Editing James A. Garfield (section)

===Treatment and death===
[[File:B&PStation1908.jpg|thumb|right|alt=An ornate Victorian Gothic style building with a square tower|[[Baltimore and Potomac Railroad Station]] in Washington D.C., where Garfield was shot July 2, 1881]]
Garfield was struck by two shots: one glanced off his arm while the other pierced his back, shattering a rib and embedding itself in his abdomen. "My God, what is this?" he exclaimed.{{sfn|Ackerman|2003|pp=333–334}} Among those at the station was [[Robert Todd Lincoln]], who was deeply upset, thinking back to when his father Abraham Lincoln was assassinated 16 years earlier. Garfield was taken on a mattress upstairs to a private office, where several doctors examined him. At his request, Garfield was taken back to the White House, and his wife, then in New Jersey, was sent for.{{sfn|Ackerman|2003|pp=335–336}} Blaine sent word to Vice President Arthur in New York City, who received threats against his life because of his animosity toward Garfield and Guiteau's statements.{{sfn|Rutkow|2006|pp=88–89}}

Although [[Joseph Lister, 1st Baron Lister|Joseph Lister]]'s pioneering work in antisepsis was known to American doctors, few of them had confidence in it, and none of his advocates were among Garfield's treating physicians.{{sfn|Rutkow|2006|pp=106–107}} The physician who took charge at the depot and then at the White House was [[Doctor Willard Bliss]].{{efn|"Doctor" was his given name.}} A noted physician and surgeon, Bliss was an old friend of Garfield, and about a dozen doctors, led by Bliss, were soon probing the wound with unsterilized fingers and instruments. Garfield was given [[morphine]] for the pain, and asked Bliss to frankly tell him his chances, which Bliss put at one in a hundred. "Well, Doctor, we'll take that chance."{{sfn|Ackerman|2003|p=346}}

Over the next few days, Garfield made some improvement, as the nation viewed the news from the capital and prayed. Although he never stood again, he was able to sit up and write several times, and his recovery was viewed so positively that a steamer was fitted out as a seagoing hospital to aid with his convalescence. He was nourished on oatmeal [[porridge]] (which he detested) and milk from a cow on the White House lawn. When told that Indian chief [[Sitting Bull]], a prisoner of the army, was starving, Garfield said, "Let him starve..." initially, but a few moments later said, "No, send him my oatmeal."{{sfn|Peskin|1978|pp=601–602}}

[[Projectional radiography|X-ray imaging]], which could have assisted physicians in precisely locating the bullet in Garfield's body, would not be invented for another 14 years. [[Alexander Graham Bell]] tried to locate the bullet with a primitive metal detector, but was unsuccessful, though the device had been effective when tested on others. But Bliss limited its use on Garfield, ensuring he remained in charge. Because Bliss insisted the bullet rested someplace it did not, the detector could not locate it. Bell shortly returned after adjusting his device, which emitted an unusual tone in the area where Bliss believed the bullet was lodged. Bliss took this as confirmation that the bullet was where he declared it to be. Bliss recorded the test as a success, saying it was: <blockquote>now unanimously agreed that the location of the ball has been ascertained with reasonable certainty, and that it lies, as heretofore stated, in the front wall of the abdomen, immediately over the groin, about five inches [{{convert|5|in|mm|disp=out}}] below and to the right of the navel.<ref>{{cite book |last1=Millard |first1=Candice |title=Destiny of the Republic |date=2011 |publisher=Doubleday |isbn=978-0-385-52626-5 |pages=201–202, 213}}</ref></blockquote>

One means of keeping Garfield comfortable in Washington's summer heat was one of the first successful [[air conditioning]] units: air propelled by fans over ice and then dried reduced the temperature in the sickroom by {{convert|20|F-change|C-change|abbr=on}}.{{sfn|Peskin|1978|pp=601–602}} Engineers from the navy and other scientists worked together to develop the unit, though there were problems to solve, such as excessive noise and increased humidity.<ref>{{cite book |last1=Millard |first1=Candice |title=Destiny of the Republic |date=2011 |publisher=Doubleday |isbn=978-0-385-52626-5 |page=178}}</ref>

On July 23, Garfield took a turn for the worse when his temperature increased to {{convert|104|F}}; doctors, concerned by an [[abscess]] at the wound, inserted a drainage tube. This initially helped, and the bedridden Garfield held a brief cabinet meeting on July 29; members were under orders from Bliss to discuss nothing that might excite Garfield.{{sfn|Peskin|1978|p=603}} Doctors probed the abscess, hoping to find the bullet; they likely made the infections worse. Garfield performed only one official act in August, signing an extradition paper. By the end of the month, he was much feebler than he had been, and his weight had decreased from {{convert|210|lb}} to {{convert|130|lb}}.<ref>{{cite web|url=http://www.eyewitnesstohistory.com/gar.htm|title=The Death Of President Garfield, 1881|website=www.eyewitnesstohistory.com|access-date=August 3, 2019|archive-date=September 30, 2018|archive-url=https://web.archive.org/web/20180930045040/http://www.eyewitnesstohistory.com/gar.htm|url-status=live}}</ref>{{sfn|Ackerman|2003|pp=374–375}}

