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ca. 1882, Washington, DC, USA. When President James A. Garfield was shot on July 2nd, 1881, a mere three months and 28 days after his inauguration, the nation was shocked. Image by © Bettmann/CORBIS

President Garfield

Wounded by an Assassin, Killed by his Doctor

James Garfield was shot by a would-be assassin but killed by his doctors. His ending is a case of monumental malpractice. At his trial, Charles Guiteau, who fired the probably nonfatal gunshot, shouted, “Your honour, I admit to the shooting of the president, but not the killing.”

Guiteau was crazed, but that courtroom utterance was rational and accurate.

On July, 2, 1881, a deluded man named Charles Guiteau shot President James A. Garfield. The disabling and death of Garfield prematurely ended one of the most promising presidencies in American history. Garfield was a man of firm convictions who cooperated well with people and was widely admired. The last president born in a log cabin, Garfield rose from a more humble background than even Abraham Lincoln. Garfield distinguished himself in the Civil War, rising to the rank of Brigadier General at an earlier age that anyone else in American history. He had served nine terms in the House of Representatives, rising to Minority Leader during the presidency of Rutherford B. Hayes.

Garfield had ascended to the presidency during a time of deep turmoil. Black Americans had been freed from slavery but were still in the bondage of rampant racial discrimination. Garfield was a radical for his time. Even more radical than Lincoln, Garfield was not only a stout abolitionist but a believer in racial equality.

Another issue tearing the country apart was the question of how jobs in the civil service should be awarded. The patronage system, sometimes called the spoils system, meant granting civil service jobs to those who had supported the current president and worked for his election. However, many people wanted to see the connection between the civil service and political patronage severed. The Democratic Party was largely united in wanting to see a merit system enacted while the Republican Party was deeply divided over this issue. Supporters of continuing the patronage system were called “Stalwarts” for their stalwart defense of this status quo while Republicans favoring reform were called “Half-Breeds” because many considered them only “Half-Republican.”

The issue of the awarding of civil service jobs was pivotal in the assassination of President Garfield.

Only four months into Garfield’s presidency, Charles Guiteau, a dissatisfied office seeker and lunatic, shot the president twice once in the arm and once in the back. For the following 80 days Dr. D. Willard Bliss directed the care of the wounded Garfield. But it was not the assassin’s bullets that killed the felled president, but the inept care he received. Bliss believed that the antiseptic and sterilized operating conditions that Joseph Lister wrote about was quackery. In fact, Garfield’s bullet wound was searched by the bare and unwashed hands nine times without antiseptic on the day he was shot which led to the infections that riddled and weakened his body.

Despite the medical ineptness, James Garfield’s otherwise good health and physical fitness seemed to help the forty-nine year old president rally from his ordeal, and indeed for a few weeks, there was some hope for his recovery. The bullet in his side, however, remained elusive and a concern to Dr. Willard Bliss and his medical team.  A nationwide avalanche of letters poured in almost immediately with prayers, good wishes, and suggestions for the President’s treatment.

The letter from Dr. Alexander Graham Bell, offering to test his newly invented metal detecting device was enthusiastically received.  The President himself was interested in the experiment.  The test did not work, largely due to the metal bedsprings – but the concept would prove valid at a later date.

Then there was a letter suggesting that two strong men hold the President upside-down and shake him hard so the bullet would fall from his mouth.  That letter was filed away for the amusement of posterity.

Garfield with daughter Mollie 1870s.

James Abram Garfield was born on November 19, 1831 to Eliza and Abram Garfield. Abram died in 1833, leaving Eliza with five children to feed and deeply in debt. The family’s poverty was such that little James did not possess a pair of shoes until he was 4 years old. As an adult, he warned against romanticizing the hardscrabble life, saying, “Let us never praise poverty, for a child at least.”

James early became “enamored with reading” and shone in school. Nevertheless, as a youth he did not yearn for a higher education but for the swashbuckling adventures of a sailor.

