Garfield II: A Lengthy Demise
What happens when twenty doctors put their grubby fingers in President Garfield's gunshot wound?
Charles Julius Guiteau, in events delineated in a previous article, had worked himself into a frenzy over then-President James A. Garfield. Somewhat unbalanced, Guiteau had decided that Garfield was the architect of a vast conspiracy to remove a faction of his political enemies from Congress. Additionally, Garfield had done the shabbily-dressed Guiteau the disservice of not appointing him to a consul Generalship in a foreign country. In addition to being horribly unqualified, Guiteau had the social graces of a sewer drain and had been creepily hanging around the White House trying to get a job for over four months.
President Garfield was faring much better. One of his chief opponents in Congress, Senator Thomas Platt, had recently been discredited in an episode involving a married lady: an opponent of Platt (and a friend to Garfield) had placed a ladder underneath the Senator's hotel room, only to have reporters happen upon it and the Senator frolicking inside. "Suicide is the chief mode of political death," remarked Garfield. On the day of the assassination, the President was reportedly doing handstands on his son's bed and generally being in lively spirits.
Unfortunately, this rosy scene came to a halt at about 8:30 AM on July 2, 1881. Guiteau met Garfield at the train station in Washington, and shot him in the back. While passersby had their own reactions,  doctors were quickly sent for. Dr. D. W. Bliss, a reknowned physician in Washington, soon arrived and did a few things: he gave Garfield hot water bottles for his feet, took them off, opened a window, closed it, poked his finger in the President's back, and called for local physician Dr. Robert Reyburn. Thinking this shooting business was a prank, Reyburn himself took a while to get there. He was the tenth doctor to arrive on the scene.
Together, this group hoisted the President onto a mattress and took him back to the White House. They gave him a shot of morphine and he vomited, saying, "Well, Doctor, I suppose that was the result of your hypodermic."
At 5:30 PM that day, the doctors removed Garfield's blood-stained suit. They gave him a glass of champagne, which he promptly threw up, and continued to throw up every half hour until morning. Navy Surgeon General Wales stuck his finger in the wound, and proclaimed the bullet had hit the President's liver. Some time early the next morning, Dr. Frank H. Hamilton of New York stuck his finger in the wound, but encountered a clot and thought better of it. In all, some fifteen doctors had their fingers in Garfield's side over the course of the evening. A medical journal editorial offered, "If there is any criticism to be offered from a medical point of view, it is that there were too many physicians in attendance during the first 24 hours... there is always danger to the patient when too many medical heads are put together."
News of the President's shooting flew around the country. Telegrams poured into the White House offering suggestions:
One suggested hanging the president upside down and allowing the bullet to fall out. Another urged that a rubber tube be inserted into the wound, attached to an air pump and the bullet removed by suction... a writer from Indiana enclosed a dozen bedbugs with his letter and suggested they be put in Guiteau's prison bed. One writer urged that Guiteau be forced to eat two ounces of his own flesh every day.
Guiteau himself was escorted off to prison. The train policeman, Patrick Kearney, was so excited to have arrested this man that he failed to remove the gun from Guiteau's person until after their arrival at the police station. A reporter arrived to sketch him, and Guiteau demanded a $25 royalty for doing so. Troops were stationed outside to stave off any possible lynching parties.
Meanwhile, the doctors busied themselves with treating Garfield. Unfortunately for the President, germ theory at the time was still widely ridiculed. Surgical conditions were unsanitary and operations lengthy, thanks to the recent invention of anesthetic. In The Murder of James A. Garfield, James C. Clark notes
The appearance of pus was considered vital to healing and was eagerly awaited. In 1879 William Savory, a leading London surgeon, said, "I am neither ashamed nor afraid to see well-formed pus... and as a rule, the condition is satisfactory under a layer of laudable pus." ...The healing process was long and painful, and infection and death were frequent. Conditions were often filthy, and doctors took some pride in the filth. The odor was dismissed as "a good old surgical stink." It was said that "every surgeon was proud of his old operating coat, which he neither washed nor changed, for the accumulating incrustation of dried blood and pus attested to his experience."
Joseph Lister had been advocating antiseptic methods since 1865, but was widely met with skepticism. "In order to successfully practice Mr. Lister's Antiseptic Method, it is necessary that we should believe, or act as if we believed, the atmosphere to be loaded with germs," opined one credulous American MD in 1878. The editor of The Medical Record, George Shrady, wrote, "...we are as likely to be as much ridiculed in the next century for our blind belief in the power of unseen germs, as our forefathers were for their faith in the influence of spirits...." Shrady later suggested that Lister "had a grasshopper in his head."
