper will explore the events leading to the death of Thomas J. (Stonewall) Jackson in May of 1863. Jackson had become Robert E. Lee’s “right hand” in leading the Confederate Army of Northern Virginia, which had been very successful to that point in the Civil War. Because of Jackson's prominence, his treatment was very well documented. This paper will attempt to translate Jackson’s doctors’ writings into modern-day medical terms, though this cannot always be done with certainty. Then, when possible, a discussion of why the doctors treated Jackson the way they did will follow. This, again, is often a mystery. Finally, the treatment of Jackson in 1863 will be compared to how such wounds might be treated today. (Modern day medical thought on the treatment of Jackson will be presented in parenthetical comments.) It is ironic that Jackson was shot three times, but he did not die directly from those gunshot wounds. Instead, he contracted pneumonia under the careful supervision of the best doctors the Confederate Army had to offer.

Jackson, his commanders, and his troops were together at Chancellorsville. Jackson’s corps had just completed a daring and brilliant flanking maneuver that had routed the Union Army. On Saturday, May 2, 1863, at around eight⁴ or nine⁷ in the evening, a party of about twenty men⁴ rode in front of a line of skirmishers scout the situation near the Plank Road (see Illustration 1). This group included General Jackson,⁷ General A. P. Hill, some of Jackson's staff,⁴ and a few of his couriers. Upon returning in front of the line formed by the 18th North Carolina,⁷ this group, in the darkness, was mistaken for a body of Union cavalry.⁵ Jackson and the cluster of his men were fired upon by this regiment of Jackson’s own corps. As a result of the shooting, several men died and Jackson was wounded about fifty yards in front of the enemy line.⁷

Jackson was struck by three balls during the incident. Two of these projectiles landed in his left arm. The first, and most serious wound, was about three inches below the shoulder joint, “the ball dividing the main artery and fracturing the bone.” (Farwell, 507.) (See Illustration 2.)

The second injury in the left arm was several inches in length. A ball had entered the outside of the forearm, an inch below the elbow. The bullet came out on the opposite side, just above the wrist. (See Illustration 3.)

Jackson was propped against a tree while someone was sent to fetch a doctor. It was discovered that there were no ambulances within at least a mile. Wilbourn, an officer who was present, then proceeded to remove the general’s clothing, which was full of blood.⁴ Wilbourn placed a tourniquet on Jackson’s left arm² and a sling was made for that same fast-swelling limb. Some sources claim Jackson drank a little brandy and a lot of water at this time.⁴

Dr. Barr arrived and examined Jackson’s wounds. He came to the conclusion that nothing could be done for Jackson until he reached a field hospital.⁴ Dr. Barr deemed the tourniquet adequate and noted that Jackson's blood had started to clot.²

Jackson then took a few steps before a litter, otherwise known as a stretcher, and two ambulance men arrived. The other members of the group walked with their horses around him, shielding him against⁴ the enemy projectiles of grape, canister, and shells of all kinds.¹⁰

While on the litter, Jackson was carried through dense undergrowth, which made the walking hard and slow. In all, Jackson was carried about one-half of a mile on the litter.⁴

According to some sources, Jackson fell from the litter when one of the bearers was shot in both arms.⁷ However, there is another account that grapeshot ripped both arms of an ambulance man and he started to drop his end of litter but another man caught it before Jackson fell; then, one of the bearers caught his foot in a vine, stumbled, and lost hold of the litter.

Regardless of the cause of the fall, all agree that Jackson fell heavily to the ground on his right arm and shoulder. As a result of this fall, Jackson groaned and almost fainted.⁴ After he fell, Jackson was left lying alone for about five minutes. During this period, he lost a large amount of blood.⁴

After the fall and the brief delay, Jackson was put back on the litter and carried a few more yards until he met an ambulance.⁷ Arriving with the ambulance was Dr. Hunter Holmes McGuire, Jackson’s staff surgeon. Dr. McGuire assessed Jackson’s injuries and readjusted the tourniquet on Jackson’s left arm. Jackson was in severe shock. His skin was clammy and cold, his face was chalk-white,¹⁰ his lips were compressed and bloodless, and his face was fixed and rigid.⁷ He had lost so much blood that he had become extremely weak.¹⁰ He was given some whiskey and morphine.⁷

Jackson, at this point, was still four miles from the nearest field hospital⁴ at Wilderness Run. The ambulance headed for the Corps Field Infirmary, at the Wilderness Tavern.^₇ (See Illustration 1.) The ambulance had a plank floor and few springs for comfort. Joe Morrison, Jackson’s brother-in-law, held his left arm to lessen the shock during the ride. The road was so rough that a rider went ahead of the ambulance to warn of big bumps.²

Jackson was very calm and polite throughout the whole ordeal. He had complete control over his mind, even with the loss of blood and tremendous pain he endured. He showed few signs of suffering. The slight wrinkle of his brow and the condition of his lips were the only outward expressions of his pain. McGuire described this vividly: “. . . the thin lips so tightly compressed that the impression of the teeth could be seen through them” (McGuire 67.)

