Physical Therapy for Benign Paroxysmal Positional Vertigo

Questions: 1. List two impairments that may be found during a vestibular assessment that would indicate a central versus a peripheral vestibular pathology. Indicate during which test or observation in which these impairments may be noted. 2. Identify and describe the treatment strategies that are the most beneficial for the posterior and horizontal canal based upon the Practice Parameter: Therapies for Benign Paroxysmal Positional Vertigo (An Evidence-Based Review): Report of the Quality Standards Subcommittee of American Academy of Neurology. 3. Based upon the Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo, describe whether you would provide post-treatment precautions to a patient you treated for BPPV. If you recommend restrictions, describe your restriction, rationale as to why, and your restriction duration. 4. Perform the Dix Hallpike and the Canalith Repositioning Maneuver for the posterior canal on any willing person. Describe your experience. Do you feel you are ready to perform this on a patient? Answers: 1. It has been observed that the reduction in an appropriate neural output can happen due to the dual effect of Peripheral Vestibular Disorders (PVD) and Central Vestibular Disorders (CVD). This effect and reduction in neural output hamper the eye movement and spatial orientation. Individuals facing this impairment have found to face various problems that include dizziness, falls, imbalance, bilateral vestibulopathy, vertigo associated with dysfunction of the auditory system, benign paroxysmal positional vertigo (BPPV), vertigo associated with brainstem and oscillopsia (visual blurring) (Bhattacharyya et al., 2008). Assessment and inspection of the tympanic membrane and external ear are one of the tests and observations that can find out the impairment. Other tests and observation include Cranial nerve examination that can identify the potential cause of hearing loss and palsies. Apart from this, Dix-Hallpike test can clinically confirm the diagnosis of the posterior canal for benign paroxysmal positional vertigo (BPPV). However, various other tests are also important in finding out the impairments (Kutz 2010). These tests are vestibular testing, radiographic imaging, audiometric testing, computerized posturography, balance and gait testing, electronystagmography, orthostatic balance testing, audiometry testing, bedside testing, etc. 2. Many scientists and researchers have claimed that Dix-Hallpike maneuver therapy is the best-known diagnosis for posterior canal based BPPV. The treatment includes a top pole of rotational beating with the presence of torsion and up beating nystagmus. The whole set up is focused on the downside (affected) ear of the patient. The therapy follows a technique where the patients head is turned 45 degrees towards the position where it needs to be tested, and then the head is laid back (Fife et al., 2008). During this process, if the patient is suffering from BPVV then the nystagmus would ensure it within a second. Hence, nystagmus along with Dix-Hallpix maneuver technique is considered the ideal therapy for posterior canal BPPV. The horizontal canal based BPPV is diagnosed with Dix-Hallpike or supine maneuver process. They produce two types of geotropic positions. In the first prototype, the geotropic position is presented towards the ground that is known as the horizontal geotropic. The second prototype produces the geotropic position facing away from the ground that is known as apo-geotropic. Both of these geotropic possess a direction changing paroxysmal positional nystagmus. The patient is tested while he/she is seated in a straight supine position (Post Dickerson 2010). The patient is examined with the help of nystagmus. The observation of nystagmus is recorded by turning the head of the patient each in left and right side once. The readings and direction of nystagmus finally verify the type of horizontal canal BPPV and identifies the nature (geotropic or apogeotropic). Moreover, certain other techniques have been identified for the treatment of horizontal canal BPPV that are barbecue roll maneuver, Gu foni maneuver and VannucchiAsprella liberatory maneuver techniques (Troxel, Drobatz Vite 2015). 3. I would suggest the patients of post-treatment precautions who have been treated for BPPV under my guidance. Firstly, I would advise the patient to perform Brandt-Daroff exercises. This particular exercise would help him/her get accustomed to the abnormal balance signal that is triggered from the particles of the inner ear. Moreover, it would also assist the brain of the patient to get used to his/her conditions and it would provide immense help for setting him/her up for the further therapy and treatment. Moreover, I would like to suggest the patient that he/she should perform the exercise in three sets in a single day and should continue doing it for at least two weeks. Apart from this exercise, I would also suggest him/her to maintain a proper balance exercise for vertigo like standing up with the feet resting together, moving the head from side to side (Zaidi Sinha 2013). These small activities are believed to help the patient to get the cure and overcome the benign paroxysma l positional vertigo (BPPV) related problems. Moreover, the following exercises need to be performed by