This president was shot in the back, but the doctors are the ones who killed him

Charles Guiteau, the man known to American history as the assassin of President James Garfield, may have been both innocent and guilty at the same time.

Guiteau himself famously said as much while he was being tried, convicted and ultimately executed. When prosecutors and public critics labeled Guiteau as a murderer, he didn't deny that he had shot Garfield twice on July 2, 1881; one bullet only grazed the president's arm, but a second burrowed itself deep into the right side of his back. Yet Guiteau's contention was that he was merely an attempted murderer, not a successful one.

"Yes, I shot the president," Guiteau argued, both in court and to anyone else who would listen, "but his physicians killed him."

Both morally and legally, one can plausibly argue that Guiteau was wrong. Medically, however, he was almost certainly correct.

Charles Julius Guiteau was born on Sept. 8, 1841 in Freeport, Illinois to a family of French Huguenot ancestry. Like many would-be assassins before and since, Guiteau's life was marked by frustration and failure. Based on his behavior, psychologists speculate that he could have been a psychopath and suffered from associated conditions like narcissistic personality disorder, schizophrenia and perhaps even neurosyphilis. Guiteau had trouble paying attention, displayed unearned feelings of grandiosity and entitlement, and frequently gave rein to a volatile and violent temper. As a result of these qualities, he failed at everything — from being a college student at the University of Michigan (he couldn't focus on his studies) to being a member of a religious commune (the Oneida Community found Guiteau so off-putting that he was nicknamed "Charles Gitout").

Although Guiteau eventually became a lawyer — in those days, anyone could apply to take the bar exam, and it was much easier to pass — he only argued one case before a court. During this same period, his marriage to librarian Annie Bunn fell apart because of his physical abuse and dishonesty, particularly when it came to financial matters. Bunn successfully filed for divorce (very rare in the 1870s), and Guiteau began a life of wandering around America as a self-proclaimed religious prophet. Because he struggled with writing, however, Guiteau's "ideas" were mainly plagiarized from Oneida founder John Humphrey Noyes.

Over time, Guiteau began to focus less on religion than on politics, and aligned himself with the Republican Party. This is where Garfield enters the picture. Although Guiteau had initially supported former President Ulysses S. Grant in his bid for an unprecedented third term — even managing to focus long enough to write a brief "speech" that he passed around at the 1880 Republican National Convention — he switched his support to Garfield after the Ohio congressman unexpectedly won the Republican presidential nomination. To show his support, Guiteau swapped the name "Grant" with "Garfield" in his earlier speech and went around the country sharing it with anyone who would listen. (He may have even openly delivered it on street corners, although if so this only happened one or two times.) After Garfield was elected, Guiteau became convinced that he alone had been responsible for the president's victory.

As a result, Guiteau began a months-long personal mission to be appointed to a consulship in either Vienna or Paris. Bumming around Washington DC and staying one step ahead of the law (he survived during this time by being a thief), Guiteau obsessively stalked both Garfield and anyone else he thought might give him his dream job. For a while, the Garfield administration reacted to Guiteau in the same way as the faculty at the University of Michigan and the religious members of the Oneida Community — first by politely tolerating him, and then by blowing him off. When both of those tactics failed, Secretary of State James G. Blaine finally snapped at Guiteau, "Never speak to me again on the Paris consulship as long as you live!"

That, in sum, is why Guiteau shot Garfield in the back on July 2, 1881. After 80 days of clinging to life, Garfield died a horribly painful death.

Want more health and science stories in your inbox? Subscribe to Salon's weekly newsletter The Vulgar Scientist.

Many scholars have since argued that Guiteau's obvious mental health problems should have mitigated his sentence, and indeed Guiteau's own lawyers were among the first in American history to issue a plea of not guilty by reason of insanity. Because the public was outraged at the assassination, however, experts agree that this argument was doomed to be rejected at trial. For his part, Guiteau believed he was a brilliant man who had saved America — and insisted that he had only wounded Garfield, not killed him.

When it came to the latter assertion, Guiteau actually had a valid point.

