“What If Jackson had Survived His Wounding?”

Jackson is woundedI get the question all the time: “What if Stonewall Jackson hadn’t been shot?”

When people ask that question, what they really want to know is “What would he have done at Gettysburg?” My answer is always “He would have never made it to Gettysburg.” (You can see an in-depth answer here and here.) So many people, it seems, want Jackson to get to Gettysburg. They want to talk about the Great What-If of the war.

Sometimes, the question comes up in a slightly different way: “What if Jackson had survived his wounding?”

This very question came up last week as I spoke to the Civil War Roundtable of New York. To my delight, there was a retired pathologist who happened to be in attendance—Robert Katz, M.D.—who asked if he could share some of his thoughts. 

What sealed Jackson’s fate, said Dr. Katz, was when Jackson fell from the stretcher while being evacuated from the woods after his wounding. The fall seems to have severed the artery in Jackson’s left arm, leading to massive blood loss. According to some estimates, by the time doctors removed the arm, the wounding and surgery caused Jackson to lose half of his blood.

The fall also bruised Jackson’s right side. Those two injuries—the severed artery and the bruised side—proved a fatal combination.

“When a patient loses a massive amount of blood, we’ve discovered that it actually causes the body’s blood clotting system to malfunction and stop working,” Katz explained. “It’s a condition called Coagulopathy of Trauma.”

As a result, the bruise on Jackson’s side produced bleeding into the chest cavity, compressing Jackson’s lung— in addition to the upper respiratory infection Jackson was developing prior the battle ever beginning. “So you have an underperforming lung that is compressed by the blood, further impeding its function,” Katz explained.

Dr. Hunter McGuire, Jackson’s surgeon, diagnosed the cause of Jackson’s death as pleuropneumonia: that is, pneumonia in and around the lungs.

Treatments for pneumonia at the time called for, among other things, bedrest. As a result, Jackson’s lungs weren’t being exercised or cleared, so the congestion built up, leading to exhaustion and eventual death.

As Dr. Katz and I continued our discussion after the meeting, he offered a piece of insight that I found absolutely brilliant.

“One thing I did not mention last night, and you might want to use for further reference,” he told me in an email:

I would note that even if Jackson had recovered and returned to the army, he would not have been the same man. The physical debilitation and, perhaps as important, neuropsychiatric effects of such an injury are massive. Three examples of this are Richard Ewell, John Bell Hood, and Winfield Scott Hancock. Each survived a catastrophic injury (two injuries for Hood), each did eventually return to service, none ever performed as well as they did before their woundings.

“So,” Katz says, “there might have been some cracks in the stonewall if Jackson lived and returned to the ANV.”

Katz’s examples also suggest that, even if Jackson had survived his wounding, there’s no timetable that would have put Old Blue Light back with the army in time to make Gettysburg.

  • Ewell, knocked out of action at Second Manassas when he lost a leg, didn’t return to the army for nine months.
  • Hancock, severely wounded in the groin at Gettysburg, likewise stayed out for nine months.
  • Hood, who permanently lost the use of his left arm from a wound at Gettysburg, was out for two months; wounded again at Chickamauga, he remained out for six months.

Similarly, there was James Longstreet, accidentally shot by his own men in the same Wilderness where Jackson had been accidentally shot by his own men just a year and three days earlier. Longstreet didn’t return to duty for five months.

“In one of those sad but ironic twists of fate and history,” said Katz, “Jackson probably died at the moment most favorable for his reputation and posterity’s view of him.”

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15 Responses to “What If Jackson had Survived His Wounding?”

  1. Great article! Appreciate the modern medical insight on Jackson’s wound and pneumonia. My dad and I have debated this at length and come to similar conclusions.

    One thing I have always wondered about though…were Jackson’s wounds actually healing? Having studied CW medicine, I’ve come across some odd theories which had the surgeons believing that some “fluids” were signs of healing, though by modern medical standards we’d say “beginning of infection.” Hunter McGuire’s semi-graphic descriptions of the “healing wounds” leaves some doubt in my mind. Was Jackson’s body battling more than the lung infection? Your thoughts?

    Ultimately, it doesn’t really matter. McGuire and the other doctors did the best they could at the time, but, in the end, Jackson crossed the river and went home.

    • Robert Katz says:

      Sarah asks an excellent question. Hunter McGuire was an excellent surgeon, with a lot of experience by May of 1863. He was very diligent in changing Jackson’s dressings. He repeatedly describes the wounds as being clean and healing well. I would tend to accept his description as accurate, especially as the symptoms of Jackson’s final illness all point to his chest as the problem area, and McGuire had certainly seen many wounds become fatally infected. At least one author has suggested that Jackson suffered clots in his arm stump that traveled (as “emboli”) to his lungs, causing his death. I personally disagree with this as I would anticipate that pulmonary emboli would cause a more acute event. Jackson’s terminal illness lasted for a few days, and again McGuire was familiar with pneumonia, even if unable to do much for it.
      Hope that’s a helpful viewpoint. Of course, a chest x-ray would have answered all the questions, but Jackson was not quite born at the right time. That’s what makes retrospective diagnosis both fascinating and frustrating/infuriating.

