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

by Candice Millard

  When Baxter arrived at the White House at 9:00 the next morning, he raced up the stairs, expecting to be immediately ushered in to see the president. Instead, he was stopped cold by the sight of Bliss, lying on a sofa in a room adjacent to Garfield’s. Bliss was in the midst of dictating a letter that he intended to have copied and distributed to the other doctors. When Baxter stepped into the room, Bliss greeted him pleasantly and invited him to take a seat, gesturing to the foot of the sofa on which he was lying.

  Exhausted from his frantic trip and astonished by the scene before him, Baxter refused to sit down, demanding to see Garfield. “Why, doctor,” Bliss said cordially, “it would not be proper for me to take you to the bedside of the President at this time.” Beginning to understand what was happening, Baxter made it clear that he would not be turned away. “He is my patient,” he said, “and I want to see him.” “Your patient,” Bliss replied. “You astonish me.” “Yes, my patient,” Baxter growled. “I have been his family physician for five years, and I wish to see him.” Tossing aside any pretense of professional concern, Bliss said coldly, “You may have been his physician for ten years, for aught I know, but you are not his physician this morning.”

  Still stretched out on the sofa, Bliss looked up at Baxter with contempt. “I know your game,” he spat. “You wish to sneak up here and take this case out of my hands. You just try it on.… I know how you are, sneaking around to prescribe for those who have influence and will lobby for you.” Enraged, Baxter shouted, “That is a lie!” At this, Bliss sprang to his feet, and his son, who had witnessed the entire exchange, leapt to his father’s defense, shouting at Baxter to leave. Baxter, painfully aware of “the impropriety of having any disturbance in a room next to that in which the President lay so grievously wounded,” snatched up his hat and strode out of the room, leaving Bliss standing, triumphant, outside Garfield’s door.

  Bliss’s coup, he felt, was complete. In comparison to Baxter, the other doctors would be easy to discourage. That day, he sent out copies of his dictated letter to each of them:

  Dear Doctor,

  At the request of the President, I write to advise you that his symptoms are at present so favorable, as to render unnecessary any further consultations, until some change in his condition shall seem to warrant it.

  Thanking you most cordially for your kind attention and skillful advice, and for which the President and family are deeply grateful.

  I remain

  very respectfully

  D. W. Bliss

  As expected, the men who had followed Garfield from the train station—even Townsend, the first man to treat the president after he was shot—left quickly and quietly after reading the letter, taking Bliss at his word that the president had chosen to trust his case, and his life, solely to him.

  Later, when concern about the quality of the president’s medical care began to grow, journalists would ask how Bliss came to be in charge of the case. “He just took charge of it,” one doctor would say. “He happened to be the first man called after the shooting, and he stuck to it, shoving everybody else aside. Neither the President nor Mrs. Garfield ever asked him to take charge.” Outraged by this accusation, Bliss would insist that, in a private meeting, both Garfield and the first lady had asked him to be the president’s principal doctor and to “select such counsel as you may think best.” To his mortification, however, Lucretia herself publicly contradicted his statement. No such discussion had ever taken place, she said. Neither she nor her husband had chosen Bliss.

  Lucretia, in fact, had taken matters into her own hands, securing for James two doctors of her choosing. The first was Dr. Susan Ann Edson, one of the first female doctors in the country and Lucretia’s personal physician. The stout, bespectacled doctor with the ring of tight gray curls had become such a familiar figure at the White House that even the Garfields’ youngest son, Abe, knew her well, referring to her as “Dr. Edson, full of Med’cin.”

  Although James had chosen Baxter for his own physician, Lucretia knew that he trusted Edson as much as she did. Just a month earlier, when Lucretia was near death, Edson had been among the handful of doctors he had asked to come to the White House. Not only did he know that her presence would be a comfort to Lucretia, but he had seen her skill and compassion six years earlier, when she had struggled to save his son Neddie’s life.

  Edson, who was referred to in the press as “Mrs. Dr. Edson,” had only just returned to her home and practice when her brother and sister, who had been shopping at a market near the Baltimore and Potomac, rushed to her with news of the president’s shooting. Quickly packing a small bag, she had reached the White House just as Garfield was being carried in on the train car mattress. His first words to her had been of concern not for himself but for his wife. “What will this do for Crete?” he had asked her anxiously. “Will it put her in bed again? I had rather die.”

  To Edson, however, Lucretia seemed stronger and more determined than she had ever been. The first lady not only welcomed the sight of her own doctor and insisted that she stay, but immediately sent for yet another physician, a man her husband knew well. Dr. Silas Boynton was James’s first cousin and had grown up “tramping through the woods” with him. Lucretia’s telegram to Boynton was brief but firm: “Please to have you come as soon as possible.”

  Bliss found to his surprise and frustration that, despite his determined efforts, neither Edson nor Boynton would leave. Annoyed by their persistence, and hampered by their connection to the first lady, Bliss informed them that, if they must stay, they would be permitted to perform only nursing duties, and would not be consulted as physicians in their own right. Ignoring this pointed insult to their education and experience, both doctors agreed to Bliss’s conditions, determined to remain close to the president so that they might watch over him when Lucretia could not.

