Sanford H. Margalith
San Diego, Calif.

Expiration From Aspiration?
I enjoyed Dr. Caldroney's "Perspectives" piece on Thomas J. Stonewall Jackson's death in the May 2006 issue. I concur with his comments dealing with possible contributing factors resulting in Jackson's terminal "pneumonia."

While the author mentioned aspiration related to Jackson's ingestion of fluids shortly after his injury, he did not include the use of inhalation anesthesia as a significant cause. General anesthesia had been introduced two decades prior to the American Civil War, but the complication of aspiration during the induction of the anesthetic was not generally recognized. If a patient developed pneumonia postoperatively, it was not considered related to the administration of the anesthetic. While all of the factors mentioned by Dr. Caldroney possibly contributed to Jackson's fatal pneumonia, I have long felt that aspiration during inhalation anesthesia was the major factor.

Walter J. Loehr, M.D.
Durham, N.C.

Premature VC
I read the article "First Blood in the Boer Wars" in the June 2006 issue and was fascinated to know that Harry Smith was awarded the Victoria Cross for his victory over the Sikhs at Aliwal (January 28, 1846), since the Victoria Cross was actually first awarded on January 29, 1856, to recognize bravery in the Crimean War. The award was not backdated for conflicts prior to 1855. In fact, the VC was originally meant for soldiers other than senior officers, who could gain a knighthood or Companion of the Bath for services rendered. Harry Smith was awarded the Knight Grand Cross of the Order of the Bath for Aliwal.

John A. Davidson
Ottawa, Canada

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