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

by Candice Millard

If a man murders you without provocation, your soul bears no burden of the wrong; but all the angels of the universe will weep for the misguided man who committed the murder. JAMES A. GARFIELD

they found the track of the bullet. “The missile,” they realized with sickening astonishment, “had gone to the left.” Following its destructive path—as it shattered the right eleventh and twelfth ribs, moved forward, down, and to the left, through the first lumbar vertebra, and into connective tissue—they finally found Guiteau’s lead bullet. It lay behind Garfield’s pancreas, safely encysted, on the opposite side of the body from where they had been searching.

Running down the right side of Garfield’s body was a long channel, which Bliss and eleven other doctors had probed countless times, convinced that, at the end of it, lay the bullet. The autopsy report stated that, while “this long descending channel was supposed during life to have been the track of the bullet,” it was “now clearly seen to have been caused by the burrowing of pus from the wound.” Pus, however, does not burrow. It simply follows an open path, which, in this case, was made by the doctors’ own fingers and instruments.

the infection that had ravaged Garfield’s body. Evidence of the proximate cause of his death, profound septic poisoning, was nearly everywhere they looked.

After removing most of his organs, they finally found it—a rent, nearly four-tenths of an inch long, in the splenic artery. The hemorrhage had flooded Garfield’s abdominal cavity with a pint of blood, which by now had coagulated into an “irregular form … nearly as large as a man’s fist.” This, they realized, had been the cause of the terrible pain that had forced him to cry out to Swaim just before his death.

Arthur delivered his inaugural address at the Capitol. To the surprise of everyone present, the new president made it clear that he had no wish to strike a different path from his predecessor. On the contrary, he seemed to hope for nothing more than to be the president that Garfield would have been, had he lived. “All the noble aspirations of my lamented predecessor which found expression in his life,” Arthur said, “will be garnered in the hearts of the people, and it will be my earnest endeavor to profit, and to see that the nation shall profit, by his example.”

The House of Lords, in agreement with the queen, decided that the country needed a clear, strict definition of criminal insanity. Less than four months after M’Naghten’s trial, the judges of the British Supreme Court ruled that, in essence, the difference between a sane man and one who was insane lay in the ability to distinguish between right and wrong. A defendant, they declared, could use the insanity defense only if, “at the time of the committing of the act, the party accused was labouring under such a defect of reason, from a disease of the mind, as not to know the nature and quality of the act he was doing; or, if he did know it, that he did not know he was doing what was wrong.” The M’Naghten Rule, while quickly adopted in the United States as well as in England, did little to improve the reputation of the insanity defense. In America, it became known as the “insanity dodge,” the refuge not of the mad but of the guilty.

“I plead not guilty to the indictment,” Guiteau stated, in a plea that he had drafted himself. His first and primary defense was “Insanity, in that it was God’s act and not mine. The Divine pressure on me to remove the president was so enormous that it destroyed my free agency, and therefore I am not legally responsible for my act.” Although Guiteau laid blame for the shooting squarely on God’s shoulders, he made it clear that his faith in divine intervention—at least when his own life was at stake—remained unshaken. “I have entire confidence in His disposition to protect me,” he wrote in the plea, “and to send me forth to the world a free and innocent man.”

Guiteau had planned to make an opening statement that day, but the judge refused to allow it. Frustrated, he turned to the long row of reporters seated behind him and handed them his statement. It was not a defense of his actions, or even an argument for insanity, but an indictment of the men who were, he argued, the president’s true murderers—his doctors. The situation, Guiteau insisted, was perfectly clear. “General Garfield died from malpractice,” he wrote. “According to his own physicians, he was not fatally shot. The doctors who mistreated him ought to bear the odium of his death, and not his assailant. They ought to be indicted for murdering James A. Garfield, and not me.”

“I deny the killing, if your honor please,” he said. “We admit the shooting.”

The trial,

ended on January 26, 1882. At 4:35 that afternoon, after more than two months of testimony, the prosecution rested. Less than an hour later, the jury returned with a verdict. “Gentlemen of the jury,” the clerk called out, his voice harsh against the perfect silence of the courtroom, “have you agreed upon a verdict?” The foreman, a man named John Hamlin, replied that they had. “What say you,” asked the clerk. “Is the defendant guilty or not guilty?” “Guilty as indicted, sir,” Hamlin said.

“I’m fully resigned,” Guiteau had told Hicks the night before, when he had woken just before midnight and asked to see the minister. “God has smoothed over the road to glory which I will travel tomorrow.”

After the doors were opened and the throng was allowed to parade past Guiteau’s body, while his brother silently fanned flies from his face, he was buried in the prison courtyard.

