Post mortem (death portrait) photograph of an army hospital nurse holding a book, possibly a small bible. The revenue stamp on the back dates the image to 1864. Annapolis was the site of one of the largest Union Army Hospitals during the Civil War & at least 5 female nurses died of diseases caught while tending patients there.
This woman has her lips sewn shut. Before their burial, the deceased would be photographed in their best clothes and 'posing' (propped up) with their living relatives. In some instances, eyes were painted onto the closed eyelids of the deceased to make them appear alive. In Victorian times when photographs were rare, this might be the only photo the family had of their dearly departed.