Rutkow Ira - James A. Garfield: The American Presidents Series: The 20th President, 1881

Table of Contents

Few histories stand alone, and I received inspiration and guidance from numerous earlier works on Garfield, particularly Harry J. Brown and Frederick D. Williamss The Diary of James A. Garfield; Robert Caldwells James A. Garfield, Party Chieftain; Margaret Leech and Harry J. Browns The Garfield Orbit: The Life of President James A. Garfield; Allan Peskins Garfield, A Biography; John C. Ridpaths The Life and Work of James A. Garfield; Theodore C. Smiths The Life and Letters of James Abram Garfield; and John M. Taylors Garfield of Ohio, The Available Man. I must also thank the library and research staffs at the New York Academy of Medicine and the New York Public Library for their assistance.

This book was originally intended as a behind-the-scenes story of the medical aspects of Garfields assassination. Arthur M. Schlesinger, Jr., wisely proposed that the work be expanded into a political biography. I thank him for his suggestion and the opportunity to participate in the American Presidents series. To my editor, Paul Golob, I offer sincere thanks for his professional and scholarly skills. Eric Simonoff, my agent at Janklow and Nesbit Associates, is extraordinary and finds writing projects I never thought possible.

Finally, to my parents, Bea and Al Rutkow, this book further validates your many sacrifices made to ensure that I received a superb education. To my wife, Beth, and our children, Lainie and Eric, Idedicate this book. Lainie, a lawyer and fierce protector of the publics health, is an amazing woman who lights up everyones life. Eric, a lawyer who advocates for human rights in international development, provides sincerity to all who know him. Beth is the love of my life and without her patience and sustenance I would accomplish little.

Bleeding Blue and Gray: Civil War Surgery
and the Evolution of American Medicine

American Surgery: An Illustrated History

Surgery: An Illustrated History

History of Surgery in the United States, 17751900

On March 30, 1981, almost one hundred years after James Garfield was assassinated, another president, Ronald Reagan, was shot by a mentally deranged young man. A bullet pierced Reagans left chest, punctured his lung, and stopped an inch away from his heart and aorta. Bleeding internally and short of breath, he was rushed to the George Washington University Hospital, where he collapsed in the emergency room. Resuscitative measures stabilized Reagans condition and, within minutes, he was taken into surgery. By the time the three-hour operation ended and the hemorrhage was controlled and the pulmonary injury treated, more than 50 percent of the presidents blood volume had been replaced by transfusions. In a tribute to scientific medicine and the recuperative powers of the patient, Reagan was on his feet within twenty-four hours of the shooting and, eleven days later, returned to the White Housefully able to conduct the nations business. Reagans wound was much more life-threatening than Garfields and yet did not kill or even significantly impair him, despite his being twenty years older than Garfield. If Reagan had been shot in 1881, he would have died within hours of the shootingchest surgery did not exist. How would Garfield have fared if he had received Reagans level of care?

Garfield likely would have arrived at a medical facility within minutes of the shooting and with an intravenous line already inplace. The emergency room doctors would scan an electronically sent electrocardiogram and determine that there were no cardiac abnormalities. A physical examination of Garfield would reveal no obvious pulmonary or abdominal injuries. Since his vital organs were not injured, Garfields heart and respiratory rates, blood pressure, and blood oxygen level would likely be normal. Similarly, blood tests and urinalysis would be unremarkable. Under no circumstance would the bullet wound be probed or manipulated, but rather would simply be covered with a sterile dressing and left alone.

Since President Garfield was shot in the middle of the right back, X-rays would be taken of the abdomen and chest, demonstrating the presence of the bullet in the left side of his back and two splintered ribs and fractured thoracic and lumbar vertebrae. Everything else would appear normal. To further rule out injuries to structures located along the bullets pathincluding the colon, duodenum, kidneys, and pancreasa high-resolution, computed tomography (CT) scan would be performed and would detail no damage other than what was already known, the bullet embedded deep in the presidents back muscles. By this time, ninety minutes would have passed since the assassination attempt, and a fully conscious Garfield would receive pain medicine. The hemorrhage having been moderate in amount, the president would not require transfusions. Garfield would remain in the hospital for observation for the next twenty-four hours and started on antibiotics and not fed as precautionary measures. The following morning, a hungry and relieved Garfield would return to the White House, where he and Lucretia would marvel at the wonders of modern medicine as the president began rehabilitative therapy for his injured spine.

And, in future histories of the Garfield presidency, the assassination attempt would be regarded as a footnote, rather than the whole story.

1 : EARLY YEARS