The Excruciating Death of James A. Garfield—A Case of Medical Malpractice

President James A. Garfield being treated by doctors at the White House after being shot.  The wound was serious, but should not have been fatal.  Attempts to probe for the bullet--often with unwashed hands and fingers, widened the wound, caused more bleeding, pierced his liver, and ultimately led to a deadly and painful infection.

On September 19, 1881 President James A. Garfield died in agony on the Jersey Shore 78 days after being shot in the back by a disappointed office seeker in a Washington train station.  He had only been in office a total of 199 days, almost half that time incapacitated by his injury.  

One of the bullets that fired the morning of July 2 by Charles J. Gateau grazed the President’s arm.  The other lodged in his back near the spine.  It could not be found.  But the search for the bullet, rather than missile itself ultimately cost Garfield his life.  

Taken back to the White House several doctors over the next few days probed for the bullet with instruments, and with their own unwashed hands—a bad practice even in those days.  One doctor even managed to pierce his liver.  The resulting infection, probably caused by Streptococcus, resulted in “blood poisoning,” untreatable in the days before antibiotics. 

Alexander Graham Bell, left, attempted to locate the bullet with a magnetic device of his invention but was foiled by metal bed springs.

Still desperate to find the bullet, inventor Alexander Graham Bell was called in.  He had developed a magnetic device to locate the projectile.  It would have worked, too.  But neither he nor the other doctors realized that the bed on which Garfield was lying had a metal frame and springs—relatively uncommon at the time—rendering the magnetic devise useless.  Even if the bullet had been discovered, however, the infection had already taken hold and it was probably too late to save the President by surgery.

On September 9, Garfield was taken by train to a beach home in Elberon (now Long Branch) New Jersey in hopes that the sea air would revive him.  It didn’t.

Garfield was born in Moreland Hills, Ohio on November 19, 1831.  His father died when he was small and he was raised by his mother.  A gifted student, he attended college in nearby Hiram at a school maintained by his family’s Church of Christ (The Christian Church) denomination before going east to complete his education at Williams College in Williamstown, Massachusetts from which he graduated with distinction in 1856.

Returning to Ohio he took up preaching at the Franklin Circle Christian Church.  He decided against making a career in the ministry, but was ordained as an elder, making him the only clergy person ever elected President.  He remained a devoted church member the rest of his life.  

Garfield married in 1858 and began supporting his growing family as a teacher.  Meanwhile he privately studied law and entered politics.  He was elected to the Ohio State Senate as a Republican in 1859 and passed the bar the following year.

Garfield’s rise to prominence began as a youthful officer in the Civil War.  He helped raise the 42nd Ohio Volunteer Infantry Regiment and was named its Colonel.  Major General Don Carlos Buell gave him a command of a mixed brigade of Ohio and Kentucky Volunteer infantry and Virginia loyalist cavalry.  He helped clear Confederate forces out of western Kentucky and was promoted to Brigadier.  He was a brigade commander at Shiloh and at the Siege of Corinth, Mississippi.

Garfield as a young Brigadier General in the Civil War.

Pleading health concerns Garfield asked for leave from the Army and was elected to the U.S. House of Representatives.  He returned to active duty until the new Congress was sworn in and served as Chief of Staff for William S. Rosecrans, Commander of the Army of the Cumberland.  After the Battle of Chickamauga he was promoted Major General.  In December, 1863 he resigned his commission to take his seat in Congress.

Garfield quickly rose to prominence in the House as a hawk on the war and for a harsh Reconstruction policy.  He was handily re-elected every two years, despite having been brushed by the Crédit Mobilier scandal in which members of Congress were alleged to have taken bribes to support the Union Pacific Railroad.

In 1876 he was one of the appointed Republican Special Commissioners that handed the Presidency to Republican Rutherford B. Hayes despite lagging Democrat Samuel Tilden in the popular vote.  The same year he became Republican Floor Leader of the House.