At 16, James obtained a position on a canal boat. In six weeks, he managed to fall overboard no less than 14 times. On the first 13, men on deck pulled him up. The 14th fall was different – and traumatizing.

Falling overboard close to midnight, he screamed for help as he splashed in the water but his screams went unheard because no one was on deck. He grabbed on a rope and pulled himself up.

As he sat, dripping and scared, on the deck of the canal boat, Garfield wondered why he was still alive. The rope was not secured to anything on the boat. When he had pulled on it, it should have fallen off the deck, slipping to the bottom of the canal and leaving him to drown.

Garfield later wrote, “Carefully examining it, I found that just where it came over the edge of the boat it had been drawn into a crack and there knotted itself.”

Having his life saved by such a happenstance convinced James he was destined for importance. He wrote, “I did not believe that God had paid any attention to me on my own account but I thought He had saved me for my mother and for something greater and better than canalling. . . . Providence only could have saved my life. Providence, therefore, thinks it worth saving.”

He turned out to be a gifted learner and was hired at Hiram College to teach where he had been a student. Garfield was elected as an Ohio State Senator, nine-time United States Congressman from Ohio, and served as a General in the Union Army during the Civil War. After the war in Congress, Garfield was a tireless supporter of freed slaves and political reform railing against the political spoils system.

Garfield was a skilled and compelling orator. In 1880, at the Republican National Convention he was asked to give a nomination speech for the Secretary of the Treasury, John Sherman, who was running for the presidency. His spellbinding speech so moved the conventioneers that Garfield himself was nominated on the 35th ballot.

An engraving of James A. Garfield’s assassination, published in Frank Leslie’s Illustrated Newspaper.

When President James A. Garfield was shot on July 2nd, 1881, a mere three months and 28 days after his inauguration, the nation was shocked. Lincoln’s assassination was deemed a sort of war casualty, a freak occurrence brought on by Civil War, not the opening of a floodgate, so presidents had no security detail and moved about in public places like anyone else. It was easy, therefore, for a disgruntled office-seeker/nutjob with a delusional amount of self-regard like Charles J. Guiteau to approach Garfield at the Baltimore and Potomac Railroad station in Washington, D.C., and shoot him twice. One bullet penetrated his lower back; the other grazed his right arm.

Even from a few away and taking his victim by surprise with a shot to the back, Guiteau was too incompetent to kill immediately. Garfield lived for 79 days, two months and 17 days of agony, before dying of blood poisoning on September 19th, 1881. Sadly, as you might have deduced from his cause of death, Garfield’s doctors were in part, maybe even in large part, responsible for the president’s painful death, a point that Guiteau made at his trial when he took responsibility for shooting Garfield but not for killing him. That outcome he laid at the doctors’ door, with a little help from God, of course, who was behind the whole thing, according to Guiteau.

Although Joseph Lister had first published his successful tests of disinfection with carbolic acid in 1867 and had travelled across the United States in 1876 lecturing on his method, even though by 1879 Lister’s antiseptic protocols were almost universally adopted in Europe and Great Britain, the majority of American surgeons in 1881 rejected Listerism. They took pride in that “good old surgical stink” caused by years of accumulated blood and pus and god knows what all assorted fluids on their surgical gowns. Garfield’s doctors were no exception.

The first doctor to arrive at the scene was the District of Columbia’s health officer Dr Smith Townsend. He gave Garfield brandy and smelling salts to keep him conscious, and then stuck his doubtless germ-laden fingers into the entrance wound, fishing around hoping to find the bullet. Nine more doctors followed, each poking and prodding the suffering man. As a crowd gathered, Townsend ordered the President be moved to a room on the second floor. Garfield’s cabinet members, who had come to the station to see him off, kept vigil by his side. One of those cabinet members, Secretary of War Robert Todd Lincoln, was particularly traumatized by seeing so painful a history repeat itself. He sent for Dr Willard Bliss, one of the surgeons who had tried (and failed) to save his father’s life.