Today, two sections of Guiteau’s spleen, parts of his skeleton—including his ribs, left hand, and left foot—and a glass jar containing the pieces of his brain, which were eventually returned to Washington, remain in the Army Medical Museum, now known as the National Museum of Health and Medicine. These specimens are kept in a large metal cabinet with long, deep drawers. The drawer just below Guiteau’s holds the vertebrae of another presidential assassin—John Wilkes Booth—as well as a six-inch section of Garfield’s spine, which had served as an exhibit at Guiteau’s trial. A red, plastic rod rests in a hole in the knobby, yellowed bone, indicating the path of the bullet.

Secret Service agents would not be officially assigned to protect the president until after William McKinley was shot in Buffalo, New York, on September 6, 1901. The day McKinley was shot—he would die from his wounds eight days later—Robert Todd Lincoln was once again standing with the president, thus earning the dubious distinction of being the only man to be present at three of our nation’s four presidential assassinations.

With Garfield’s death, the cries of indignation reached such a fevered pitch that they could no longer be ignored. Finally, civil service reform would find its most powerful advocate in the most unlikely of men—Chester Arthur. No man in the country owed more to the spoils system—or to its most powerful advocate, Roscoe Conkling—than Arthur. Since Garfield’s death, however, it had become strikingly apparent that Arthur was no longer the man Conkling had made. “He isn’t ‘Chet Arthur’ any more,” one of Conkling’s men mournfully said after he had taken office. “He’s the President.” In his first official address as president, Arthur called for civil service reform. Just one year later, he signed the Pendleton Civil Service Act. This act, named for the Ohio Senator who sponsored it, transformed government appointments from what men like Conkling and Guiteau believed them to be—gifts given at the pleasure of powerful officials to those who had been most useful to them—into positions won on the basis of merit.

When Arthur left the White House, after having meticulously and beautifully renovated it, he was almost unrecognizable as the man who had been Garfield’s running mate and vice president. “No man ever entered the Presidency so profoundly and widely distrusted,” the well-known journalist Alexander McClure wrote, “and no one ever retired … more generally respected.”

New York City was buried under twenty-two inches of snow, more than twice as much snow as it had seen all winter. The wind howled at forty-five miles per hour, with gusts nearly twice as fast, and the city was littered with towering snow drifts, some as high as fifty feet.

Conkling insisted on going to work. Then, as the storm steadily worsened, he refused a hack driver’s offer to drive him for fifty dollars, and insisted on walking home. It took even Conkling, who was a famously vigorous walker, three hours to walk the three miles from his office to the New York Club at Broadway and Twenty-first Street. Moments after he walked in the door, he fell facedown onto the entryway floor. “He didn’t crumble, he didn’t collapse,” his biographer would write. “He fell full length. For he was that kind of man.”

Although there were many deaths in the late nineteenth century that even the most skilled physicians had no ability to prevent, Garfield’s was not one of them. In fact, following his autopsy, it became immediately and painfully apparent that, far from preventing or even delaying the president’s death, his doctors very likely caused it.

Bliss had done “more to cast distrust upon American surgery than any time heretofore known to our medical history,” one doctor wrote. Young surgeons, especially, were scornfully critical of Bliss’s care. “None of the injuries inflicted by the assassin’s bullet were necessarily fatal,” wrote Arpad Gerster, a thirty-three-year-old New York surgeon who had recently been in Europe, studying the “Listerian method of wound treatment,” and would write the first American surgical textbook based on that method. To the physicians of his generation, Gerster continued, Garfield’s death proved with certainty that, as the poet Thomas Gray had written more than a century earlier, “ignorance is Bliss.”

To the astonishment of the members of Congress, Bliss confidently presented them with a bill for $25,000—more than half a million dollars in today’s currency. While caring for the president, Bliss said, he had lost twenty-three pounds, and his health was “so greatly impaired as to render him entirely unable to recover or attend to his professional duties.” Congress agreed to pay Bliss $6,500, and not a penny more. Bliss, outraged, refused to accept it, bitterly complaining that it was “notoriously inadequate as a just compensation.” Seven years later, Bliss would die quietly at his home following a stroke, having never recovered his health, his practice, or his reputation.

Lucretia’s first concern, however, was for her husband’s papers. She asked Joseph Stanley Brown for his help in organizing them, and she used some of the money from the fund that had been established for her to build an addition to the farmhouse. The second floor of this wing was made into a library, which would become the nation’s first presidential library.

Like Bell, Joseph Lister would live a long life, long enough to see his ideas not only vindicated, but venerated. Over the years, he would be given his country’s most distinguished honors—from being knighted by Queen Victoria in 1882, to being made a baron by William Gladstone a year later, to being named one of the twelve original members of the Order of Merit, established in 1902 by Edward VII, Victoria’s son, to recognize extraordinary achievement. What Lister valued above all else, however, was the knowledge that doctors around the world now practiced antiseptic surgery, and that their patients had a far greater hope of keeping their limbs, and their lives.