“James Abraham Garfield was one of the most extraordinary men ever elected president,” Destiny of the Republic‘s dust jacket proclaims. “Born into abject poverty, he rose to become a wunderkind scholar, a Civil War hero, a renowned congressman, and a reluctant presidential candidate who took on the nation’s corrupt political establishment.” And those are just as his bad points. Candice Millard’s tome is as close to hagiography as you can get without reading the authorized pabulum of a living politician. No matter. Millard’s a great writer. Although she fell deeply in love with her subject, it’s infectious. Besides she shines a light on one of the most important aspects of armed self-defense . . .

Medical care. Or, in President Garfield’s case, the lack thereof.

Just five minutes after the shooting, Dr. Smith Townsend, the District of Columbia’s health officer, arrived at the Baltimore and Potomac. Although he was the first doctor to reach the station, within the hour he would be joined by a succession of nine more physicians, each of whom wanted to examine the president.

Townsend’s first concern was simply keeping Garfield conscious. After asking White to place his head back on the floor so that it would not be elevated, he gave the president half an ounce of brandy and aromatic spirits of ammonia. When Garfied was alert enough to speak, Townsend asked him where he felt the most pain, and Garfield indicated his legs and feet.

What Townsend did next was something that Joseph Lister, despite years of traveling the world, proving the source of infection and pleading with physicians to sterilize their hands and instruments, had been unable to prevent. As the president lay on the train station floor, one of the most germ-infested environments imaginable, Townsend inserted an unsterilized finger into the wound in his back, causing a small hemorrhage and almost certainly introducing an infection that was far more lethal than Guiteau’s bullet.

And there you have it: who really killed President Garfield. With a great deal of help from Doctor D. Willard Bliss—the unctuous chief physician who inserted a probe into Garfield’s wound several times (creating entirely new wound channels) and made enough aftercare mistakes to launch a thousand malpractice lawsuits.

Of course, there were no such things back in 1881 (although lawyers were no less plentiful than they are today). And hindsight is always 20/20. I mean, to be fair, Lister’s sterilization techniques were less than entirely well-developed at the time of Garfield’s [eventual] assassination. Adherents to his theory operated in rooms literally dripping with carbolic acid.

Millard is to be forgiven; her unabashed admiration for Garfield made her angry that such a glorious man, gunned down by a homicidal narcissist, died slowly, painfully and “needlessly” at the hands of ignorant doctors. And she’s to be praised for [unintentionally] highlighting the role of modern medicine in armed self-defense. To wit:

Destiny of the Republic brought to mind a recent piece of advice from a gun guru during force-on-force training: “you will be shot.” A scary thought, to be sure. But not nearly as scary as it would be if there weren’t first responders ready, willing and able to treat armed self-defenders—and treat them effectively—for gunshot wounds. And physicians and nurses schooled in the modern medical arts of repair and recovery.

I realize that this realization is, at best, subconscious. No one wants to get shot, or thinks that it’s OK to get shot because all the king’s doctors and all the king’s nurses can put Humpty Dumpty back together again. But it’s also true that while ballistics have not changed much since Guiteau plugged the President with a .44 caliber British Bulldog revolver, firearms are not nearly as lethal as they once were.

Estimates vary, but my Google-Fu indicates that as many as 80 percent of gunshot victims live to fight another day. Anecdotally, an ER doc at Rhode Island hospital told me “if the victim is breathing when they come in, there’s a 90 percent chance they’ll survive.”

Yes, well, like all human advances, modern medical care is a double-edged sword. The vast majority of those gunshot “victims” are gang bangers. You could make an argument that their treatment increases the likelihood of gun violence, rather than decreases it. But why would you?

I have no idea how may victims doctors saved from slaughter in Aurora, Colorado. You can rest assured that James Holmes would have claimed many more lives if not for their medical care. More than that, any civilian who might have launched a counter-attack could have done so with the knowledge that they stood a fighting chance of living if Holmes had shot them.

By the same token, President Garfield would have easily survived Guiteau’s bullet had the entire even occurred a decade later. As my father used to say, if my grandmother had wheels she’d be a trolley car. Even so . . .

In the shadow of the Midnight Movie Massacre, it behooves those of us who carry firearms to remember that doctors have increased our ability to defend ourselves a hundredfold by increasing our odds of surviving a shooting. In that sense, Destiny of the Republic is a must-read for those of us who understand, and remain thankful, that we stand on the shoulders of giants.