The white marble sculpture of James A. Garfield. This white Carrara marble sculpture by Alexander Doyle captures James Garfield just as he stood beside a chair to deliver a speech in Congress.

D.W. Bliss. The inept doctor who killed President Garfield. Only four months into Garfield’s presidency, Charles Guiteau, a dissatisfied office seeker and lunatic, shot the president twice once in the arm and once in the back. For the following 80 days Dr. D. Willard Bliss directed the care of the wounded Garfield. But it was not the assassin’s bullets that killed the felled president, but the inept care he received.

Bliss arrived and immediately took over. He administered morphine and had a go at tracking the bullet, sticking his pinky finger and a number of metal probes into the wound. One of the probes was jammed in so deep that it got caught in Garfield’s broken rib and had to be jiggled this way and that to remove it. Only after this examination was done did Bliss order Garfield transported to the White House.

There even more doctors showed up, including Dr Jedediah Baxter, Garfield’s personal physician. Baxter was turned away at the door by Bliss who insisted on taking complete control of the illustrious patient. Bliss was an egocentric martinet of a man, difficult to work with.  The medical team argued continually and vociferously, and often at the President’s bedside. Not only did the doctors debate medical treatment, but they feuded constantly over precedence and authority, each zealously guarding his purview and opinion, most of which were wrong.  As word leaked out about the quarrelsome physicians, they became a laughing stock.

Bliss dismissed all the doctors who had “helped” at the station and assembled his own team. Only two doctors were allowed to attend Garfield against Bliss’ wishes at the insistence of First Lady Lucretia Garfield: Dr. Susan Ann Edson, Mrs. Garfield’s personal physician and one of a very few women doctors in the country, and Garfield’s first cousin Dr Silas Boynton. Bliss still managed to shut them out from making any decisions on treatment, relegating them to a nursing role. Victorian bedside manners however, were designed to keep the patient and the patient’s family completely in the dark, most likely because the doctors had no answers.  They would “tsk” and “tut” and talk about things being in God’s hands, but they never discussed anything of consequence with either President or his wife. The only way the President found out “how he was”, was when his wife read the newspapers to him.  They ran daily bulletins on his temperature, pulse and respiration rates.

When Garfield survived the night and woke feeling refreshed, his breathing even, his temperature normal and his pulse rate a high but not alarming 114 beats per minute, it seemed his strong constitution might pull him through after all. His team of doctors did not leave well enough alone, however. They continued to obsess over the bullet, trying to find it so they could determine whether to remove it surgically or leave it in place. Without X-rays or other non-invasive technologies at their disposal and rejecting Lister’s precautions, unwashed fingers and probes were the method of choice.

No device existed that could locate a bullet within a human body, and doctors couldn’t remove a bullet without knowing where it was. So Alexander Graham Bell, the recent inventor of the telephone, created a device to do just that.

Enter Alexander Graham Bell. Bell was then at the crest of the wave of his fame. His telephone, patented in 1876, was a sensation that would make him a very rich man. Spurred by interference on the line caused by telegraph lines running near a telephone conductor, in 1877 he patented an induction balance system that used two conductors with equal and opposite induced currents to create a “quiet circuit.” Induction balance machines weren’t new (a certain Professor Dove in Germany had invented one in 1841), and metals were known to interrupt the currents. What Bell thought of when he learned of the President’s predicament was how to connect his telephone technology with induction balance technology so that the interruption in the current could be heard as a ring through a handheld earpiece. Working urgently, he came up with the induction balance, a coiled device that could detect metal in the human body.

Using an induction balance device by Professor D.E. Hughes, with the help of his assistant Charles Sumner Tainter and the input of many eminent scientists, Bell created an amplified induction balance machine that would hopefully detect the bullet inside the President. Bliss wouldn’t let him near his patient until the machine was tested on another human guinea pig, so the doctor directed Bell to try it on Lieutenant Simpson who had been carrying a bullet inside of him since the Civil War. On July 22nd, Bell tested the machine on Simpson. He heard a signal but it was weak so he added a condenser which increased the hearing distance and made the sound more detectable.

