Destiny of the Republic: A Tale of Madness, Medicine and the Murder of a President

by Candice Millard

Finally, after nearly two months of being chased by Guiteau, Blaine had had enough. When Guiteau cornered him one day, the secretary of state abruptly turned and addressed him directly. He told Guiteau that “he had, in my opinion, no prospect whatever of receiving” the appointment. Determined to end the matter once and for all, he snapped, “Never speak to me about the Paris consulship again.” Guiteau watched in shock as Blaine walked away, and then he returned to his boardinghouse, determined to warn Garfield that his secretary of state was a “wicked man” and that there would be “no peace till you get rid of him.”

Secretary of State James Blaine.

Conkling was confident that the legislature at Albany would reelect them both. However, on the last day of May, the same day that Lucretia’s doctors finally pronounced her well—telling Garfield, “with emphasis, it is ended”—both men were soundly defeated. Conkling received just a third of the Republican votes, and Platt six fewer than Conkling. “Stung with mortification at his inability to control the President, and believing that the people of this State shared his disappointment,” wrote the New York Times, Conkling “has thrown away his power, destroyed his own influence.”

the legendary senator who had declared himself Garfield’s enemy, and whose iron grip on his administration had threatened to destroy it before it had even begun, was alone and powerless in Albany. Three months after his inauguration, Garfield was finally free to begin his presidency.

NY Senator Roscoe Conkling, leader of the corrupt Stalwarts wing of the GOP.

The idea came to Guiteau suddenly, “like a flash,” he would later say. On May 18, two days after Conkling’s dramatic resignation, Guiteau, “depressed and perplexed … wearied in mind and body,” had climbed into bed at 8:00 p.m., much earlier than usual. He had been lying on his cot in his small, rented room for an hour, unable to sleep, his mind churning, when he was struck by a single, pulsing thought: “If the President was out of the way every thing would go better.” Guiteau was certain the idea had not come from his own, feverish mind. It was a divine inspiration, a message from God.

By the end of May, Guiteau had given himself up entirely to his new obsession. Alone in his room, with nowhere to go and no one to talk to, he pored over newspaper accounts of the battle between Conkling and the White House, fixating on any criticism of Garfield, real or implied. “I kept reading the papers and kept being impressed,” he remembered, “and the idea kept bearing and bearing and bearing down upon me.” Finally, on June 1, thoroughly convinced of “the divinity of the inspiration,” he made up his mind. He would kill the president. The next day, Guiteau began to prepare.

With his forthcoming celebrity in mind, Guiteau decided that his first task should be to edit a religious book he had written several years ago called The Truth: A Companion to the Bible. The publicity it would bring the book, he believed, was one of the principal reasons God wanted him to assassinate the president. “Two points will be accomplished,” he wrote. “It will save the Republic, and create a demand for my book, The Truth.… This book was not written for money. It was written to save souls.

As was true of most things in Guiteau’s life, The Truth was largely stolen. In a single-sentence preface, he insisted that “a new line of thought runs through this book, and the Author asks for it a careful attention.” There was, however, nothing new about The Truth. The ideas, most of them copied verbatim, came from a book called The Berean, which John Humphrey Noyes, the founder of Oneida, had written in 1847, and which Guiteau’s father had treasured, believing that it was “better than the Bible.”

The next stage of Guiteau’s plan was more difficult than the first. If he was to assassinate the president, he realized, he would need a gun. Guiteau knew nothing about guns. Not only had he never owned a gun, he had never even fired one.

In his letters and, he would later insist, his thoughts, Guiteau never referred to what he was about to do as murder, or even assassination. He was simply removing the president—in his mind, an act not of violence or cruelty but practicality.

When Blaine finally appeared, he and Garfield stepped out together for a walk. From the alley, Guiteau, who had passed the time examining his gun and wiping it down, watched as the two men walked down the street arm in arm, their heads close together as they spoke. Garfield’s camaraderie with his secretary of state enraged Guiteau, proving, he said, that “Mr. Garfield had sold himself body and soul to Blaine.”

One of those letters, however, he had addressed to just one man—General William Tecumseh Sherman. Scrawled on the back of a telegraph sheet, it read: To General Sherman: I have just shot the President. I shot him several times, as I wished him to go as easily as possible. His death was a political necessity. I am a lawyer, theologian, and politician. I am a Stalwart of the Stalwarts. I was with Gen Grant, and the rest of our men in New York during the canvas. I am going to the jail. Please order out your troops, and take possession of the jail at once. Charles Guiteau

he turned to the detective seated next to him and attempted to strike a deal. “You stick to me and have me put in the third story, front, at the jail,” he said. “Gen. Sherman is coming down to take charge. Arthur and all those men are my friends, and I’ll have you made Chief of Police.” Although he was in police custody, on his way to prison, Guiteau could not have been more pleased had he been bound for Paris, the consulship to France finally his. He complained that, for weeks, he had been “haunted and haunted and oppressed and oppressed, and could get no relief.” Now that he had finally carried out his divine mission, he could relax and enjoy what was to come. He believed he was about to shake off the poverty, misery, and obscurity of his former life, and step into the national spotlight. He felt happy for the first time in a long time. “Thank God it is all over,” he thought.