  Very much aware that the world was watching, Bliss was determined not to make any missteps. His temporary ouster from the District of Columbia Medical Society years earlier for consulting with “irregulars”—physicians who were outside the mainstream of medical thought—had led him to shun any association with what he considered to be experimental medicine. In this case above all others, dangerous new ideas were to be avoided at all costs.

  High on Bliss’s list of suspect medical theories was Joseph Lister’s antisepsis—a fact that would surprise no one less than Lister himself. “I had a taste of what has been alas! experienced so largely by our profession,” he had lamented years earlier, “how ignorant prejudice with good intentions may obstruct legitimate scientific inquiry.” This prejudice persisted despite the fact that, in the sixteen years since Lister had introduced it, antisepsis had fundamentally changed the way British and European doctors practiced medicine, and had saved countless lives. In his own hospital in London, Lister had not seen a single case of hospital gangrene or pyaemia, a particularly virulent and common form of septicemia, since he had begun using antisepsis. He was certain that, were antisepsis to be adopted in the United States, “all evil consequences might be averted.”

  Although five years had passed since Lister presented his case to the Medical Congress at the Centennial Exhibition, many American doctors still dismissed not just his discovery, but even Louis Pasteur’s. They found the notion of “invisible germs” to be ridiculous, and they refused to even consider the idea that they could be the cause of so much disease and death. “In order to successfully practice Mr. Lister’s Antiseptic Method,” one doctor scoffed, “it is necessary that we should believe, or act as if we believed, the atmosphere to be loaded with germs.”

  Why go to all the trouble that antisepsis required simply to fight something that they could not see and did not believe existed? Even the editor of the highly respected Medical Record found more to fear than to admire in Lister’s theory. “Judging the future by the past,” he wrote, “we are likely to be as much ridiculed in the next century for our blind belief in the power of unseen germs, as our forefathers were for
their faith in the influence of spirits, of certain planets and the like, inducing certain maladies.”

  Not only did many American doctors not believe in germs, they took pride in the particular brand of filth that defined their profession. They spoke fondly of the “good old surgical stink” that pervaded their hospitals and operating rooms, and they resisted making too many concessions even to basic hygiene. Many surgeons walked directly from the street to the operating room without bothering to change their clothes. Those who did shrug on a laboratory coat, however, were an even greater danger to their patients. They looped strands of silk sutures through their buttonholes for easy access during surgery, and they refused to change or even wash their coats. They believed that the thicker the layers of dried blood and pus, black and crumbling as they bent over their patients, the greater the tribute to their years of experience.

  Some physicians felt that Lister’s findings simply did not apply to them and their patients. Doctors who lived and worked in the country, away from the soot and grime of the industrialized cities, argued that their air was so pure they did not need antisepsis. They preferred, moreover, to rely on their own methods of treatment, which not infrequently involved applying a hot poultice of cow manure to an open wound.

  Even those doctors willing to try antisepsis rarely achieved better results than they had with traditional practices. Their failure, however, was hardly a mystery. Although they dipped their instruments in carbolic acid, they used wooden handles, which could not be sterilized, and they rested them on unsterilized towels. If the surgical knife they had carefully sterilized happened to fall on the floor during an operation, they would simply pick it up and continue to use it. If a procedure required both hands, they would hold the knife in their teeth until they needed it again.

  In the midst of the arrogance, distrust, and misunderstanding that characterized the American medical establishment’s attitude toward Lister’s theories, there was a small but growing bastion of doctors who understood the importance of practicing antisepsis, not halfheartedly but precisely. A young surgeon in New York would later write that he and his colleagues had watched with helpless horror the progress of Garfield’s medical care. The president’s life might have been spared, he wrote with disgust, “had the physician in charge abstained from probing Garfield’s wound while he lay on a filthy mattress spread on the floor of a railroad station.”

  Even as far west as Kansas, Lister’s followers sought to intervene on the president’s behalf. In a letter to Lucretia the day after the shooting, Dr. E. L. Patee, a highly respected surgeon from Manhattan, Kansas, warned her that she must shield her husband from potentially harmful medical care. “Do not allow probing of the wound,” he urged. “Probing generally does more harm than the ball.” Although he lived far from what was then considered the center of medical thought in the United States, Patee had read carefully Lister’s work and understood its importance. “Saturate everything with carbolic acid,” he begged the first lady. “Our whole state is in … great grief. God help you.”

  Unfortunately, young, inexperienced surgeons and rural doctors had little hope of being heard. The morning after Patee wrote to Lucretia, two surgeons arrived at the White House, summoned there by Bliss. David Hayes Agnew, the chief of surgery at the University of Pennsylvania, and Frank Hamilton, a surgeon at the Bellevue Medical College in New York, were “old men,” an American doctor would write, “and not likely to be pioneers in a new field of surgery.” Both men had attended Lister’s talk at the Centennial Exhibition, and both had made it clear that they distrusted his ideas. So vigorously had Agnew and Lister disagreed that day that a journalist covering the conference had written that “these gentlemen used no buttons to their foils. Thrusts were given in earnest.” Hamilton had openly questioned the value of antisepsis, while extolling the virtues of his own practice of treating wounds with simple warm water, a common and germ-laden procedure that Lister had long warned “would in many cases sacrifice a limb or a life.”