Alexander Graham Bell and wife Mabel.

Bell arrived in Washington on July 26th and passed the induction balance machine over Garfield’s right side and only his right side. That was at Dr Bliss’ insistence since he was sure the bullet was on the right and wanted to move the President as little as possible. The machine made a feeble sound over Garfield’s abdomen, the area Bliss and his crew thought the bullet was lodged in, but Bell was dubious that it was a legitimate signal. He went made more modifications to the machine, tested it on another Civil War veteran, a side of beef he’d stuck a bullet into and a thick bag of cotton he’d hidden a bullet in, and returned to the White House again on August 2nd. He got much the same results. The doctors took it as confirmation of their assessment. Bell thought it was interference from external metal elements, perhaps the springs under the mattress.

Bell had Tested it on Civil War soldiers with bullet fragments inside them; he verified the device worked as intended. For all its successful tests, it only failed twice — the two times Bell tried to find the bullet inside the president.

He was baffled about why it failed until he learned that Bliss hadn’t followed his instructions to remove the box spring to the president’s bed, which contained metal coils that would interfere with the detector.

Bell sought a third attempt with the box spring removed, but Bliss made a public announcement about Bell’s failure, and declared the device ineffective.

Charles Guiteau, the man who shot Garfield on July 2, 1881, has gone down in history as Garfield’s assassin. But given that Garfield survived for months before succumbing to his injuries, inadequate medical care was the more direct cause of the president’s death.

It was neither the bullet nor primitive medical practices of the time that killed Garfield, but the conscious, intentional negligence of one man — Dr. Bliss — who valued his own reputation and status over human life.

D.W. Bliss was a Union surgeon in the Civil War. After the Battle of Bull Run saw 2,000 Union soldiers, including his infantry, killed or wounded, it was alleged that he turned coward and ran, leaving wounded soldiers to die. After, rather than feeling guilt, he wrote to a relative, “A great battle fought. I am safe.”

When President Lincoln needed someone to help set up veterans’ hospitals, Bliss was recommended for the job. Lincoln, unaware of the Bull Run controversy, hired him. The president personally oversaw the building of a “jerry-rigged” local hospital called Armory Square, and appointed Bliss superintendent.

In April 1863, Bliss was arrested for taking a $500 bribe to use a certain inventor’s stove in the hospital. He was thrown in prison, but he had friends in high places. Sen. John Hale — whose daughter, Lucy, was engaged to actor John Wilkes Booth — agreed to represent him, and got the charges dropped.

When Booth shot Lincoln at Ford’s Theater in April 1865, an Armory surgeon named Charles Leale took charge, attempting to save the president. Recognizing his wounds as lethal, Leale summoned the president’s family and cabinet, as well as his personal doctor, Robert Stone, the surgeon general, Joseph Barnes, and Bliss.

Leale assigned Barnes and Stone tasks to assist him in treating the president. Despite the fact that Bliss was his boss, Leale gave him nothing to do. Bliss was forced to watch as history unfolded without him. But Bliss took credit as part of the team that tended to the president after the shooting, and his practice grew along with his unearned prestige. Everyone believed that Dr. D.W. Bliss had treated Abraham Lincoln. For Bliss, it was a lesson well learned.

ca. 1882, Washington, DC, USA. Bliss dismissed all the doctors who had “helped” at the station and assembled his own team. Only two doctors were allowed to attend Garfield against Bliss’ wishes at the insistence of First Lady Lucretia Garfield: Dr. Susan Ann Edson, Mrs. Garfield’s personal physician and one of a very few women doctors in the country, and Garfield’s first cousin Dr. Silas Boynton. Bliss still managed to shut them out from making any decisions on treatment, relegating them to a nursing role. Image by © Bettmann/CORBIS

Bliss used his newfound fame to promote and sell cundurango, a fake cancer cure, leading the Medical Association of the District of Columbia to charge him with “quackery.” But this, too, left the public memory in short order.

