Destiny of the Republic: A Tale of Madness, Medicine, and the Murder of a President by Candice Millard

Source of book: Borrowed from the library

True story: one of my wife’s co-workers complained about someone spoiling the end of the film, Lincoln. (In case you weren’t paying attention in elementary school, Lincoln dies.) Obviously, this is pretty funny, in a disturbing sort of way, because Lincoln is pretty famous. Not so famous, though, was James Garfield, the second American president to be assassinated. 

This book tells that story, with a particular focus the actual cause of Garfield’s death: medical “treatment.” In 1880, the United States was at a turning point in medical practice. A decade and a half prior, British surgeon Joseph Lister perfected sterilization, which drastically reduced infections and the subsequent deaths. However, doctors in the United States were largely resistant to the new knowledge, clinging to their encrusted aprons, and washing wounds with unboiled water. Not long after, John Harvey Kellogg would build an empire on the theory that all ills could be cured by a bland, vegetarian diet and enemas. Oh, and by giving up masturbation, which he claimed had killed more people than war or disease. So, he was pretty much a distillation of the American obsession with diet, medical quackery, and sexuality.

Candice Millard tells enough of the background of the assassination to set the events in historical and political context. She is a bit of a pro-Garfield partisan, but one can see why she would go that direction.

The post-Civil War United States was an interesting place. One key fight was over the policy toward the South, and also toward the former slaves. This was also the time of the Railroads, when widespread corruption led to a looting of the public treasury by the Robber Barons. (My review of Railroaded can be found here.) Crucial to this corruption was the “Spoils System.” As in, “to the victor belongs the spoils.” Government jobs were given as a reward for service to the candidate rather than for merit, and “machines” like Tammany Hall essentially ran local - and even national - politics. Two movements within the Republican Party battled. On the one hand, reformers such as James G. Blaine (who would later run for president) sought to eliminate the Spoils System and replace it with a Civil Service law granting jobs on merit. On the other was Senator Roscoe Conklin, a party boss and thoroughly corrupt defender of the Spoils System.

At the 1880 Republican convention, no clear winner was to be found. Blaine, John Sherman, and former president Ulysses Grant were those vying for the nomination. After days of wrangling, a movement arose to nominate Garfield, who didn’t even wish to run. Nominated, he was, however, and he felt compelled to accept.

Garfield seems to have been a decent guy in person. He was well read, having a house where the books spilled out of the library into stacks around the house. Even in the bathroom. (Actually, I worry that my house will be like that by the time I reach my 50s.) He was a supporter of full civil rights for African Americans, and was a friend of, and supported by Frederick Douglass. But he wasn’t much of a politician. I consulted one of my reference books, They Also Ran, by Irving Stone - a great book about those who lost presidential races - for more information. Stone wasn’t a fan of Garfield, in large part because he didn’t do much during his Senate career, and lacked a vision for his presidency. I think these criticisms are valid, as is the one that he tried to placate the Conklin faction by appointing people of dubious honesty to posts on his cabinet. Whatever the case, Garfield didn’t get much of a chance to govern, because he was gunned down by Charles Guiteau a few months into his administration.

Guiteau was an interesting character, and his story takes up a good portion of this book. Always a bit of a ne'er-do-well, he bounced from “career” to “career” without making much money. He primarily survived off of a combination of charity from relatives and fraud on his creditors. At one point, he became involved with John Humphrey Noyes, who founded the Oneida utopian colony and coined the term “free love.” Yeah, the late 1800s in America were weird times. In a really surreal twist, the Oneida colony eventually became the Oneida silverware company we know today. From utopian socialism and wife swapping to flatware. Who predicted that?

After leaving the colony - largely because they expected him to work - he spent time as a “preacher,” with a very limited audience, and then as a lawyer, never really making a success at anything. Narcissistic and self absorbed, he appears to have believed the world owed him a living, but somehow didn’t recognize his genius. He believed that he had been the person responsible for getting Garfield elected, and expected to be given a patronage in thanks. When that didn’t happen, he turned against Garfield, and shot him, expecting that he would be hailed as a hero. The turning point came after Guiteau survived a horrific steamboat accident (almost like the one fictionalized in Mark Twain’s The Gilded Age), and decided that God had given him a divine mission to assassinate Garfield.

The bullet that struck Garfield in the back clipped a minor artery, broke a couple of ribs, fractured the tip of a vertebra, but didn’t hit anything vital. In our modern times, he would probably have been treated and released after a day or two at most in the hospital. In his own times, had he been shot on the battlefield and received little to no treatment beyond food and water, he likely would have survived. In fact, many Civil War veterans survived worse, and were still walking around with bullets in them 20 years later.

Unfortunately for Garfield, he was attended to on the scene by Dr. D. Willard Bliss. Bliss was one of the surgeons who attempted to save President Lincoln years earlier, and was eager to have a success to go with that failure. Perhaps because the "D" stood for "Doctor." His parents were ambitious. Bliss stuck his finger into the wound - and then a series of probes designed to find the location of the bullet. Rather than do so, they merely opened new wounds and introduced bacteria. Furthermore, Bliss would railroad the family into putting him in charge of Garfield’s care, and drove away any physicians who did not agree with him.

