I have sometimes thought that we cannot know any man thoroughly
well while he is in perfect health. As the ebb-tide discloses the real
lines of the shore and the bed of the sea, so feebleness, sickness, and pain
bring out the real character of a man.
JAMES A. GARFIELD
In his sickroom in the White House, Garfield was exhausted and weakened by the suffering he endured, but he was not surprised. He had been poor, and he had been a soldier, and like any man who had known want or war, he understood that the cruelest enemy was disease. “This fighting with disease,” he had written to Lucretia nearly ten years earlier, after watching twenty-two of his men die from typhoid fever during the Civil War, “is infinitely more horrible than battle.”
Now, his body, which had miraculously survived the initial trauma of the bullet wound, was so riddled with infection that he was literally rotting to death. Although Bliss closely tracked the spikes in the president’s temperature, the chills, restlessness, vomiting, pounding heart, and profuse sweating, he either did not know, or refused to acknowledge, that they were symptoms of severe septicemia. He also insisted that he was not worried about the small, pus-filled lumps that dotted Garfield’s back and arms. Known as “septic acne,” they were yet another indication of blood infection. When a reporter, who had seen them mentioned in the bulletins, asked Bliss about them, the doctor dismissed them as being fairly common. “They will not be allowed to get large,” he said, “but will be opened as they may form.”
On August 8, a few days after Bell left for Boston, Bliss directed Agnew to again operate on the president, to “facilitate the escape of pus.” When Bliss told Garfield that he would need to undergo another operation, Garfield, with “unfailing cheerfulness,” replied, “Very well; whatever you say is necessary must be done.” Using a long surgical knife with an ivory handle, Agnew made a deep incision down to and slightly past Garfield’s twelfth rib, following what he believed to be the track of the bullet, but which was, in fact, a long, vertical cavity that had been created by the doctors’ own fingers and instruments, and filled with infection. Before closing the incision, Agnew inserted two drainage tubes, which, Bliss noted with satisfaction, quickly issued “a profuse discharge of pus and bloody serum.” Garfield, Bliss recalled with astonishment, endured the procedure “without an anæsthetic, and without a murmur, or a muscular contraction.”
Neither the incisions the surgeons made, however, nor even the drainage tubes they inserted could keep up with the copious amounts of pus Garfield’s body was producing. Just two weeks after the surgery, another abscess formed, this one on Garfield’s right parotid gland, the largest salivary gland, which lies between the mouth and ear. Within days, the abscess had become so filled with pus that it caused his eye and cheek to swell and paralyzed his face. Finally, it ruptured, flooding Garfield’s ear canal and mouth with so much pus, mixed with thick, ropy saliva, that it nearly drowned him.
So toxic was the infection in Garfield’s body that it was a danger even to those who were treating him. One morning, while dressing the president’s wound, Bliss reached for a knife that was partially hidden under some sheets. Unable to see the blade, he accidentally sliced open the middle finger of his right hand. “It is thought that some pus from the President’s wound penetrated the cut,” the New York Times reported the next day, “and produced what is known as pus fever.” The resulting infection caused Bliss’s hand to become so painfully swollen that he had to carry it in a sling.
Before his hand had even had a chance to fully heal, Bliss gave an interview in which he proclaimed that there was no evidence of blood infection in the president. “Not the minutest symptom of pyæmia has appeared thus far in the President’s case,” he told a reporter. “The wound,” he said, “is healthier and healing rapidly.… In a word, the wound is in a state that causes us no apprehension whatever.”
What did cause Bliss apprehension was the very real possibility that the president might die—not from infection, but starvation. In less than two months, Garfield had lost more than a third of his body weight, plunging from 210 pounds to 130. The barrel-chested, broad-shouldered former soldier who had taken office just five months earlier, radiating health and vitality, was now a near skeleton, so weak he could hardly hold a pen. The president, one of his doctors privately told a reporter, had reached “the limit of what a man can lose and yet live.”
Not only did Garfield continue to suffer from violent bouts of vomiting, but he had long since lost any interest in eating. Edson, Lucretia’s doctor who had agreed to serve as a nurse so that she could watch over the president, had told the New York Herald earlier in the month that, “at the best meal he has had lately, after the couple of mouthfuls he would ask to have it removed.” Most days, Garfield was able to keep down a little bit of oatmeal. Unfortunately, that happened to be the one food he despised.
