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Handbook of Cerebrovascular Disease and
Neurointerventional Technique 3rd Edition Mark R.
Harrigan Digital Instant Download
Author(s): Mark R. Harrigan, John P. Deveikis, (auth.)
ISBN(s): 9783319667799, 3319667793
Edition: 3
File Details: PDF, 26.65 MB
Year: 2018
Language: english
Handbook of
Cerebrovascular
Disease and
Neurointerventional
Technique

Third Edition

Mark R. Harrigan
John P. Deveikis
Contemporary Medical Imaging

Series Editor
U. Joseph Schoepf

More information about this series at:

http://www.springer.com/series/7687
Mark R. Harrigan • John P. Deveikis

Handbook of
Cerebrovascular Disease
and Neurointerventional
Technique
Third Edition
Mark R. Harrigan John P. Deveikis
Departments of Neurosurgery Department of Neurosurgery and
Neurology and Radiology Radiology
University of Alabama at Birmingham University of Alabama at Birmingham
Birmingham Birmingham
Alabama Alabama
USA USA

Originally published by Humana Press, USA 2009

Contemporary Medical Imaging
ISBN 978-3-319-66777-5    ISBN 978-3-319-66779-9 (eBook)
https://doi.org/10.1007/978-3-319-66779-9

Library of Congress Control Number: 2018934717

© Springer International Publishing AG 2009, 2013, 2018

This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
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The registered company is Springer International Publishing AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Acknowledgements

Jerzy P. Szaflarski
Beth Erwin
Kimberly Kicielinski
Paul Foreman
Christoph Grissenauer
Joel K. Curé
Patricia Harrigan
Casey C. May
Stephanie Falatko
Philip Schmalz
David Fisher

v
Introduction

To the astonishment of the authors of this handbook, the publisher agreed to

yet another edition.
This edition is much more than an update. For the first time, the authors
recognize intracerebral hemorrhage as a cerebrovascular disorder and have
dedicated a chapter to it. Kids Korners! have been inserted throughout the
handbook to highlight pediatric-specific aspects of the field. A principal find-
ing statement, in bold, has been added to each important clinical study
summary.
Neurointervention is a rarified and complex field, with a set of tech-
niques and a knowledge base that are distinct from other fields within medi-
cine. At the same time, clinicians from an assortment of disciplines have
come to practice neurointerventional radiology, with backgrounds ranging
from radiology to neurosurgery, neurology, cardiology, and vascular sur-
gery. Presently, there are more people training to become neurointerven-
tionalists than there ever have been before in history. These developments
created a need for a practical, unified handbook of techniques and essential
literature.
This purpose of this handbook is to serve as a practical guide to endovas-
cular methods, as a reference work for neurovascular anatomy, and as an
introduction to the cerebrovascular literature. We have striven to cover the
essential aspects of the entire fields of neurointervention and cerebrovascular
disease. It is particularly challenging to sift through the cerebrovascular lit-
erature because of the uneven quality; badly done and poorly written studies
appear side-by-side with high quality publications in even the most presti-
gious journals. Indeed, so-called “meta-analysis” and “guidelines” publica-
tions are notorious for variability and poor quality. Therefore, this handbook
should not be a substitute for reading the primary literature. We encourage
readers to read the primary research papers, scrutinize them carefully, and
form their own opinions.
We attempted to enhance the accessibility and ease use of this handbook
by arranging it in a semi-outline format. Dense narrative passages have been
avoided wherever possible (who has time to read long, thick chapters, any-
way?). In that spirit, the rest of this Introduction will be presented in the style
of this book.

vii
viii Introduction

1. This book is divided into three parts.

(a) Fundamentals
(i) Essential neurovascular anatomy and basic angiographic tech-
niques provide the foundation of the first section.
• The focus of Chap. 1 (Essential Neurovascular Anatomy)
remains on vascular anatomy that is pertinent to day-to-day
clinical practice. Embryology and discussions of angio-
graphic shift, which is less pertinent these days because of
widely available noninvasive intracranial imaging, are left
out. Discussions of anatomic variants include both normal
variants and anomalies.
–– New for the second edition are some Angio-Anatomic
Correlates that illustrate anatomic structures with angio-
graphic pictures.
• Chapters 2 and 3 cover diagnostic angiographic techniques.
• Chapter 4 is an introduction to basic interventional access
techniques with an appendix on the Neurointerventional
Suite, primarily intended for newcomers to the angio suite
and for experienced interventionalists planning a new suite.
(b) Techniques
(i) Endovascular methods, device information, and tips and tricks
are detailed.
• The second edition is packed with new information on evolv-
ing technology.
(c) Specific disease states
(i) Essential, useful information about each commonly encoun-
tered condition is presented.
• Significant clinical studies are summarized and placed into
context.
• Interesting and novel facts (and “factlets”) are included here
and there.
(ii) The term “systematic review” is used to refer to useful publica-
tions that have analyzed published clinical data in an organized
way. The term “meta-analysis” is avoided because it refers to a
specific statistical technique that is not always present in review
articles purporting to be a meta-analysis.
(iii) For readers with extra time on their hands, A Brief History of…
sections describe the background and evolution of various
techniques.
2. Core philosophy. Within the practical information contained within this
book, we hope to impart our underlying patient-oriented clinical philoso-
phy. In our view, each patient’s welfare is paramount. The clinical outcome
of each case takes priority over “pushing the envelope” by trying out new
devices or techniques, generating material for the next clinical series or
case report, or satisfying the device company representatives standing in
the control room. In practical terms, clinical decision-making should be
based on sound judgment and the best available clinical data. Moreover,
new medical technology and drugs should be used within reason, and
Introduction ix

whenever possible, based on established principles of sound practice. Thus,

while we have the technology and the ability to coil aneurysms in very old
patients with Hunt Hess V subarachnoid hemorrhage, embolize asymptom-
atic and low-risk dural AV fistulas, and perform carotid angioplasty and
stenting in patients with asymptomatic stenosis, we should recognize the
value of conservative management when it is called for. We hope that this
cautious and commonsensical outlook is reflected throughout this book.
3. Cookbook presentation. We have made every attempt to present proce-
dures in a plainly written, how-to-do-it format. Although some readers
may take issue with the reduction of a field as complex as neurointerven-
tion to a relatively simplistic how-to manual, we feel that structure and
standardization of technique can only serve to benefit the field in the long
run. For comparison, consider commercial air travel in the present era. Air
travel fatalities are extremely rare, due to pilot training, standardization of
flying techniques, and meticulous aircraft maintenance. Even the most
skilled and careful neurointerventionalists cannot hold a candle to the stel-
lar safety record obtained by the airline industry.
4. Conventions used in this book:
(a) Terminology can be confusing. The authors have adopted the most
current and commonly used terms; synonymous terms are listed in
parentheses after “aka,” for also known as.
(b) We have limited the use of abbreviations to those commonly used in
everyday conversation, such as “ICA” and “MCA.” Excessive use of
abbreviations, particularly for uncommon terms, can clutter the text
and make it difficult to read.
(c) The terms, see below and see above, are used to indicate other mate-
rial within the same chapter.
5. New for the third edition:
(a) Kids Korner! sections to highlight pediatric aspects.
(b) A dedicated chapter on intracerebral hemorrhage.
(c) Fewer typographical errors (hopefully) than the first two editions.
(d) Astute readers will also find many new pearls of wisdom and a few
sparks of levity.
6. Medicolegal disclaimer. This book is meant to serve as a guide to the use
of a wide variety of medical devices and drugs. However, the authors and
the publisher cannot be held responsible for the use of these devices and
drugs by readers, or for failure by the readers of this book to follow spe-
cific manufacturer specifications and FDA guidelines.
7. Lastly, we would like to mention six simple truths that have emerged in
our field since the last edition:
(a) Endovascular treatment of acute ischemic stroke is strongly indicated
for selected patients.
(b) Routine general anesthesia for acute ischemic stroke cases is not indi-
cated; general anesthesia should be reserved for the subset of stroke
cases that are not feasible or safe without it.
(c) CTA has replaced catheter angiography for the initial evaluation of
spontaneous subarachnoid hemorrhage.
x Introduction

