The assassination of President James Garfield: Could he have survived?

James A. Garfield was elected U.S. President in 1880 and set out to govern a nation still deeply fractured by the Civil War and tense postwar regional differences in political views. Charles Guiteau was a social misfit, failed attorney, documented swindler, and wife abuser who harbored a deranged idea that he deserved a place in the newly elected president’s administration.* Failing to obtain even the slightest interest in his efforts, Mr. Guiteau felt “divinely ordained” to kill the president and apply for positions in the next administration.^† On July 2, 1881, he shot President Garfield twice with a .44 caliber British Bulldog revolver in the Baltimore and Potomac Railroad Station in Washington, DC.* The first wound was superficial, grazing the right arm; the second struck the right lower back area (see photo).

A changing time in medical history

D. Willard Bliss, MD, was summoned immediately to care for the president. He had practiced in Washington, DC, for 20 years and had been a medical officer in the U.S. Army during the Civil War. Dr. Bliss tightly controlled the care of and access to the ailing patient.

Viewed through the lens of modern trauma care, President Garfield’s wounds would be regarded as distinctly survivable. The president’s shooting came at a time when seismic changes in medicine were taking place. Lord Joseph Lister, a Scottish physician, had reported his nearly 20 years’ experience with antiseptic techniques, yet American surgeons were far behind their European colleagues in adopting them.* From the day of the shooting, and over the next nine weeks, Dr. Bliss and the attending physicians probed the president’s wound with their unwashed fingers or metal probes with little regard for sterility. Several local drainage procedures were performed, opening and draining the wound and its progressing formation of purulence.

Dr. Bliss placed great importance on localization of the bullet. He summoned Alexander Graham Bell to the White House with the intent of using Bell’s induction coil apparatus to perform a “noninvasive” procedure. Dr. Bliss allowed only a limited exam, which was unsuccessful.

Additionally, Dr. Bliss and his colleagues treated the ailing president with large doses of morphine for pain and quinine for what they mistakenly believed was malaria. This regimen was not only ineffective but contributed to poor oral intake. During the course of his hospitalization, the president lost nearly 80 pounds and was severely emaciated at the time of his death. Strict isolation from friends and family deprived the garrulous and intellectually inquisitive president of significant psychological support.

Despite repeated updates to an anxious nation from Dr. Bliss about the president’s “improving condition,” President Garfield expired September 19, 1881, as a result of overwhelming sepsis and profound nutritional deficit. An autopsy demonstrated massive abscess formation from the bullet track into the retroperitoneal area extending to the right groin area and severe emaciation.

Mr. Guiteau was tried and found guilty of murder. During his trial, he made the following observation in his defense, “I admit to shooting the president. It was the doctors who murdered him.”^† Mr. Guiteau was hanged for his crime on July 30, 1882.

Dr. Bliss defended his care of the president, despite substantial criticism from his contemporaries, until his own death in 1889.

*Rutkow I. James A. Garfield: The American President Series: The 20th President, 1881. New York, NY: Times Books; 2006.

^†Millard C. Destiny of the Republic: A Tale of Madness, Medicine and the Murder of a President. New York, NY: Doubleday Books; 2011.