the patient on a regular basis (at least five times a day for the two weeks and so on). On the other hand, individual studies and research works have revealed that self-administered Canalith repositioning procedure (CRP) if assisted with Semont maneuver and Brandt-Daroff techniques result in good post-treatment precautions for the patients. And hence, I would also like to suggest the patient perform CRP's to provide them with better precautions. Apart from this, certain restrictions should be followed by the patients at every time as post-treatment restrictions are as follows - Getting up slowly from the bed and sitting on the edge of the bed before standing Try to avoid leaning to pick up anything from the ground Avoid sleeping sideways with the year as that may cause fatal and severe consequences Need to be extra careful while reclining Physical sports like football, rugby or anything that requires a vigorous jerk to the body should be avoided Avoid to move the head up and down . Avoid tilting the head frequently 4. The experience that I gained is that the Dix-Hallpike test requires "head hanging" for the patient maintaining a 10-degree rise in head position. Now, if the movement fails, then tests for horizontal semicircular canals are conducted. Again, if no nystagmus result is obtained in this position, then posterior semi-circular canals are tested. Moreover, I have also observed that the head hanging position followed by right and left movement of the head results in the collection of canaliths that ultimately provides a positive outcome. However, I have also observed that failure in conducting the posterior semi-circular canal testing will eventually provide us with false negative results. I have also experienced that horizontal canal trial and repetition of Dix-Hallpike test will ultimately decrease the chances for the patient undergoing extra tests. Moreover, these additional tests often lead to misdiagnosis. Furthermore, I also understood that if vertigo or nystagmuses elicit a moveme nt then a proper and appropriate CRM is carried out. Yes, as a doctor I am very much confident and ready on the fact that I can perform these methods on the patients. Reference Bhattacharyya, N., Baugh, R. F., Orvidas, L., Barrs, D., Bronston, L. J., Cass, S., ... Fuller, D. C. (2008). Clinical practice guideline: benign paroxysmal positional vertigo.Otolaryngology-Head and Neck Surgery,139(5), S47-S81. Fife, T. D., Iverson, D. J., Lempert, T., Furman, J. M., Baloh, R. W., Tusa, R. J., ... Gronseth, G. S. (2008). Practice Parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review) Report of the Quality Standards Subcommittee of the American Academy of Neurology.Neurology,70(22), 2067-2074. Kutz, J.W., (2010). The dizzy patient.Medical Clinics of North America,94(5), pp.989-1002. Post, R. E., Dickerson, L. M. (2010). Dizziness: a diagnostic approach.Am Fam Physician,82(4), 361-68. Troxel, M. T., Drobatz, K. J., Vite, C. H. (2015). Signs of neurologic dysfunction in dogs with central versus peripheral vestibular disease.Journal of the American Veterinary Medical Association,227(4), 570-574. Zaidi, S. H., Sinha, A. (2013). Benign Paroxysmal Positional Vertigo (BPPV). InVertigo(pp. 81-90). Springer Berlin Heidelberg. Zhang, Y. X., Wu, C. L., Xiao, G. R., Zhong, F. F. (2012). [Comparison of three types of self-treatments for posterior canal benign paroxysmal positional vertigo: modified Epley maneuver, modified Semont maneuver and Brandt-Daroff maneuver].Chinese journal of otorhinolaryngology head and neck surgery,47(10), 799-803.

Should Orcas Be Kept in Captivity free essay sample

Should Orcas be Kept in Captivity? In my opinion I think orcas should not be kept in captivity because they are dangerous. They will not be kept in their natural habitat. And they get stressed from being enclosed. It is to dangerous for orcas to be kept in captivity. They are to hard to understand nobody knows what can happen. What if they go wild or something. What if they can’t control themselves. I mean they are used to doing every thing on their own. What if they get taught. What can happen. Also because they will not be kept in their natural habitat that can cause many things. Like since they know what to do alone then if we were to just like do every thing for them then they will forget to do it alone. All scientist may want is to study the orcas after that they my just let them go. We will write a custom essay sample on Should Orcas Be Kept in Captivity or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page That is not right because learning about something can take years. And in that time the people will do everything for them. Then when it’s time to let them go they won’t know what to do anymore because humans did everything for it. Also because they can get stressed out when being enclosed. Nobody knows what they can do people think look that orca is so cute but dangerous. What if it gets stressed and goes on rage. What will happen now. It can do anything now that it’s crazy. What if it gets to stressed and starts hitting everything and break the window were you can see them under water. They should not be kept in captivity. Orcas should once again not be kept in captivity because they are dangerous. They won’t be in their natural habitat and forget everything. And they are stressed being enclosed.

