Presidents under the knife: James A. Garfield

When James A. Garfield was sworn in on March 4, 1881 to become the twentieth president of America, little did he know how short his term would be. He was shot only four months into his presidency and would die an agonizing death seventy-nine days later. Garfield’s death was to a great extent caused by his doctors’ refusal to apply knowledge about antisepsis, despite the fact that Joseph Lister had reported his observations more than a decade earlier. Lister’s theories had been accepted by physicians in Europe but were looked down upon by many surgeons on this side of the pond, including those in leading positions in American surgery. A deranged Charles Julius Guiteau may have had a point when during his murder trial, he exclaimed, “Yes, I shot the President, but his physicians killed him.”

When Guiteau realized he would not be rewarded with the consulship in Paris or the mission in Vienna for what he considered was his essential help to get Garfield elected president, he turned against the President and became obsessed with finding a way to eliminate him. He bought a .44 snub-nosed revolver, a “British Bull Dog” known for its killing power. He spent hours at the Potomac River where he “deliberately practiced his arm and tested his weapon.”1 The opportunity to use the weapon arrived on the second of July. On that day, Garfield was scheduled to travel by train to New York City and meet his wife Lucretia who was returning from New Jersey after having spent time to recover from illness. They were going to be joined by several cabinet members and their wives on a two-week journey through New England. Guiteau knew from the president’s schedule, made public in newspapers, that Garfield was to board the train at the Baltimore and Potomac depot (the present site of the National Gallery of Art) at 9:30 am. Guiteau decided this would be the time to kill the president.

Garfield was accompanied by his Secretary of State, James Blaine, on the short ride from the White House to the train station in the morning of that fateful July 2. Blaine was not planning to join the President on the travels to New England but wanted to come along this morning to see Garfield off and get a chance to greet several of his colleagues in the cabinet and their wives. To get to the train, Garfield and Blaine walked through the ladies’ waiting room which was almost empty except a few passengers, a female attendant and one additional person: a “down-and-out-looking man” hiding in a dark corner of the room. He was initially unnoticed by Blaine and the President. Once they had passed, Guiteau stepped out from the shadow and approached the Garfield from behind. He pulled his weapon and fired twice.

The first shot hit Garfield’s right upper arm, causing only a superficial wound. The second bullet hit the president in the back and felled him to the floor. With the president on the floor in a pool of blood, panic erupted. A frantic search for any available physician was started. Within a couple of minutes, Dr. Smith Townshend arrived. His first action was to have Garfield swallow “a half ounce of brandy and a dram of aromatic spirits of ammonia.”2 Townshend’s second action was to insert one of his unwashed fingers into the wound on Garfield’s back probing for the bullet. He did not find the slug, only “a small clot of blood” which he removed with his finger.3 Townshend’s finger would be followed by numerous additional dirty digits inserted into the bullet hole by surgeons called to the President’s side.

The second doctor to arrive was Charles Purvis, the surgeon-in-chief at the Freedman’s Hospital. Doctor Willard Bliss (“Doctor” was one of his given first names) was the third physician to arrive on the scene. Bliss was considered an expert in gunshot wounds after serving as a surgeon in the Civil War and was considered by some as “one of the best surgeons in the army.”

Words about the shooting spread like wildfire. There were rumors about a coordinated conspiracy rather than a lone gunman and a palpable anxiety was rapidly engulfing Washington. Federal troops took up positions throughout the capital and the White House was closed off for the public.

Bliss, who put himself in charge of the president’s care, asked two of the country’s most respected surgeons to come and see the patient who was now back at the White House: David Hayes Agnew, professor of surgery at the University of Pennsylvania School of Medicine in Philadelphia, and Frank Hamilton, professor of surgery at Bellevue Hospital Medical College in New York City. They arrived early July 4. They found a patient with high fevers and repeated what Bliss had already done, inserting unclean fingers and instruments into the wound feeling for the ball. Like Bliss, they could not localize the bullet.

Although Bliss and his team and some of the other surgeons consulted during the course of Garfield’s treatment were prominent doctors, they have been described as “arrogant physicians who did not accept the new theory of antisepsis.” Their unclean fingers caused severe infections with abscesses developing throughout Garfield’s body. Critical voices started to be heard pointing out the recklessness and incompetence of Garfield’s care: “Pus had through carelessness and neglect been allowed to be in the wound till it rotted and pyemia had done its perfect work.” .

When a large abscess developed on Garfield’s back close to the bullet entrance wound, the star surgeon Agnew, assisted by Hamilton, opened the abscess by performing a surgical incision and drainage of purulent matter. Despite being “two inches in length and an inch and a half in depth,” the incision was not big enough, and a second operation was needed just two days later to more completely drain the abscess. Even though the procedures were performed by two of the country’s top surgeons, they were considered “an exercise in surgical incompetence” by a recent surgical historian. Despite excruciating pain during the operations, “the President displayed his usual courage … (and) … neither flinched nor moved.”4

After seventy-nine days of suffering, Garfield died from overwhelming infection on September 19, 1881. The predominant finding of the post mortem examination of Garfield’s body was that of widespread infections with abscesses located at multiple sites in the abdomen, the retroperitoneal space, and at distant locations, including in the right parotid gland. A remarkable finding was a pseudoaneurysm of the splenic artery, “nearly as large as a man’s fist,” with evidence of recent rupture.

Guiteau’s blaming the surgeons for Garfield’s death did not save him from execution. The murderer’s weirdness would continue to the bitter end. He was reported to have “danced his way to the gallows,” smiling and waving at the crowds and shaking hands with his executioner. He had written a poem, “I am going to the Lordy,” towards the end of his time in jail and had requested that an orchestra would be allowed to play while he sang the poem on the gallows. The request for music and singing was denied and instead Guiteau read the poem. He kept smiling as a black hood was placed over his head. The trapdoor opened, the rope immediately broke his neck, and gone was one of the most bizarre political murderers this country has seen.

___________

 This post contains material from Presidents Under the Knife: Surgical Successes, Failures and Deceptions © 2025 Per-Olof Hasselgren by permission of McFarland & Company, Inc., Box 611, Jefferson NC 28640.