Jackson's clothes were covered with blood. The hemorrhages were continuing from his wounds. McGuire compressed the artery in Jackson’s left arm with his finger to stop the bleeding.⁷

Word had reached Dr. Black, who was in charge of the field hospital, that Jackson was on his way. Black had a warm tent, blankets, whiskey, and water waiting. The ambulance arrived at eleven-thirty. This was more than two hours after Jackson had been wounded.⁴

(Today, a victim with Jackson’s wounds would be treated for shock in the field and his condition stabilized before he was ever moved. The treatment would consist of providing intervenous fluids.⁶)

After Jackson arrived at the hospital, he was put in a bed and covered with blankets. He was also given more whiskey and water.⁷ When Jackson first got to the field hospital, his pulse was weak from loss of blood.²

McGuire made the decision to wait another two and a half hours for Jackson to partially recover from the shock before further treating his wounds.⁴ McGuire’s reasons for taking this plan of action are not known.⁶ (Such a delay would not take place today.¹²)

After a long and torturous trip from the site of the injury to the field hospital, and long delays for the shock to diminish, Jackson went into surgery. Dr. McGuire, Dr. Black, Dr. R. T Coleman, and Dr. Walls were all present during the operation on Jackson. Dr. Coleman administered the chloroform.⁴ He folded a cloth in the shape of a cone and poured a large amount of clear chloroform on it. Jackson was then told to exhale fully and, as he then drew the breath in, the doctor held the wet cloth a few inches above Jackson’s nose and mouth. This procedure was continued until Jackson drifted off into a state of unconsciousness.² While Jackson was receiving the chloroform, he said, “What an infinite blessing,” and continued to repeat those words until he lost consciousness. (Farwell 512.) The chloroform was continually administered during the operation and Jackson was unconscious the entire time.⁷

First, a swift incision was used to remove the ball in Jackson’s right hand.¹⁰ The ball came from a Springfield musket. This was a Confederate ball, not one of the Union’s, putting to rest any hope that Union soldiers had shot him.

Jackson’s other two wounds were treated by amputating his left arm. The possibility of gangrene setting in was extremely high.¹⁰ Jackson’s left arm was amputated about two inches below the shoulder.⁷ The operation was routine and one all of these doctors had performed often in the field. It was not considered to be dangerous.² (Today, according to Dr. Windle, Jackson’s arm most likely have been saved, provided there was adequate blood flow to the arm.¹²)

The amputation, performed by McGuire,⁴ was done very rapidly, with little loss of blood. The ordinary circular operation was used in this case.⁷ The circular amputation was a very old technique, dating back to the first century A.D.⁴ The bone was sawed off with an appliance quite similar to a household saw.² Dr. Black, an internist, which is a specialist in internal medicine (as opposed to a surgeon), monitored Jackson’s heart during the operation. Dr. Walls tied the arteries at the conclusion of the procedure.⁴

Jackson also had two or three slight wounds on his face. These were a result of scraping his head against the branches of trees.⁷ His face was dressed with isinglass plaster. This is a gelatin obtained from the air bladders of various fish.⁴

Jackson regained consciousness at about three-thirty on the morning of Sunday, May 3.⁹ He drank coffee and did not sleep for quite a while. Later, after McGuire told Jackson that he needed rest, he fell asleep.²

At nine o'clock on Sunday morning, Jackson seemed almost free of pain. He ate well and his mind was clear.⁴ All the signs indicated he would recover.¹⁰ The stump’s surface was covered with healthy granulations. Lint and water dressings were used for his stump and hand.⁸

At about ten o'clock in the morning,⁷ he complained of pain on the right side. He and the doctors concluded that this was a result of the fall he had taken from the litter.⁴ Jackson thought he had hit his right side against a stone or stump of a sapling, though McGuire found no signs of injury; the skin was not broken or bruised and his lung performed normally.⁷ McGuire recommended “some simple application” and hoped the pain would disappear.⁴

On Sunday, Jackson was doing so well that the doctors though he would be back in the field soon.² By eight o’clock on Sunday evening, the pain in Jackson’s side had disappeared.⁷ Jackson slept well Sunday night. (Vandiver, 491.)