Robert Todd Lincoln, the president’s eldest son, was President Garfield’s secretary of war. That is how, less than two decades after his father was the first president shot while in office, he became a witness for the second.

Just after Garfield was hit, someone yelled, “The president’s been shot!” Lincoln, with rare experience in such matters, took charge.

First, he ordered the president moved to the White House. Then, remembering that his father had been attended to by a Dr. Bliss — and not knowing that Bliss had not been allowed to participate in his father’s care — he summoned the doctor to the White House.

As Bliss spoke to Lincoln, he mentioned his “friendship” with his father, and convinced the secretary to place him in charge. He had learned from Lincoln’s assassination, No one was going to shut him out this time.”

When Garfield, who had met and befriended Bliss when both were in their 20s, was informed that Bliss would be in charge of his care, he was delighted, unaware of the doctor’s many transgressions. In an era that had yet to embrace cleanliness as a weapon against disease, Bliss believed, “the dirtier, the better.”

His dirty probe snaked its way through Garfield’s back, deep enough that it snagged on one of his ribs. Then he stuck his finger into the wound, pushing further and further. Bliss formed the opinion that the bullet was close to the president’s liver. No matter what, he would not deviate from that conclusion.

As for presidential security, believe it or not it took another 20 years and yet another assassination in full public view, that of William McKinley on September 6th, 1901, for Congress to task the Secret Service with protecting the person of the President of the United States.

The unsanitary conditions were standard for the time, as sepsis prevention was not yet an accepted medical practice in the United States. But anesthesia administered while operating was, yet Bliss subjected Garfield to his probing without giving him anything for pain. In effect, he tortured the president for no reason, keeping him in “intense and unnecessary pain during the entire procedure.” Bliss then released a statement to the press stating the president “has returned to his normal condition,” which wasn’t true. Garfield was deteriorating; his vital signs were dropping, and he soon lost feeling in his feet.

Bliss was making his condition worse.

Unknown to anyone else, except the doctors he kept by the wayside, Bliss kept exploring for the bullet, making the wound bigger and bigger as he did

And always without anesthetic, keeping Garfield in pain. While Bliss “tried” to save the president, others took real measures. Given the oppressive July heat, the president’s secretary asked Simon Newcomb, a prominent scientist, if he could figure out a way to bring the president’s body temperature down.

Newcomb and several naval engineers created a device that forced air over ice blocks, effectively lowering the room temperature by twenty degrees; It was the world’s first air conditioner. While this lowered the president’s temperature, it did nothing to solve the problem of the bullet. But Bell was following Garfield’s plight closely, and contemplating solutions.

Believing that “electricity and magnetism” might help, he invented the induction balance. When he met with Bliss, their brief conversation left Bliss believing that “the person who wielded the invention was the one who would get credit for locating the bullet.” It also gave him the idea that if Bell could invent something, so could he.

The president was having trouble eating, Bliss would invent another way of him taking food, besides through his mouth. Bell instructed Bliss in advance to “move the president to a bed without metal box springs,” so they could search for the bullet without other metal confusing the signals.

When Bell arrived, Bliss insisted he be the one to hold the coil. Bell was surprised, but relented. But as Bliss “moved the coil from the wound down the back, beside the spine, and near the liver,” they heard nothing.

Bell was perplexed. The coil had worked every single time in the tests, yet was now ineffective. Bliss proclaimed the experiment over, and Bell thought he had failed. The inventor rechecked the device and made some tweaks. Testing it on soldiers again and finding it operable, he contacted Bliss for a second attempt. Not wanting blame for failing to do everything possible to save the president, Bliss agreed, but this effort failed as well.

Bell was beside himself, “certain it had to be some outside source at the White House that caused his experiment to go awry.” He returned to the Executive Mansion the next day, pressing the other doctors on whether some metal might have remained near the president, and only then learning that Bliss had ignored his instructions about removing the box spring.

