Book Review: Destiny of the Republic, A Tale of Madness, Medicine and the Murder of a President

“James Abraham Garfield was one of the most extraordinary men ever elected president,” Destiny of the Republic‘s dust jacket proclaims. “Born into abject poverty, he rose to become a wunderkind scholar, a Civil War hero, a renowned congressman, and a reluctant presidential candidate who took on the nation’s corrupt political establishment.” And those are just as his bad points. Candice Millard’s tome is as close to hagiography as you can get without reading the authorized pabulum of a living politician. No matter. Millard’s a great writer. Although she fell deeply in love with her subject, it’s infectious. Besides she shines a light on one of the most important aspects of armed self-defense . . .

Medical care. Or, in President Garfield’s case, the lack thereof.

Just five minutes after the shooting, Dr. Smith Townsend, the District of Columbia’s health officer, arrived at the Baltimore and Potomac. Although he was the first doctor to reach the station, within the hour he would be joined by a succession of nine more physicians, each of whom wanted to examine the president.

Townsend’s first concern was simply keeping Garfield conscious. After asking White to place his head back on the floor so that it would not be elevated, he gave the president half an ounce of brandy and aromatic spirits of ammonia. When Garfied was alert enough to speak, Townsend asked him where he felt the most pain, and Garfield indicated his legs and feet.

What Townsend did next was something that Joseph Lister, despite years of traveling the world, proving the source of infection and pleading with physicians to sterilize their hands and instruments, had been unable to prevent. As the president lay on the train station floor, one of the most germ-infested environments imaginable, Townsend inserted an unsterilized finger into the wound in his back, causing a small hemorrhage and almost certainly introducing an infection that was far more lethal than Guiteau’s bullet.

And there you have it: who really killed President Garfield. With a great deal of help from Doctor D. Willard Bliss—the unctuous chief physician who inserted a probe into Garfield’s wound several times (creating entirely new wound channels) and made enough aftercare mistakes to launch a thousand malpractice lawsuits.

Of course, there were no such things back in 1881 (although lawyers were no less plentiful than they are today). And hindsight is always 20/20. I mean, to be fair, Lister’s sterilization techniques were less than entirely well-developed at the time of Garfield’s [eventual] assassination. Adherents to his theory operated in rooms literally dripping with carbolic acid.

Millard is to be forgiven; her unabashed admiration for Garfield made her angry that such a glorious man, gunned down by a homicidal narcissist, died slowly, painfully and “needlessly” at the hands of ignorant doctors. And she’s to be praised for [unintentionally] highlighting the role of modern medicine in armed self-defense. To wit:

Destiny of the Republic brought to mind a recent piece of advice from a gun guru during force-on-force training: “you will be shot.” A scary thought, to be sure. But not nearly as scary as it would be if there weren’t first responders ready, willing and able to treat armed self-defenders—and treat them effectively—for gunshot wounds. And physicians and nurses schooled in the modern medical arts of repair and recovery.

I realize that this realization is, at best, subconscious. No one wants to get shot, or thinks that it’s OK to get shot because all the king’s doctors and all the king’s nurses can put Humpty Dumpty back together again. But it’s also true that while ballistics have not changed much since Guiteau plugged the President with a .44 caliber British Bulldog revolver, firearms are not nearly as lethal as they once were.

Estimates vary, but my Google-Fu indicates that as many as 80 percent of gunshot victims live to fight another day. Anecdotally, an ER doc at Rhode Island hospital told me “if the victim is breathing when they come in, there’s a 90 percent chance they’ll survive.”

Yes, well, like all human advances, modern medical care is a double-edged sword. The vast majority of those gunshot “victims” are gang bangers. You could make an argument that their treatment increases the likelihood of gun violence, rather than decreases it. But why would you?

I have no idea how may victims doctors saved from slaughter in Aurora, Colorado. You can rest assured that James Holmes would have claimed many more lives if not for their medical care. More than that, any civilian who might have launched a counter-attack could have done so with the knowledge that they stood a fighting chance of living if Holmes had shot them.

By the same token, President Garfield would have easily survived Guiteau’s bullet had the entire even occurred a decade later. As my father used to say, if my grandmother had wheels she’d be a trolley car. Even so . . .

In the shadow of the Midnight Movie Massacre, it behooves those of us who carry firearms to remember that doctors have increased our ability to defend ourselves a hundredfold by increasing our odds of surviving a shooting. In that sense, Destiny of the Republic is a must-read for those of us who understand, and remain thankful, that we stand on the shoulders of giants.

Yes, even politicians.