Reviewed by Frederick H. Millham

Four American presidents have been assassinated in office. Lincoln and Kennedy are famous martyrs, remembered more for their extraordinary presidencies than for their deaths. William McKinley is less familiar, but did complete one term in office before his death. Among other accomplishments, he started a war and managed an economic depression. James Garfield, shot 32 days after his inauguration, left behind virtually no record. Even to the most ardent history buff, he remains a sphinx, known only as the fourth member of the martyred quartet. He is the answer to a trivia question and little more.

Candice Millard has stepped into this void with The Destiny of the Republic, a history of Garfield’s election and assassination. Millard’s first book, the critically well received River of Doubt, was about Theodore Roosevelt’s 1909 journey to the headwaters of the Amazon. With this wonderful second book Millard establishes herself as a new voice for the period between the Civil and First World Wars.

Garfield’s nomination for the Republican ticket in 1880 was the result of a fractured party convention. In that year the Republican Party was divided into two groups. The Stalwarts, who supported the existing patronage system, favored a third term for Ulysses S. Grant. Garfield belonged to the reform element of the Republican Party, the Half-Breeds, so called because their rejection of the patronage system rendered them “half Republicans.” These men were split between James Sherman, senator and brother of William Tecumseh, and James Blaine, senator from Maine.

Millard succeeds in putting the reader inside the massive Chicago convention hall. She describes the confusion, arm-twisting and intrigue behind the nomination as though she herself were there. We meet Roscoe Conkling, the powerful senator from New York, a king-maker, whom Millard describes as committed to “no cause more passionately than the spoils system.” It is Conkling whom the Half-Breeds must outwit to control the nomination. Garfield was given the job of swinging the convention to the Half-Breeds on the 34th ballot. After Garfield’s eloquent nomination of Sherman, a single vote for Garfield quickly swelled, resulting in his own nomination by acclamation. As Millard explains, “having never agreed to become even a candidate — on the contrary, having vigorously resisted it — he was suddenly the nominee.”  The book is worth reading for Millard’s detailed description of the 1880 Republican convention alone.

The assassination is equally well elaborated. Readers will marvel at the notion of the president of the United States waiting for a train like an ordinary person. Unguarded and vulnerable, Garfield was accompanied to the station by his two sons and a few Cabinet members, including, ironically, Robert Todd Lincoln. His assassin, Charles J. Guiteau, found Garfield an easy mark. Millard describes Guiteau calmly placing two shots: one of little consequence that pierced the president’s right arm, and a second that entered his right flank and did not exit.

It is this lack of an exit wound that drives the rest of the story. Although Garfield’s surgeon — Dr. Doctor Bliss (given the first name “Doctor” by his ambitious parents) — never leaves Garfield’s side, he makes a shamble of things despite assistance from a number of eminent surgeons. Bliss and others explored the wound with unwashed fingers countless times during the 79 days Garfield survived. Thus are we shown Bliss’s indifference to the work of Joseph Lister, the Scottish surgeon who had yet to convince his American colleagues that infection was worth preventing.

We also learn of the work of Alexander Graham Bell, the Scottish inventor, who concocted a bullet detector specifically for the president’s case, it being a decade before Roentgen’s discovery of the x-ray. In a fascinating scene, Millard shows us the intransigent, interfering Bliss as he forbids Bell from scanning to the left of the president’s spine, where the bullet actually was located. Had Bell been allowed to examine Garfield more thoroughly, the bullet would have been located prior to autopsy — and perhaps might have been extracted, avoiding the multiple unproductive, probably excruciating and ultimately lethal attempts to find it manually.

Unlike her insight into the politics of the period, however, Millard’s analysis of Garfield’s medical care lacks nuance that medically informed readers may note. She is correct that the exploration of the wound did not follow Lister’s antiseptic method, and that these unsanitary maneuvers were ultimately what killed Garfield. However, she mistakenly criticizes a final attempt to drain the massive abscess caused by the repeated dirty probing; drainage was the most effective treatment available. She also overlooks the importance of Bliss’ failure to use anesthesia, which had been discovered 35 years before the shooting; had Garfield been anesthetized while his doctors searched for the bullet, they might have had better luck finding its path through the president’s flank. Perhaps most strikingly, though, she notes without comment the fact that Bliss ignored Garfield’s complaints of “back pain” and pain shooting down his legs. Garfield’s comments suggest that the bullet traveled through the spine, as, in fact, it had. Bliss did not need Bell’s bullet detector; all he had to do was listen to his patient.

But these are details that only surgically astute readers will note. This book offers a complete and beautifully written summary of the life and death of a great man who, had he lived, might have been one of our finest presidents. We are treated to a comprehensive description of the events, their background and their consequences. Millard succeeds in moving James Garfield from the back of a “Trivial Pursuit” card to his proper place in our minds as a great American, lost prematurely due to an ironic combination of inattention, incompetence and ambition.

Frederick H. Millham is a surgeon practicing in Newton, Massachusetts.