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james a garfield

31 august 2008

Ira Rutkow's James A. Garfield might as well be titled Garfield Dying, given the lugubrious fact that about all Garfield managed to get done during his brief Presidency was expiring. Rutkow, a professor of surgery and a historian of 19th-century medicine, makes the most of the Time Books series injunction to examine an American Presidency. He explores the utter mess that Garfield's doctors made of treating a non-lethal (even by 1880s standards) bullet wound.

Garfield's doctors (chief among them a character whose actual given name was Doctor Willard Bliss) weren't malicious. But they were ignorant, presumptuous, embroiled in discipline-wide turf battles, and at times out-and-out mendacious. Garfield, conscious and lucid for much of the 79 days between his wounding and his death, had newspapers read to him every day. Since the lead story in most of the papers was Garfield's health, Bliss routinely lied to the press, hoping that his patient would rally at false reports of his own recovery.

The fact that Garfield could live for 79 days while his doctors stuffed unwashed probes, tubes, and fingers deep into his torn abdomen shows both how healthy he was to begin with, and how unserious the initial injury was. Charles J. Guiteau ("a lunatic with few sane thoughts," says Rutkow [131], but perceptive enough in this instance) claimed that "General Garfield died from malpractice" (130). If he'd been shot a hundred years later, Garfield would have been sitting up in bed at the White House the next morning on the road to full recovery, says Rutkow. Indeed, Ronald Reagan recovered quickly from a much more serious assault exactly a hundred years on. (One should note here that Rutkow's conclusion is at odds with that of Allan Peskin, Garfield's standard biographer, who argued in Garfield [1978] that the after-effects of the shooting were more serious than commonly believed; Rutkow, of course, has the advantage of medical expertise on the issue.)

Rutkow argues that the scandal of Garfield's maltreatment led to a paradigm shift in American medicine. The maintenance of a scrupulously disinfected medical environment, now taken for granted, had been proposed by 1881 – first by the brilliant Hungarian obstetrician Ignác Semmelweis in the 1840s, and then, in an independent rediscovery, by English surgeon Joseph Lister in the 1860s.

Despite a stemwinding lecture tour of the United States in 1876, Lister had made few inroads on convincing his American colleagues to adopt aspetic procedures. American medicine was torn by a bizarre contention between allopaths and homeopaths. All licensed American doctors are today allopaths of one school or another, but they would hardly recognize themselves in their late-Victorian forbears. The duty of an 1880s allopath, says Rutkow, lay in "heroic" treatment: bleeding, blistering, purging, and assorted reamings-out of the patient with frightening devices.

Homeopaths, by contrast, believed in non-invasive internal medicine (and still do, in their fringy modern incarnations). Garfield had always been treated by homeopaths until he was shot and his Secretary of War, Robert Lincoln, summoned the eminent military allopath Bliss to take charge of the case. The President's preferred homeopaths Susan Edson and Silas Boynton shadowed Bliss's treatment, trying to make their patient comfortable and do him no harm while Bliss continued to monkey around inside the President. Despite the fact that homeopathic philosophy is pure moonshine (it revolved then, as it still does, around doses of distilled water that had once been in contact with a pathogen), the homeopaths knew that the allopaths were hurting Garfield. They didn't know how to help him, though, and neither side in the debate had taken in the lessons taught by Joseph Lister. After the very public debacle of Garfield's death, most American doctors figured that a little sterilization in the theater couldn't hurt, and they were correct.

Garfield's doctors most likely changed history, though we cannot know exactly how. Garfield was young (just 49), energetic, extremely bright, a primeval policy wonk, and possessed of an ambitious edge that didn't seem to belong to his placid predecessor Rutherford Hayes or his somnolent successor Chester Alan Arthur. A Garfield presidency would have been extremely interesting. It's interesting enough in Rutkow's medical narrative, which brings home the tremendous suffering that its protagonist went through.

Rutkow, Ira. James A. Garfield. New York: Times Books, 2006.