Garfield’s death attributed to poor medical care?

Dr. Howard Markel, a distinguished professor of the history of medicine and a psychiatrist at the University of Michigan in Ann Arbor, writes a monthly column for the PBS NewsHour, highlighting momentous events that have shaped modern medicine.

One of his essays in 2016 reviewed the shooting of U.S. President James A. Garfield and the subsequent medical treatment he received in 1881…(or the dagnabbit lack thereof).

After serving less than four months as president, Garfield was attacked on the morning of July 2, 1881, while standing on the platform of the Baltimore and Potomac Railroad Station in Washington, D.C.

Garfield’s shooter, Charles J. Guiteau, fired two shots from a revolver that struck the president in the back. Guiteau was mentally deranged; he reportedly believed he should have been awarded a diplomatic job in Paris, France, by the new Garfield administration.

Garfield’s wounds on July 2 were serious but not immediately fatal. His death occurred Sept. 18, 1881. Garfield died at age 49. Medical sources now agree that Garfield could have, should have and would have recovered had doctors followed a present-day sanitary protocol.

Commenting on Garfield’s medical care, Dr. Markel said, “doctors stuck their unwashed fingers in the wound and probed around, all for naught and without applying the numbing power of ether anesthetic.”

“In late 19th century America, such a grimy search was a common medical practice for treating gunshot wounds,” Dr. Markel said. “A key principle behind the probing was to remove the bullet; it was thought that leaving buckshot in a person’s body led to problems ranging from ‘morbid poisoning’ to nerve and organ damage.

“Indeed, this was the same method the doctors pursued in 1865 after John Wilkes Booth shot President Abraham Lincoln in the head.”

Dr. Markel said the doctors caring for President Garfield would “widen the three-inch deep wound into a 20-inch-long incision, beginning at his ribs and extending to his groin. It soon became a super-infected, pus-ridden, gash of human flesh.”

“This…probably led to an overwhelming infection known as sepsis. It is a total body inflammatory response to an overwhelming infection that almost always ends badly – the organs of the body simply quit working,” Dr. Markel noted.

In Europe, beginning in the late 1860s, British surgeon Sir Joseph Lister encouraged fellow physicians to adopt “anti-sepsis” in their operating rooms. This technique required surgeons and nurses to thoroughly wash their hands and instruments in anti-septic chemicals, such as carbolic acid or phenol, before touching the patient.”

Dr. Lister’s contributions to clinical medicine earned him recognition as the “father of modern surgery.” His work inspired Dr. Joseph Lawrence of St. Louis to develop an alcohol-based formula for a surgical antiseptic and general germicide that included eucalyptol, menthol, methyl salicylate and thymol. Dr. Lawrence named his antiseptic “Listerine” in honor of Dr. Lister.

Dr. Lawrence licensed his formula in 1881 (the same year that Garfield was assassinated) to St. Louis pharmacist Jordan Wheat Lambert, who subsequently started the Lambert Pharmacal Company, marketing Listerine. (Listerine brand products were promoted to dentists for oral care in 1895, with the first over-the-counter mouthwash sales occurring in 1914.)

Writing for the White House Historical Association in 2006, Frank Freidel and Hugh Sidey, affirmed that “Garfield’s death was a turning point in the history of American medicine. His death spurred positive reforms, furthering the use of antiseptics and sterilization methods.”

Circumstances surrounding “Garfield’s death also helped raise awareness of the lack of trained nursing care in America, resulting in the development of national standards for American nursing schools at a forum held at the 1893 World’s Fair in Chicago,” added Freidel and Sidey.

To complete the circle, after Garfield’s death, vice president Chester A. Arthur became the 21st American president.

As a tribute to the Arthur presidency, Alexander McClure, editor of the Philadelphia Times, wrote: “No man ever entered the presidency so profoundly and widely distrusted, and no one ever retired…more generally respected.”