Garfield would linger for two and a half months after the shooting, eventually succumbing to a massive septic infection. Guiteau may have been delusional about most everything else, but he did have a point (which he made at his trial for murder) that the doctors did more to kill Garfield than he did. One great point the author makes is just how similar Guiteau and Bliss were. The both were amazingly self confident and self absorbed, impervious to the opinions and desires of others. The Garfield shooting was viewed by both as the way they were going to make their fortunes and reputations.

One does wonder what would have happened had chance gone the other way. Had Garfield been shot earlier, when Guiteau lost his nerve, Bliss would not have been on scene, and he may have been cared for instead by Mrs. Garfield’s personal doctor, Susan Edson. (Bliss refused to let Edson do anything more than give nursing care. Sexist much?) In addition, a number of younger doctors had embraced Lister’s techniques, and would have insisted on sterilizing things before probing Garfield’s wound. Had any of these happened, he likely would have survived.

There was one progressive person who was allowed to assist with Garfield, and that was Alexander Graham Bell. Newly famous for his telephone, Bell was determined to find a less invasive way of locating bullets than the knife and probe. “Science should be able to discover some less barbarous method,” he said.

Bell did in fact invent a metal detector that could have done the job. But Bliss again interfered, forbidding Bell to use the device freely. Bell was permitted only to scan where Bliss believed the bullet was, rather than the other side of Garfield’s body. (Can’t allow one’s self to be proven wrong…) Needless to say, Bell’s experiment failed. It was not until the autopsy that the truth came out, and Bell realized that it wasn’t that his device had failed, but that he had been prevented from using it effectively.

It is easy sometimes to forget, living in the times we do, just how recently medicine has been revolutionized. Germ Theory was first proposed in the 1500s, based solely on observation of disease transmission. However, the great breakthroughs of Semmelweis, Pasteur, Lister, and Koch didn’t occur until the middle of the 19th Century. Really, we have had a mere 150 years of understanding of a seemingly basic reality.

One small biographical detail really drove this home. Garfield lost two children to disease during their infancy. His first daughter died of diphtheria, and his youngest son of whooping cough. Both of these used to kill thousands of people - mostly children. But now, they are preventable. However, efforts to eliminate these and other diseases are hampered by many who seem to prefer to follow the Kellogg approach. The more things change…

There are some other details which are really intriguing in this book as well. For example, Garfield was extremely popular with African Americans because of his support for civil rights. Thus, when Guiteau was being held in jail, one of the lynch mobs that tried to have at him was largely African American.

Another bit that the book discusses is the legal rule regarding insanity. Guiteau never had a chance, of course, of proving his insanity. The nation would have lynched him if the justice system didn’t execute him. But in hindsight, he does appear to have suffered from a significant disconnect with reality. While this book discusses the legal side of things, a much more detailed look at the neurobiological side of things can be found in Sam Kean’s outstanding book, The Tale of the Dueling Neurosurgeons.

It was also interesting to see what happened after the assassination. Vice President Chester Arthur was considered to be Roscoe Conklin’s errand boy when he was elected. However, Arthur somehow grew a spine after he became president, largely through the letters he received from Julia Sand, an invalid woman who encouraged him to be better than everyone expected him to be. Inspired by this encouragement, he rebelled against the machine, cutting Conklin off completely. Even worse, he supported and signed into law the Pendleton Act, which established the Civil Service Commission, effectively making government jobs the merit-based employment they are today. No more would a postal worker be out of a job when his party lost power. Say what you will about the bureaucracy, but it is far better than the Spoils System. Ironically, it was Garfield’s death that paved the way for civil service reform. It was widely (though wrongly) believed that Conklin had masterminded the assassination. When Guiteau shot this suggestion down, the belief switch to one that the Spoils System itself had given Guiteau his motive. And thus do unintended consequences make vast changes.

One more historical bit deserves a mention. Garfield had the support not just of African Americans, but of the large immigrant population, who saw in his hardscrable beginnings a bit of their own lives. When we think of immigration, we often forget the massive immigration between 1850 and 1930. This is the period when my own ancestors came to the United States. (In my case, between 1880 and 1895.) By the end of that period, there would be no fewer than 14 million living in America who were born overseas. Not only is this more than the number now, but when adjusted for population is incredible. In fact, the greatest immigration by percentage of the population occurred between 1845 and 1855. And there was a lot of bigotry and panic then too. Something to keep in mind when discussing the issue today. 

As I mentioned earlier, I found Garfield to be personally quite likeable. He rose from poverty to become highly educated across a wide range of disciplines, from literature to mathematics. (He even published an original proof of the Pythagorean Theorem, to the astonishment of everyone that someone in Congress could do it. Politicians haven’t changed much either, apparently…)

Garfield had a great affection for science as well, believing that it had done more good in the world than any other study. He has my respect for being both devoutly Christian and yet open to new discoveries, even when they changed longstanding religious superstition and tradition.

The scientific spirit has cast out the Demons and presented us with Nature, clothed in her right mind and living under the reign of law. It has given us for the sorceries of the Alchemist, the beautiful laws of chemistry; for the dreams of the Astrologer, the sublime truths of astronomy; for the wild visions of Cosmogony, the monumental records of geology; for the anarchy of Diabolism, the laws of God.

I couldn’t have put it better myself.

This is a fascinating and well written book. It is a good example of how even forgotten details of history can hold unexpected interest and truth.

Candice Millard also wrote The River of Doubt, about Theodore Roosevelt’s ill-fated South American trip, which also sounds interesting.