You Can Write a Computer Science Essay Online - Here Are Some Tips

You Can Write a Computer Science Essay Online - Here Are Some TipsOne of the requirements for the DNP (Digital Natives Package) Essay in Computer Science is writing a computer science-based essay. The Essay has to address specific topics and computer science research and development in current universities, colleges and universities. Students taking the test need to write a paper that is coherent with the rest of the course and needs to be original.There are several methods available for writing DNP Essay samples. Students can make use of book-length textbooks, books on CD or software to assist them. However, software is much more efficient, quick and easy to use. Students can use several practice essays using this software to gain familiarity with its operation.An efficient and popular program is the PowerPort Essay Program. It is easy to use and provides automatic editing of your essay. It will save you much time as you move on to solving other problems.If you are a student who wan ts to learn to write Computer Science-based essays, then you should look for Essay samples in your local library. Most of the books that have been written on this subject include Essay samples. Moreover, there are many websites that offer essays on these subjects.Writing a paper for any subject is not an easy task. Though it is hard, it is not impossible. If you are creative and eager to work on your writing skills, then the online essay writing services will prove to be beneficial.You may choose to do all the writing yourself or to employ the help of someone else for this purpose. There are many who prefer to hire a ghost writer to write the essay for them. However, this can become expensive.For those students who want to do it on their own, they need to understand the needs of the subject. They also need to find out what the subject is about. Only then, can they create their own personal idea for the topic.The Computer Science essay writing can prove to be a challenge if you want to do it alone. It is important that you study hard, practice your writing skills and use software to help you write the paper. You must be aware of the other considerations, so that you can solve your problems.

#8220;Argumentative Essay Sample on the Myth of the Half Soul #8220;

#8220;Argumentative Essay Sample on the Myth of the Half Soul #8220; Religion is a potent instrument in directing peoples opinions and conviction so the masculinity of the god it represent certainly have a impressive influence to those who believe that doctrine. When this attitude is taught to a child, he/she receives it as the ultimate truth. As he grows up, the patriarchal society imposes the same teaching through the stories like Beauty and the Beast, Psyche and Eros, Iseult and Tristan, and Lancelot and Guenevere. Because of how I was brought up, I am having a hard time believing that even divine scriptures could be only derived from what a writer just want to believe. And based from the book, the writer is a masculine imposing his power and control over women. The gender used in the Bible that refers to God only imposes mens superiority over women, so as the use of man instead of woman and he instead of she. Using god for this gender issue make patriarchy the natural and original thing. I disagree with the part where it is said that the romantic myth declares that a man longs to posses his beloved and that a woman longs to be posses, not only sexually, but emotionally and spiritually. It is like saying that women should be inferior compared to men. Because of the negative characteristics given to the first woman, females were prearranged to have the same personality. I prefer the first version of origin of humanity were man and woman were made together. It gives a sense of equality compared to that version where Eve was made for Adam. The myth about the rib only suppresses women’s image. Man is given the authority to say that they are guilty of sins but accuse Eve as responsible for it. Like in the story of Iseult, a couple could not be happily married forever because they followed the romantic expectations set for them. They must truly love each other and not just long for love. Females are posed to be the objects of the fulfillments of males needs. Even if women try to get away from this they could not free themselves because of what the society imposes. Instead of being compared to men by qualities like diligence and productiveness, they are measured by attractiveness and purity. The story of Beauty, in a way, could also tell mens weaknesses. The father and the beast depended on Beauty for their life. It lifts a womans worth and at the same time, she may not need any rescuing like what was shown on the retelling of Beauty’s story. The Myth of the Half Soul shows women that they have a choice. They could stand up to the standards made for them but may not be prepared for their worth. It does not mean that Romantic Love is not real if we cannot pin down what exactly we long for. Like the characters in the stories, women could be equal to men or could find their own Romantic love if they could understand the source of their love or the basis of their relationship with men.