Garfield had the additional difficulties of dealing with two warring factions of doctors. In the nineteenth century most physicians could be pigeonholed into two categories: allopaths and homeopaths. Allopaths relied on what they called "heroic" measures, which usually meant invasive, drastic, and infection-begetting surgery. Homeopaths included phrenologists (who subscribed to the belief that one's personality and health could be determined by feeling bumps on the head), mesmerists, and the like. Homeopaths would also dilute various herbs, drugs, and poisons down to one part per billion in water, "dynamize" them by shaking up the vial, and administer them to their patients. While doubtlessly ineffectual, these curious methods did little harm, as compared to the rampant infections caused by the surgeons. Some days after the President's shooting, his personal physician, one Dr. Baxter, arrived. Baxter was a homeopath, and Bliss was an allopath. They promptly initiated a fistfight over the patient. Baxter backed down, left Bliss in charge, and never saw the President again.
Malaria was quite common in Washington in those days; most of all in the White House. The Washington Post had noted that "The old White House is unfit for longer use as a Presidential residence... It is literally packed with vermin from cellar to garret. Defective plumbing and the influences of an unhealthy location have saturated it with the seeds of disease." The swampy river valley of the Potomac proved to be a hearty breeding ground for mosquitoes, and dank, humid summer was mounting. Garfield had actually gone to the train station hoping to get out to the cooler state of Ohio. Accordingly, schemes immediately developed to keep the President cool during his recovery. Various machines involving wet muslin, blocks of ice or huge cooling engines were brought into the White House, given their moment of glory, and discarded out the back. One large air compressor was brought in from New York, assembled, and disassembled without ever working after the engineers realized they did not have an engine large enough to drive it. The Boston Herald reported on another scheme: "...the water in the troughs that supplied the linen cloths became warm and useless... The President takes great interest in this." One machine arrived that actually would have worked, had Garfield's doctors not insisted on leaving one door and one window open in the room. Eventually the director of the U.S. Geological Survey built an air conditioner that functioned fairly well, but one of the technicians lost a finger when it fell on him. He claimed $500 for the loss, and was paid $150.
Having exhausted the possibilities of their own fingers, the physicians were ready to pass their search for the bullet into the unsteady hands of technology. Alexander Graham Bell had invented a metal detector to find the intruding particle, and brought it to the White House on July 26, some three weeks after the shooting. This obsession with finding the bullet was a curious one; the doctors would have been unable to do anything about it other than comfort themselves with the knowledge. Bell's device was two electromagnets connected to a telephone receiver; it was to click when a metal object passed in between the magnets. In any event, it didn't work; Bell was searching in the wrong part of Garfield's body. Garfield also lay on a bed with metal springs; this was surely unhelpful. Bell's wife wrote to her mother, "Mr. Garfield himself is reported to have said that he was much obliged, but did not care to offer himself to be experimented upon."
Garfield's diet was not one for a man with a poor stomach. He received beefsteak, eggs, and brandy daily. Soon he was vomiting continuously, and to stave off his weight loss (he had lost some 80 pounds in six short weeks), his doctors opted for nutritional enemas. They mixed together an egg, one ounce of boullion, one and a half ounces of milk, a half ounce of whiskey, and ten drops of opium and inserted this stew into the President's rectum. Needless to say, this strategy proved ineffective. The doctors operated to remove the bullet, and, not finding it, opted instead to insert pus drainage tubes. Someone stole bone fragments taken from the President's body afterwards, perhaps as momentoes. The doctors released promising news to the press, and recorded their own dismal expectations in their private journals. The press, to its credit, quickly grew skeptical of the reports and suspected the President's death was near.
An infection raged in his system. Pus drained voluminously from the wound, and his face grew large and puffy as a salivary gland near his ear filled with more purulence. On August 19 his right eye had swollen shut, on August 30 several incisions were made in his face to faciliate draining. Pus ran from most of his orifices, and he nearly drowned in his own secretions. The doctors attempted solid food and it was rebuffed; they substituted charcoal for the egg in the enema because the egg "in the judgment of the surgeons, was the cause of annoying and offensive flatus."
Fed up with the heat, Garfield dictated that he be moved to New Jersey. The region there was suffering the greatest heat wave in twenty years, and it did little to improve his condition. He deteriorated further, and died September 19. The Medical Counselor, a homeopathic journal: "Summing up the case from an allopathetic standpoint, the man Is ignorantly or willfully blind who fails to see that President Garfield's case has been the most grossly mismanaged case in modern history, and his sugeons are guilty of a deliberate attempt to throw the burden of a glaring incompetence upon Providence, rather than leave it where it justly belongs."
As a cheery post scriptum, we note that at the time the U.S. government offered no health insurance. Garfield's prolonged illness had generated over six figures' worth of medical and other bills. The bumbling MDs called for some $90,000 in expenses; not to mention the cost of installing all the air-conditioners, building train track to move the President to Ohio, and the large funeral. Congress footed the bill, but paid most of the claimants less than half what was requested. For example, Bliss billed the First Lady $25,000, and was given $6,500. The remainder of those purporting to be owed received no payment at all. As for Guiteau, he attempted to defend himself in court against everyone's wishes and was quickly hung for his crime. We are left to wonder if perhaps his was not the worst crime in this tragicomedy.
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