Book Review

James A. Garfield

N Engl J Med 2006; 355:2053-2054November 9, 2006

Article

James A. Garfield
(The American Presidents.) By Ira Rutkow. 181 pp. New York, Times Books, 2006. $20. ISBN: 0-8050-6950-X

From his vantage point as both surgeon and historian, Ira Rutkow brilliantly navigates that narrow space that contains both the political history and the medical facts concerning the untimely death of President James A. Garfield. This book is the 33rd in the American Presidents Series, edited by Arthur M. Schlesinger, Jr. I was thrilled to find it to be more than just a detailed case report of the man's death. It is also the story of a boy, born in a log cabin, who became fatherless at the age of 2, who loved to learn, and who made himself into the 20th American president. We are treated to a detailed look at the fractious politics of the time — the Civil War and its aftermath — which spurred Garfield's ascent and ultimately led to his death.

The Assassination of President James A. Garfield.

Like most of you, I knew little about the man who was wounded only a few months into his presidency, but halfway though this book, I found myself wondering what this Civil War general — the only person in U.S. history to serve simultaneously as a representative in Congress, a senator elect, and a president elect — would have accomplished had he been given the chance. Therein lies the ultimate irony that the author nicely lays out for us: Garfield did not have to die of the wounds he sustained. The book reads like a well-written novel that you cannot put down, even though you have a general idea of what is going to happen.

The year 1881 was a time of transition in medicine and surgery. The first appendectomy had not yet been performed, and many of the tools we use and take for granted today were either in their infancy or not yet invented. Rutkow leads us to Dr. Doctor Willard Bliss (yes, Doctor was his given name), surgeon in chief at the Armory Square Hospital in Washington, DC. Bliss was a traditionalistic allopathic physician who had yet to embrace the concept of antisepsis that Joseph Lister had tried to introduce to the United States. Despite the great strides made in England and Europe, here he met with little success. Worse, even though Ignaz Semmelweis had initiated hand-washing to prevent obstetrical infection in Vienna in the 1840s and Louis Pasteur had all but proven the germ theory of disease in the 1860s, the many surgeons who probed Garfield's wounds with filthy fingers and dirty tools were not even aware of these concepts. Although today allopathic medical treatment is the rule, in 1881, homeopathic physicians, including Garfield's personal doctor, were far more prominent. They were kept at arm's length from the president by Bliss — despite the fact that they were probably closer to the right track than our allopathic ancestors were in terms of providing adequate nutrition and avoiding large doses of toxic drugs — while Garfield wasted away.

Change, and the adoption of new ideas, is hard, and in this book we learn just how hard it was at the time of Garfield's shooting. Even though I was inclined to cringe at the description of Garfield's surgical care, the actions taken must be considered in the context of the time. How well would any of us have done then? How many transitions has medicine gone through, even in our lifetime? How many concepts did we think we understood, only to find out how wrong we were? Rutkow gives us more than a history lesson. His book also helps us to understand the way we contemplate new ideas. If history teaches us anything, let it be that we should not allow ourselves to be divided by age, young physicians versus old physicians.

You will have to read the book to learn the details and conclusion of the story (i.e., the nature of the wounds). Although I wish that Rutkow had included more pictures, I found this story riveting.

Steven D. Schwaitzberg, M.D.
Cambridge Health Alliance, Cambridge, MA 02139
sschwaitzberg@challiance.org