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Posted on Sep 11, 2006 in Front Page Features, War College

What Really Killed Stonewall Jackson?

By J.D. Haines

Dr. McGuire observed that Jackson’s clothes were saturated with blood and that the wound in his arm was in fact still bleeding. He applied compression to an artery and then called for a light. The bandage had slipped, and he therefore adjusted it to stop the hemorrhage. McGuire found that Jackson’s hands were cold, his skin clammy, and his face and lips pale – all classic signs of hemorrhagic shock. Although Jackson refused to admit any discomfort, he was given morphine and whiskey before being transported to a nearby field hospital.

At the hospital, McGuire determined that surgery was necessary. When he informed Jackson, the general replied, “Yes, certainly Dr. McGuire, do for me whatever you think best.” As chloroform was administered, Jackson remarked, “What an infinite blessing,” and slipped into unconsciousness.
McGuire first extracted a round ball, which had lodged under the skin of the back of Jackson’s right hand. It had entered the palm and fractured two bones. The doctor later wrote, “The left arm was then amputated, about two inches below the shoulder, very rapidly, and with slight loss of blood, the ordinary circular operation having been made.”


Amputation accounted for approximately 75 percent of all operations during the War Between the States. Antiseptic technique was not yet in practice, and contaminated instruments and non-sterile conditions resulted in many wound infections. However, prompt amputation undoubtedly saved lives by converting a traumatic wound into a surgical wound, thereby improving survivability. Civil War-era surgeons found that amputations performed within 48 hours of an injury were twice as likely to be successful as those performed later. While Confederate medical records were destroyed, their results were probably comparable to Union figures. Union records report 5,540 upper arm amputations of which 1,273 of the patients later died from complications – a 23-percent fatality rate.

Treatment and Decline

Jackson tolerated surgery well despite his significant blood loss from his injuries. At 3:30 a.m. the following morning, Major Sandie Pendleton arrived at the hospital to obtain orders for Major General J.E.B. Stuart. Jackson attempted unsuccessfully to respond to Pendleton. He then slept for several hours and appeared to be free of pain upon awakening. However, at 10 a.m. he experienced a severe and sudden episode of pain in his right side. He called for Dr. McGuire, presuming that he must have injured his side when he struck a stone or stump during the fall from the litter the night before.

After a careful assessment, McGuire concluded, “No evidence of injury could be discovered by examination; the skin was not broken or bruised, the lung performed, as far as I could tell, its proper function.”

By 8 p.m. Sunday, the pain had disappeared and Jackson seemed to be doing well. The following day, Lee ordered McGuire to remove Jackson to Guiney’s Station, fearing his capture by nearby Federal troops. Early Tuesday morning the ambulance set out, and Jackson seemed to tolerate the transfer well. Upon arrival, he felt well enough to take bread and tea. Later in the day, however, he became nauseated and asked that a wet towel be placed on his abdomen.

The house where Jackson was to convalesce already contained other wounded, including several cases of highly contagious erysipelas caused by the bacteria streptococcus. Dr. McGuire would not allow Jackson to be exposed to the infection, and instead found for him on the grounds a small building that had been used as an office. The general slept well that night, and awaking early Wednesday “ate hearty and was cheerful.”

McGuire dressed Jackson’s wounds and found them to be healing well with no sign of infection. Jackson seemed satisfied with his progress and inquired how long it would be before he could return to the field.

Confederate Gen. Robert E. Lee depended on Stonewall Jackson more
than any of his other generals. In 1862 and early 1863, the pair
won the battles of Fredericksburg and Chancellorsville in Virginia

At 1 a.m. Thursday, however, Jackson suffered another attack of nausea and asked a servant to apply a wet towel to his abdomen. He did not disturb the exhausted McGuire, who later awoke to find his patient again complaining of pain in his right side. After an examination, McGuire concluded that Jackson had “pleuro-pnemonia of the right chest,” presumably secondary to the fall from the litter. McGuire speculated, “Contusion of the lung, with extravasation of blood in the chest, was probably produced by the fall referred to, and shock and the loss of blood prevented any ill effects until reaction had been well established, and then inflammation ensued.”

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