James A. Garfield

James Garfield is one of three presidents whose most notable accomplishment was to die while serving as president. William Henry Harrison barely lived long enough to give his inaugural speech, and Zachary Taylor, who did manage to get 500 days in office under his belt before dying of (most likely) food poisoning, probably needed another six months to leave his mark on the presidency.

But Garfield is one of the so-called “Lost Presidents” (Hayes, Garfield, Arthur, Cleveland, and Benjamin Harrison), as Garfield biographer Ira Rutkow calls them. The running joke is that the presidents between Grant and McKinley are noted for for their facial hair than their accomplishments. In most cases, this is not really a fair assessment. These presidents guided the nation out of the Reconstruction Period, built up the US Navy to take its current place among the most powerful fleets in the world, and began the reforms that kept American industry from becoming a block of monopolies. (Yes, I’m pretty sure they despise Benjamin Harrison in the offices of BP North America, IBM, AT&T, and Microsoft.)

Garfield, however, was cut down by Charles Guiteau, a man who would make Glenn Beck shudder with the level of his paranoia. But Guitaeu did not kill Garfield. In fact, at his trial, he argued that the doctors killed Garfield.

Actually, they did. How?

Let’s compare the most similar presidential shooting to Garfield’s, that of Ronald Reagan. In 1881, Reagan would have been a dead man walking after being shot. The surgical techniques to save Reagan simply did not exist in 1881, nor did the X-Ray machine that would have found the bullet. Garfield?

His wounds suggest he should have lived. However, a dozen physicians, none of whom could be called quacks by any stretch of the imagination, all manipulated Garfield’s bullet wound with unsanitary hands. It’s quite likely that, had carbolic acid been poured into the wound and the doctors’ hands been washed before touching the entry point, Garfield would have, at worst, had a very nasty summer with the resignation of perennial pain-in-the-ass Senator Roscoe Conkling as the best get-well present ever. Instead, Garfield’s physician, D.W. Bliss, usurped control over the president’s treatment. When the president did not respond, Bliss began to flail, all the while putting out deceptive bulletins assuring the nation that Garfield was on the mend. In reality, he could not keep food down, and Bliss even attempted a bizarre means of providing food through rectal feeding (a practice that would soon be discredited.) By the final weeks of Garfield’s life, it became clear to everyone but Bliss himself that the doctor’s own hubris was killing the president. But how did it get that far?

In reality, Garfield might have been shot at the right time in terms of what physicians knew. Certainly, Bliss, a former Civil War surgeon with an enviable record treating gunshot wounds, had enough experience to save the president. And in 1881, Joseph Lister was extolling the virtues of hand washing and antiseptic treatment. So why did things go so wrong?

Well, 1881 was a time when modern medicine was in its infancy. Many doctors simply did not understand or trust the discoveries about microbes and infection. Bliss was of the old school. Many others were disciples of Lister’s new methods. Even in the pre-antibiotic era, Lister’s protocols called for keeping the wound, all instruments, and physicians’ hands sterile. Because of this, Bliss likely killed the president before he even realized the patient was lost.

It is a tragedy, and no one can deny that Charles Guiteau deserved the full brunt of the justice system’s wrath. But let’s think about what might have happened one hundred years later, if Garfield, not Reagan, had stepped in front of John Hinckley’s bullet. According to Rutkow, himself a surgeon, Garfield would have, like Reagan, been whisked off the George Washington Medical Center and quite likely walked into the ER, the same as his eventual successor. Unlike Reagan, whose wound was much more severe however, Garfield would have spent only one night in the hospital before returning to the White House for a couple of days rest (and under the current system, been briefed by Vice President Arthur or Bush, depending on how your alternate reality works) before starting a rigorous physical rehab program. In short, Garfield’s first reaction would have been, “Ouch.” The rest would be anti-climactic.

What surprises me the most about Garfield’s death, however, is the ease with which Guiteau could get to the president, a mistake that would be repeated with William McKinley twenty years later. Even JFK moved in a hermetically sealed bubble that became even tighter after his own assassination. (Hint to future presidents: Open-topped cars are a really bad idea for powerful heads of state.) Lincoln, of course, served at a time when the president had no body guards. What is shocking is that Garfield, whose Secretary of War was Robert Todd Lincoln, also did not have such a detail. Neither did McKinley. (I’m assuming Teddy Roosevelt would have simply shot back or personally strangled his would-be assassin.) Both presidents were killed at point-blank range by people who, today, would likely be hitting you up for change on a street corner.

Over the course of 222 years under the Constitution, it’s inevitable that we’d lose some of the men serving as our chief executive to disease, old age, or a gunman’s bullet. Certainly, the killings should never have happened, but Garfield’s death is particularly outrageous. Twenty years after Lincoln’s murder, the government failed to protect America’s head of state. Compounding the atrocity is the aftermath. James Garfield should have been able to recover and finish his term. And in an era when presidents did not directly campaign for office, even a weakened Garfield could have won reelection without taxing his constitution too much.

We will never know.