General George H. Thomas, who had commanded the Army of the Cumberland, recommended Walker for the medal. General William T. Sherman reportedly added his own recommendation. The case went to President Andrew Johnson, who signed the award on November 11, 1865. Because Lincoln had been assassinated in April 1865, Johnson was the president who formally authorized the award; the question of when Lincoln had been involved, if at all, in earlier stages of the recommendation is not definitively resolved by available records. The presentation of the medal itself is dated to 1866 by some accounts, though the authorization document is dated November 11, 1865.
The citation acknowledged multiple dimensions of her service: her work as assistant surgeon in charge of female prisoners at Louisville, her care for the sick and wounded, and her four months as a prisoner of war. It was a recognition of sustained service over years, not of a single act of valor in a specific engagement. This would become relevant to the 1917 review.
She was the only woman to receive the medal — then or since. She was also one of only eight civilians ever awarded it.
## Wearing the Medal: The Years Between
After the war Walker resumed her multiple campaigns simultaneously. She was a physician who needed patients. She was a dress reformer who needed audiences. She was a suffragist and women’s rights advocate who needed forums. She was a writer who needed readers.
The pension was modest and the medical practice remained difficult to sustain. She wrote and lectured extensively. In 1871 she published *Hit: Essays on Women’s Rights*, a book that covered marriage, divorce, temperance, suffrage, working conditions for women, and dress reform. In 1878 she published *Unmasked*, a broader social critique. Neither book made her wealthy. She supplemented her income with lecture tours and occasional journalism.