James A. Garfield
Ira Rutkow
(Times Books)

    Goin' down the street the other day
    I heard the report of a pistol.
    I asked, what did that mean?
    A friend of mine looked up excited
    And he give me something like this:
    Oh them tell me Mr. Garfield is shot
    And is laying mighty low, mighty low
    Oh they tell me Mr. Garfield is shot.

--- "Mr. Garfield"
Bascom Lamar Lunsford

James Garfield is the kind of president we could wish to have working on our behalf right now. Like Adams, Jefferson, Wilson, Taft, and Clinton, he was a man of books, a man who seemed intrigued by learning, and words, with a benign view of justice. No politics from the hip here.

One visitor said of the books in his house, "They confront you in the hall when you enter, in the parlor and the sitting room, in the dining-room and even in the bath-room, where documents and speeches are corded up like firewood."

It was said that Garfield could "simultaneously write Greek with one hand and Latin with the other." In 1866, he argued before the Supreme Court the case of Ex parte Milligan, concerning oh deja vu whether citizens could or should be tried and sentenced to death by a military tribunal for engaging in what was deemed to be "treasonous activities." Garfield, then not only a representative in Congress but a practicing lawyer, was attorney for the penniless petitioners, and won. This was a president who would work to prevent citizens from being ordered hanged by a military tribunal when they were "far from the war zone ... where ordinary civil courts were in session!"

Garfield was in office but four months before he was shot. The focus of Rutkow's modest treatise is that Garfield was not killed by Charles Guiteau's bullet, but by a set of unspeakably ignorant doctors who had heard of Lister but had never acted on his theories, despite all evidence to the contrary. Thus they busied themself in sticking their dirty little mitts in the wound again and again, trying to find the bullet or to discover which organs or bones were damaged by the impact of the shot.

Rutkow is a clinical professor of surgery in New Jersey, and is obviously shocked by "the numerous individuals [who would] place their unwashed fingers and unclean instruments directly into the president's wound."

Dr. Willard Bliss, a friend of Garfield's, was on the scene from the beginning, and

    in an effort to determine the direction of the bullet track, he took the little finger of his unwashed and possibly manure-tinged left hand --- Bliss had arrived by horse --- and, in his words, "passed [it] to its full extent into the wounds."

From then on, and for the next seventy-nine days, Bliss was in charge of the treatment of the president. He restricted access to Garfield, even friends and family, fed the patient indigestible foods (and endless shots of morphine), and engaged in bitter battles with the press and other doctors, many of whom considered the treatment rudimentary and dangerous. Garfield's slow decline was attributed by Bliss to "blood poisoning," which Rutkow explains, probably indicates "widespread septicemia or pyemia."

Indeed, much of this book is a showcase of the appalling medical treatment available to most Americans in the 1870s. According to the author, the death of an otherwise healthy man from a simple wound was to not only destroy the careers of those who treated him, but was to change the course of medicine in America forever. And, ironically, one of the few to testify to this was Charles Guiteau himself, who, at his trial, stated, "The doctors ought to be indicted for murdering James A. Garfield, and not me."

Historians like to claim that Guiteau's success served to bring on new government agencies, the Civil Service, and the Secret Service. Probably more important than both was the fact that Frank Hamilton, David H. Agnew and Willard Bliss were too stupid to make use of Joseph Lister's findings which were soon enough to change the face of American medicine.

As the author writes, "Despite Bliss, Agnew, and Hamilton's genuine feelings of devotion toward Garfield and their sincere desire to see him get well,"

    the generational divide and the physicians' hubris resulted in the death of an American president.

The result all these years later is what we like to call "Modern Medicine" with its many benefits: breast enhancement, face-lifts, hours yawning in waiting rooms, painful penile implants, endless government and hospital forms to fill out, five minute visits, and the usual doctors' continuing lord-like hubris.

--- Fred G. Wise, M. D.
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