(d) Routine catheter angiography for follow-up surveillance imaging of

coiled aneurysms is not indicated, as MRA is adequate and often
superior than angiography for most cases.
(e) Joint Commission-certified Primary and Comprehensive Stroke
Centers in the United States, and regionalization of stroke care around
the world, have revolutionized the care of patients with cerebrovascu-
lar disease and underscore the importance of organized and special-
ized stroke care.
(f) Although live case demonstrations have become popular, they have
little actual educational value and exist mainly for self-promotion by
certain physicians and as a form of entertainment for the audience.
Operators are distracted during live case demonstrations and compli-
cations are more likely. We hope that live case demonstrations turn out
to become a passing fad.

Mark R. Harrigan, M.D.

Departments of Neurosurgery
Neurology and Radiology
University of Alabama at Birmingham
Birmingham, AL, USA

John P. Deveikis, M.D.

Department of Neurosurgery
and Radiology
University of Alabama at Birmingham
Birmingham, Alabama, USA
Abbreviations

ACAS Asymptomatic Carotid Atherosclerosis Study

ACCP American College of Chest Physicians
ACE Angiotensin converting enzyme
A-comm Anterior communicating artery
ACST Asymptomatic Carotid Surgery Trial
ACT Activated clotting time
ACTH Adrenocorticotropic hormone
ADC Apparent diffusion coefficient
ADH Antidiuretic hormone
ADPKD Autosomal dominant polycystic kidney disease
AED Antiepileptic drug
AF Atrial fibrillation
AHA American Heart Association
AICA Anterior inferior cerebellar artery
aka Also known as
ALT Alanine aminotransferase
AMA Accessory meningeal artery
ANA Antinuclear antibody
ANP Atrial natriuretic peptide
ARCHeR Acculink for Revascularization of Carotids in High-Risk
patients
ARR Absolute risk reduction
ARUBA A Randomized trial of Unruptured Brain Arteriovenous
malformations
ASA Aspirin (acetylsalicylic acid)
ASAN Atrial septal aneurysm
ASITN American Society of Interventional and Therapeutic
Neuroradiology
ASNR American Society of Neuroradiology
atm Atmosphere
AV Arteriovenous
AVF Arteriovenous fistula
AVM Arteriovenous malformation
BA Basilar artery
BE Bacterial endocarditis
BEACH Boston Scientific EPI-A Carotid stenting trial for High risk
surgical patients

xi
xii Abbreviations

bFGF Basic fibroblast growth factor

BNP Brain natriuretic peptide
BRANT British Aneurysm Nimodipine Trial
CAA Cerebral amyloid angiopathy
CABERNET Carotid Artery Revascularization Using the Boston
Scientific FilterWire EX/EZ and the EndoTex NexStent
CADASIL Cerebral autosomal dominant arteriopathy with subcortical
infarcts and leukoencephalopathy
CADISS Cervical Artery Dissection in Stroke Study
cANCA Circulating antineutrophil cytoplasmic antibody
CAPTURE Carotid Acculink/Accunet Post-Approval Trial to Uncover
Rare Events
CARASIL Cerebral autosomal recessive arteriopathy with subcortical
infarcts and leukoencephalopathy
CaRESS Clopidogrel and Aspirin for Reduction of Emboli in
Symptomatic Carotid Stenosis
CAS Carotid angioplasty and stenting
CASANOVA Carotid Artery Stenosis with Asymptomatic Narrowing:
Operation versus Aspirin
CASES-PMS Carotid Artery Stenting with Emboli Protection
Surveillance—Post-Marketing Study
CBC Complete blood count
CBF Cerebral blood flow
CBV Cerebral blood volume
CCA Common carotid artery
CCF Carotid cavernous fistula
CCM Cerebral cavernous malformation
CCSVI Chronic cerebrospinal venous insufficiency
CEA Carotid endarterectomy
CI Confidence interval
CK Creatine kinase
CK-MB Creatine kinase—MB isoenzyme (cardiac-specific CK)
CM Cardiomyopathy; centimeter
CMS Centers for Medicare and Medicaid Services
CN Cranial nerve
CNS Central nervous system
COSS Carotid Occlusion Surgery Study
CPA Cerebral proliferative angiopathy
CPAP Continuous positive airway pressure
CPK Creatine phosphokinase
CPP Cerebral perfusion pressure
Cr Creatinine
CREATE Carotid Revascularization with ev3 Arterial Technology
Evolution
CREST Calcinosis, Raynaud’s phenomenon, esophageal dysmotil-
ity, sclerodactyly, and telangiectasia; Carotid
Revascularization, Endarterectomy versus Stenting Trial
CRH Corticotropin releasing hormone
Abbreviations xiii

CRP C-reactive protein

CRT Cathode ray tube
CSC Comprehensive stroke center
CSF Cerebrospinal fluid
CSW Cerebral salt wasting
CTA CT angiography
CVP Central venous pressure
CVT Cerebral venous thrombosis
DAC Distal access catheter
dAVF Dural arteriovenous fistula
DMSO Dimethyl sulfoxide
DPD Distal protection device
DSA Digital subtraction angiography
DSPA Desmodus rotundus salivary plasminogen activator
DVA Developmental venous anomaly
DVT Deep venous thrombosis
DWI Diffusion weighted imaging
EBV Epstein Barr Virus
ECA External carotid artery
EC-IC Extracranial to intracranial
ECST European Carotid Surgery Trial
EDAMS Encephalo-duro-arterio-myo-synangiosis
EDAS Encephalo-duro-arterio-synangiosis
EDS Ehlers-Danlos syndrome
EEG Electroencephalogram
EEL External elastic lamina
EJ External jugular vein
EKG Electrocardiogram
EMG Electromyography
EMS Encephalo-myo-synagiosis
EPD Embolic protection device
ESPS European Stroke Prevention Study
ESR Erythrocyte sedimentation rate
EVA-3S Endarterectomy vs. Angioplasty in Patients with
Symptomatic Severe Carotid Stenosis
EXACT Emboshield and Xact Post Approval Carotid Stent Trial
F French
FDA Food and Drug Administration
FLAIR Fluid attenuated inversion recovery
FMD Fibromuscular dysplasia
fps Frames per second
GCS Glasgow coma scale
GESICA Groupe d’Etude des Sténoses Intra-Crâniennes
Athéromateuses symptomatiques
GIST-UK United Kingdom Glucose Insulin in Stroke Trial
GP Glycoprotein
Gy Gray
HbF Fetal hemoglobin
xiv Abbreviations

