Diagnosing A Failed Presidency

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The New York Sun

President for only six months, James Garfield had no opportunity to establish a legacy. Normally, a biographer faced with such constraints would focus on his subject’s path to power and on unfulfilled promise. It is not clear, though, that Garfield would have achieved much even if he had not been gunned down in 1881 by a disappointed office seeker.

Although an accomplished self-made man, an impressive scholar, litterateur, and long-serving Congressman from Ohio, Garfield seemed on his way to a mediocre presidency no better than that of his immediate predecessor, Rutherford B. Hayes. Beset by factionalism in his own Republican party, and dogged by the insatiable demands of that rascally New York politico, Roscoe Conkling, Garfield was stymied at every turn. Perhaps he would have righted himself, but he seems to have been too timorous a leader to do so.

It took Garfield two months to die, and that agonizing period – during which his doctors mishandled his case – excites the expertise of Ira Rutkow, a clinical professor of surgery at the University of Medicine and Dentistry of New Jersey, in the latest title in the American Presidents series, “James A. Garfield” (Times Books, 184 pages, $20). The biographer does a perfectly adequate job of describing the man and his era, but what makes this book riveting – contributing to an understanding of healthcare and not just retailing poor Garfield’s plight – is Mr. Rutkow’s powerful grounding in the history of surgery and postoperative procedures.

In 1881, Mr. Rutkow explains, a new generation of doctors had come to understand the importance of antisepsis. Joseph Lister, who lectured at important medical schools in America, demonstrated the crucial need for a sterile operating environment.Yet older physicians were slow to follow Lister’s lead, even when they did not openly scoff at the elaborate precautions he insisted on or misunderstood that it was not just wounds that had to be kept clean but also surgeon’s hands and instruments.

In an age before x-rays and other diagnostic apparatus, and in which surgical gloves had not yet been invented, doctors routinely stuck fingers in wounds attempting to assess damage – in Garfield’s case, the trajectory of the bullet that had embedded itself deep in his back. I lost count – while wincing – of how many times doctors with dirty hands digitally examined Garfield’s entry wound.

The result, not surprisingly, was a massive infection. Unfortunately, most physicians then knew almost nothing about the etiology of infection. When pockets of pus began to form on Garfield’s back, his attending physicians were not alarmed. What they called “laudable pus” was a sign of healing.They reacted by merely inserting unsterilized tubes into the pus pockets to drain away the suppurations.

Garfield, of course, got worse – his state a tribute not only to medical ignorance (now his type of wound would have been quickly diagnosed, treated, and he would be back in the White House within a week), but also to the stubborn arrogance of Willard Bliss, who took charge of Garfield’s care and shut out better diagnosticians and trained medical care specialists. Bliss issued falsely optimistic bulletins and bullied other attending physicians into seconding his procedures. Those who argued with him and who did not leave were dismissed in disgust.

Mr. Rutkow, however, may accord Bliss too large a role in Garfield’s demise. Apparently Mrs. Garfield took no active role in her husband’s care.This is a puzzle since the Garfields believed strongly in homeopathic medicine. Garfield himself, while in tremendous distress, was lucid until his last week, and so why he allowed Bliss to isolate him from Susan Edson, his homeopathic doctor, is also mystifying. Edson, in turn, does not seem to have asserted herself – which is a pity, because if her advice had been taken from the outset (she was a strong believer in antisepsis), Garfield would have had a fighting chance of warding off infection.

Curiously, like his brief presidency, Garfield’s last two months of life were directionless – save for Bliss’s blundering dictatorial program – and Mr. Rutkow treats this painful period as an episode in itself.And so it is. But I could not help wondering if another biographer might have made far more of the latitude accorded Bliss.

Garfield was in need of openness. When secrecy prevails it is all too easy for the guardians to believe in their probity and purpose.The press and political rivals become those who seek to penetrate the inner sanctum of government. In Garfield’s case, for example, his vice-president, Chester Arthur, was not allowed even to see Garfield after he was shot. A Conkling crony, Arthur became suspect as a usurper.

In fact, Garfield should have relinquished the presidency – as Woodrow Wilson should have during the period after his stroke when his wife practically ran the executive branch. So bemused is Mr. Rutkow with his exploration of what the doctors might have done – even given their rudimentary understanding of what today is considered routine care – that he seldom canvases the broader implications of Garfield’s case.

Even so, for sheer drama and expertise, Mr. Rutkow’s narrative resembles the forensic medical shows that grip viewers of cable channels like Discovery. I especially appreciated his fascinating explanation of how allopaths and homeopaths regarded Garfield’s case. Both kinds of doctors could have contributed to healing Garfield if he had not become imprisoned in the false state of protectiveness that effectively doomed him.

crollyson@nysun.com


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