Although it seemed to everyone in the station that the president was surely dying, the injury he had sustained from Guiteau’s gun was not fatal. The second bullet had entered his back four inches to the right of his spinal column. Continuing its trajectory, it had traveled ten inches and now rested behind his pancreas. It had broken two of Garfield’s ribs and grazed an artery, but it had missed his spinal cord and, more important, his vital organs.

What Townsend did next was something that Joseph Lister, despite years spent traveling the world, proving the source of infection and pleading with physicians to sterilize their hands and instruments, had been unable to prevent. As the president lay on the train station floor, one of the most germ-infested environments imaginable, Townsend inserted an unsterilized finger into the wound in his back, causing a small hemorrhage and almost certainly introducing an infection that was far more lethal than Guiteau’s bullet.

Dr. Smith Townsend, the first physician on the scene after President Garfield was shot. Dr. Lister discovered the source of infections, but was ignored by by doctors such as Townsend.

While the cabinet members discussed Guiteau, a second doctor entered the room—Charles Purvis, surgeon in chief of the Freedmen’s Hospital. Although he was only thirty-nine years old, Purvis had already made history several times over. He was one of the first black men in the country to receive his medical training at a university, had been one of only eight black surgeons in the Union Army during the Civil War, and was one of the first black men to serve on the faculty of an American medical school. Now, as he leaned over Garfield, recommending that blankets be wrapped around his body and hot water bottles placed on his feet and legs, he became the first black doctor to treat a president of the United States.

Bliss when the doctor was expelled from the powerful District of Columbia Medical Society after disagreeing with its policy to bar black doctors and showing an interest in the relatively new medical field of homeopathy.

Dr. D. Willard Bliss. (“D.” for Doctor, his given first name).

More ominous for Garfield was the fact that Bliss had very little respect for Joseph Lister’s theories on infection, and even less interest in following his complicated methods for antisepsis.

As soon as Bliss arrived at the station in Lincoln’s carriage, he assumed immediate and complete control of the president’s medical care.

Bliss selected a long probe that had a white porcelain tip. Fourteen years before the invention of the X-ray, doctors used these probes to determine the location of bullets. If the tip came against bone, it would remain white, but a lead bullet would leave a dark mark.

Although the probe was finally out, Garfield had no respite. Bliss immediately began to explore the wound again, this time with the little finger of his left hand. He inserted his finger so deeply into the wound that he could feel the broken rib and “what appeared to be lacerated tissue or comparatively firm coagula, probably the latter.”

By this time, Purvis had seen enough. With a boldness that was then extraordinary in a black doctor addressing a white one, he asked Bliss to end his examination.

Had Garfield been shot just fifteen years later, the bullet in his back would have been quickly found by X-ray images, and the wound treated with antiseptic surgery. He might have been back on his feet within weeks. Had he been able to receive modern medical care, he likely would have spent no more than a few nights in the hospital.

Even had Garfield simply been left alone, he almost certainly would have survived. Lodged as it was in the fatty tissue below and behind his pancreas, the bullet itself was no continuing danger to the president.

If Garfield “had been a ‘tough,’ and had received his wound in a Bowery dive,” a contemporary medical critic wrote, “he would have been brought to Bellevue Hospital … without any fuss or feathers, and would have gotten well.” Instead, Garfield was the object of intense medical interest from a menagerie of physicians, each with his own theories and ambitions, and each acutely aware that he was treating the president of the United States.

Dr. Doctor Willard Bliss made it perfectly clear that he was in charge.

Later, when concern about the quality of the president’s medical care began to grow, journalists would ask how Bliss came to be in charge of the case. “He just took charge of it,” one doctor would say. “He happened to be the first man called after the shooting, and he stuck to it, shoving everybody else aside. Neither the President nor Mrs. Garfield ever asked him to take charge.” Outraged by this accusation, Bliss would insist that, in a private meeting, both Garfield and the first lady had asked him to be the president’s principal doctor and to “select such counsel as you may think best.” To his mortification, however, Lucretia herself publicly contradicted his statement. No such discussion had ever taken place, she said. Neither she nor her husband had chosen Bliss.