Impact of Other Industries on Power Tools Industry Essay

Impact of Other Industries on Power Tools Industry - Essay Example Hand Tools are tools that are powered manually (U.S. Department of Labor, 2002). These tools are powered solely by the person using it and do not use motors (Wikipedia, 2007). These include hammers, screw drivers, hand drills, saws and knives etc., that require manual power to operate. The Hand Tools industry can be a threat for power tools. Though outdated and used less frequently, yet they can be the tools of choice by some consumers due to their lesser costs and supposedly longer lives. Hand Tools offer some benefits as compared to power tools, these don't rust easily, there is no expenditure required for purchasing batteries etc., electricity is not required to operate these and there are no essential scheduled maintenance requirements. Hence, hand tools can provide a cost competitive alternative for some people, mainly the Do-It-Yourself (DIY) type of customers. The forecasting for the hand tools industry depends upon the value the user derives from the use of these tools. The estimations can be obtained using customer surveys that show preferences of customers who are using hand tools. The surveys can provide valuable information about the features that power tools manufacturers should try to incorporate in their design if possible. In addition, some estimates can be developed by analyzing the revenues and sales data of various companies providing hand tools and then comparing this data with the power tools sales information to identify the extent of competition hand tools providers are posing for power tools industry. Bench Mounted Tools Bench Mounted tools are those that are not portable; these are fixed (mounted) at a place. Usually, these are required in small industries where tools like Thickness Planer, Saw Table etc. (Mitre 10, 2007) are used by a group of workers at the same time. These are mainly used where a number of people are involved in doing a single task like an assembly line where all workers follow similar procedures. In these kinds of situations, using portable tools is cost ineffective; instead the bench-mounted tools are used for efficiency and effectiveness gains. These are also used in metal working environments. The Bench Mounted tools industry provides competitions to the portable electric power tools industry because a large number of industries have now installed fixed tools instead of providing portable tools to all its workers. The forecasts can be derived by analyzing the historical industrial data for new technology deployment and from sales figure of these tools. Air Driven (Pneumatic) Tools Pneumatic tools are powered by compressed air and include chippers, drills, hammers and sanders (U.S. Department of Labor, 2002). These tools are usually used in the mechanical and automotive industries which require high power tools. They may pose a competition to the portable electric tools market where the electric tools face the threat of substitution. The relevant forecasts and statistics can be obtained by analyzing the market size and segmentation. Liquid Fuel and Hydraulic Power Tools These tools are operated by generating power from liquid fuel like gasoline or water. These are used in environments where there is a need of extremely high power to operate the tool. The industry data can be obtained for estimating the market size and usage level and then an estimate can be made regarding

Housing Pre and Post Recession Lab Report Example | Topics and Well Written Essays - 750 words

Housing Pre and Post Recession - Lab Report Example From figure 1, we see that the data starts off from the middle of a recession in 1982. It lasted only till the 4th quarter of the year. The percentage of GDP growth since then rose sharply until the 2nd quarter of 1982 and then started gradually moderating. The ensuing period was characterized by some volatility until the 1st quarter of 1991 from where the GDP growth dipped sharply and the second recession initiated. This recession also lasted only for two quarters. The decade of the 1990s marked a steady climb in the GDP growth rate and signs of the next recession were observed only in the first quarter of 2000 since when it started decreasing rapidly. This third recession lasted from the 1st quarter of 2001 to the last quarter of the same year. There was a small climb in terms of GDP growth since then until 2007. From the last quarter of 2007 the recent recession set in and it lasted for seven quarters making it the longest recession in the time horizon under consideration. Figure 1 Housing Starts Turning to the Housing markets, we start by looking at housing starts in Figure 2. Interestingly, apart from a steady dip a few quarters ahead of the current recession, inter-temporal movements in housing starts have been moderately stable. The recessions do not seem to have affected housing starts to any considerable extents and we find only small dips in the first two recessions. Strangely during the third recession, we find that housing starts actually increased. However, it can also be seen from the graph that housing starts exhibit a marked decline from around the 3rd quarter of 2005 onwards well into the recent recession. Figure 2 Average real housing prices The next housing market indicator considered is the real average housing price. As can be seen from figure 3, housing prices exhibit smooth but evident cyclical movements. Comparing these movements with figure 1 reveals that in terms of trends the housing price movements particularly in the latter half of the time horizon match those of the real GDP growth although real GDP volatility is considerably higher. The peaks and the troughs in the average housing price time plots are clearly distinguishable and there are substantially lesser reversals making the series a lot smoother. Although resemblances in trend are not so clear in the quarters before 2000, since