HbS Hemoglobin S
HbSS Hemoglobin S homozygosity
HDL High density lipoprotein
HERS Heart and Estrogen/Progestin Study
HIPAA Health Insurance Portability and Accountability Act
HIT Heparin-induced thrombocytopenia
HMG CoA 3-Hydroxy-3-methylglutaryl coenzyme A
HRT Hormone replacement therapy
IA Intra-arterial
ICA Internal carotid artery
ICE Intentional cerebral embolism
ICG Indocyanine green
ICH Intracerebral hemorrhage
ICP Intracranial pressure
ICSS International Carotid Stenting Study
ICU Intensive care unit
IEL Internal elastic lamina
IEP Intracranial embolization procedure
II Image intensifier
IIH Idiopathic intracranial hypertension
IJ Internal jugular vein
IMA Internal maxillary artery
IMT Intima media thickness
INR International Normalized Ratio
IPS Inferior petrosal sinus
IPSS Inferior petrosal sinus sampling
IRB Institutional Review Board
ISAT International Subarachnoid Aneurysm Trial
IV Intravenous
IVH Intraventricular hemorrhage
KHE Kaposiform hemangioendotheliomas
KSS Kearns-Sayre syndrome
KTS Klippel-Trenaunay syndrome
LDL Low density lipoprotein
LINAC Linear accelerator (radiosurgery)
LMWH Low molecular weight heparin
LOC Level of consciousness; loss of consciousness
LV Left ventricle
MA Maxillary artery
MAC Mitral annular calcification
MACE Major adverse cerebrovascular events
MATCH Management of Atherothrombosis with Clopidogrel in
High-Risk patients
MAVEriC Medtronic AVE Self-Expanding Carotid Stent system with
Distal Protection in the Treatment of Carotid Stenosis
MCA Middle cerebral artery
MELAS Mitochondrial encephalomyopathy, lactic acidosis, stroke-­
like episodes
Abbreviations xv

MERFF Myoclonic epilepsy and ragged red fibers

MI Myocardial infarction
mm Millimeter
MRA Magnetic resonance angiography
MRI Magnetic resonance imaging
mRS Modified Rankin Scale
MRV Magnetic resonance venography
MTT Mean transit time
MVP Mitral valve prolapse; most valuable player
NA Not available
NASCET North American Symptomatic Carotid Endarterectomy
Trial
NBCA N-butyl-2-cyanoacrylate
NBTE Nonbacterial thrombotic endocarditis
NCRP National Council on Radiation Protection and
Measurements
NCS Nerve conduction study
NEMC-PCR New England Medical Center Posterior Circulation
Registry
Newt Newton
NG Nasogastric
NICU Neurological intensive care unit
NIH-SS National Institutes of Health Stroke Scale
NNH Number needed to harm
NNT Number needed to treat
NPH Neutral Protamine Hagedorn insulin
NPO Nil per os (no feeding)
NS Not significant
NSAID Nonsteroidal anti-inflammatory drug
OA-MCA Occipital artery to middle cerebral artery
OCP Oral contraceptive
oCRH ovine corticotrophin releasing hormone
OEF Oxygen extraction fraction
OSA Obstructive sleep apnea
OTW Over-the-wire
PA Postero-anterior
PAC Partial anterior circulation stroke
PAN Polyarteritis nodosa
PASCAL Performance And Safety of the Medtronic AVE Self-­
Expandable Stent in the Treatment of Carotid Artery
Lesions
PCA Posterior cerebral artery
P-comm Posterior communicating artery
PCR Polymerase chain reaction
PCWP Pulmonary capillary wedge pressure
PCXR Portable chest X-ray
PEEP Positive end-expiratory pressure
PFO Patent foramen ovale
xvi Abbreviations

PICA Posterior inferior cerebellar artery

PKD Polycystic kidney disease
PNS Peripheral nervous system
POC Posterior circulation stroke
PPRF Paramedian pontine reticular formation
PROACT Prolyse in Acute Cerebral Thromboembolism
Pro-UK Prourokinase
PSA Posterolateral spinal arteries
PSV Peak systolic velocity
PT Prothrombin time
PTA Percutaneous transluminal angioplasty
PTE Pulmonary thromboembolism
PTT Partial thromboplastin time
PVA Polyvinyl alcohol
RA Rheumatoid arthritis
rem roentgen-equivalent-man, rapid eye movement sleep stage
RHV Rotating hemostatic valve (aka Y -adapter, aka Touhy-Borst
Valve)
RIND Reversible ischemic neurological deficit
RPR Rapid plasma reagin
RR Risk reduction
RRR Relative risk reduction
RVAS Rotational vertebral artery syndrome
RX Rapid exchange
SAMMPRIS Stenting vs. Aggressive Medical Management for
Preventing Recurrent Stroke in Intracranial Stenosis
SAPPHIRE Stenting and Angioplasty with Protection in Patients at
High Risk for Endarterectomy
SBP Systolic blood pressure
SCA Superior cerebellar artery
SCD Sickle cell disease
SCIWORA Spinal cord injury without radiographic abnormality
SDH Subdural hematoma
SECURITY Study to Evaluate the Neuroshield Bare Wire Cerebral
Protection System and XAct Stent in Patients at High Risk
for Endarterectomy
SIADH Syndrome of inappropriate antidiuretic hormone secretion
SIM Simmons catheter
SIR Society of Interventional Radiology
SLE Systemic lupus erythematosus
SOV Superior ophthalmic vein
SPACE Stent-Protected Percutaneous Angioplasty of the Carotid
versus Endarterectomy
SPARCL Stroke Prevention by Aggressive Reduction in Cholesterol
Levels
SPECT Single photon emission computed tomography
SSS Superior sagittal sinus
Abbreviations xvii

