• Jonathan Anderson, David Peace, and Michael S Okun.
• Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts, USA.
• Neurosurgery. 2008 Dec 1;63(6):1192-7; discussion 1197.

ObjectiveTo determine whether General Albert Sidney Johnston's dueling wound and nerve injury (1837) contributed to his death at the Battle of Shiloh (1862). General A.S. Johnston was commander of the Confederate Army at Shiloh and was killed by a bullet that severed his right popliteal artery. The location of this wound in the popliteal fossa region was largely unnoticed and, consequently, was not treated expeditiously. It has been widely assumed that the sciatic nerve was injured in a duel 3 decades before and that this injury resulted in a loss of sensation in the right posterior thigh and knee. This loss of sensation was assumed to be the reason why Johnston failed to notice that he was bleeding and consequently died.MethodsA complete review of all accounts of the battle was performed, as well as a complete review of the previous dueling injury. Primary source documents were examined, including Johnston's collected papers and original letters from eyewitness accounts and from family member observations. The wounds were traced using modern anatomic textbooks, and relevant published literature was reviewed regarding expected symptoms. Numerous secondary literature resources on the battle were also reviewed and compared with the original accounts.ResultsAll sources agree that Johnston was severely injured during his 1837 duel. Sciatic nerve injury was clearly documented by his physicians. His recovery was punctuated by many of the classical symptoms of sciatic nerve injury, including foot pain, muscle wasting, and numbness. Johnston's recovery from the dueling wound was nearly complete, and he returned to full active military life. No serious signs or symptoms were noted by biographers during the next 25 years. He was, however, noted to have a mild limp when overly exerting himself and to have occasional intermittent foot pain and numbness. He was never known to use a cane. Comparison to modern literature on sciatic nerve injury suggests that the constellation of symptoms was closer to sciatic injury or entrapment than total sciatic transection. There are no descriptions of Johnston having complete anesthesia or even numbness in the distribution of the posterior femoral cutaneous nerve, and he never suffered from pressure sores in the buttock or posterior leg, despite long and frequent horse rides. There remains debate as to the circumstances of his death at Shiloh. The wound he received on the battlefield was to the right popliteal artery; by accounts from primary sources, it took approximately 30 to 40 minutes before he died. These widely held time estimates were most likely incorrect, as injury to the popliteal artery as described by his surgeon in the field would have rapidly led to a change in his level of consciousness, as well as to his almost immediate death (within minutes).ConclusionJohnston's dueling injury was likely not sufficient to cause total sensory loss in the popliteal fossa. His dueling wound, although leaving him mildly impaired, was not sufficient to be responsible for his failure to recognize his wound on the Shiloh battlefield.

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