then the GDP growth and housing prices seem to follow very similar patterns. Figure 3 Months’ supply Finally, in figure 4 below, we look at movements in months’ supply of housing across the duration considered. In between the first two recessions here, the series seems to have been substantially volatile though stably so, around a mean of 2. Thereon, the movements of the series have been relatively less volatile. Figure 4 We see from the figure that months’ supply has declined in periods subsequent to the 1st, 2nd and 4th recessions. After the 1982 recession, housing supply exhibits a small decline in the ge neral trend although it as mentioned earlier fluctuated around an average. A more pronounced decline in the series occurred following the 2nd recession in 1991. The strong declining trend during this phase continued on through the onset of the third recession. There was a surge in early 2005 reflecting what we know now as the gradually forming housing bubble. The series attained its maximum halfway into the fourth recession. The housing supply series seems to reflect a lagged

The American Civil War Essay Example for Free

The American Civil War Essay After the War of Independence the United States of America was governed by the Articles of Confederation. This provided for a weak central government and strong state governments. However, it proved unworkable and a new Constitution was adopted that resulted in a stronger Federal government with powers which included regulating interstate commerce as well as foreign affairs. The different states had varying policies concerning slavery. In some areas of the country where religious groups such as the Quakersplayed a prominent role in political life, there was strong opposition to having slaves. Rhode Island abolished slavery in 1774 and was soon followed by Vermont (1777), Pennsylvania (1780), Massachusetts (1781), New Hampshire (1783), Connecticut (1784), New York (1799) and New Jersey (1804). The new states of Maine, Michigan, Wisconsin, Ohio, Indiana, Kansas, Oregon, California and Illinois also did not have slaves. The importation of slaves from other countries was banned in 1808. However, the selling of slaves within the southern states continued. Conflict grew in the 19th century between the northern and southern states over the issue of slavery. The northern states were going through an industrial revolution and desperately needed more people to work in its factories. Industrialists in the North believed that, if freed, the slaves would leave the South and provide the labour they needed. The North also wanted tariffs on imported foreign goods to protect their new industries. The South was still mainly agricultural and purchased a lot of goods from abroad and was therefore against import tariffs. In 1831 Arthur Tappan and Lewis Tappan established the first Anti-Slavery Society in New York. When two years later it became a national organization, Tappan was elected its first president. William Lloyd Garrison, Theodore Weld, Samuel Eli Cornish, Angelina Grimke, Sarah Grimke Robert Purvis, Wendell Phillips, John Greenleaf Whittier, Frederick Douglass, Lucretia Mott, Lydia Maria Child, William Wells Brownsoon emerged as the main figures in the organization. Its main supporters were from religious groups such as the Quakers and from the free black community. By 1840 the society had 250,000 members, published more than twenty journals and 2,000 local chapters. The growth in the Antislavery Society worried slaveowners in the South. They feared that the activities of the abolitionists would make it more difficult to run their plantation system. Where possible they wanted to see an expansion of slavery into other areas. They therefore supported the annexation of Texas as they were certain it would become a slave state. They also favoured the Mexican War and agitated for the annexation of Cuba. Conflict grew in the middle of 19th century between the northern and southern states over the issue of slavery. The northern states were going through an industrial revolution and desperately needed more people to work in its factories. Industrialists in the North believed that, if freed, the slaves would leave the South and provide the labour they needed. The North also wanted tariffs on imported foreign goods to protect their new industries. The South was still mainly agricultural and purchased a lot of goods from abroad and was therefore against import tariffs. In 1850 Congress passed the Fugitive Slave Law. In future, any federal marshal who did not arrest an alleged runaway slave could be fined $1,000. People suspected of being a runaway slave could be arrested without warrant and turned over to a claimant on nothing more than his sworn testimony of ownership. A suspected black slave could not ask for a jury trial nor testify on his or her behalf. Any person aiding a runaway slave by providing shelter, food or any other form of assistance was liable to six months imprisonment and a $1,000 fine. Those officers capturing a fugitive slave were entitled to a fee and this encouraged some officers to kidnap free African Americans and sell them to slave-owners. Frederick Douglass, Wendell Phillips, William Lloyd Garrison and John Greenleaf Whittier led the fight against the Fugitive Slave Law. Even moderate anti-slavery leaders such as Arthur Tappan declared he was now willing to disobey the law and as a result helped fund theUnderground Railroad. In 1854 Stephen A. Douglas introduced his Kansas-Nebraska bill to the Senate. These states could now enter the Union with or without slavery. Frederick Douglass warned that the bill was an open invitation to a fierce and bitter strife. The result of this legislation was to open the territory to organized migrations of pro-slave and anti-slave groups. Southerners now entered the area with their slaves while active members of the Antislavery Society also arrived. Henry Ward Beecher, condemned the bill from his pulpit and helped to