SSYLVIA Stenting of Symptomatic Atherosclerotic Lesions in the

Vertebral or Intracranial Arteries
STA Superficial temporal artery
STA-MCA Superficial temporal artery to middle cerebral artery bypass
TAC Total anterior circulation stroke
TASS Ticlopidine Aspirin Stroke Study
TCD Transcranial Doppler ultrasonography
TEE Transesophageal echocardiography
TGA Transient global amnesia
TIA Transient ischemic attack
TOAST Trial of ORG 10172 in Acute Stroke Treatment
tPA Tissue plasminogen activator
TTE Transthoracic echocardiography
TTP Time to peak; thrombotic thrombocytopenic purpura
U Unit
UAC Umbilical artery catheter
UOP Urinary output
USA United States of America
VACS Veterans Affairs Cooperative Study on Symptomatic
Stenosis
VAST Vertebral Artery Stenting Trial
VBI Vertebrobasilar insufficiency
VDRL Venereal Disease Research Laboratory
VERiTAS Vertebrobasilar Flow Evaluation and Risk of Transient
Ischemic Attack and Stroke
VERT Vertebral
VIVA ViVEXX Carotid Revascularization Trial
VOGM Vein of Galen malformation
VZV Varicella zoster virus
WASID Warfarin versus Aspirin for Symptomatic Intracranial
Disease
WEST Women Estrogen Stroke Trial
WHI Women’s Health Initiative
Contents

Part I Fundamentals

1 Essential Neurovascular Anatomy ��������������������������������������������     3

2 Diagnostic Cerebral Angiography����������������������������������������������   111
3 Spinal Angiography ��������������������������������������������������������������������   147
4 General Considerations for Neurointerventional
Procedures������������������������������������������������������������������������������������   167

Part II Interventional Techniques

5 Intracranial Aneurysm Treatment ��������������������������������������������   249

6 Intracranial Embolization����������������������������������������������������������   333
7 Extracranial and Spinal Embolization��������������������������������������   395
8 Treatment of Acute Ischemic Stroke������������������������������������������   431
9 Extracranial Angioplasty and Stenting��������������������������������������   501
10 Endovascular Treatment of Intracranial
Stenosis and Vasospasm��������������������������������������������������������������   531
11 Venous Procedures ����������������������������������������������������������������������   549

Part III Specific Disease States

12 Intracranial Aneurysms and Subarachnoid Hemorrhage ������   601

13 Arteriovenous Malformations����������������������������������������������������   713
14 Dural Arteriovenous Fistulas������������������������������������������������������   755
15 Venous Disorders and Cavernous Malformations��������������������   787
16 Ischemic Stroke����������������������������������������������������������������������������   827
17 Intracerebral Hemorrhage����������������������������������������������������������   919
18 Extracranial Cerebrovascular Occlusive Disease ��������������������   957

xix
xx Contents

19 Intracranial Cerebrovascular Occlusive Disease���������������������� 1015

20 Spinal Vascular Lesions�������������������������������������������������������������� 1049
Index������������������������������������������������������������������������������������������������������ 1073
 Part I
Fundamentals
 Essential Neurovascular Anatomy
1

1.1 Aortic Arch and Great Vessels

Aortic arch anatomy is pertinent to neuroangiography because variations of arch anatomy can affect
access to the cervicocranial circulation.

1. Branches
(a) Innominate (aka brachiocephalic) artery
(b) Left common carotid artery
(c) Left subclavian artery
2. Variants (Fig. 1.1):
(a) Bovine arch (Figs. 1.1b and 1.2): The innominate artery and left common carotid artery (CCA)
share a common origin (up to 27% of cases), or the left CCA arises from the innominate artery
(7% of cases) [1]. The bovine variant is more common in blacks (10–25%) than whites (5–8%)
[2].
(b) Aberrant right subclavian artery: The right subclavian artery arises from the left aortic arch,
distal to the origin of the left subclavian artery. It usually passes posterior to the esophagus
on its way to the right upper extremity. This is the most common congenital arch anomaly,
incidence: 0.4–2.0% [3] associated with Down syndrome.
(c) Origin of the left vertebral artery from the arch is seen in 0.5% of cases [1].
(d) Less common variants (Fig. 1.3): Some of these rare anomalies can lead to formation of a
vascular ring in which the trachea and esophagus are encircled by connecting segments of the
aortic arch and its branches.
3. Effects of aging and atherosclerosis on the aortic arch and great vessels: The aortic arch and great
vessels become elongated and tortuous with age (Fig. 1.4); this can have practical implications for
neurointervention in the elderly, as a tortuous vessel can be difficult to negotiate with wires and
catheters. Although atherosclerosis has been implicated in the etiology of this phenomenon, more
recent data suggest that the cervical internal carotid artery (ICA) may undergo metaplastic trans-
formation, in which elastic and muscular tissue in the artery wall is replaced by loose connective
tissue [4].

© Springer International Publishing AG 2018 3

M.R. Harrigan, J.P. Deveikis, Handbook of Cerebrovascular Disease and Neurointerventional
Technique, Contemporary Medical Imaging, https://doi.org/10.1007/978-3-319-66779-9_1
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324 HISTORY OF THE NEGRO RACE IN AMERICA. THE

BLACK REGIMENT. MAY 27, 1863. BY GEORGE H. BOKER. Dark as
the clouds of even, Ranked in the western heaven, Waiting the
breath that lifts All the dread mass, and drifts Tempest and falling
brand Over a ruined land ; — So still and orderly, Arm to arm, knee
to knee, Waiting the great event, Stands the black regiment. Down
the long dusky line Teeth gleam and eyeballs shine ; And the bright
bayonet, Bristling and firmly set, Flashed with a purpose grand, Long
ere the sharp command Of the fierce rolling drum Told them their
time had come, Told them what work was sent For the black
regiment. " Now," the flag-sergeant cried, " Though death and hell
betide, Let the whole nation see If we are fit to be Free in this land ;
or bound Down, like the whining houndBound with red stripes of
pain In our old chains again ! " Oh ! what a shout there went From
the black regiment ! " Charge ! " Trump and drum awoke, Onward
the bondmen broke ; Bayonet and sabre-stroke Vainly opposed their
rush.
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WEGXOES AS SOLDIERS 325 Through the wild battle's

crush, With but one thought aflush, Driving their lords like chaff, In
the guns' mouths they laugh ; Or at the slippery brands Leaping with
open hands, Down they tear man and horse, Down in their awful
course ; Trampling with bloody heel Over the crashing steel, All their
eyes forward bent, Rushed the black regiment. " Freedom ! " their
battle-cry— " Freedom ! or leave to die ! " Ah ! and they meant the
word, Not as with us 't is heard, Not a mere party-shout : They gave
their spirits out • Trusted the end to God, And on the gory sod
Rolled in triumphant blood. Glad to strike one free blow, Whether for
weal or woe ; Glad to breathe one free breath, Though on the lips of
death. Praying — alas ! in vain ! — That they might fall again, So
they could once more see That burst to liberty ! This was what "
freedom " lent To the black regiment. Hundreds on hundreds fell ;
But they are resting well ; Scourges and shackles strong Never shall
do them wrong. Oh, to the living few, Soldiers, be just and true !
Hail them as comrades tried ; Fight with them side by side ; Never,
in field or tent, Scorn the black regiment !
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326 HISTORY OF THE NEGRO RACE IN AMERICA. The

