Detail of the title page of President Garfield's autopsy report stamped Surgeon General's Library.

“The President is Somewhat Restless…”: Aftermath

By Jeffrey S. Reznick and Lenore Barbian

The Beginning of the End

While the ocean air of Elberon initially caused some improvement in Garfield’s condition, and he was delighted to be near the sea, he eventually took a turn for the worse, complaining of chills, fever, a troublesome cough, and weakness. The bulletins of his final days—at least up to September 16—tended to obscure these issues, primarily due to the persistent optimism of Dr. Bliss. In an attempt to demonstrate his confidence in Garfield’s recovery, Bliss announced the dismissal of Drs. Barnes, Woodward, and Reyburn shortly after the arrival in Elberon. Only Drs. Agnew and Hamilton remained available to Bliss as consultants.

The fateful day of September 19 arrived, when, around 10:30 P.M., Garfield complained of severe chest pain. Within minutes, after suffering for 80 days, he was dead.


Photograph of Woodward
Dr. Joseph J. Woodward
National Library of Medicine #b017096
Photograph of Dr. Lamb.
Dr. Daniel S. Lamb
National Library of Medicine #b017096

Eighteen hours later, at 4:30 P.M. on September 20, Garfield’s physicians assembled in the cottage for a postmortem examination of his body. Dr. Woodward and his colleague Dr. Daniel S. Lamb from the Army Medical Museum took charge of the examination.

Only then did the doctors learn the true course and location of the fatal bullet. The bullet had fractured ribs, penetrated the first lumbar vertebra, missed the spinal cord, and lodged near the spleen. The autopsy confirmed what Bliss publicly and adamantly denied, that the bullet was on the left side of the president’s body.

At the time, the doctors concluded that a hemorrhage of the major artery leading to the spleen caused Garfield’s death. Since then many doctors and pathologists have subsequently reviewed the evidence and suggested that infection, malnutrition, or even a heart attack may have been the actual cause of death.  In the testimony offered at trial, Guiteau may have been correct about the President’s doctors. “Who killed Garfield?,” asked judge John K. Porter. “The doctors,” replied Guiteau. “The doctors?,” asked Porter. “Yes,” stated Guiteau, “the Lord let them do it to confirm my act.”

Following his autopsy, President Garfield’s body was placed aboard a train, draped in black, for the trip back to Washington. It arrived at the same train station where he was shot, the Baltimore and Potomac Depot. Upon arriving in Washington, his body was taken to the Capitol to lay in state.  National mourning ensued. As one broadside of the day stated so eloquently:

He is mourned by the people because he was one of them, and because in his career, conduct and life he showed them the way to rise by application, industry, energy and uprightness to the highest office in the government; because high as he ascended, he remained modest, unaffected and manly, holding every honest man as his equal and friend…

The Trial

Guiteau’s trial began on November 14, 1881, and lasted over two months. The event was one of the very first high-profile cases in the United States in which the insanity defense was considered. During the course of the proceedings, Guiteau shouted repeatedly that God had instructed him to kill the President. He insisted that he did not murder him, that he was merely an “agent of God.” He insisted (with some validity, as is now recognized) that incompetent medical care had really killed the President. He sang, delivered speeches, and abused witnesses and officials, including his own attorneys.  Guiteau’s defense tried to prove him insane, a strong point being that there was insanity in his family.

The Government’s case was that Guiteau was a disappointed office-seeker, who shot for revenge and refuted the claims of insanity. Many witnesses were called to describe Guiteau’s behavior and his apparent well-being including Dr. Wilson Noble, the jail physician.  Dr. Noble reported that besides suffering from malaria while incarcerated, Guiteau appeared to be of sound body.

Guiteau was ultimately found sane and sentenced to death. He appealed his conviction, but it was rejected. Guiteau’s execution took place on June 30, 1882, just days before the first anniversary of the assassination. As he proceeded to the gallows, Guiteau smiled and waved at the surrounding crowd. As he waited for the hangman, Guiteau read a prayer and recited a poem that he had written for the event.