raise funds to supply weapons to those willing to oppose slavery in these territories. Kansas elected its first legislature in March, 1855. Although less than 2,000 people were qualified to take part in these elections, over 6,000 people voted. These were mainly Missouri slave-owners who had crossed the border to make sure pro-slavery candidates were elected. The new legislature passed laws that imposed the death penalty for anyone helping a slave to escape and two years in jail for possessing abolitionist literature. In 1856 Abraham Lincoln joined the Republican Party and unsuccessfully challenged Stephen A. Douglas for his seat in the Senate. Lincoln was opposed to Douglass proposal that the people living in the Louisiana Purchase (Louisiana, Arkansas, Oklahoma, Kansas, Missouri, Nebraska, Iowa, the Dakotas, Montana, and parts of Minnesota, Colorado and Wyoming) should be allowed to own slaves. Lincoln argued that the territories must be kept free for poor people to go and better their condition. Abraham Lincoln raised the issue of slavery again in 1858 when he made a speech at Quincy, Illinois. Lincoln argued: We have in this nation the element of domestic slavery. The Republican Party think it wrong we think it is a moral, a social, and a political wrong. We think it is wrong not confining itself merely to the persons of the States where it exists, but that it is a wrong which in its tendency, to say the least, affects the existence of the whole nation. Because we think it wrong, we propose a course of policy that shall deal with it as a wrong. We deal with it as with any other wrong, insofar as we can prevent it growing any larger, and so deal with it that in the run of time there may be some promise of an end to it. Lincolns speech upset Southern slaveholders and poor whites, who valued the higher social status they enjoyed over slaves. However, with rapid European immigration taking place in the North, they had a declining influence over federal government. Opponents of slavery were also becoming more militant in their views. John Brown and five of his sons moved to Kansas Territory to help antislavery forces obtain control of this region. With the support of Gerrit Smith and other prominent Abolitionists, Brown moved to Virginia where he established a refuge for runaway slaves. In 1859 John Brown led a party of 21 men in a successful attack on the federal armory at Harpers Ferry. Brown hoped that his action would encourage slaves to join his rebellion, enabling him to form an emancipation army. Two days later the armory was stormed by Robert E. Lee and a company of marines. Brown and six men barricaded themselves in an engine-house, and continued to fight until Brown was seriously wounded and two of his sons had been killed. Brown was executed on 2nd December, 1859. Southern slaveholders were outraged when in 1860 the Republican Party nominated Abraham Lincoln as its presidential candidate in 1860. They looked to the Democratic Party to defend its interests but when it met in Charleston in April, 1860, it selected, Stephen A. Douglas. Unhappy with this decision, Southern delegates decided to hold another convention in Baltimore in June, where they selected John Breckenridge of Kentucky to fight the election. The situation was further complicated by the formation of the Constitutional Union Party and the nomination of John Bell of Tennessee as its presidential candidate. Abraham Lincoln won with 1,866,462 votes (18 free states) and beat Stephen A. Douglas (1,375,157 1 slave state), John Breckenridge(847,953 13 slave states) and John Bell (589,581 3 slave states). In January 1862 the Union Army began to push the Confederates southward. The following month Ulysses S. Grant took his army along the Tennessee River with a flotilla of gunboats and captured Fort Henry. This broke the communications of the extended Confederate line andJoseph E. Johnston decided to withdraw his main army to Nashville. He left 15,000 men to protect Fort Donelson on the Cumberland River but this was not enough and Grant had no difficulty taking this prize as well. With western Tennessee now secured, Abraham Lincoln was now able to set up a Union government in Nashville by appointing Andrew Johnson as its new governor. General George McClellan appointed Allan Pinkerton to employ his agents to spy on the Confederate Army. His reports exaggerated the size of the enemy and McClellan was unwilling to launch an attack until he had more soldiers available. Under pressure from Radical Republicans in Congress, Abraham Lincoln decided in January, 1862, to remove the conservative Simon Cameron as Secretary of War, and replace him with Edwin M. Stanton. Soon after this Lincoln ordered George McClellan to appear before a committee investigating the way the war was being fought. On 15th January, 1862, McClellan had to face the hostile questioning of Benjamin Wade and Zachariah Chandler. Wade asked McClellan why he was refusing to attack the Confederate Army. He replied that he had to prepare the proper routes of retreat. Chandler then said: General McClellan, if I understand you correctly, before you strike at the rebels you want to be sure of plenty of room so that you can run in case they strike back. Wade added Or in case you get scared. After McClellan left the room, Wade and Chandler came to the conclusion that McClellan was guilty of infernal, unmitigated cowardice. As a result of this meeting Abraham Lincoln decided he must find a way to force McClellan into action. On 31st January he issued General War Order Number One. This ordered McClellan to begin the offensive against the enemy before the 22nd February. Lincoln also insisted on being consulted about McClellans military plans. Lincoln disagreed with McClellans desire to attack Richmond from the east. Lincoln only gave in when the division commanders voted 8 to 4 in favour of McClellans strategy. However, Lincoln no longer had confidence in McClellan and removed him from