19th-century medicine

The DO Book Club, Jan. 2020: The Destiny of the Republic

This page-turner provides a short history of President James A. Garfield’s shooting and subsequent fatal infection.


The world of medicine is filled with incredible stories, which fill the pages of countless spellbinding books. Starting this year, The DO will post a new book review near the end of each month. For each book, we’ll share a summary, notable quotes, parts that DOs might find interesting and overall thoughts.

We will also share the title we plan to cover the next month—you’re welcome to read along and join our virtual book club!

For January, I read The Destiny of the Republic: A Tale of Madness, Medicine, and the Murder of a President by Candice Millard. If you’ve read this one, please share your thoughts in the comments below. If you’d like to write a book review for a future month, please email me at abrown@osteopathic.org.

Plot summary

This narrative history tracks the stories of three men as their lives move closer to intersecting:

  1. Former President James Garfield, who rose from extreme poverty to national renown as a scholar and war hero before his reluctant election to Congress and then the 20th U.S. presidency.
  2. Charles Guiteau, a drifter who dabbled, without credentials, in law and theology before developing a theory likely influenced by mental illness that he was predestined to be in a position of power.
  3. Alexander Graham Bell, who invented the telephone and, in search of new projects, began conducting medical research and creating methods for teaching speech to deaf people.

On July 2, 1881, the intersection began. Guiteau, in a delusional attempt to pave his way to political capital, shot James Garfield, who was four months into his first term as president, at a train station in New Jersey. Garfield’s treatment for his gunshot wounds—during a time when the American medical community largely didn’t believe germs existed—cost him his life two months later.

Garfield was shot twice. One bullet went through his right arm; the other entered his back four inches to the right of his spinal column before resting, benignly, behind his pancreas. Dr. Smith Townsend arrived on the scene shortly afterward. In an effort to locate and remove the lodged bullet, he inserted an unsterilized finger directly into Garfield’s wound, which was a common practice in those days.

The rest of the book details the endless, unnecessary and ultimately unsuccessful hunt for the bullet. It was not actively causing harm, but removal was standard at the time. The president’s doctors probed him constantly with unsanitized hands and instruments, unknowingly making his infection worse.

In a last-ditch attempt to locate the bullet, Bell invented the metal detector, but his device didn’t work when he tested it on the ailing president. Garfield eventually passed away from the infection his treatment caused.

Interesting tidbits for DOs

This book provides a fascinating look at mainstream medicine in the 1880s—the decade when A.T. Still, MD, DO, continued developing and refining osteopathic medicine and prepared to open the first DO school in 1892. It’s easy to see why Dr. Still’s methods, many of which involved alleviating illnesses without drugs or unsterilized surgery, were a welcome respite to the status quo.

Millard describes James Lister’s discovery of germs and the importance of antisepsis. Lister presented his findings at the United States Centennial Exhibition in 1876, five years before Garfield’s death, to an audience of the top physicians in the U.S., who for the most part didn’t believe him.

Lister had hard evidence that the process of destroying germs had completely eradicated gangrene in his London hospital, which saw its death rates plummet. But the physicians he spoke to complained that antisepsis was “too much trouble” and useless.

Unfortunately, one of the doctors in this school of thought was the president’s own: Dr. Willard Bliss. A vocal minority of young or rural American doctors who believed in antisepsis could do nothing but watch from afar. One even wrote a letter to Garfield’s wife, Lucretia, but Dr. Bliss never listened.

Notable quotes

Millard provides graphic details on both the state of medicine in the 19th century and the condition of Garfield’s fatal infection as it worsened.

“‘In order to successfully practice Mr. Lister’s Antiseptic Method,’ one doctor scoffed, ‘it is necessary that we should believe, or act as if we believed, the atmosphere to be loaded with germs.’ … [American doctors] took pride in a particular brand of filth that defined their profession. They spoke fondly of the “good old surgical stink” that pervaded their hospitals and operating rooms … they believed that the thicker the layers of dried blood and pus, black and crumbling as they bent over their patients, the greater the tribute to their years of experience.” p. 184-5

“Each time they inserted an unsterilized finger or instrument into Garfield’s back, something that happened several times a day, they introduced bacteria … cavities of pus had begun to ravage the president’s body. One cavity in particular, which began at the site of the wound, would eventually burrow a tunnel that stretched past Garfield’s right kidney … down nearly to his groin.” p. 226-7


This is a fascinating book and a quick read. You’ll cringe at times at what passed for standard medical procedures, but it’s a great look into the history of medicine. Just 140 years ago, the existence of germs was considered to be up for debate. That’s wild! If you’re interested in an often underreported period of U.S. history, enjoy historical narrative literature or want to get a sense of what being a physician was like in the 1880s, I cannot recommend this book highly enough.

February’s book

For February, The DO Book Club will be reading Lifespan: Why We Age and Why We Don’t Have To, by David A. Sinclair, PhD, and Matthew D. LaPlante. We encourage all who are interested to read along!

As a reminder, if you read The Destiny of the Republic and want your reflections to be shared in future posts, or want to write your own book review for a future month, please leave a comment below or email abrown@osteopathic.org.

Happy reading!

Related reading:

Happy Birthday A.T. Still, MD, DO! 5 facts about the father of the profession

Osteopathic medicine: 125 years of history

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