Garfield had long been anxious to escape hot, unhealthy Washington, and in early September the doctors agreed to move him to [[Elberon, New Jersey|Elberon]], part of [[Long Branch, New Jersey]], where his wife had recovered earlier in the summer. He left the White House for the last time on September 5, traveling in a specially cushioned railway car; a spur line to the [[Charles G. Francklyn|Francklyn Cottage]], a seaside mansion given over to his use, was built in a night by volunteers. After arriving in Elberon the next day, Garfield was moved from the train car to a bedroom where he could see the ocean as officials and reporters maintained what became (after an initial rally) a death watch. Garfield's personal secretary, [[Joe Stanley Brown]], wrote forty years later, "to this day I cannot hear the sound of the low slow roll of the Atlantic on the shore, the sound which filled my ears as I walked from my cottage to his bedside, without recalling again that ghastly tragedy."{{sfn|Ackerman|2003|pp=374–376}}

[[File:Chester A. Arthur by Abraham Bogardus (cropped) (2).jpg|thumb|upright|Vice-president [[Chester A. Arthur]] assumed the presidency after Garfield's death.]]
On September 18, Garfield asked Colonel A.F. Rockwell, a friend, if he would have a place in history. Rockwell assured him he would and told Garfield he had much work still before him. But his response was, "No, my work is done."{{sfn|Caldwell|1965|p=355}} The following day, Garfield, then suffering also from pneumonia and hypertension, marveled that he could not pick up a glass despite feeling well and went to sleep without discomfort. He awoke that evening around 10:15&nbsp;p.m. complaining of great pain in his chest to his chief of staff General [[David G. Swaim|David Swaim]], who was watching him, as he placed his hand over his heart.<ref>{{Cite book|title=The Life and Work of James A. Garfield|last=Ridpath|first=John Clark|year=1881|page=638}}</ref> The president then requested a drink of water from Swaim. After finishing his glass, Garfield said, "Oh Swaim, this terrible pain—press your hand on it." As Swaim put his hand on Garfield's chest, Garfield's hands went up reflexively. Clutching his heart, he exclaimed, "Oh, Swaim, can't you stop this? Oh, oh, Swaim!" Those were Garfield's last words.<ref>{{Cite book|url=https://books.google.com/books?id=9GGxDAAAQBAJ|title=Murdering the President: Alexander Graham Bell and the Race to Save James Garfield|last=Rosen|first=Fred|date=September 2016|publisher=University of Nebraska Press|isbn=978-1-61234-865-0|page=173|access-date=September 17, 2020|archive-date=January 26, 2021|archive-url=https://web.archive.org/web/20210126031423/https://books.google.com/books?id=9GGxDAAAQBAJ|url-status=live}}</ref> Swaim ordered another attendant to send for Bliss, who found Garfield unconscious. Despite efforts to revive him, Garfield never awoke, and he was pronounced dead at about 10:30&nbsp;p.m.{{sfnm|Ackerman|2003|1pp=376–377|Rutkow|2006|2p=127}}<ref>{{cite news |url=https://www.pbs.org/newshour/health/dirty-painful-death-president-james-garfield |title=The dirty, painful death of President James A. Garfield |date=September 16, 2016 |work=PBS |first=Howard |last=Markel |author-link=Howard Markel |access-date=July 1, 2022 }}</ref> Learning from a reporter of Garfield's death the following day, Chester A. Arthur took the presidential oath of office administered by New York Supreme Court Justice [[John R. Brady]].{{sfn|Peskin|1978|p=608}}

