WASHINGTON, DC — James Garfield was shot by a would-be assassin but killed by his doctors. His ending is a case of monumental malpractice. At his trial, Charles Guiteau, who fired the probably nonfatal gunshot, shouted, "Your honor, I admit to the shooting of the president, but not the killing."

Guiteau was crazed, but that courtroom utterance was rational and accurate.

His death included all of the worst elements that could be found in a presidential medical crisis:

"Garfield's death," states the 1987 book Medical Cover-Ups in the White House, "included all of the worst elements that could be found in a presidential medical crisis: faulty diagnosis, grossly improper treatment, prideful bickering among doctors and a massive cover-up of the truth before and after death."

"In short, Garfield never had a chance." The second president to be assassinated, once a professor of Greek and Latin, Garfield served a brief term of office: only two hundred days. On July 2, 1881, he arrived at the Washington railroad depot to depart for a reunion at his alma mater, Williams College in Massachusetts, where he had also taught and served as its president.

faulty diagnosis, grossly improper treatment, prideful bickering among doctors, a massive cover-up — in short, Garfield never had a chance.

The wounded president exclaimed, "My God, what is this?" and collapsed to the floor.

Garfield remained fully conscious, though in traumatic shock. His pulse alternately raced and grew feeble, and his breathing became shallow. He was rushed to the White House, where doctors discovered that one bullet had grazed his arm but the other had lodged internally. Though the president complained of numbness of the legs and feet, which would suggest damage to the spinal cord, several of the physicians believed the troubling bullet rested in the abdomen.

As the doctors argued over the bullet's location and what to do about it, Garfield lingered for eighty days, conducting state business from his bed. But the lodged bullet was rapidly poisoning his blood. Within a month the once robust, 210-pound president was down to an emaciated 130 pounds, with new infections throughout his lungs. With Washington's summer heat soaring to almost a hundred degrees, Garfield was kept relatively comfortable by a primitive "air cooling" system: rows of cotton towels dampened by ice water that was evaporated by fans. The blood poisoning and related infections finally claimed his life on September 19.

The first doctor stuck an unwashed finger, then a nonsterile metal instrument, deep into the wound.

At the autopsy, the bickering doctors discovered they had blundered gravely: Guiteau's bullet had settled about four inches to the right of the spinal cord, resting harmlessly in a bed of tissue. The first doctor to examine the president, Willard Bliss, had first stuck an unwashed finger, then a nonsterile metal instrument, deep into the wound probing for the bullet.

Not only had he likely infected the president, but he dug a false passage in tissue that later confused other physicians of the bullet's actual trajectory. Having mistakenly concluded that the bullet penetrated the liver, Bliss projected the president would die quickly from hemorrhage and that an operation on the liver would only exacerbate the bleeding and hasten death.

In all, sixteen doctors consulted on Garfield's condition; several worsened that condition. The army surgeon general stuck his unwashed finger into the wound and dug as deep as the president's ribs. The navy surgeon general probed so extensively with his unwashed finger that he actually punctured the liver, destroying its protective outer covering.

The army surgeon general, then the navy surgeon general probed so extensively with unwashed fingers that the liver was puctured.

He agreed with Bliss that the liver was violated (as it now was) and that the president would be dead within twenty-four hours from internal bleeding.

Persistent and unclean fingers and instruments turned a three-inch-deep, harmless hole into a twenty-inch pustulating canal stretching from ribs to groin.

Days passed and Garfield did not die. His fever climbed (from multiple infections) and he was put on a diet of only brandy-spiked milk. His doctors puzzled that he had "not improved in strength." Worse, they persisted, with unclean fingers and instruments, to poke inside the wound for the lost bullet.

The gross damage: They turned a three-inch-deep, harmless hole into a twenty-inch-long contaminated canal stretching from the president's ribs to his groin and oozing more pus each day. The doctors themselves had produced most of the infection and all of the hemorrhaging that disrupted the president's bowels, bladder, and eventually beclouded his mind. Their ineptness, combined with the bullet's poisoning, fatally weakened Garfield's heart.