High on Bliss’s list of suspect medical theories was Joseph Lister’s antisepsis—a fact that would surprise no one less than Lister himself. “I had a taste of what has been alas! experienced so largely by our profession,” he had lamented years earlier, “how ignorant prejudice with good intentions may obstruct legitimate scientific inquiry.” This prejudice persisted despite the fact that, in the sixteen years since Lister had introduced it, antisepsis had fundamentally changed the way British and European doctors practiced medicine, and had saved countless lives. In his own hospital in London, Lister had not seen a single case of hospital gangrene or pyaemia, a particularly virulent and common form of septicemia, since he had begun using antisepsis.

Although five years had passed since Lister presented his case to the Medical Congress at the Centennial Exhibition, many American doctors still dismissed not just his discovery, but even Louis Pasteur’s. They found the notion of “invisible germs” to be ridiculous, and they refused to even consider the idea that they could be the cause of so much disease and death. “In order to successfully practice Mr. Lister’s Antiseptic Method,” one doctor scoffed, “it is necessary that we should believe, or act as if we believed, the atmosphere to be loaded with germs.”

Not only did many American doctors not believe in germs, they took pride in the particular brand of filth that defined their profession. They spoke fondly of the “good old surgical stink” that pervaded their hospitals and operating rooms, and they resisted making too many concessions even to basic hygiene.

Some physicians felt that Lister’s findings simply did not apply to them and their patients. Doctors who lived and worked in the country, away from the soot and grime of the industrialized cities, argued that their air was so pure they did not need antisepsis. They preferred, moreover, to rely on their own methods of treatment, which not infrequently involved applying a hot poultice of cow manure to an open wound.

Even in the moment when he learned that the president had been shot, Arthur was with Conkling.

Vice President Chester Arthur, a political opponent of President Garfield.

Across the country, among men and women of both parties, the prospect of Arthur in the White House elicited reactions of horror. Even a prominent Republican groaned, “Chet Arthur? President of the United States? Good God!” Arthur had never been seen as anything more than Conkling’s puppet, with no mind or ambition of his own.

As collector of the New York Customs House, he had rarely arrived at work before noon. In stark contrast to Garfield, he had been a lackluster student, and even now seemed to have little interest in the life of the mind. “I do not think he knows anything,” Harriet Blaine wrote disdainfully of Arthur.

It was Arthur’s friends, and, in particular, his close ties to Conkling, that worried Americans even more than his own questionable character. “Republicans and Democrats alike are profoundly disturbed at the probable accession to the Presidency of Vice-President Arthur, with the consequence that Conkling shall be the President de facto,” one newspaper reported.

those looking for a conspiracy had been given all the evidence they needed in the words of Guiteau himself. It was already widely known that, as he was being hurried away from the train station, the would-be assassin had shouted, “I am a Stalwart, and Arthur will be president!” Although Guiteau insisted he had acted alone, and both Conkling and Arthur quickly denied any relationship with him, in the minds of the American people the connection had been made.

White House was not much better. The structure had been built into sloping ground, and water constantly trickled in, keeping three layers of floors, two of which were made of unmortared brick, perpetually damp. The servants’ living quarters were dark, cold, and dank. The kitchen, which was underneath the central hallway, was almost beyond repair, with whitewash peeling from the ceilings and sifting down into the cooking pots. Over the years, the moist rooms and rotting woodwork had proved irresistible to the rats that roamed the city and woods. By the time Garfield and his family had moved in, the entire house was, in the words of one reporter, “packed with vermin from cellar to garret.” At night, when the office seekers had finally abandoned their hopes for the day and the staff had retired to their rooms, the family could hear rats scampering under the floorboards and rustling in the pantries. Worse than the whitewash in the soup or even the rats in the flour bins, however, was the house’s antiquated plumbing system. An inspection found that it did not even meet the most basic “sanitary requirements of a safe dwelling.” Much of the plumbing, one inspector noted, was “defective—not a little of it radically so.” The plumbing system had been built nearly half a century earlier and could not hope to hold up under the daily demands of waste from seven bathrooms in the primary living quarters, as well as the servants’ chambers, the kitchen, and the pantries. Many of the pipes ...

the city itself seemed noxious and diseased. Raw sewage floated down the Potomac, coating the thick summer air with a hazy stench, and dust and dirt settled over everything, from buildings to people.

For freed slaves, an impoverished and, until recently, almost entirely powerless segment of the population, Garfield represented freedom and progress, but also, and perhaps more importantly, dignity. As president, he demanded for black men nothing less than what they wanted most desperately for themselves—complete and unconditional equality, born not of regret but respect. “You were not made free merely to be allowed to vote, but in order to enjoy an equality of opportunity in the race of life,” Garfield had told a delegation of 250 black men just before he was elected president. “Permit no man to praise you because you are black, nor wrong you because you are black. Let it be known that you are ready and willing to work out your own material salvation by your own energy, your own worth, your own labor.”