  In the five years since he had heard Lister speak, Hamilton’s opinions had not changed, and his arrogance, it seemed, had only grown. Soon after reaching the White House, he assured a reporter that the president’s care would “bear the severest scrutiny of the experts,” and that there was little danger of him dying. “The symptoms are so encouraging,” Hamilton said, “that it seems to me the President now has pretty clear sailing. He is fairly in deep water, with no threatening rocks and little danger of running aground.”

  In his confidence, Hamilton was exceeded only by Bliss, who was impatient to present himself to the American people as the calm, competent leader of the president’s medical team. Just a few days after the shooting, he settled into Joseph Stanley Brown’s office with a journalist from the New York Times. Languidly lighting a cigar, he told the reporter, “I think that we have very little to fear.” As a crowd began to gather around him, anxious for news of the president, Bliss warmed to his subject. “President Garfield has made a remarkable journey through this case, and it was a happy wound after all,” he assured his audience. “I think it almost certain that we shall pull him through.”

  As Bliss spoke, smoke from his cigar rising in thick curls and filling the room with a heavy, pungent smell, the bright sky outside Brown’s window darkened. Without warning, an afternoon thunderstorm swept through the city. Rain fell in torrents, distorting the trees and river beyond, and lightning illuminated the grounds in short, sharp flashes.

  The president, Bliss said, was “the most admirable patient I have ever had. He obeys me to the letter in everything, and he never makes any complaints about my orders.” This quality above all others, Bliss believed, would serve Garfield well. As he had stressed to another reporter only a few days earlier, the president could not hope for better medical care. “If I can’t save him,” he said, “no one can.”

  As he sat in his father-in-law’s house in Boston, surrounded by chattering children and a wife eager for his attention, Alexander Graham Bell’s mind was still churning. Since he had learned of the assassination attempt, he had been able to think of nothing but the president. “I cannot possibly persuade him to sit, just these days,” Mabel complained in a letter to her mother. “He is hard at work day and night … for the President’s benefit.”

  Bell knew he could find the bullet. He just did not yet know how. His first thought was that he might be able to flood Garfield’s body with light. He had read about a patient in Paris whose tumor had been revealed when his doctors inserted an electric light in his stomach, setting him aglow “like a Chinese lantern.” After considering Garfield’s injury, “it occurred to me,” Bell wrote, “that leaden bullets were certainly more opaque than tumors.” Deciding to run a few quick tests, he asked his secretary to hold a bullet and a miniature light in his mouth. As he had hoped, Bell could clearly see the bullet, a dark shadow against the young man’s illuminated cheek.

  In a simplistic way, the technique anticipated the medical X-ray. The problem was that, even if Bell used an intensely bright light in a darkened room, the bullet would have to be very near the surface to be discernible. If it was deep in his back, as Garfield’s likely was, hidden behind dense layers of tissue and organs, it would never be seen.

  As Bell worried about the flaws in his initial idea, the answer suddenly came to him. What he needed was not a light, but a metal detector. The memory of an earlier invention, he would later write, “returned vividly to my mind.”

  Four years earlier, while struggling to fend off interference from nearby telegraph wires, which were cluttering his telephone lines with their rapid clicking sounds, Bell had found an ingenious solution. The problem stemmed from the telegraph wires’ constantly changing magnetic field, which created, or induced, corresponding currents in the telephone wires. Bell realized that if he split the telephone wire in two and placed one wire on each side of the telegraph line, the currents would cancel each other out. “The currents induced in one of the telephone conductor
s,” he would later explain, “were exactly equal and opposite to those induced in the other.” The technique, known as balancing the induction, left the line silent.

  The idea had worked, and Bell had patented it in England that same year but had given it little thought since. Now, as he considered the president’s wound, he recalled that his tests in 1877 had shown him that his method of balancing induction could not only achieve a quiet line, it could detect metal. “When a position of silence was established,” he wrote, “a piece of metal brought within the field of induction caused the telephone to sound.”

  After “brooding over the problem,” Bell realized that he could turn his system for reducing interference into an instrument for finding metal—the induction balance. He would loop two wires into coils, connecting one coil to a telephone receiver and the other to a battery and a circuit interrupter, thus providing the changing current necessary for induction. Then he would arrange the coils so that they overlapped each other just the right amount. He would know he had them perfectly adjusted when the buzzing sound in the receiver disappeared. If he then passed the coils over Garfield’s body, the metal bullet would upset the balance, and Bell would literally be able to hear it through the receiver. In this manner, the telephone, his most famous and frustrating invention, would “announce the presence of the bullet.”

  Bell’s instincts told him that the induction balance would work, but he could not be certain until he tested it. Feeling frustrated and helpless in Boston, without his laboratory, his equipment, or his assistant, he once again turned to Charles Williams’s electrical shop, where he had met both Watson and Tainter, and where, just seven years earlier, he had built the first telephone. At “great personal inconvenience,” Williams did everything he could to help Bell, giving him laboratory space, equipment, and his best men.