Yes, even politicians.

12 Responses to Book Review: Destiny of the Republic, A Tale of Madness, Medicine and the Murder of a President

  1. “You will be shot”. Yes. And you will feel the ache and effect of nerve damage, every day and every time you move. And you will know……… what only those who have “taken action” know………………

    Nous Defions

  2. A few random thoughts:

    1. I remember at least one “dude” who came in shot at least three times during the five years of my training.

    2. CCW carriers should take responsibility for themselves in this matter just as much as they do with self defense. Get a little training or at least read: Beating the Reaper.
    http://www.thetruthaboutguns.com/2012/02/eric-nelson/book-review-beating-the-reaper-trauma-medicine-for-the-ccw-operator/

    3. Get a tourniquet and learn how to apply it to yourself and others.

    4. I am pretty blown away at the response of the University Hospitals’ mass casualty system from both the Giffords shooting in AZ and this event. I can imagine the controlled chaos going on in the ER and OR with all hands on deck being called in from home. I heard they had nine ORs going at once with this recent shooting.

    Either way, these hospitals’ mass casualty plans seem to have worked well as I am unaware of any folks dying at the hospital (yet).

    5. If you get shot, you just made some surgical resident’s night happy. Really happy. GSW patients are particularly fun to treat since they almost always require a trip to the operating room, and they tend to get better fast once fixed up (unlike the drunk driver with a head injury).

    • I hate to say it, but probably the shooting at Columbine forced ALL hospitals in Colorado to evaluate their plans for a mass casualty incident. The readiness probably saved lives.

  3. That’s what they always taught us in officer survival schools…”If you get shot keep fighting. If you are not killed outright by the shot, your chances of survival are about 90 percent.”

  4. Wikipedia says that the 44 bulldog shot a 168 gr bullet at 460 fps. 80 ftlbs of energy. more of an infection inducing device than a gun.

    • True, but the weapon used was a British Bulldog chambered in .442 Webley, which was capable of a 200 grn bullet at 700 fps, which equals 239 ft/lbs of energy. About the same as a .380 ACP.

  5. Illustration makes it look more like he’s being upbraided for dancing badly whilst Congressional wrangling gets a bit heated in the background…

  6. Sadly, James Holmes did not get a new orifice in all this. But if he did, valuable OR space would be wasted on saving him.

  7. It’s hard not to fall in love with Garfield. Considering the quality of “winners” who infested the White House in the late 1800s, Garfield shines as a beacon in comparison. It may not be great English, but the phrase I think of is that he is the “most good” man to ever hold the office of President.

    An interesting aside: Lincoln may also have survived (albeit with severe brain damage) had his doctors not attempted to probe out the bullet and done even more damage.

    The number one invention for trauma victims was the Israeli compression bandage. Combined with clotting agents, they save a lot of people who would otherwise bleed out, and that’s why hospitals are getting their 80-90% survival rates (they’re not fighting cell death from oxygen starvation too).

    They’re $5-$10 each on Amazon. No reason for the well-prepared among us to not have one or two in the shooting bag and glovebox.

  8. Well, no, not really. While illegal immigration is a major issue, and possibly a major problem, it’s also been, until very recently, one of the most interesting issues on the public policy front: interesting because until recently none of the large, conventional political groups – liberals and conservatives, Republicans and Democrats – had a single, unified position on the issue. This fascinating situation was destroyed late last year by the Tea Party, whose virulent members inspired a stampede among the Republican candidates for president to prove who could propose the harshest, least tolerant “solution” to the problem of illegal immigration. In their sheer hatred for anyone who doesn’t look, act, and think exactly like they do (especially the guy who currently resides at 1600 Pennsylvania Avenue in Washington, D.C.), Tea Party members successfully forced their warped perspective on every candidate seeking the Republican presidential nomination. It may be years before some semblance of reason can be restored to the public discourse on this issue, but that healing will probably begin on November 7, the day after President Obama is re-elected and Republicans realize they need to go back to the drawing board on this (and possibly other) issues. Until this recent upheaval, though, it was pretty interesting to see people of all political stripes, unaccustomed to doing their own thinking, having to puzzle out matters for themselves for once because their political parties and factions hadn’t formed a single, unified position on the issue.

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