battle of Milliken's Bend was fought on the 6th of June, 1863. The
troops at this point were under the command of Brig.-Gen. E. S.
Dennis. The force consisted of the 2$d Iowa, 160 men; 9th La., 500;
nth La., 600; 1st Miss., 150; total, 1,410. Gen. Dennis's report places
the number of his troops at 1,061 ; but evidently a clerical error
crept into the report. Of the force engaged, 1,250 were Colored,
composing the Qth and nth Louisiana, and the 1st Mississippi. The
attacking force comprised six Confederate regiments — about 3,000
men, — under the command of Gen. Henry McCulloch. This force,
coming from the interior of Louisiana, by the way of Richmond,
struck the Qth Louisiana and two companies of Federal cavalry, and
drove them within sight of the earthworks at the Bend. It was now
nightfall, and the enemy rested, hoping and believing himself able to
annihilate the Union forces on the morrow. During the night a
steamboat passed the Bend, and Gen. Dennis availed himself of the
opportunity of sending to Admiral Porter for assistance. The gun-
boats, " Choctaw " and " Lexing ton " were despatched to Milliken's
Bend from Helena. As the " Choctaw " was coming in sight, at 3
o'clock in the morning, the rebels made their first charge on the
Federal earthworks, filling the air with their vociferous cries : " No
quarter ! " to Negroes and their officers. The Negro troops had just
been recruited, and hence knew little or nothing of the manual or
use of arms. But the desperation with which they fought has no
equal in the an nals of modern wars. The enemy charged the works
with des perate fury, but were checked by a deadly fire deliberately
de livered by the troops within. The enemy fell back and charged the
flanks of the Union columns, and, by an enfilading fire, drove them
back toward the river, where they sought the protection of the gun-
boats. The " Choctaw " opened a broadside upon the exulting foe,
and caused him to beat a hasty retreat. The Negro troops were
ordered to charge, and it was reported by a " Tri bune "
correspondent that many of the Union troops were killed before the
gun-boats could be signalled to " cease firing" The following
description of the battle was given by an eye-witness of the affair,
and a gentleman of exalted character : " My informant states that a
force of about one thousand negroes and two hundred men of the
Twenty-third Iowa, belonging to the Second brigade, Carr's division
(the Twenty-third Iowa had been up
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NEGROES AS SOLDIERS. 327 the river with prisoners, and

was on its way back to this place), was surprised in camp by a rebel
force of about two thousand men. The first intimation that the
commanding officer received was from one of the black men, who
went into the colonel's tent and said : ' Massa, the secesh are in
camp.' The colonel ordered him to have the men load their guns at
once. He instantly replied : ' We have done did dat now, massa.'
Before the colonel was ready, the men were in line, ready for action.
As before stated, the rebels drove our force toward the gun-boats,
taking colored men prisoners and murdering them. This so enraged
them that they rallied and charged the enemy more heroi cally and
desperately than has been recorded during the war. It was a genuine
bayonet charge, a hand-to-hand fight, that has never occurred to
any extent during this prolonged conflict. Upon both sides men were
killed with the butts of muskets. White and black men were lying
side by side, pierced by bayonets, and in some instances transfixed
to the earth. In one instance, two men, one white and the other
black, were found dead, side by side, each having the other's
bayonet through his body. If facts prove to be what they are now
represented, this engage ment of .Sunday morning will be recorded
as the most desperate of this war. Broken limbs, broken heads, the
mangling of bodies, all prove that it was a contest between enraged
men : on the one side from hatred to a race ; and on the other,
desire for self-preservation, revenge for past grievances and the
inhuman murder of their comrades. One brave man took his former
master prisoner, and brought him into camp with great gusto. A
rebel prisoner made a particular request, that his own negroes
should not be placed over him as a guard. Dame Fortune is
capricious ! His request was not granted. Their mode of warfare
does not entitle them to any privileges. If any are granted, it is from
mag nanimity to a fellow-foe. " The rebels lost five cannon, two
hundred men killed, four hundred to five hundred wounded, and
about two hundred prisoners. Our loss is reported to be one hundred
killed and five hundred wounded ; but few were white men." 3 Mr.
G. G. Edwards, who was in the fight, wrote, on the I3th of June : "
Tauntingly it has been said that negroes won't fight. Who say it, and
who but a dastard and a brute will dare to say it, when the battle of
Milliken's Bend finds its place among the heroic deeds of this war ?
This battle has significance. It demonstrates the fact that the freed
slaves will fight." 1 Rebellion Records, vol. vii. Doc. p. 15.
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328 HISTORY OF THE NEGRO RACE IN AMERICA. The

month of July, 1863, was memorable. Gen. Mead had driven Lee
from Gettysburg, Grant had captured Vicksburg, Banks had captured
Port Hudson, and Gillmore had begun his operations on Morris
Island. On the I3th of July the New York Draft Riot broke out. The
Democratic press had advised the people that they were to be called
upon to fight the battles of the " Niggers " and " Abolitionists ";
while Gov. Seymour " re quested" the rioters to await the return of
his adjutant-general whom he had despatched to Washington to
have the President suspend the draft. The speech was either
cowardly or trea sonous. It meant, when read between the lines, it
is unjust for the Government to draft you men ; I will try and get the
Gov ernment to rescind its order, and until then you are respectfully
requested to suspend your violent acts against property. But the riot
went on. When the troops under Gen. Wool took charge of the city,
thirteen rioters were killed, eighteen wounded, and twenty-four
made prisoners. The rioters rose ostensibly to resist the draft, but
there were three objects before them : robbery, the destruction of
the property of the rich sympathizers with the Union, and the
assassination of Colored persons wherever found. They burned the
Colored Orphans' Asylum, hung Colored men to lamp posts, and
destroyed the property of this class of citizens with impunity. During
these tragic events in New York a gallant Negro regi ment was
preparing to lead an assault upon the rebel Fort Wagner on Morris
Island, South Carolina. On the morning of the 1 6th of July, 1863,
the 54th Massachusetts — first Colored regiment from the North —
was compelled to fall back upon Gen. Terry from before a strong and
fresh rebel force from Georgia. This was on James Island. The 54th
was doing picket duty, and these early visitors thought to find Terry
asleep ; but instead found him awaiting their coming with all the
vigilance of an old soldier. And in addition to the compliment his
troops paid the enemy, the gunboats " Pawnee," " Huron," "
Marblehead," "John Adams," and " Mayflower" paid their warmest
respects to the intruders. They soon withdrew, having sustained a
loss of 200, while Gen. Terry's loss was only about 100. It had been
arranged to concentrate the Union forces on Morris Island, open a
bombardment upon Fort Wagner, and then charge and take it on the
i8th. The troops on James Island were put in motion to form a
junction with the forces already upon Morris
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NEGROES AS SOLDIERS. 329 Island. The march of the 54th

