James A. Garfield (1831-1881) and Lucretia Rudolph (1832-1918)

What desperately needed changing in nineteenth-century American politics was the spoils system, in which elected officials doled out civil-service jobs as favors to supporters. Garfield, a reform-minded Republican and a man of deep personal honor, opposed the system for the obvious reason that it fomented corruption at all levels of government. Other Republicans, called Stalwarts, opposed reform. Led by Roscoe Conkling, a paradigm of corruption, the Stalwarts tried at the 1880 Republican convention to ramrod the nomination of the pliable U.S. Grant for a third term. Garfield, a former university president, Civil War hero, and congressman—the very model of the soldier-scholar-statesman—did not seek or want the nomination but nonetheless received it as a compromise, and easily won the presidency. Watching the process was Guiteau—the very model of the delusional madman—who believed he should be rewarded for his loyalty to the Republican cause by being made American consul general to France. When the post was denied him, his insanity drove him to another, violent outlet.

American medicine also needed reform in the late nineteenth century. Despite advances brought by technology and the experience of the Civil War, American physicians had not embraced—and many actively opposed—advances in germ theory that had already revolutionized medicine in Europe. There, Dr. Joseph Lister had developed an antiseptic method that dramatically reduced infection and increased patient survival of traumatic injuries, including gunshot wounds. “Not only did many American doctors not believe in germs, they took pride in the particular brand of filth that defined their profession,” Millard notes. “They spoke fondly of the ‘good old surgical stink’ that pervaded their hospitals and operating rooms, and they resisted making too many concessions even to basic hygiene.”

Both the spoils system and the barbaric use of unsterilized surgical equipment came to belated ends after Americans watched their remarkable, beloved president linger in agony for more than two months following Guiteau’s assassination attempt. The dual evils of being shot by a spurned office-seeker and having his wound repeatedly probed by unwashed fingers and medical instruments turned Garfield himself into a powerful case study of just how broken both systems were. Garfield’s autopsy revealed he had died not of the gunshot but of the infection introduced by doctors, an internal assault that had spread pus-filled abscesses throughout his once vigorous body. “Had Garfield been shot just fifteen years later,” Millard writes, “the bullet in his back would have been quickly found by X-ray images, and the wound treated with antiseptic surgery. He might have been back on his feet within weeks.” The shared national trauma of the assassination catalyzed the reform process in both politics and medicine.

"...Darling, the days are passing rapidly, still it is so lonely without you, not lonely either in the common acceptation, but I want you. Want you in the morning, want you all day, want you in the quiet night when the whole world gives you all up to me, want to hear the sound of your voice and look into your eyes and through them down into the deep wells of thought and precious love. O, how I want you to come and be near me and stay near me...Loving you and longing for you more than words can tell, I am always and forever,
Your own Crete."