But Bliss, having given Bell two attempts, saw no need to grant a third. He told the press of Bell’s failure, and newspapers “excoriated Bell as a charlatan. No one knew what Bliss had done to sabotage both of Bell’s attempts to use the induction balance on the president.” Bell’s life-saving induction balance was dead.

Now, Bliss would show the world that he, too, had an inventive mind.

Since the president had a poor appetite and needed his nourishment, Bliss had an idea. He would pump food up the president’s anus.

The Garfield Tomb, Lake View Cemetery, Cleveland, Ohio.

It had been proven several decades earlier that food was digested in the stomach and no other place in the human body. So when D.W. Bliss proposed to feed the president through the rectum he had to know it wouldn’t work. What it was, was torture. Bliss pumped specially treated blood as well as beef extract into the president’s intestines through his rectum. Garfield winced through the pain. He neither complained nor improved.

The doctor also operated on Garfield again to hopefully remove the bullet, without knowledge of the bullet’s location. He found nothing. After this, Garfield began a rapid decline, as “blood poisoning ravaged his body.

On Sept. 9, 1881, Bliss told Garfield that he was “getting out of the woods.” Garfield died 10 days later. Bliss conducted the autopsy with two other doctors. They cited “blood poisoning from the bullet wound” as the cause of death, but, the details of the coroner’s autopsy report did not back up their conclusions.

The autopsy showed that Bliss had created a false wound track with his painful probing. He had taken a three-inch entry wound and, in probing for the bullet, made a pus-infected wound track, twenty-one inches long. Worse, it was a false wound track, leading away from the bullet. A modern analysis of the report proved, that Bliss’ probing also “punctured Garfield’s bladder.

The autopsy showed that Bell’s invention didn’t work because it had not been placed anywhere near the bullet. Bliss was so convinced that the bullet was near the liver, it’s the only place he put the coil. The bullet had been stuck on the other side of Garfield’s body.

The doctors had debated the position of the elusive bullet for ten weeks.  An autopsy was performed, and they would finally find it.

To everyone’s amazement, they had all been grossly incorrect.  All their probing and poking had done was to create a false channel several inches long.  The bullet itself was lodged only an inch from where it had entered.

The bullet had also encapsulated itself, rendering it essentially harmless.   If they had done nothing, Garfield likely would have survived.  Thousands of Civil War veterans had lived for decades with bullets lodged somewhere in their bodies.  The insane assassin Charles Guiteau was right when he said at his trial, “I only shot at the President.  The doctors killed him.”

After Garfield’s death, Bliss sent a bill for his services to Congress, and they agreed to pay just a fraction. The fight over payment was ugly and public and Bliss lost. He continued practicing medicine until his death in 1889 at age 64.

On Sept. 6, 1901, President William McKinley was shot at the Pan-American Exposition in Buffalo, New York. (Amazingly, Robert Todd Lincoln was there, having accepted a presidential invitation to the event. After, he resolved to accept no more presidential invitations, and didn’t for over two decades.)

The X-ray machine had been invented five years earlier, but was still a scarce object. The nearest one was at the exposition, but the president’s doctors, caring for him at a nearby private home, considered it too risky to move him.

The only portable machine on the planet capable of detecting the bullet, was the induction balance. But Bliss had discredited the balance, which “would eventually be an exhibit in the Smithsonian Institute.” Therefore, doctors operated on the president with no idea where the bullet was.

Eight days after he was shot, William McKinley died from gangrene, He was buried with the death bullet still inside him; his surgeons never located it.

Charles Julius Guiteau was executed by hanging in a Washington, D.C. prison. Though few but history and trivia buffs know Guiteau’s name today, he was quite infamous at the time, and briefly was the most famous man in America. When Garfield died on September 19, 1881, this made Guiteau, already charged with attempted murder, the second successful Presidential assassin in American history.

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