Although Garfield found it difficult to eat anything, for a while at least he seemed to relish drinking a glass of milk. He dutifully swallowed the koumiss, a drink made from fermented horse milk, that Bliss gave him nearly every day, but he strongly preferred cow’s milk. Eager to help in any way, Americans latched onto this small piece of information. So that the president might have the freshest possible milk, a company in Baltimore sent him an Alderney cow, which could be seen tied up on the White House lawn. The White House cook, who was the only Catholic among the staff, poured a large glass of milk for Garfield every day. Just before she carried his tray up the winding servant stairs to his sickroom, she quietly sprinkled holy water into his glass.
Realizing that he urgently needed to find a way to feed the president, Bliss came up with an alternative to food: “enemata,” or rectal feeding. He mixed together beef bouillon—predigested with hydrochloric acid—warmed milk, egg yolk, and a little bit of opium, to help with retention. The solution, which, if absorbed, would provide protein, fatty acids, and saline, was injected into the president rectally every four hours, night and day. For a stretch of eight days, Garfield had nothing but enemata.
Then Bliss began altering the mixture. On one day he added 5 drams, or roughly 1.25 tablespoons, of whiskey. On another, he removed the egg yolk, which had been causing the president gastric pain, and replaced it with a small amount of charcoal. The danger was that, if the solution was too thick, this type of feeding could actually contribute to malnutrition rather than combat it. At first, Garfield seemed to rally, but as the days passed, he continued to lose weight at an alarming rate.
As well as being malnourished, Garfield was almost certainly suffering from profound dehydration. He had lost a dangerous amount of fluid through profuse bleeding on the day he was shot, and had continued to lose water every day, through vomiting, fever, drenching sweats, frequent enemas, and nearly constant drainage of his wound. Bliss had also been giving him almost daily doses of alcohol, from brandy to claret to whiskey, all of which are dehydrating. Not only was Garfield losing large quantities of fluid, he was not ingesting nearly enough. In a modern hospital, a sweating, feverish patient would be given at least two quarts of intravenous fluid every day. Garfield’s daily fluids never amounted to more than a single quart.
While newspapers continued to print Bliss’s assurances that the only danger to the president now was exhaustion, it was painfully apparent to anyone who saw Garfield that he could not live long. “This dreadful sickness will soon be over,” Harriet Blaine wrote to her son in late August. “Every night when I go to bed I try to brace for that telephone which I am sure before morning will send its shrill summons through our room. The morning is a little reassuring, for light itself gives courage.”
Each time she stepped into the White House, however, Harriet felt even that small source of strength slip away. It seemed that everyone she encountered, from the cook to cabinet members, had already succumbed to despair. Dr. Edson, who had spent many long nights by Garfield’s side, admitted to Harriet in a private conversation that she no longer held out hope. Robert Todd Lincoln’s “darkness,” she told her family, “is unillumined by one ray of courage.” Even Almon Rockwell, who, since the day of the shooting, had reacted with anger and indignation at the slightest suggestion that Garfield might not survive, looked as though he had already lost his old friend. His “feathers,” Harriet wrote sadly, “I imagined drooped.”
So desperate had the situation become that her husband felt that, as secretary of state, he was obliged to ask Chester Arthur to take over the president’s responsibilities, at least temporarily. “Your father [is] much exercised on the question of disability,” Harriet wrote to her daughter. “Should Arthur be brought to the front, and how?”
The Constitution was of no help. Nothing in it offered any guidance on how to determine when a president was no longer able to perform his duties. Nor was there any precedent. Only three other presidents had died while in office. Lincoln had lived only a few hours after he was shot; Zachary Taylor had succumbed to cholera in just a few days; and William Henry Harrison had survived only one month after contracting pneumonia while giving the longest inaugural address in history on a cold, rainy day. Garfield—much younger, stronger, and with a family to care for—had already lived twice as long as Harrison.
