Historians and doctors have debated for decades what medical complications caused the death of legendary Confederate fighter Thomas J. "Stonewall" Jackson, felled by friendly fire from his troops during the Civil War.
Shot three times while returning from scouting enemy lines in the Virginia wilderness, Jackson was badly wounded in the left arm by one of the large bullets the night of May 2, 1863. Blood gushed from a severed artery. It took at least two hours to get him to a field hospital, and Jackson was dropped twice in a stretcher before his arm was amputated. He died days later at 39.
Scholars have long questioned whether it was an infection or pneumonia that killed Jackson, who gained the nickname "Stonewall" early in the war and went on to be lionized in the South and feared in the North because of his military exploits.
On Friday, the 150th anniversary of Jackson's death, a trauma surgeon with experience on the battlefield in Iraq and Afghanistan revealed his diagnosis of Jackson's death after reinvestigating the medical record. After reviewing the 1860s files and subsequent reports, University of Maryland surgeon and professor Joseph DuBose told The Associated Press that Jackson most likely died of pneumonia.
DuBose is confirming the original diagnosis given by Jackson's personal physician, the famed Confederate doctor Hunter H. McGuire.
"You would be hard-pressed to find someone more qualified than him for the treatment of this injury and taking care of Stonewall Jackson," DuBose said. "I do defer to him in some regard. I kind of have to. He's not only the treating physician; he's also the only source of information."
McGuire's original medical notes were lost when he was captured by Union soldiers. He recreated them from memory three years later for the Richmond Medical Journal.
Pneumonia was common in the Civil War, becoming the third most fatal disease for soldiers.
Jackson was the subject of an annual conference Friday at the University of Maryland School of Medicine in Baltimore that reviews medical diagnoses of historical figures. In the past, researchers have reviewed the deaths of Alexander the Great, Edgar Allan Poe and Abraham Lincoln, among others.
DuBose is a graduate of the Virginia Military Institute, where Jackson was a professor before the Civil War. A large statue of Jackson stands near the campus barracks. So, his legacy and death were ingrained in DuBose's experience as a cadet.
Jackson was shot by soldiers from the 18th North Carolina regiment in a moment of confusion. He had led a surprise attack in the Battle of Chancellorsville in Virginia, and the Confederates drove Union forces back about three miles. Civil War historian James I. Robertson Jr. recounts that Jackson wasn't satisfied and rode out at night to review the enemy's position. When he rode back, he was shot by his own soldiers.
Then, being dropped during a frantic nighttime rescue may well have contributed to Jackson's death, DuBose found.
"If he had been dropped and had a pulmonary contusion, or bruise of the lung, it creates an area of the lung that doesn't clear secretions real well, and it can be a focus that pneumonia can start in," DuBose said. "That's probably what happened in this particular instance."
DuBose, a U.S. Air Force veteran, said pulmonary embolism - a blockage of the major blood vessel in the lung - still occurs in nearly 6 percent of combat casualties in Iraq and Afghanistan. It is even more common among those who have amputations, as Jackson did.
Still, the debate will continue over Jackson's death.
Dr. Philip Mackowiak, an internist who organizes the conference each year, said he differs with DuBose on the Jackson case. He reviewed the records and said he believes a recurrent pulmonary emboli destroyed Jackson's lung over time, leading to his death. The medical records don't describe Jackson coughing, as one would expect with pneumonia, Mackowiak said.
It's impossible to know for sure what killed Jackson. But DuBose said modern medicine could have saved him. Jackson's doctor didn't have the tools or knowledge to treat the complications after the shooting.
Robertson, a former Virginia Tech historian and professor who wrote Jackson's biography, said he has been persuaded that sepsis, caused by severe infection, killed Jackson, due to his chaotic rescue and unsanitary conditions. He noted, though, doctors at the time agreed Jackson had pneumonia.
"Unfortunately, medicine in the mid-19th century was still in the dark ages," he said. "Obviously, I'm not overly concerned with how he died. I'm terribly concerned that he died."
Jackson was a pivotal figure and perhaps the most esteemed soldier in the war, Robertson said. He was known for secrecy and speed to execute surprise flank attacks for Gen. Robert E. Lee's strategy.
"He was killed in what may be the high-water mark of the Confederacy," Robertson said. "You can make a case that after Chancellorsville, it's just a question of time for Lee."