Could simultaneously write Greek with one hand and Latin with the other. 1a

For six weeks when he was 15, Garfield drove horses along the narrow towpaths running beside the Ohio canal network. After falling into the water for literally the 14th time, Garfield developed fever, chills, exhaustion, and became bedridden for weeks. This illness was diagnosed as an "ague," which was then a term applied generically to any malaria-like illness. He was treated with large doses of calomel, a chloride of mercury with cathartic properties. At that time it was the standard treatment for any fever. 2

Garfield had a bad cold in 1851 that was treated by a homeopathic practitioner, Alpheus Morrill, with "cold cloths applied to the chest and infinitesimal doses of medicine." 2

Garfield developed a painful anal fissure in 1875 that kept him in bed for several weeks. Ultimately, Dr. John Shaw Billings (later the Surgeon General of the US Army, and the architect of the Johns Hopkins Hospital) operated on him. 2

Garfield had a "weak stomach" for years. 2

"Garfield was elected president at age 49. He was six feet in height and weighed 185 pounds, and was characterized as 'very strong, atheletic and energetic." 2

On July 2, 1881, Charles J. Guiteau fired two bullets from his Bulldog .44 at Garfield. One caused a superficial arm wound. The other entered in the right posterior thorax, fractured rib 11, traveled leftward and anteriorly into the L1 vertebral body, then lodged about 2.5 inches to the left of the spine, below the inferior border of the pancreas.

3 (President Garfield's spine is held by the National Museum of Health and Medicine. It was on display in 2000, and apparently shows the path of the bullet 4.)

The whereabouts of this second bullet was a mystery until the autopsy, despite even the efforts of Alexander Graham Bell. Bell used his newly invented "induction balance," better known now as a metal detector, to attempt locating the bullet. 1b

For some period after the shooting, Garfield was fed rectally 1c. Comment: It would be interesting to know if this was an innovation at the time and whether, due to absorptive peculiarities of the rectum, this could have led to a deficiency state of any kind.

After the shooting, Garfield was treated with high maintenance doses of quinine (5 to 10 grains per day) and morphine (one-fourth grain daily), frequent sips of brandy, and a single dose of calomel. Garfield had chronic abdominal symptoms during his convalescence. They were ascribed to the calomel by one of the homeopathic practitioners attending him. 2 MORE

Pendel 5a heard this from a White House steward, Mr. Crump, hours after Garfield died:

He was always so cheerful and had so much nerve. Why, he used to astonish me with his jokes, even while he was suffering horribly. Suffer? I should say he did. The first week or ten days it was his feet. He kept saying, "Oh, my God! my feet feel as though there were millions of needles being run through them." I used to squeeze his feet and toes in both my hands, as hard as I possibly could, and that seemed the only relief he could get.

Comment: This presumably relates to a post-shooting time. It is difficullt to know what to make of this symptom. It doesn't sound like gout (squeezing would be excruciating). Vascular or neurological causes seem most likely.

Garfield died 80 days after being shot. The cause of death has usually been described as either: (1) rupture of a splenic artery aneurysm, or (2) pyemia. In fact, his death was probably due to ischemic heart disease. 1d MORE

At his trial, the assassin Guiteau admitted shooting the President, but denied killing him. Instead, he claimed that Garfield's physicians killed him. Although Guiteau was executed because his defense was not strong enough, he was probably correct.

Garfield's original wound was 3.5 inches long, and ended with the bullet lodged in a harmless part of the abdomen. The wound was probed by the fingers of numerous physicians during the rest of Garfield's life so that, by the time of his death, the wound track was 20 inches long and oozing pus.

It seems reasonable that the terminal event in Garfield's life was a myocardial infarction. However, the wound could have contributed to the terminal event in three ways, all of them derived from the fact that Garfield was mightily infected for a period of 3 months:

1. It seems reasonable to suppose that Garfield had anemia of chronic disease, which would have lowered the ischemic threshold.
2. Chronic infection could have led to amyloidosis. If it affected the heart, then it is not surprising that an ischemic event would have been so rapidly fatal.
3. It is becoming increasingly clear that coronary atherosclerosis is an inflammatory, perhaps infectious, disease. It is possible that Garfield's chronic inflammation and infection could have accelerated atherosclerosis.