Even a massive heart attack was a botched diagnosis: Clawing at his chest Garfield moaned, "This pain, this pain." But his doctors claimed it was only a blood vessel rupturing in the stomach. Minutes later Bliss said to the first lady, "It's all over. He's dead."

The Washington Post was the first of several papers to accuse the doctors of malpractice. When the treating physicians submitted their bill of eighty-five thousand dollars, the Senate authorized payment of only ten thousand dollars, privately denounced the doctors as quacks, and pointed to them as the real assassins. Bliss was forced to admit publicly that he had erred.

Only 49 when he died, Garfield left no will. He had collected only a portion of his $50,000 salary, and his estate, passing on to his family, was valued at $61,733.06. Just weeks before taking office, he had providentially taken out a life insurance policy for $25,000 with his wife as beneficiary. And Congress, a year after the president's death, awarded his widow an annual pension of $5,000 plus a lump sum of $50,000.

Guiteau's Ending.
Charles Julius Guiteau was hanged for assassinating the president about one year after the shooting.

Bizarrely, the day of the incident, Guiteau had a hansom cab waiting at the depot to take him directly to jail, terrified an angry mob might Iynch him. As Washington police dragged him from the station, he even pleaded, "I wish to go to jail."

Days before the assassination Guiteau visited the Washington jail to evaluate its amenities. He liked what he saw.

Stranger yet, only days before the assassination he had visited the Washington jail to evaluate its amenities and liked what he saw: "An excellent jail." He was crazed, but also savvy.

Both states of mind were on display at his trial. Given his legal training, he acted in part as his own defense attorney, aided by his brother-in-law, George Scoville, a Chicago lawyer. Scoville's defense was insanity, for which there was ample evidence: Guiteau had a long history of erratic, violent behavior as well as a family tree of institutionalized relatives. Guiteau, however, used the then uncommon defense of medical malpractice. Alternately ranting irrationally and reasoning brilliantly, he concluded that the president's doctors were the murderers, abetted in their deed by the will of God.

To support the claim that he had only harmlessly wounded the president, he introduced newspaper accounts and doctors' journals. "According to the physicians' statements," he said, "the president was not fatally shot on the 25th of July, at the time they made the official examination, and said he would recover." He cursed the judge, the jury, and at one point lambasted the prosecutor as "a low-livered whelp." But he calmly summed up his claim: "If he was not fatally shot ... we say that his death was caused by malpractice. My defense here is that it is the Deity's act and not mine."

After five minutes of deliberation, he was found guilty of murdering the president. Shaking a finger at the jury he snarled, "You are all low, consummate jackasses!" He was sentenced to the death he feared most — hanging, to be carried out at Washington's Old Capitol Prison on June 30, 1882.

Army physicians stripped Guiteau's corpse of all tissue, intending to slake public anger by publicly displaying his skeleton.

Guiteau's sister, aware of her brother's dread of the hangman's noose, visited him in prison carrying a bouquet of flowers that concealed a vial of arsenic; but his suicide was prevented. Jailers claimed that he even slept in terror of hanging, blankets clutched protectively over his neck, and that he awoke screaming from nightmares of dangling at the end of a rope.

On the actual scaffold, the forty-one-year-old political malcontent recited a poem he composed for the occasion — "I am going to the Lordy ..." — then shouted his farewell: "Glory, hallelujah! Glory!"

Government officials refused to turn Guiteau's body over to his family or to bury it. They had other plans. Army physicians stripped the corpse of all tissue, tendons, and organs with the intention of slaking the public's anger over the assassination by publicly displaying his skeleton. Admission was to be free. Sensibly, this was never done. Doctors did, however, progress as far as producing a cleanly bleached skeleton. The surgeon general, C. H. Crane, took custody of the dismantled bones and is supposed to have secretly disposed of them. However, historians believe that the bones, divided among several metal trays, are in the huge storage vaults of the Army Medical Museum. [See the link below for the final answer to Guiteau's final resting place.]

Mourners in Washington, deprived of a glimpse of the assassin's mounted frame, satisfied themselves by choosing among the souvenirs that went on sale throughout the capital. There were pictures of Guiteau dangling from the scaffold, facsimiles of the murder bullet, and many snippets of the hanging rope — too many to be authentic.

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