Hello, my name is Matthew Helton. I'm a third-year resident at the University of Arkansas for Medical Sciences. First off, I'd like to thank the American Association of Neurological Surgery for allowing me to present today. Today I'll be talking about the crippled brain that prolonged the Civil War, General Joseph Hooker's concussion at Chancellorsville. I have no disclosures. The purpose of this presentation is to examine the Battle of Chancellorsville and its role in the war. We'll evaluate Hooker's concussion and view it through a modern lens to determine his ability to command. We will then determine the impact Hooker's concussion had on not only the battle, but also the war. And if the general was relieved of command, would the battle and war have ended differently? December 1862 in Fredericksburg, Virginia, General Burnside's Army of the Potomac crossed the Rappahannock River to encounter heavily fortified Confederate defenses, which repelled their wave after wave attack, resulting in humiliating Union defeat. President Lincoln was embarrassed by this defeat. In January of 1863, he fired General Burnside and replaced him with General Hooker. He told Hooker, Beware of rashness, but with energy and sleepless vigilance, go forward and give us victories. General Fightin' Joe Hooker was the grandson of a Revolutionary War veteran. He graduated from West Point in 1837. He was a veteran of Seminole and Mexican-American Wars. He was given his nickname by a newspaper's punctuation error, however, he earned it at the Battle of Antietam. He restored morale to the Army of the Potomac. He instituted demands that they wash their clothes weekly, they bathe themselves, he gave them furloughs to go home and visit family members. He even made sure that they were paid on time. In early April of 1863, President Lincoln came down to see the Army of the Potomac and was impressed with what Hooker had assembled. He looked at Hooker and said, In your next fight, put in all of your men. Hooker confidently stated, If the enemy does not run, God help them. In April, he planned his next offensive campaign. The map shows Hooker's three-pronged attack. First, he was going to send his cavalry to intercept the supply lines between Richmond and the Confederate Army. Next, he was going to send a small force across the river east of Fredericksburg to demonstrate and distract the Confederates, meanwhile sending a much larger force in a roundabout march to surprise them in their rear and cause a pincer maneuver. Rains and a swollen river delayed Hooker's forces until April 27th, but by April 30th, Hooker had achieved his goal of reaching across the river. His second-in-command, Couch, said, The hour was, therefore, auspicious for Hooker to assume the offensive, and he seized it with a boldness which argued well for his fitness to command. On May 1st, the action began. Hooker and Lee's forces met east of Chancellorsville. Hooker was concerned that the cavalry of the Confederacy could outflank him, so he retreated back to the stronghold that was Chancellorsville. General Lee knew the odds were against him at Chancellorsville, as he only had 65,000 men compared to Hooker's 130,000. He advised Jackson to go on a roundabout march through the middle of the night in order to surprise the right flank of the Union forces. When Jackson arrived, all hell broke loose. He routed the right flank of the Army of the Potomac, sending them into mass chaos and retreat. Eventually, they were able to recover and reorganize their lines in order to repel the Confederates. The map shows the way things stood on the morning of May 3rd, the small pocket of Union forces surrounding Chancellorsville. However, they retained the numerical advantage over the attacking Confederates. The Confederates forces set up their artillery and began bombarding the headquarters of General Hooker, which was John Chancellor's house. Hooker recalled, I was standing on this step of the portico on the Sunday morning of the 3rd of May, when a solid shot struck the pillar near me, striking my whole right side. For a few moments, I was senseless. After the blast, Hooker was unconscious for 30 minutes to an hour. He attempted to mount his horse to dispel rumors of his death, but then collapsed and vomited. He was described as stunned and incoherent. General Couch found him, quote, lying down in a soldier's tent by himself. Other staff members said that his mind was not clear and they had to wake him up to communicate with him, and the blow seemed to knock all sense out of him, and he was wandering and unable to get any ideas into his head. It is doubtful that he was capable of exercising the command after the accident. Modern clinical recommendations for return to activity after mild traumatic brain injury require six 24-hour periods with progression in activity, starting at rest and ending with unrestricted occupational activity, and each period must be symptom-free in order to advance to the next. Even the asymptomatic can have executive dysfunction with intensive cognitive testing. Clearly, after Hooker's concussion and his symptoms, he was not fit to continue to command the Army. Concussions were a recognized entity of the time. Dr. Chisholm, a Confederate surgeon, wrote a textbook stating that concussions appear to be a shock to the brain by which its substance is more or less shaken. He recommended laying patients horizontally with the head lower than body, and wrapping in warm blankets and dry frictions, which we don't do today. But he did recommend that the safest practice consist in doing as little as possible, avoiding stimulation and bloodletting, avoiding alcohol use, avoiding excitement, and correcting constipation. As Hooker laid in his tent, none of the other officers would issue commands. His staff members recall the Army was virtually without a head. They also recall that had the 1st or 5th Corps been thrown into action, they would have made Chancellorsville a complete success, and that a large part of this force stood with arms in their hands as spectators, almost directly on the left flank of the enemy so that their mere advance would have swept everything before it. They say that Hooker did intend to use his reserve force as soon as the enemy were utterly exhausted. However, after his concussion, he simply turned to Couch and said, I turn the command of the Army to you. You will withdraw it and place it in the position designated on this map. Hooker was more concerned with saving the Army than being aggressive. Once again, this map demonstrates the advantage Meade and Reynolds Corps had over the left side of the Confederate Army and how their mere advance could have swept them off the battlefield. Instead, Lincoln was left pondering after retreat, My God, my God, what will the country say? The resultant defeat tarnished Hooker's legacy. His contemporary officers said that he was spineless. Historians later said that he had simply folded up, or that his nickname had proven to be a sad misnomer. Modern military protocol would dictate that General Hooker give up his command of the Army of the Potomac. His second in command, Major General Couch, would have likely sent in all his men. Thus, the Battle of Chancellorsville would have ended differently. Only two months later, Gettysburg occurred. Imagine a different outcome at Chancellorsville, preventing that bloody battle. 270,000 casualties occurred after Chancellorsville. Many of those could have been avoided had Hooker not been compromised. Hooker's concussion clearly prolonged the suffering of the nation. I would like to thank the artists for their novel contributions, the photographer for capturing Harper's Weekly Pictures from 1863, Harper's Magazine for allowing us to use these illustrations, and especially thanks to all the journalists who risked their lives documenting the bloodiest conflict in American history. Thank you.

General Joseph Hooker

concussion

Battle of Chancellorsville

American Civil War

Army of the Potomac