supreme command of the Union Army. He also insisted that McClellan left 30,000 men behind to defendWashington. Albert S. Johnston and Pierre T. Beauregard reunited their Confederate armies near the Tennessee-Mississippi line. With 55,000 men they now outnumbered the forces led by Ulysses S. Grant. On 6th April the Confederate Army attacked Grants army at Shiloh. Taken by surprise, Grants army suffered heavy losses until the arrival of General Don Carlos Buell and reinforcements. During the fighting Albert S. Johnston was killed and the new commander, Pierre T. Beauregard, decided to retreat to Corinth, Mississippi.Shiloh was the greatest battle so far of the Civil War. The Union Army suffered 13,000 casualties and the Confederates lost 10,000. However, the Union Army, with the arrival of General Henry Halleck and his troops, were now the stronger and had little difficulty driving Beauregard out of Corinth. The difference in manpower between the two sides now becoming more noticeable. Whereas the Union consisted of 23 states and 22,000,000 people, the Confederacy had only 9,000,000 people (including 3,500,000 slaves). President Jefferson Davis now announced that the South could not win the war without conscription. In April the Confederate Congress passed the Conscription Act which drafted white men between eighteen and thirty-five for three years service. In May, 1862 General David Hunter began enlisting black soldiers in the occupied districts of South Carolina. He was ordered to disband the 1st South Carolina (African Descent) but eventually got approval from Congress for his action. Hunter also issued a statement that all slaves owned by Confederates in the area were free. Lincoln quickly ordered Hunter to retract his proclamation as he still feared that this action would force slave-owners in border states to join the Confederates. Radical Republicans were furious and John Andrew, the governor of Massachusetts, said that from the day our government turned its back on the proclamation of General Hunter, the blessing of God has been withdrawn from our arms. The actions of General David Hunter and Lincolns reaction stimulated a discussion on the recruitment of black soldiers in the Northern press. Wendell Phillips asked, How many times are we to save Kentucky and lose the war? This debate was also taking place in the Cabinet, as Edwin M. Stanton was now advocating the creation of black regiments in the Union Army. Horace Greeley, editor of the New York Tribune, one of the leaders of the anti-slavery movement, urged Lincoln to convert the war into a war on slavery. Lincoln replied that he would continue to place the Union ahead of all else. My paramount object in this struggle is to save the Union, and is not either to save or destroy slavery. If I could save the Union without freeing any slave, I would do it; and if I could save it by freeing all the slaves, I would do it; and if I could do it by freeing some and leaving others alone, I would also do that. The federal fleet under David Farragut captured the forts guarding the New Orleans in April, 1862. The following month General Benjamin F. Butler and his troops took control of the city. Butler was accused of treating Rebels very harshly and after ordering the execution of a man who had torn down the United States flag, he was nicknamed the beast. Alexander Walker, a pro-Confederate journalist who was one of those arrested, complained that the prisoners were: closely confined in portable houses and furnished with the most wretched and unwholesome condemned soldiers rations. He added that some were compelled to wear a ball and chain, which is never removed. President Jefferson Davis accused Benjamin F. Butler of inciting African slaves to insurrection by arming them for war. Davis issued a statement ordering that Butler no longer be considered or treated simply as a public enemy of the Confederate States of America, but as an outlaw and common enemy of mankind, and that, in the event of his capture, the officer in command of the captured force do cause him to be immediately executed by hanging. During the summer of 1862, George McClellan and the Army of the Potomac, took part in what became known as the Peninsular Campaign. The main objective was to capture Richmond, the base of the Confederate government. McClellan and his 115,000 troops encountered the Confederate Army at Williamsburg on 5th May. After a brief battle the Confederate forces retreated South. McClellan moved his troops into the Shenandoah Valley and along with John C. Fremont, Irvin McDowell and Nathaniel Banks surroundedThomas Stonewall Jackson and his 17,000 man army. First Jackson attacked John C. Fremont at Cross Keys before turning on Irvin McDowell at Port Republic. Jackson then rushed his troops east to join up with Joseph E. Johnston and the Confederate forces fighting McClellan in the suburbs the city. General Joseph E. Johnston with some 41,800 men counter-attacked McClellans slightly larger army at Fair Oaks. The Union Army lost 5,031 men and the Confederate Army 6,134. Johnson was badly wounded during the battle and General Robert E. Lee now took command of the Confederate forces. On 26th June, 1862, Major General John Pope, was appointed the commander of the new Army of Virginia. Pope soon made it clear he intended to develop an aggressive approach to the war. Soon after taking command he issued a proclamation to his troops: I have come to you from the West, where we have always seen the backs of our enemies; from an army whose business it has been to seek the adversary, and to beat him where he was found; whose policy has been attack and not defense. I presume that I have been called here to pursue the same system and to lead you against the enemy. It is my purpose to do so, and that speedily. Major General John Pope was instructed to move east to Blue Ridge Mountains towards Charlottesville. It was hoped that this move would help McClellan by drawing Robert E. Lee away