Guiteau’s Autopsy

Anatomical specimen in a glass jar.
A portion of the autopsied brain of Charles Guiteau.
Courtesy National Museum of Health and Medicine

After his execution, Guiteau was autopsied in an attempt to identify any evidence of insanity. Dr. Daniel S. Lamb performed the autopsy. Guiteau’s brain was examined carefully, but no unusual pathological changes to support the claim of insanity were found. The only obvious pathology was a greatly enlarged spleen, consistent with Dr. Noble’s report that Guiteau had suffered from malaria.


Thank you for joining us for this reenactment of the bulletins that documented the aftermath of President Garfield’s assassination. We appreciate all the thoughtfulness and interest shown by our readers throughout the series.  This post concludes this topic, but we hope you will stay tuned to Circulating Now and continue to explore more topics in the history of medicine with us!

Learn more about the assassination of President James A. Garfield, and the aftermath, through these selected sources:

Primary sources

From NLM’s PubMed Central® (PMC), a free full-text archive of biomedical and life sciences journal literature, encompassing more than 2.7 million articles

Case of the late President Garfield, British Medical Journal, 1881 October 29; 2(1087):     711-720.

F. H. Hamilton, A review of the late President Garfield’s case British Medical Journal, 1881 October 15; 2(1085): 619-620.

A record of the post mortem examination of the body of President Garfield. British Medical Journal, 1881 October 22; 2(1086): 657-659

From the Medical Heritage Library, a collaboration among some of the world’s leading medical libraries, including the National Library of Medicine, via the Internet Archive

Porter, John K. Guiteau trial. Closing speech to the jury of John K. Porter, of New York, in the case of Charles J. Guiteau, the assassin of President Garfield, Washington, January 23, 1882 (1882)

The Great Guiteau Trial: with life of the cowardly assassin. A full account! A complete history! The judge’s charge to the jury. Speeches of counsel on both sides. Likenesses of all the parties concerned. Guiteau as a theologian, a politician, a tramp law (1882)

Other Primary Sources include:

Bliss, D. W. “The Story of President Garfield’s Illness, As Told by the Physician In Charge.” Century Magazine, December 1881, 299-305.

Hayes, Henry Gillespie and Charles Joseph Hayes.  A Complete History of the Life and Trial of Charles Julius Guiteau, Assassin of President Garfield. (Philadelphia:  Hubbard Brothers, Publishers, 1882).

Charles A. Wimer, Complete Medical Record of President Garfield’s Case (Washington, DC: Charles A. Wimer, 1881)

Secondary sources

Candice Millard, Destiny of the Republic: A Tale of Madness, Medicine and the Murder of a President (New York: Doubleday, 2011)

“How doctors killed President Garfield,” CBS Sunday Morning July 1, 2012, broadcast featuring Candice Millard and Jeffrey S. Reznick, PhD, Chief, NLM History of Medicine Division

Charles Rosenberg, The Trial of the Assassin Guiteau: Psychiatry and the Law in the Gilded Age (Chicago: University of Chicago Press, 1968)

This post is one of a series reenacting the official bulletins released to the public by the physicians to President Garfield during his illness after the shooting on July 2, 1881.

Jeffrey S. Reznick, PhD, is Chief of NLM’s History of Medicine Division and author of two books and numerous articles on the cultural history of war and medicine. Lenore Barbian, PhD, is Associate Professor and Anthropology Program Director at Edinboro University of Pennsylvania. She is author of numerous articles, including “Remains of War: Walt Whitman, Civil War Soldiers, and the Legacy of Medical Collections”, co-authored with Jeff Reznick and Paul Sledzik, which received the 2013 best article award from the Archivists and Librarians in the History of the Health Sciences (ALHHS).

One comment

  1. I agree with his physicians at the time that the immediate cause of death was exsanguination due to rupture of the splenic artery. I do not believe myocardial infarction occurred —there was no evidence of clots in the heart. The chest pain that was experienced most likely was due to dissection ( tearing ) of that artery, the wall of which grazed and thereby weakened by the bullet. Of course malnutrtion, debilitation, sepsis all were contributory but the main catastrophic event was haemmorhage into the abdomen.

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