James A. Garfield, the 20th U.S. president, was the dark horse candidate of the 1880 Republican National Convention in Chicago, emerging victorious as a "decent and unabrasive man" when a field of much better-known politicians all failed to win a majority of delegates.

James Garfield
Library of Congress
James Garfield

Yet he would serve only a few months in office before meeting with disasters both criminal and medical.

Garfield was born poor in an Ohio log cabin and raised by his widowed mother. While laboring on the Erie and Ohio Canal, he made his way through college and started teaching Greek and Latin at what is now Hiram College while still a student and married his star pupil, Lucretia Rudolph. He completed his degree at Williams College in Massachusetts,  passed the Ohio bar,  and became principal of Western Reserve Eclectic Institute (which later became Hiram) at age 26.

As the Civil War started in 1861, Garfield enlisted in the Union Army as a lieutenant colonel, rising to the rank of major general, despite a case of infectious hepatitis. He was elected to the U.S. House of Representatives for five terms from Ohio, famously stating, "the chief duty of government is to keep the peace and stand out of the sunshine of the people."

At the 1880 Republican party convention, none of the leaders, including war hero Ulysses S. Grant, emerged on top, paving the way for the mild-mannered Garfield on a record-setting 36th ballot. In the general election, Garfield squeaked past Democrat Winfield Hancock by only 9,070 votes, the tightest margin ever.

Scene from the assassination of President Garfield
Library of Congress
Scene from the assassination of President Garfield

On July 2, 1881, barely four months after his inauguration, Garfield was passing through Washington's Baltimore and Potomac train station, en route to Williams College, when James Guiteau, who had been stalking Garfield for weeks, shot him in the back with a .44 caliber revolver.

The president would linger for 80 days as multiple doctors and even Alexander Graham Bell tried to save him. What ultimately killed him?


Right after the shooting, Dr. D. Willard Bliss took control of the multitude of physicians seeking to care for the president. Bliss inserted his finger and a metal probe into the wound, searching for the bullet. Sixteen doctors tried probing the wound with their fingers and various instruments – none of them sterilized —  increasing the wound from three inches to 20 inches. Garfield became feverish as infection set in.

As doctors tried to drain the pus that continuously collected, the wound was stretched from his ribs to his groin. Unable to eat, Garfield dropped weight, from 210 to 130 pounds.

Without antibiotics, his fever reached 106 degrees. U.S. Navy engineers rigged one of the first working air conditioners, with fans blowing over a six ton box of ice into the president's sickroom to lower the room temperature 20 degrees.

Though British surgeon Joseph Lister had pioneered antisepsis during the 1860s and even visited the United States in the 1870s, most American doctors – including Bliss – didn't trust Lister's "germ theory" findings that his recommendations prevented  infection and could save lives and limbs.  Lister successfully introduced carbolic acid (now known as phenol) to sterilize surgical instruments and cleanse wounds, leading to a reduction in post-operative infections and safer surgery. For all this, he would come to be known as the father of modern surgery.

But his work made no impact on Garfield's doctors, who kept probing for the bullet with their dirty fingers and unsterilized instruments. They called for an emergency consultation with Alexander Graham Bell, who had invented the first metal detector. But Bell's device could not locate the bullet because the metal springs and frame in Garfield's bed interfered with the magnetic process.

Mrs. Garfield decided to move her husband to the New Jersey shore for the salt air, ocean breezes and views. A special train track was built from the railroad's mainline to the door of the cottage, borrowed from a British nobleman. Doctors and family gathered as Garfield died.

Most medical historians and physicians agree that massive infection was the cause of Garfield's death. Most likely, the president would have recovered from his wounds with sterile medical care, which became common in the United States just 10 years after his death.

Allan B. Schwartz, M.D., is a professor of medicine in the Division of Nephrology & Hypertension at Drexel University College of Medicine.