On the morning of Monday, May 4, Jackson was moved by ambulance because Federal troops were threatening to cross the nearby Rapidan River at Ely’s Ford. (See Illustration 1.) Had this event taken place, it could have resulted in the capture of Jackson. He was taken twenty-four miles to Guiney’s Station, which is south of Fredericksburg.⁴ The road along the way was very rough. Soldiers were sent ahead to fill in some of the worst holes. The road was very crowded with walkers, other ambulances, and commissary, quartermaster, and ordinance wagons.⁴

May 4, the day Jackson was moved, was very warm. Jackson suffered from slight nausea. The doctors placed a wet towel over his stomach, which relieved Jackson for the time being.⁷ In the afternoon, he again felt slight nausea. A damp cloth provided relief from the nausea, but the pain in his side returned.

At eight o'clock in the evening, during a thunderstorm, the ambulance arrived at the Chandler house at Guiney’s station. There were other officers in the house and McGuire thought it would not be healthy for Jackson to be placed there. For one thing, it was not quiet enough for Jackson. There was also a case of erysipelas in the house.⁴ Lastly, McGuire thought there was a danger of infection because some soldiers had died in the make-shift hospital.³ Near the main house, there was a small building where Jackson was placed to keep him away from these harmful things. After Jackson arrived at Chandler’s house, he ate bread, drank tea, and slept for a long time.⁴

Jackson was very refreshed the next morning, which was Tuesday, May 5. He ate a lot, his wounds were healing, and there were no signs of infection in his stump. Though he showed good signs, his hand gave him a little pain.⁴ A light, short splint was put on the palm of his hand,⁷ “to assist in keeping at rest the fragments of the second and third metacarpal bones.” (McGuire, 520.) (See Illustration 4.) Lime and water dressings were also used for his stump and hand. Jackson was very satisfied when he was told his wounds were healing well. He asked how long he would be kept from the field. On Wednesday, May 6, Jackson was also thought to be doing very well. He ate a lot of food and was cheerful.⁷ At one o’clock on Thursday morning, May 7, Jackson had nausea and towels were again applied. The remedy did not work this time. McGuire then listened to Jackson’s chest and found pneumonia in the right lung.³ The pneumonia flushed Jackson’s cheeks and oppressed his breathing.¹¹ The nausea may have been a result of the inflammation from the pneumonia, instead of the fall.⁷

McGuire came to the conclusion that the wet clothes had not caused the pneumonia, but they did not help it, either.¹⁰ The disease came too soon after the application of the wet clothes to have been induced by them, as was once believed.⁷ McGuire thought the lung inflammation might have started when Jackson was dropped from the litter.¹⁰ (However, modern medical knowledge suggests that the fall probably did not start lung inflammation, unless he broke some ribs. Had some ribs been broken, the pain might have kept him from taking sufficiently deep breaths, contributing to his pneumonia; but no such pain was noted. Otherwise, falling off the litter may have contributed to the inflammation, but Jackson’s inactivity was most likely the cause of his pneumonia. If he was not turned and moved frequently, fluid would have gravitated to his lungs, creating a rich medium for bacteria. If some bacteria found its way into the lung, it would have grown fast and possibly caused the pneumonia.⁶

Jackson thought that he might have gotten pneumonia on May 1, the night before he was shot. During that night, he slept without any cover on pine-needles.⁹ (Doctors today doubt that the fact that Jackson slept without covering probably had anything to with his catching pneumonia. However, if he had been out in cold a lot, his resistance to infection would have been lowered. This would have caused him to become more prone to this illness, but not a direct cause of it.⁶)

After the onset of pneumonia, Jackson was drugged with morphia to decrease the pain. He was delirious at times, while rational at others. (Vandiver, 492.) He talked gibberish much of the time. Sometimes he acted as if he was in other situations.³ (It is known now that Jackson’s delirium probably resulted from the lack antibiotics. The infection probably spread from the lungs into the bloodstream. This probably caused him to act in this manner.⁶) The pneumonia was now benumbing his senses. He suffered greatly on Friday and Saturday, May 8 and 9.¹⁰

The doctors examined Jackson and came to the conclusion that his ailment was pleuro-pneumonia of the right side.⁷ (Though there is no word for pleuro-pneumonia of the right side in modern medical terms, there is a lining around the lung called the “pleura.” It is a double layer, similar to a bag around the lung. This lining is often inflamed when pneumonia is contrived. A sound can be heard when this lining is involved, which is most
likely what McGuire heard. McGuire probably meant that Jackson had pneumonia involving the pleura when he said that Jackson had pleuro-pneumonia.⁶)