In January 1880 Garfield was elected to the Senate by the Ohio Legislature, which had just returned to Republican hands.  He went to the Republican National Convention later that year pledged to support the candidacy of fellow Ohioan John Sherman.  At the convention the leading candidates, former President Ulysses S Grant and Maine’s James G. Blaine, were hopelessly deadlocked after multiple ballots.  Grant’s partisans, the so-called Stalwarts represented a return to business-as-usual and an aggressive use of political patronage.  Blaine and Sherman represented, to one degree or another advocates of Civil Service Reform and were nick-named the Half Breeds.  On the 36th ballot, Blaine and Sherman threw their combined support behind a surprised Garfield who won the nomination.

The election campaign, against another Civil War General, Democrat Winfield Scott Hancock, was close fought.  In addition the perennial issues of the pace of Reconstruction and Civil Service, Chinese immigration was a hot button issue in California, a crucial swing state.  Both candidates publicly opposed further Asian immigration.  A handwritten letter purporting to be from Garfield to an H.L. Morey of Massachusetts indicated he supported unrestricted immigration.  The firestorm threatened to effectively derail his campaign until Garfield proved that the letter was a forgery and that no H. L. Morey existed.  Public sympathy swung to the wronged Candidate.  The popular vote was tight—Garfield won by only 2,000 votes out of 8.89 million cast—but he handily won the Electoral College.     

Garfield in an official portrait during his brief presidency.

Garfield spent the first months of his term trying to put together a Cabinet in the face of opposition from Stalwart leader Senator Roscoe Conkling of New York.  Conkling had succeeded in getting his protégée, former Collector of the Port of New York Chester Allan Arthur on the ticket as Vice President, but he could not get the Cabinet posts he desired for his faction, particularly the patronage rich position of Post Master General.  Garfield nominated Blaine as Secretary of State and Robert Todd Lincoln, son of the martyred President as Secretary of War.   He gave the Post Master General job to a New York state rival of Conkling.  Conkling and the other New York Senator resigned in protest to the affront to Senatorial privilege, but were surprised when the New York Legislature did not promptly re-elect them.  After months of struggle, Garfield had consolidated his power and defeated the Stalwarts.  He finally was ready to turn to his agenda—the passage of Civil Service Reform and the defense of suffrage for Freedmen in the South.  He never got to either task.

Garfield with Robert Todd Lincoln at his side was shot in the back at a Washington railroad station by a man described as a "disappointed office seeker." 

On the morning of July 2 Garfield entered the Sixth Street Station of the Baltimore and Potomac Railroad for a trip to his alma mater Williams College where he was slated to make a speech.  He was accompanied by Blaine and Lincoln and two of his young sons.  He was shot in the back by Gateau, who had fruitlessly been pursuing an appointment as a U.S. Consul in Paris, a job for which he was manifestly unqualified.  After he was subdued by onlookers, Gateau told police that, “I am the Stalwart of Stalwarts!  Now Arthur is President!”

That led to brief speculation that the horrified Arthur or other Stalwarts were somehow involved in an assassination plot.  Gateau, however, was quickly proven to have acted alone.  After the President died, his lawyers tried to defend him on the charge of murder by saying that the bullets he fired did not kill the Garfield, his doctors did.  Fair enough, but the doctors could have never botched their treatment if Gateau had not fired.  A jury quickly found him guilty and he was hanged on June 30, 1882.

This famous front page Puck cartoon depicts assassin Guiteau, the disappointed office seeker.  The public perception of Garfield as a martyr to Civil Service reform, forced the hand of incoming President Chester Alan Arthur, a veteran New York spoilsman himself and loyal Stalwart, to back reform.

The new president surprised everyone, including himself, by successfully pushing Civil Service reform through Congress.  Arthur signed the Pendleton Civil Service Reform Act into law on January 16, 1883, a fitting memorial to Garfield.

Robert Todd Lincoln, who had endured the assassination of his father and was at Garfield’s side when he was shot, was also in Buffalo, New York at the Pan-American Exposition at the invitation of the President when William McKinley was shot in 1901.  He understandably felt he was something of a jinx and declined all invitations to appear with other Presidents until the dedication of the Lincoln Memorial in 1922.  And that day, he was looking over his shoulder.