      • Thank you, Dr. Katz, for the opinion and clarification. McGuire was probably right – he certainly seemed to be accurate in every other cases I’ve studied when he treated a wounded soldier, so I probably shouldn’t doubt his opinion on the cleanliness and healing of the wounds.
        I agree with you and McGuire that pneumonia seems the most likely cause of death, not other theories. It was interesting (and sad) to learn that the doctors of that era understood pneumonia so well that they could almost predict the hour of death – hence McGuire’s statements to General and Mrs. Jackson. There was nothing he could do, and, being the well-trained physician that he was, he knew it. How heartbreaking – I can’t even imagine his feelings at that time.

  2. joe truglio says:

    Great article! Best explanation I’ve ever heard. Do you think it will put to rest the “Jackson at Gettysburg” debates?!!

  3. Trueism says:

    There’s a circle of Civil War enthusiasts who focus on the what-ifs in the war. Some call it the “Confederate Fantasy” — historians hypothesizing that if some event or person had been different, the Confederacy would have won the war. One of the most popular of these is “What if Stonewall Jackson had lived?” Some hard-core “the South will rise again” fans think the Confederacy never would have lost Gettysburg and the war.

    Jackson, considered one of the best military minds around and Robert E. Lee’s most trusted general, had been killed by friendly fire in the previous major battle, at Chancellorsville. Some historians theorize that had he been alive, he would have been an invaluable counsel to Lee at Gettysburg.

    What if? What a JOKE and NEVER done seriously but claiming that Jackson would have been a hero. Obviously the author is blind to history but in love with a lost cause and slavery.

    This is a favorite subject for many civil war buffs. What if Stonewall Jackson had lived and marched with Robert E. Lee to Gettysburg? What if Lee’s orders for troop movements were not lost and subsequently retrieved by Union soldiers prior to the battle of Antietam? What if General McClellan had not been so cautious a commander? These questions and more began to be debated around Union and Confederate camp fires. Following the war, former Confederate and Union officers spent much of their time writing about and defending their theories on these issues. The debate spread and is nearly prolific today. The reason being is that there are no concrete answers to these questions. One hundred years from now the debate will continue with no end in sight. We cannot prove what might have happened because too many variables impact the facts, each with their own consequences. We don’t know what role Jackson would have played at Gettysburg because we don’t know if Lee would have reorganized the army after Chancellorsville had Jackson lived. We don’t even know if there would have been a battle after Chancellorsville. Had Jackson lived he might have continued to fight on the night of May 2, 1863, and crushed Fighting Joe Hooker’s demoralized force. If the war continued and Lee invaded the north, we don’t know what Jackson’s position in the march to Pennsylvania would have been. Subsequently we don’t know where Jackson’s corps would have been placed on the field at Gettysburg. We don’t know what orders Jackson would have given, and to whom, whether those orders would have gotten through and been executed, or if Jackson’s presence would have even had an impact on Longstreet and his actions or lack thereof. Clearly we cannot change one condition without creating other, unknown scenarios.

    • Trueism says:

      Allow me to correct myself. The author is not a believer in slavery or the lost cause but many of those who dabble in this idea hoping for a better outcome of the south do. It is clear that this author is just making a stand of Jackson’s medical condition and not a stand on the politics of the time or how Jackson would have won the war, single handed. (play on words as it be)

    • When people ask me this question–or a version of it–at a talk, I first start by thanking them for the slow, underhanded softball pitch. I love to swing at this one! I don’t like to get into the “What If” at all because there are too many factors involved, which people tend to overlook. Before you can ever get Jackson to July 1, you have to first get him through May 2, and that’s hardly a sure thing–yet people tend to forget about the situation on the ground that evening. Beyond that, there are too many dominos. So, instead of getting into the What If, I try to explain to people just why that’s an impossible question to ask.

      I hope you read the other two posts (links embedded above), and you’ll see what I mean.

  4. Meg Thompson says:

    I sure hope this article gets some legs. I want to include it in Aftermath of Battle! This is just a wonderful bit of work–modern medicine and forensics has solved so many of the conundrums pondered in the middle of the 19th century. This is another good one! Huzzah!

  5. Mathew Lively says:

    As another physician who has studied this event, I agree with Dr. Katz that the existing evidence supports neither a wound infection nor an embolic phenomenon as being the source of Jackson’s illness. And it is highly unlikely he would have sufficiently recovered to be present at Gettysburg two months later.

  6. Dwight Hughes says:

    We can never know the outcome of what-ifs, but in addition to being fun and interesting (and if not carried too far), they can serve a useful purpose. By thinking about what might have happened, we have to concentrate on what did happen up to a certain point and why, change a key variable, and project the consequences forward—a form of war gaming. Such an exercise in objective analysis (not historical revisionism) can clarify historical context as well as strategic and tactical thinking.

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