Mass., oegan on the night of the i6th and continued until the
afternoon of the i8th. Through ugly marshes, over swollen streams,
and broken dykes — through darkness and rain, the regiment made
its way to Morris Island where it arrived at 6 A. M. of the i8th of July.
The bombard ment of Wagner was to have opened at daylight of
this day ; but a terrific storm sweeping over land and sea prevented.
It was 12:30 P.M. when the thunder of siege guns, batteries, and
gun boats announced the opening of the dance of death. A semi
circle of batteries, stretching across the island for a half mile, sent
their messages of destruction into Wagner, while the fleet of iron
vessels battered down the works of the haughty and impregna ble
little fort. All the afternoon one hundred great guns thun dered at
the gates of Wagner. Toward the evening the bom bardment began
to slacken until a death-like stillness ensued. To close this part of the
dreadful programme Nature lifted her hoarse and threatening voice,
and a severe thunder-storm broke over the scene. Darkness was
coming on. The brave Black regiment had reached Gen. Strong's
headquarters fatigued, hun gry, and damp. No time could be allowed
for refreshments. Col. Shaw and Gen. Strong addressed the
regiment in eloquent, inspiring language. Line of battle was formed
in three brigades. The first was led by Gen. Strong, consisting of the
54th Massa chusetts (Colored), Colonel Robert Gould Shaw ; the 6th
Con necticut, Col. Chatfield ; the 48th New York, Col. Barton ; the 3d
New Hampshire, Col. Jackson ; the /6th Pennsylvania, Col.
Strawbridge ; and the 9th Maine. The 54th was the only regi ment of
Colored men in the brigade, and to it was assigned the post of honor
and danger in the front of the attacking column. The shadows of
night were gathering thick and fast. Gen. Strong took his position,
and the order to charge was given. On the brave Negro regiment
swept amid the shot and shell of Sumter, Cumming's Point, and
Wagner. Within a few minutes the troops had double-quicked a half
mile ; and but few had suffered from the heavy guns ; but suddenly
a terrific fire of small arms was opened upon the 54th. But with
matchless courage the regi ment dashed on over the trenches and
up the side of the fort, upon the top of which Sergt. Wm. H. Carney
planted the colors of the regiment. But the howitzers in the bastions
raked the ditch, and hand-grenades from the parapet tore the brave
men as they climbed the battle-scarred face of the fort. Here waves
the
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330 HISTORY OF THE NEGRO RACE IN AMERICA. flag of a

Northern Negro regiment ; and here its brave, beautiful, talented
young colonel, Robert Gould Shaw, was saluted by death and kissed
by immortality ! Gen. Strong received a mor tal wound, while Col.
Chatfield and many other heroic officers yielded a full measure of
devotion to the cause of the Union. Three other colonels were
wounded, — Barton, Green, and Jack son. The shattered brigade
staggered back into line under the command of Major Plympton, of
the 3d New Hampshire, while the noble 54th retired in care of
Lieutenant Francis L. Higginson.. The second brigade, composed of
the /th New Hampshire, Col. H. S. Putnam; 62d Ohio, Col. Steele ;
6;th Ohio, CoL Vorhees; and the icoth New York, under Col. Danby,
was led against the fort, by Col. Putnam, who was killed in the
assault. So this brigade was compelled to retire. One thousand and
five hundred (1,500) men were thrown away in this fight, but one
fact was clearly established, that Negroes could and would fight as
bravely as white men. The following letter, addressed to the Military
Secretary of Gov. Andrew, of Massachusetts, narrates an instance of
heroism in a Negro soldier which deserves to go into history : "
HEADQUARTERS 54TH MASSACHUSETTS VOLS., ) " MORRIS
ISLAND, S. C., Oct. 15, 1863. ) " COLONEL : I have the honor to
forward you the following letter, received a few days since from
Sergeant W. H. Carney, Company C, of this regiment. Mention has
before been made of his heroic conduct in preserving the American
flag and bearing it from the field, in the assault on Fort Wagner on
the i8th of July last, but that you may have the history complete, I
send a simple statement of the facts as I have obtained them from
him, and an officer who was an eye-witness ' " When the Sergeant
arrived to within about one hundred yards of the fort. — he was with
the first battalion, which was in the advance of the storming column
— he received the regimental colors, pressed for ward to the front
rank, near the Colonel, who was leading the men over the ditch. He
says, as they ascended the wall of the fort, the ranks were full, but
as soon as they reached the top, ' they melted away ' before the
enemy's fire ' almost instantly.' He received a severe wound in the
thigh, but fell only upon his knees. He planted the flag upon the
parapet, lay down on the outer slope, that he might get as much
shelter as possible ; there he remained for over half an hour, till the
2d brigade came up. He kept the colors flying until the second con
flict was ended. When our forces retired he followed, creeping on
one knee, still holding up the flag. It was thus that Sergeant Carney
came
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NEGROES AS SOLDIERS. 331 from the field, having held

the emblem of liberty over the walls of Fort Wagner during the
sanguinary conflict of the two brigades, and having received two
very severe wounds, one in the thigh and one in the head. Still he
refused to give up his sacred trust until he found an officer of his
regiment. " When he entered the field hospital, where his wounded
comrades were being brought in, they cheered him and the colors.
Though nearly exhausted with the loss of blood, he said : ' Boys, the
old flag never touched the ground.' " Of him as a man and soldier, I
can speak in the highest term of praise. " I have the honor to be,
Colonel, very respectfully, " Your most obedient servant, " M. S.
LlTTLEFIELD, " Col. Comtfg 54^ Regt Mass. Vols. " Col. A. G.
BROWN, Jr., Military Secretary to his Excellency John A. Andrew,
Mass." It was natural that Massachusetts should feel a deep interest
in her Negro regiment : for it was an experiment ; and the fair name
of the Old Bay State had been committed to its keeping. Edward L.
Pierce gave the following account of the regiment to Gov. John A.
Andrew: "BEAUFORT, July 22, 1863. " MY DEAR SIR : You will
probably receive an official report of the losses in the Fifty-fourth
Massachusetts by the mail which leaves to-morrow, but perhaps a
word from me may not be unwelcome. I saw the officers and men
on James Island on the thirteenth instant, and on Saturday last saw
them at Brigadier-General Strong's tent, as they passed on at six or
half-past six in the evening to Fort Wagner, which is some two miles
beyond. I had been the guest of General Strong, who commanded
the advance since Tuesday. Colonel Shaw had be come attached to
General Strong at St. Helena, where he was under him, and the
regard was mutual. When the troops left St. Helena they were
separated, the Fifty-fourth going to James Island. While it was there,
General Strong received a letter from Colonel Shaw, in which the
desire was expressed for the transfer of the Fifty-fourth to General
Strong's brigade. So when the troops were brought away from
James Island, General Strong took this regiment into his command.
It left James Island on Thursday, July sixteenth, at nine P. M., and
marched to Cole's Island, which they reached at four o'clock on
Friday morning, marching all night, most of the way in single file,
over swampy and
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332 HISTORY OF THE NEGRO RACE IN AMERICA. muddy