According to some historians and medical experts, Garfield might have survived his wounds had the doctors attending him had at their disposal today's medical research, knowledge, techniques, and equipment.{{sfn|Schaffer|2006}}<ref>{{cite news |last1=Healy |first1=Donna |title=Famous assassinations: Who could doctors save today? |url=https://billingsgazette.com/lifestyles/famous-assassinations-who-could-doctors-save-today/article_978d85a3-6f92-5b79-84dc-a3389e7d2b44.html |access-date=December 25, 2018 |work=[[Billings Gazette]] |date=February 29, 2008 |quote=Today's outcome: Doctors would have been able to treat his injuries and infection and been able to offer nourishment intravenously or through tube feedings. 'This was a no-brainer. It would have been an unreasonable death by today's standard,' [Dr. Terry] Housinger said. |archive-date=February 13, 2021 |archive-url=https://web.archive.org/web/20210213011631/https://billingsgazette.com/lifestyles/famous-assassinations-who-could-doctors-save-today/article_978d85a3-6f92-5b79-84dc-a3389e7d2b44.html |url-status=live }}</ref><ref>{{cite news |last1=Charies |first1=Eric J. |last2=Hanks |first2=John B. |title=The assassination of President James Garfield: Could he have survived? |url=http://bulletin.facs.org/2018/01/the-assassination-of-president-james-garfield-could-he-have-survived/ |access-date=December 25, 2018 |work=Bulletin of the [[American College of Surgeons]] |date=January 6, 2018 |quote=Viewed through the lens of modern trauma care, President Garfield's wounds would be regarded as distinctly survivable. |archive-date=December 25, 2018 |archive-url=https://web.archive.org/web/20181225225103/http://bulletin.facs.org/2018/01/the-assassination-of-president-james-garfield-could-he-have-survived/ |url-status=live }}</ref> Standard medical practice at the time dictated that priority be given to locating the path of the bullet. Several of his doctors inserted their [[Asepsis|unsterilized]] fingers into the wound to probe for the bullet, a common practice in the 1880s.{{sfn|Schaffer|2006}} Historians agree that massive infection was a significant factor in Garfield's demise.{{sfn|Schaffer|2006}} Biographer Peskin said medical malpractice did not contribute to Garfield's death; the inevitable infection and blood poisoning that would ensue from a deep bullet wound resulted in damage to multiple organs and spinal fragmentation.{{sfn|Peskin|1978|p=607}} Rutkow, a professor of surgery at the [[University of Medicine and Dentistry of New Jersey]], has argued that starvation also played a role. Rutkow suggests "Garfield had such a nonlethal wound. In today's world, he would have gone home in a matter of two or three days."{{sfn|Schaffer|2006}} The conventional narrative regarding Garfield's post-shooting medical condition was challenged by Theodore Pappas and Shahrzad Joharifard in a 2013 article in ''[[The American Journal of Surgery]]''. They argued that Garfield died from a late rupture of a splenic artery [[pseudoaneurysm]], which developed secondary to the path of the bullet adjacent to the splenic artery. They also argued that his sepsis was actually caused by post-traumatic acute acalculous [[cholecystitis]]. Based on the [[autopsy]] report, the authors speculate that his gallbladder subsequently ruptured, leading to the development of a large bile-containing abscess adjacent to the gallbladder. Pappas and Joharifard say this caused the septic decline in Garfield's condition that was visible starting from July 23, 1881. Pappas and Joharifard also state that they don't believe that Garfield's doctors could have saved him even if they had been aware of his cholecystitis, since the first successful [[cholecystectomy]] ([[surgical]] removal of the gallbladder) was performed a year after Garfield's death.<ref>{{cite journal |title=Did James A. Garfield die of cholecystitis? Revisiting the autopsy of the 20th president of the United States |date=July 8, 2013 |first1=Theodore N. |last1=Pappas |first2=Shahrzad |last2=Joharifard |journal=[[The American Journal of Surgery]] |volume=206 |issue=4 |pages=613–618 |doi=10.1016/j.amjsurg.2013.02.007 |pmid=23827513  |issn = 0002-9610 }}</ref>

Guiteau was indicted on October 14, 1881, for the murder of the president. During his trial, Guiteau declared that he was not responsible for Garfield's death, admitting to the shooting but not the killing. In his defense, Guiteau wrote: "General Garfield died from malpractice. According to his own physicians, he was not fatally shot. The doctors who mistreated him ought to bear the odium of his death, and not his assailant. They ought to be indicted for murdering James A. Garfield, and not me."<ref>{{cite book |last1=Millard |first1=Candice |title=Destiny of the Republic |date=2011 |publisher=Doubleday |isbn=978-0-385-52626-5 |page=239}}</ref> After a chaotic trial in which Guiteau often interrupted and argued, and in which his counsel used the [[insanity defense]], the jury found him guilty on January 25, 1882, and he was sentenced to death by hanging. Guiteau may have had [[neurosyphilis]], a disease that causes physiological mental impairment.<ref>{{Cite journal
| last1 = Paulson | first1 = G.
| title = Death of a President and his Assassin—Errors in their Diagnosis and Autopsies
| doi = 10.1080/096470490953455
| journal = Journal of the History of the Neurosciences
| volume = 15
| issue = 2
| pages = 77–91
| year = 2006
| pmid = 16608737
| s2cid = 21899497
}}</ref> He was executed on June 30, 1882.{{sfn|Ackerman|2003|pp=444–446}}