Garfield’s plan was to “give the South, as rapidly as possible, the blessings of general education and business enterprise and trust to time and these forces.” The South had taken him at his word, and, for the first time in decades, had accepted the president of the North as its president as well.

With Garfield in the White House, the New York Times wrote, Southerners “felt, as they had not felt before for years, that the Government … was their Government, and that the chief magistrate of the country had an equal claim upon the loyal affection of the whole people.”

As he waited cheerfully in Cell Two, Charles Guiteau felt no remorse for his actions, or even fear for his life. He was, in fact, happier now than he had ever been. Having long thirsted for fame and recognition, he found the intense interest in his life and the frenzy of activity that surrounded him at the District Jail not terrifying but thrilling. “I felt lighthearted and merry the moment I got into that cell,” he would later say.

Nearly a month had passed since the shooting, but Bliss and his team of doctors were still probing Garfield’s wound in the hope of answering one question: Where was the bullet? Eager to help solve the mystery, Americans flooded the White House with letters not just of concern and sympathy but medical advice. “We received every morning literally bushels of letters,” one doctor in the White House would later recall. “Every crank … in the country seemed to think himself called upon to offer to cure the president.” One man sent the doctors plans for a suction device that he assured them would suck the bullet right out of Garfield. Another suggested that they simply hang the president upside down until the bullet fell out. A man in Maryland wrote to Bliss saying that there was no reason for concern. The bullet was not in Garfield at all, but with him in Annapolis.

Not only had Arthur begun to pull away from Conkling, but he had started taking political advice from a very different and, even to him, completely unknown source. After Garfield’s shooting, he had received a letter from a woman named Julia Sand. Although he had never met Sand and knew nothing about her, Arthur read the letter, and was surprised to find in it a reflection of his own tortured thoughts.

Americans’ complete lack of faith in Arthur had inspired her to attempt to inspire him. She was as brutally honest in her assessment of the situation as she was galvanizing. “Your kindest opponents say: ‘Arthur will try to do right’—adding gloomily—‘He won’t succeed, though—making a man President cannot change him,’ ” she wrote. “But making a man President can change him! Great emergencies awaken generous traits which have lain dormant half a life. If there is a spark of true nobility in you, now is the occasion to let it shine. Faith in your better nature forces me to write to you—but not to beg you to resign. Do what is more difficult & more brave. Reform!”

Arthur had been given an extraordinary opportunity, and he had found in Sand perhaps the one person in the nation who believed him capable of change.

“My new form of Induction Balance,” he had written to Bliss the day before, “gives brilliant promise of success.” Bliss, however, had a very specific definition of success. He expected Bell not only to find the bullet, but to find it where Bliss believed it to be. He would not allow the inventor and his assistant to waste his time or the president’s energy on fruitless efforts. It was understood that they were to search the right side of Garfield’s body, and only the right.

Now, his body, which had miraculously survived the initial trauma of the bullet wound, was so riddled with infection that he was literally rotting to death. Although Bliss closely tracked the spikes in the president’s temperature, the chills, restlessness, vomiting, pounding heart, and profuse sweating, he either did not know, or refused to acknowledge, that they were symptoms of severe septicemia. He also insisted that he was not worried about the small, pus-filled lumps that dotted Garfield’s back and arms. Known as “septic acne,” they were yet another indication of blood infection.

Unwilling to accept defeat, Bell redoubled his efforts from Boston, still believing that the president’s life could be saved or, failing that, that his invention would prove to have lasting value for others. Perfecting the induction balance was a personal and scientific obligation, and he was not about to abandon it now, whatever the cost. “Heartless science,” he would write years later, “seeks truth, and truth alone, quite apart from any consequences that may arise.”

Members of the White House staff filled the windows with tear-streaked faces, watching the solemn procession to the express wagon that waited on the gravel drive. As they looked down, Garfield looked up, caught sight of them, and lifted his hand in a feeble but warm wave. “A last token of amity,” one of the staff wrote, “from a man who loved the world and the people in it.”

Before the train could reach its final destination, however, it stopped short. The cottage sat at the top of a hill, and the engine was not strong enough to breach it. No sooner had the problem become apparent than, out of the crowd of people who had waited all day in the tremendous heat for Garfield’s arrival, two hundred men ran forward to help. “Instantly hundreds of strong arms caught the cars,” Bliss wrote, “and silently … rolled the three heavy coaches” up the hill.