The underlying issue is that the doctors who probed Garfield's body refused to wash their hands. Even though doctors had known about hand-washing since the 1840s, many American physicians were put off by the idea that a doctor's hands could ever be unclean, or were simply unaware of the strong evidence that hand-washing works. The doctors who attended to Garfield, led by a former Civil War surgeon named Dr. D. Willard Bliss (the first 'D' actually stood for 'Doctor,' his given name), insisted on probing the bullet wound in the president's back without first washing their hands. Dozens of medical professionals — not one of them washing their hands — poked and prodded Garfield's open wound. Even their instruments were not sterilized, despite British surgeon Joseph Lister proving by the mid-1860s that sterilization was important. (These ideas had also either not reached American doctors or, when that happened, been rejected by them.) To add figurative salt to the wound, Garfield's doctors declined to use ether as anesthetic (this practice had existed since the 1840s), meaning the president was in horrible pain every day as they gradually expanded his three-inch bullet wound into a 1 foot, 8 inch long incision that oozed pus.

While it is tempting to condemn Garfield's doctors as cruel or incompetent, their biases against hand-washing and sterilization were ubiquitous among American physicians until the mid-1890s, when American doctors began by and large accepting the need to be clean. While their views can be characterized as ignorant, the willful nature of that ignorance was simply part of the zeitgeist. What's more, unlike Guiteau, the doctors almost certainly had Garfield's best interests at heart, even recruiting inventor Alexander Graham Bell to build a primitive metal detector in the hope of locating the path of the bullet.

Characteristically, however, Bell's attempt to save Garfield's life was hampered by egotism and bad luck. Dr. Bliss refused to let Bell pass the device over the entirety of Garfield's body, as he had already stated it was somewhere on the right side of the president's body. In fact, the bullet had passed through Garfield's first lumbar vertebra of his spine on his right side and passed through to his left side, ultimately lodging in his abdomen. What's more, even if Bell had been allowed to pass his device all over Garfield's body, it likely would not have mattered. The entire time, Bell's invention produced so much static that doctors could not determine if it actually found the bullet. It later came out that the president's mattress had metal coils, which had likely rendered the device ineffective.

Barring any definitive way of locating the bullet, the doctors continued probing and prodding until the president eventually succumbed to an infection. When he passed away on Sept. 19, 1881, the cause of death was septic blood poisoning — worsened, no doubt, by the doctors' decision to limit his solid food intake in case the bullet had pierced his intestines. For the last two months of Garfield's life, he was only "fed" by having egg yolks, beef bouillon, whiskey, milk and opium drops inserted up his anus. During that time, he lost roughly 80 pounds. When he finally died, the catalyst was a rupturing of his splenic artery and a heart attack. The passionate abolitionist's final words were, "This pain. This pain."

Medical historian Dr. Ira Rutkow perhaps has the final word on this subject, telling The New York Times in 2006 that Garfield's doctors "basically starved him to death" and that "Garfield had such a nonlethal wound" that in early 21st century America "he would have gone home in a matter or two or three days." Guiteau, to no one's surprise, was sentenced to death and hanged on June 20, 1882.

If there is any way to end this tragedy on an upbeat note, it is by pointing out that Garfield still left an impressive legacy behind him. It is a testament to his intelligence, work ethic and political idealism that one can safely say America would have been a better place if he had lived. In many ways, Garfield was ahead of his time, having won the presidency because of a half-improvised speech where he implored Republican delegates to create a better nation after the Civil War, which had ended only 15 years earlier.

Then, after the storms of battle, were heard the calm words of peace spoken by the conquering nation, saying to the foe that lay prostrate at its feet: "This is our only revenge—that you join us in lifting into the serene firmament of the Constitution, to shine like stars for ever and ever, the immortal principles of truth and justice: that all men, white or black, shall be free, and shall stand equal before the law."

If Garfield had survived Guiteau's assassination attempt, he could have used his power — no doubt significantly enhanced by the near-unanimous public sympathy at his disposal — to make that dream into a reality. Instead his doctors refused to wash their hands or sterilize their instruments, and starved him while shoving food, liquor and opium into his rectum.

The rest, as they say, is history.