On this day in 1881, US President James A. Garfield was shot while waiting to a board a train at the Baltimore & Potomac Railroad Passenger Terminal in Washington DC. The shooter was identified as Charles Guiteau and he was later convicted of this murder. Garfield did not die immediately but rather lingered for over two months before finally succumbing on September 19, 1881.
Apparently two shots were fired during the assassination attempt, the first grazing Garfield’s arm, and the second, the killing bullet, striking him near the spine in his mid-back. It was reported that the bullet lay near the first lumbar vertebrae. It did not apparently damaged his spinal cord, did not enter the lung, and caused no major organ injury. Gunshots kill instantly only if a vital structure is damaged, structures such as the brain, the heart, or the upper portions of the spinal cord. If these are not damaged, then death can come fairly quickly from severe bleeding, or much more slowly, over days, or weeks, or months, from infection.
With modern treatment President Garfield would have survived with little if any disability. Surgery to remove a bullet, repair of the damage done, and a course of antibiotics would have restored him to health and to the presidency. But in 1881 things were a bit different.
The first order of business was to locate the bullet and this was not apparent from the injury. Fearful of digging around in the president’s back with surgical instruments, the physicians that took care of him were unsure what to do. Enter Alexander Graham Bell. Bell stated that certain characteristics of his telephone could be used to manufacture a metal detector and this is exactly what he did. The hope was that the detector would locate the bullet, which could then be removed without harming Mr. Garfield. The problem was that Garfield lay on the bed with a metal frame and this apparently interfered with the functioning of the metal detector, though it seems that they did not exactly understand that and were unsure why the detector behaved so erratically. In the end, Bell’s invention failed to save the day.
Many surgeons visited the president and examined him, several inserting unclean fingers into the wound and introducing infection on top of what the bullet and the open wound had already allowed in. One finger apparently even damaged Garfield’s liver. He ultimately developed septicemia, which is an infection in the bloodstream, and this led to his demise over two months later. He was undoubtedly in what we call septic shock, a bloodstream infection that causes a very low blood pressure, but whether he suffered a heart attack or some other complication from the infection is unknown. However there is no doubt that the gunshot injury allowed a portal for infection to enter and then to seed the bloodstream, resulting in the septicemia that ultimately killed him.
Today septicemia is treated with powerful, and usually multiple, antibiotics, intravenous fluid replacement, steroids, and other supportive measures until the infection clears. It can still be deadly but nothing like it was in 1881. Then there were no antibiotics, penicillin being nearly a half-century away. Though Joseph Lister had devised surgical techniques that took into to account the Germ Theory of disease causation, the theory was still awaiting proof. This did not come until 1890 when Robert Koch published his seminal paper on the subject, a paper that laid out what became known as Koch’s Postulates, the first proof that infections were caused by microorganisms.
It is unfortunate that the surgeons didn’t keep their fingers out of the wound and did not attempt to remove the bullet as this might have been Garfield’s only chance for survival. It is equally unfortunate that they didn’t follow Lister’s surgical techniques for avoiding infection but rather manipulated the wound with unclean fingers. Both of these failures allowed an infection to take hold, an infection that without antibiotics was essentially a death sentence.