ground. There they remained during the day, with hard-tack and
coffee for their fare, and this only what was left in their haver sacks
; not a regular ration. From eleven o'clock of Friday evening until
four o'clock of Saturday they were being put on the transport, the
General Hunter, in a boat which took about fifty at a time. There
they breakfasted on the same fare, and had no other food before
enter ing into the assault on Fort Wagner in the evening. "The
General Hunter left Cole's Island for Folly Island at six A.M., and. the
troops landed at the Pawnee Landing about half-past nine A.M., and
thence marched to the point opposite Morris Island, reaching there
about two o'clock in the afternoon. They were trans ported in a
steamer across the inlet, and at five P.M. began their march for Fort
Wagner. They reached Brigadier-General Strong's quarters, about
midway on the island, about six or half-past six, where they halted
for five minutes. I saw them here, and they looked worn and weary.
" General Strong expressed a great desire to give them food and
stimulants, but it was too late, as they were to lead the charge. They
had been without tents during the pelting rains of Thursday and
Friday nights. General Strong had been impressed with the high
character of the regiment and its officers, and he wished to assign
them the post where the most severe work was to be done, and the
highest honor was to be won. I had been his guest for some days,
and knew how he re garded them. The march across Folly and
Morris Islands was over a very sandy road, and was very wearisome.
The regiment went through the centre of the island, and not along
the beach where the marching was easier. When they had come
within about one thousand six hun dred yards of Fort Wagner, they
halted and formed in line of battle — • the Colonel leading the right
and the Lieutenant-Colonel the left wing. They then marched four
hundred yards further on and halted again. There was little firing
from the enemy at this point, one solid shot falling between the
wings, and another falling to the right, but no musketry. " At this
point the regiment, together with the next supporting regi ments,
the Sixth Connecticut, Ninth Maine, and others, remained half an
hour. The regiment was addressed by General Strong and Colonel
Shaw. Then at half-past seven or a quarter before eight o'clock the
order for the charge was given. The regiment advanced at quick
time, changed to double-quick when at some distance on. The
intervening distance between the place where the line was formed
and the Fort was run over in a few minutes. When within one or two
hundred yards of the Fort, a terrific fire of grape and musketry was
poured upon them along the entire line, and with deadly results. It
tore the ranks to pieces and disconcerted some. They rallied again,
went through the
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NEGROES AS SOLDIERS.* 333 ditch, in which were some

three feet of water, and then up the parapet. They raised the flag on
the parapet, where it remained for a few min utes. Here they melted
away before the enemy's fire, their bodies fall ing down the slope
and into the ditch. Others will give a more detailed and accurate
account of what occurred during the rest of the conflict. " Colonel
Shaw reached the parapet, leading his men, and was prob ably
killed. Adjutant James saw him fall. Private Thomas Burgess, of
Company I, told me that he was close to Colonel Shaw ; that he
waved his sword and cried out : ' Onward, boys ! ' and, as he did so,
fell. Burgess fell, wounded, at the same time. In a minute or two, as
he rose to crawl away, he tried to pull Colonel Shaw along, taking
hold of his feet, which were near his own head, but there appeared
to be no life in him. There is a report, however, that Colonel Shaw is
wounded and a prisoner, and that it was so stated to the officers
who bore a flag of truce from us, but I cannot find it well
authenticated. It is most likely that this noble youth has given his life
to his country and to mankind. Brigadier-General Strong (himself a
kindred spirit) said of him to-day, in a message to. his parents : * I
had but little opportunity to be with him, but I already loved him. No
man ever went more gallantly into battle. None knew but to love
him.' I parted with Colonel Shaw be tween six and seven, Saturday
evening, as he rode forward to his regi ment, and he gave me the
private letters and papers he had with him, to be delivered to his
father. Of the other officers, Lieutenant-Colonel Hallowell is severely
wounded in the groin ; Adjutant James has a wound from a grape-
shot in his ankle, and a flesh-wound in his side from a glancing ball
or piece of shell. Captain Pope has had a musketball extracted from
his shoulder. Captain Appleton is wounded in the thumb, and also
has a contusion on his right breast from a hand-gre nade. Captain
Willard has a wound in the leg, and is doing well. Cap tain Jones was
wounded in the right shoulder. The ball went through and he is
doing well. Lieutenant Romans wounded by a ball from a smooth-
bore musket entering the left side, which has been extracted from
the back. He is doing well. " The above-named officers are at
Beaufort, all but the last arriving there on Sunday evening, whither
they were taken from Morris Island to Pawnee Landing, in the Alice
Price, and thence to Beaufort in the Cosmopolitan, which is specially
fitted up for hospital service and is provided with skilful surgeons
under the direction of Dr. Bontecou. They are now tenderly cared for
with an adequate corps of surgeons and nurses, and provided with a
plentiful supply of ice, beef and chicken broth, and stimulants.
Lieutenant Smith was left at the hos pital tent on Morris Island.
Captain Emilio and Lieutenants Grace, Appleton, Johnston, Reed,
Howard, Dexter, Jennison, and Emerson, were not wounded and are
doing duty. Lieutenants Jewett and
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334 HISTORY OF THE NEGRO RACE IN AMERICA. Tucker

were slightly wounded and are doing duty also. Lieut. Pratt was
wounded and came in from the field on the following day. Cap tains
Russell and Simpkins are missing. The Quartermaster and Sur geon
are safe and are with the regiment, " Dr. Stone remained on the
Alice Price during Saturday night, caring for the wounded until she
left Morris Island, and then returned to look after those who were
left behind. The Assistant Surgeon was at the camp on St. Helena
Island, attending to duty there. Lieuten ant Littlefield was also in
charge of the camp at St. Helena. Lieuten ant Higginson was on
Folly Island with a detail of eighty men. Cap tain Bridge and
Lieutenant Walton are sick and were at Beaufort or vicinity. Captain
Partridge has returned from the North, but not in time to participate
in the action. " Of the privates and non-commissioned officers I send
you a list of one hundred and forty-four who are now in the Beaufort
hospitals. A few others died on the boats or since their arrival here.
There may be others at the Hilton Head Hospital ; and others are
doubtless on Morris Island ; but I have no names or statistics
relative to them. Those in Beaufort are well attended to — just as
well as the white sol diers, the attentions of the surgeons and nurses
being supplemented by those of the colored people here, who have
shown a great interest in them. The men of the regiment are very
patient, and where their condition at all permits them, are cheerful.
They express their readi ness to meet the enemy again, and they
keep asking if Wagner is yet taken. Could any one from the North
see these brave fellows as they lie here, his prejudice against them,
if he had any, would all pass away. They grieve greatly at the loss of
Colonel Shaw, who seems to have ac quired a strong hold on their
affections. They are attached to their other officers, and admire
General Strong, whose courage was so con spicuous to all. I asked
General Strong if he had any testimony in relation to the regiment to
be communicated to you. These are his precise words, and I give
them to you as I noted them at the time : " ' The Fifty-fourth did
well and nobly, only the fall of Colonel Shaw prevented them from
entering the Fort. They moved up as gallantly as any troops could,
and with their enthusiasm they deserve a better fate.' The regiment
could not have been under a better officer than Colonel Shaw. He is
one of the bravest and most genuine men. His soldiers loved him like
a brother, and go where you would through the camps you would
hear them speak of him with enthusiasm and affec tion. His wound
is severe, and there are some apprehensions as to his being able to
recover from it. .Since I found him at the hospital tent on Morris
Island, about half-past nine o'clock on Saturday, I have been all the
time attending to him or the officers of the Fifty-fourth, both on the
boats and here. Nobler spirits it has never been my fort 
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NEGROES AS SOLDIERS. 335 une to be with. General