from defending Richmond. Lees 80,000 troops were now faced with the prospect of fighting two large armies: McClellan (90,000) and Pope (50,000) Joined by Thomas Stonewall Jackson, James Longstreet, and George Pickett, the Confederate troops attacked George McClellan atGaines Mill. and on 27th June. After severe fighting the Union Army losses were 893 killed, 3,107 wounded and 2,836 missing. Whereas the Confederate Army had 8,751 killed and wounded. George McClellan wrote to Abraham Lincoln complaining that a lack of resources was making it impossible to defeat the Confederate forces. He also made it clear that he was unwilling to employ tactics that would result in heavy casualties. He claimed that ever poor fellow that is killed or wounded almost haunts me! On 1st July, 1862, McClellan and Lincoln met at Harrison Landing. McClellan once again insisted that the war should be waged against the Confederate Army and not slavery. In July, 1862, John Pope decided to try a capture Gordonsville, a railroad junction between Richmond and the Shenandoah Valley. Pope selected Nathaniel Banks to carry out the task. Robert E. Lee considered Gordonsville to be strategically very important and sent Thomas Stonewall Jackson to protect the town. On 9th August, Jackson defeated Banks at Cedar Run. George McClellan and army based at Harrisons Landing was told to join Popes campaign to take the railroad junction. When Lee heard this news he brought together all the troops he had available to Gordonsville. On 29th August, troops led by Thomas Stonewall Jackson and James Longstreet, attacked Popes Union Army at Manassas, close to where the first battle of Bull Run had been fought. Pope and his army was forced to retreat across Bull Run. The Confederate Army pursued the Army of Virginia until they reached Chantilly on 1st September. The Union Army lost 15,000 men at Bull Run. John Pope was blamed for the defeat. A staff officer later recalled that Pope was entirely deceived and outgeneralled. His own conceit and pride of opinion led him into these mistakes. Relieved of his command Pope was sent to Minnesota to deal with a Sioux uprising. The government was now seriously concerned about the poor performance of the Union Army and Salmon Chase (Secretary of the Treasury), Edwin M. Stanton (Secretary of War) and vice president Hannibal Hamlin, who were all strong opponents of slavery, led the campaign to have George McClellan sacked. Unwilling to do this, Abraham Lincoln decided to put McClellan in charge of all forces in theWashington area. George McClellan became a field commander again when the Confederate Army invaded Maryland in September. McClellan and Major General Ambrose Burnside attacked the armies of Robert E. Lee and Thomas Stonewall Jackson at Antietam on 17th September. Outnumbered, Lee and Jackson held out until Ambrose Hill and reinforcements arrived. It was the most costly day of the war with the Union Army having 2,108 killed, 9,549 wounded and 753 missing. Although far from an overwhelming victory, Lincoln realized the significance of Antietam and on 22nd September, 1862, he felt strong enough to issue his Emancipation Proclamation. Lincoln told the nation that from the 1st January, 1863, all slaves in states or parts of states, still in rebellion, would be freed. However, to keep the support of the conservatives in the government, this proclamation did not apply to border slave states: Delaware, Maryland, Kentucky and Missouri that had remained loyal. Lincoln now wanted George McClellan to go on the offensive against the Confederate Army. However, McClellan refused to move, complaining that he needed fresh horses. Radical Republicans now began to openly question McClellans loyalty. Could the commander be loyal who had opposed all previous forward movements, and only made this advance after the enemy had been evacuated wrote George W. Julian. Whereas William P. Fessenden came to the conclusion that McClellan was utterly unfit for his position. Frustrated by McClellan unwillingness to attack, Abraham Lincoln recalled him to to Washington with the words: My dear McClellan: If you dont want to use the Army I should like to borrow it for a while. On 7th November Lincoln removed McClellan from all commands and replaced him with Ambrose Burnside. Throughout the autumn of 1862 the Confederate Army continued to make progress in Kentucky. However, in September, General E. Kirby Smith was halted by Union troops led by General Don Carlos Buell in Covington. The following month General Braxton Bragg installed a Confederate government in Frankfort, Kentucky. However, this was short-lived and on 8th October, 1862, Bragg came under attack atPerryville (Chaplin Hills). During the battle Don Carlos Buell lost 4,211 men (845 killed, 2,851 wounded, and 515 missing) whereas Braxton Bragg lost 3,396 (510 killed, 2635 wounded and 251 missing). After the battle Bragg was forced to retreat back to Tennessee. General Ambrose Burnside had replaced George McClellan as commander of the Army of the Potomac on 7th November, 1862. After complaints that had been made by President Abraham Lincoln and the Secretary of War, Edwin M. Stanton, about the inaction of the Union Army, Burnside was determined to immediately launch an attack on the Confederate Army. With a force of 122,000, Ambrose Burnside, Joseph Hooker, Edwin Sumner, William Franklin attacked General Robert E. Lee and his army of 78,500, at Fredericksburg, Virginia, on 13th December. Sharpshooters based in the town initially delayed the Union Army from building a pontoon bridge across the Rappahnnock River. After clearing out the snipers the federal forces had the problem of mounting frontal assaults against troops commanded by James Longstreet. At the end of the day the Union Army had 12,700 men killed or wounded. The well protected Confederate Army suffered losses of 5,300. Ambrose Burnside wanted to renew the attack the following morning but was talked out of it by his commanders.