Finally, Blaine sent a cabinet member to New York to discuss the transition with the vice president. Arthur, however, made it clear that he would not even consider taking over the presidency while Garfield still lived. He refused even to return to Washington, concerned that it would appear as if he were preparing for his own inauguration. “Disappoint our fears,” his young invalid friend, Julia Sand, had urged him. “Force the nation to have faith in you. Show from the first that you have none but the purest of aims.”
In the White House, Blaine found it impossibly painful to talk to the president about any of this. Garfield, however, had no illusions about his chances of survival. When asked if he knew that he might not live, he had replied simply, “Oh, yes, I have always been conscious of that.” What worried him now was not his own death, but the suffering it would bring to those he loved most. The last letter he would write was to his mother, in the hope that he could bolster her spirits, if only for a short time. Taking a pen, he began writing in a thin, shaky script that slipped down the page.
Don’t be disturbed by conflicting reports about my condition. It is true I am still weak, but I am gaining every day, and need only time and patience to bring me through.
Give my love to all the relatives & friends, & especially to sisters Hetty and Mary.
Your loving son,
James A Garfield
Only to his wife did Garfield admit his weariness. “I wonder,” he told her one night, “if all this fight against death is worth the little pinch of life I will get anyway.” Lucretia knew that what her husband wanted more than anything now was to escape, not just from this dreary, lonely room, but from Washington altogether. He dreamed of returning to his farm in Ohio, seeing his old friends, sitting in the shade of his neighbor’s maple trees, maybe even having a slice of his aunt’s homemade bread.
If he could not go home, he hoped to go to the sea. He had never lost his childhood love of the ocean, which had seemed almost mythical to a boy from Ohio, and he wanted to see it one last time. “I have always felt that the ocean was my friend,” he had written in his diary just a few weeks before the assassination attempt. “The sight of it brings rest and peace.”
Bliss, however, terrified that Garfield would not survive the trip, refused. “It would not now be prudent,” he told the president. He could leave Washington as soon as his stomach was stronger.
“It’s all right now,” Garfield replied. “I want to get away.”
Although Harriet seemed to speak for everyone in the White House when she admitted to her daughter that she had lost “heart and spirit,” there remained two people who refused to surrender. Lucretia had been so sick with worry for so long that her hair had begun to fall out, forcing her finally to cover her head with a scarf. Still, a reporter from the Evening Star marveled, she seemed to have “banished despair, and hopes even when to everyone else there was no hope.”
The only person in the White House whose determination equaled Lucretia’s was Garfield’s young secretary, Joseph Stanley Brown. Although he would describe this time in his life as “one prolonged, hideous nightmare,” Brown would allow no one, not even the members of Garfield’s cabinet, to express anything but optimism in his presence. At a meeting of the cabinet members in late August, “despair,” a reporter noted, “was in their countenance, and in their speech. They said, ‘He must die.’ ” Brown, who had not yet turned twenty-four, stood and addressed the men, each one old enough to be his father. “Let nothing but words of cheer ever reach the President,” he reprimanded them. “He will not die.”
Brown rarely left the White House, sleeping, when he slept at all, on the small sofa in his office. Garfield wanted Brown near him, so the young man divided his days and nights between the sadness of the sickroom and the madness of his own office, where he replied to thousands of letters and telegrams, fielded journalists’ questions, and greeted dignitaries. “During all this terror, hope, despair, and rush at the White House,” a reporter for the Evening Critic wrote, Brown has been “the ruling spirit of the Mansion, and his young hand, guided by his wise head and kind heart, has been upon all.”
One night, as Brown was working, a member of the White House staff brought him a message that the first lady wished to see him. When he appeared before her, Lucretia did not at first speak, waiting “until control of her voice was assured.” Finally, she asked, “Will you tell me just what you think the chances are for the General’s recovery?”
Brown took one look in Lucretia’s “anguished face,” he would later say, and “threw truthfulness to the winds, and lied and lied as convincingly and consolingly as I could.” Then, as quickly as possible—“as soon as decency permitted”—he excused himself and left the room. “Once beyond the door,” he admitted, “all restraint gave way.” He could not bear to tell Lucretia the truth, but he could no longer hide it from himself. He was, he would acknowledge years later, “utterly shattered and broken.”