Strong, as he lay on the stretcher in the tent, was grieving all the
while for the poor fellows who lay uncared for on the battle-field,
and the officers of the Fifty-fourth have had nothing to say of their
own misfortunes, but have mourned constantly for the hero who led
them to the charge from which he did not return. I remember well
the beautiful day when the flags were presented at Readville, and
you told the regiment that your reputation wag to be identified with
its fame. It was a day of festivity and cheer. I walk now in these
hospitals and see mutilated forms with every variety of wound, and
it seems all a dream. But well has the regiment sus tained the hope
which you indulged, and justified the identity of fame which you
trusted to it. " I ought to add in relation to the fight on James
Island, on July sixteenth, in which the regiment lost fifty men,
driving back the rebels, and saving, as it is stated, three companies
of the Tenth Connecticut, that General Terry, who was in command
on that Island, said to Adju tant James : " ' Tell your Colonel that I
am exceedingly pleased with the conduct of your regiment. They
have done all they could do.' " Yours truly, "EDWARD L. PIERCE."*
The Negro in the Mississippi Valley, and in the Department of the
South had won an excellent reputation as a soldier. In the spring of
1864 Colored Troops made their dtbut in the army of the Potomac.
In the battles at Wilson's Wharf, Petersburg, Deep Bottom, Chapin's
Farm, Fair Oaks, Hatcher's Run, Farmville, and many other battles,
these soldiers won for themselves lasting glory and golden opinions
from the officers and men of the white organizations. On the 24th of
May, 1864, Gen. FitzHugh Lee called at Wilson's Wharf to pay his
respects to two Negro regiments under the command of Gen. Wild.
But the chivalry of the South were compelled to retire before the de
structive fire of Negro soldiers. A " Tribune " correspondent who
witnessed the engagement gave the following account the next day
: " At first the fight raged fiercely on the left. The woods were
riddled with bullets ; the dead and wounded of the rebels were
taken away from this part of the field, but I am informed by one
accustomed to judge, and who went over the field to-day, that from
the pools of 'Rebellion Recs., vol. vii. Doc., p. 215, 216.
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336 HISTORY OF THE NEGRO RACE IN AMERICA. blood

and other evidences the loss must have been severe. Finding that
the left could not be broken, Fitz-Hugh Lee hurled his chivalry —
dismounted of course — upon the right. Steadily they came on,
through obstructions, through slashing, past abattis without
wavering. Here one of the advantages of colored troops was made
apparent. They obeyed orders, and bided their time. When well
tangled in the abattis the death-warrant, ' Fire,' went forth. Southern
chivalry quailed before Northern balls, though fired by negro hands.
Volley after volley was rained upon the superior by the inferior race,
and the chivalry broke and tried to run." On the 8th of June Gen.
Gillmore, at the head of 3,500 troops, crossed the Appomattox, and
moved on Petersburg by turnpike from the north. Gen. Kautz, with
about 1,500 cavalry, was to charge the city from the south, or
southwest ; and two gun-boats and a battery were to bombard Fort
Clinton, defending the approach up the river. Gillmore was somewhat
dismayed at the formidable appearance of the enemy, and, thinking
himself authorized to use his own discretion, did not make an attack.
On the loth of June, Gen. Kautz advanced without meeting any
serious resistance until within a mile and one half of the city, drove
in the pickets and actually entered the city ! Gillmore had attracted
considerable attention on account of the display he made of his
forces ; but when he declined to fight, the rebels turned upon Kautz
and drove him out of the city. Gen. Grant had taken up his
headquarters at Bermuda Hun dreds, whence he directed Gen.
Butler to despatch Gen. W. F. Smith's corps against Petersburg. The
rebel general, A. P. Hill, commanding the rear of Lee's army, was
now on the south front of Richmond. Gen. Smith moved on toward
Petersburg, and at noon of the I5th of June, 1864, his advance felt
the out posts of the enemy's defence about two and one half miles
from the river. Here again the Negro soldier's fighting qualities were
to be tested in the presence of our white troops. Gen. Hinks
commanded a brigade of Negro soldiers. This brigade was to open
the battle and receive the fresh fire of the enemy. Gen. Hinks — a
most gallant soldier — took his place and gave the order to charge
the rebel lines. Here, under a clear Virginia sky, in full view of the
Union white troops, the Black brigade swept across the field in
magnificent line. The rebels received them with siege gun, musket,
and bayonet, but they never wa vered. In a short time they had
carried a line of rifle-pits,
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NEGROES AS SOLDIERS. 337 driven the enemy out in

confusion, and captured two large guns. It was a supreme moment ;
all that was needed was the order, " On to Petersburg," and the city
could have been taken by the force there was in reserve for the
Black brigade. But he who doubts is damned, and he who dallies is a
dastard. Gen. Smith hesitated. Another assault was not ordered until
near sundown, when the troops cleared another line of rifle-pits,
made three hundred prisoners, and captured sixteen guns,
sustaining a loss of only six hundred. The night was clear and balmy
; there was nothing to hinder the battle from being carried on ; but
Gen. Smith halted for the night — a fatal halt. During the night the
enemy was reenforced by the flower of Lee's army, and when the
sun light of the next morning fell upon the battle field it revealed an
almost new army, — a desperate and determined enemy. Then it
seems that Gens. Meade and Hancock did not know that Petersburg
was to be attacked. Hancock's corps had lingered in the rear of the
entire army, and did not reach the front until dusk. Why Gen. Smith
delayed the assault until evening was not known. Even Gen. Grant,
in his report of the battle, said : " Smith, for some reason that I have
never been able to satisfacto rily understand, did not get ready to
assault the enemy's main lines until near sundown." But whatever
the reason was, his conduct cost many a noble life and the
postponement of the end of the war. On the i6th of June, 1864,
Gens. Burnside and Warren came up. The i8th corps, under Gen.
Smith, occupied the right of the Federal lines, with its right touching
the Appomattox River. Gens. Hancock, Burnside, and Warren
stretched away to the ex treme left, which was covered by Kautz's
cavalry. After a con sultation with Gen. Grant, Gen. Meade ordered a
general attack all along the lines, and at 6 P.M. on the i6th of June,
the bat tle of Petersburg was opened again. Once more a division of
Black troops was hurled into the fires of battle, and once more
proved that the Negro was equal to all the sudden and startling
changes of war. The splendid fighting of these troops awakened the
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