McGuire explained Jackson’s illness as “contusion of the lung, with extravation of blood in his chest, was probably produced by the fall . . .” (McGuire 70.) Extravation is where blood comes out of the body, specifically the chest in this case. (This is, most likely, not what happened. Contusion of the lung could have resulted from the fall of Jackson, but without breaking a rib, such bleeding would have been unlikely.⁶) McGuire also explained that “ . . . shock and loss of blood, prevented any ill effects until reaction had been well established, and then inflammation ensued.” (McGuire 70.)

The standard treatment for this ailment was cupping. In this process, hot glasses were applied to the afflicted area to draw blood, a process requiring opium. Mercury and antimony, two metals, were also used in this cure.⁴ This process was used to out the poison.⁶

Jackson’s wounds were dressed again on Friday, May 8.⁷ The quantity of discharge from the wounds diminished⁸ and the healing process was still taking place. The pain in his side disappeared, but he had difficulty breathing and felt exhausted.⁷ Anna, Jackson’s wife, thought his fever and restlessness caused him to grow weaker.

When Dr. Morrison, who was experienced in dealing with pneumonia, saw Jackson he said, “There is an old familiar face,” referring to the pneumonia. (Farwell 522.) On this day, Dr. Morrison told Jackson that he might not recover.⁴

Jackson had a fever developing, so his face was given a cold sponging to help his condition.² Dr. David Tucker from Richmond, who was also knowledgeable in the care of pneumonia, came on Saturday. Everything possible was done to save Jackson. He suffered no pain and his breathing was less difficult, but he grew weaker each hour.⁷ (Jackson’s ease in breathing may have been because he tired suddenly. Before this, his breathing was mosst likely fast, due to the infection. Then, he probably could not breath as quickly because of fatigue, so his breathing slowed. If this was the case, he would have appeared to be doing better, when, in fact, his condition was deteriorating.⁶)

Sunday, the tenth of May, 1863, was a warm and pleasant day. The doctors told Anna they had done all they could and Jackson was going to die in a few hours. Anna then told this news to her husband.⁴

At one-thirty on Sunday afternoon, Jackson was told he had two hours to live. The doctors were very close in guessing the time of death of Jackson. “Nineteenth-century doctors watched so many of their patients die that they became adept at predicting the hour of death.”⁴

Near the end, Jackson’s mind began to fail even more frequently than before. Jackson sank into unconsciousness, murmuring disconnected words from time to time.⁴

At three-fifteen⁷ (or three-thirty, depending upon which source is consulted), he said cheerfully, “Let us cross over the river and rest under the shade of the trees.” (Farwell 526.) His features then sank into repose and he died,⁴ eight days after he had been shot at Chancellorsville.⁵

It is generally accepted that Jackson did not of his gun-shot wounds or his surgery. The symptoms, as described by Dr. McGuire, are not completely translatable into modern terms. McGuire’s daily records were lost after they were captured by Union troops in 1865. Most authorities agree that Jackson died of pneumonia. This was not uncommon, as pneumonia was fatal for one in six Confederate soldiers who contracted the disease.⁴ (Jackson probably did not have pneumonia before he was show. It is common for people who suffer trauma to develop pneumonia. This is at least partly because they are put in bed, kept still, and do not take sufficiently deep breaths.⁶)

It is believed by some that Jackson might, in addition, have suffered some intraabdominal injury when his litter was dropped.⁴ (An intraabdominal injury is one that is below the diaphragm,⁴ that is usually internal, such as the rupture of an organ with resulting internal bleeding.¹ According to Dr. Plummer, it is unlikely, but possible, that Jackson had an intraabdominal injury.⁶)

The death of Jackson is a very complicated subject that is not easy to understand. There are many contradictory reports in different sources. While Dr. McGuire probably kept very revealing notes, those notes were lost in 1865. Perhaps due to that, modern authorities cannot agree on the exact cause of Jackson’s death. However, all agree that the death of Jackson was very significant in the outcome of the Civil War. Had Jackson been in command throughout the war, many claim the Confederates would have won. For example, just a few weeks later, the crucial Battle of Gettysburg took place, and many argue that Jackson, who would have commanded the field for the confederates on the first day, would have pressed the initial Confederate advantage to a full victory, perhaps changing the outcome of the war.