Assassination Medicine

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Twice during my tenure as President Reagan’s White House physician, I accompanied him to performances at Ford’s Theatre. Each time I found myself looking up at the flag-draped box where Booth shot Lincoln and wondering what I would have done had I been one of the doctors who rushed to the President’s aid. Could the medical techniques that had saved Reagan’s life after he was shot in 1981 have helped Lincoln? What about Garfield, McKinley, or Kennedy? Nothing, I have concluded, could have saved Lincoln or Kennedy; Garfield and McKinley are another story.

“His wound is mortal,” said the first doctor to reach Lincoln, and that verdict would be as true in 1992 as it was in 1865. But what of our three other murdered Presidents? A former White House physician speculates about whether he could save them today.

Booth fired his one-shot derringer pistol an inch away from the back of Lincoln’s head; the bullet went through the President’s brain and lodged behind his left eye. Charles Leale, a young Army doctor who reached Lincoln minutes later, managed to restore his breathing and had him moved to more comfortable quarters across the street, but Lincoln never regained consciousness. Today we could replace fluids and blood and put him on life-support systems to keep him breathing. We could certainly prolong his life. But the likelihood that he would ever have regained anything like his normal capacities is slender indeed.

The rifle shots Lee Harvey Oswald fired at John F. Kennedy’s limousine on November 22, 1963, did their work even faster than Booth’s derringer. Entering the base of Kennedy’s neck while his right arm was raised to wave to the crowds, the bullets opened a massive gaping wound on the back of his head. The President was moribund when he arrived at Parkland Memorial Hospital shortly after 12:30 P.M. At 1:00 P.M. he was pronounced dead.

But modern medicine could certainly have saved the life of James Garfield. On July 2, 1881, Garfield entered a Washington railroad station en route to Williams College, his alma mater. His only guard was a local policeman, and as the President walked toward his train, Charles J. Guiteau, an unbalanced lawyer and evangelist, fired two bullets from an English bulldog .44-caliber revolver. One pierced Garfield’s sleeve; the other hit him in the back close to his spine.

Garfield was carried to the second floor of the station, and his boyhood friend Dr. D. W. Bliss was called to the scene. Dr. Bliss gave the President half an ounce of brandy, a dram of spirits of ammonia, and began searching for the bullet with his little finger and a long silver probe. Within an hour Garfield was moved to the White House in a horse-drawn ambulance. From his symptoms it appeared that he was hemorrhaging internally and could not survive the night. But the President rallied, and the next morning Dr. Bliss appointed two Army surgeons and three civilian doctors to help look after him.

The surgeons determined that none of the President’s internal organs had been hurt and agreed to keep a sharp eye out for signs of infection. On July 23 Garfield developed a chill and his temperature shot up to 104 degrees. His doctors traced the problem to pus found in the channel the surgeons had created with their probes. When this was cut open and cleaned out, the President did feel some relief, but on August 18 a swelling in the parotid gland began discharging pus through his mouth and ear. By early September he seemed well enough to be moved by special train over tracks laid to the door of a cottage by the sea in Elberon, New Jersev. There, however, the fever returned, and on the night of September 19 he died.

In Garfield’s day doctors would probe gunshot wounds in the belief that if they could remove the bullet everything would be fine. Today we know a hot bullet is self-sterilizing. Garfield’s real problem was the ill-advised, ill-directed poking with nonsterile instruments by every doctor who entered the sickroom and thought he could do a better job than the one before. All that meddling introduced more bacteria into Garfield’s body.

Garfield’s physicians never found the bullet that killed him, even after they shot at cadavers in an effort to reproduce the wound. Alexander Graham Bell joined the search, using a telephone-like receiver as a metal-detecting device. When the doctors finally located the bullet during an autopsy on Garfield’s body, they found it lodged in the back muscle—a far less dangerous place than they had thought. During his trial Charles Guiteau claimed he hadn’t killed the President, the doctors had. He was probably right.