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Progress

Having doubts about the progress of mankind? Consider how much better your medical care is than that received by your fellow Eph, President James Garfield ’56.

Three vertebrae, removed from the body of President James A. Garfield, sit on a stretch of blue satin. A red plastic probe running through them marks the path of his assassins bullet, fired on July 2, 1881.

The vertebrae form the centerpiece of a new exhibit, commemorating the 125th anniversary of Garfields assassination. The exhibit also features photographs and other images that tell the story of the shooting and its aftermath, in which Garfield lingered on his deathbed for 80 days. Located at the National Museum of Health and Medicine, on the campus of the Walter Reed Army Medical Center, the exhibit opened on July 2 and will close, 80 days later, on Sept. 19.

Garfield was waiting at the Baltimore and Potomac Railroad Station in Washington, about to leave for New England, when he was shot twice by the assassin, Charles J. Guiteau.

As all good Ephs know, Garfield was on the way to his 25th Williams Reunion. But it wasn’t the bullet that killed him.

At the autopsy, it became evident that the bullet had pierced Garfields vertebra but missed his spinal cord. The bullet had not struck any major organs, arteries or veins, and had come to rest in adipose tissue on the left side of the presidents back, just below the pancreas.

Dr. Ira Rutkow, a professor of surgery at the University of Medicine and Dentistry of New Jersey and a medical historian, said: Garfield had such a nonlethal wound. In todays world, he would have gone home in a matter or two or three days.

In addition to causing sepsis by probing the wound with unsterile hands and instruments, Garfields doctors did him a disservice by strictly limiting his solid food intake, believing that the bullet might have pierced his intestines, said Dr. Rutkow, the author of James A. Garfield, a book in the American Presidents Series.

In mid-August, the doctors insisted that Garfield be fed rectally, and he received beef bouillon, egg yolks, milk, whiskey and drops of opium in this manner.

They basically starved him to death, said Dr. Rutkow, noting that the president lost over 100 pounds from July to September.

Rough. The poorest person in America today receives free medical care which is orders of magnitude better than Garfield’s was. If that isn’t progress than the term has no meaning.

The assassins lawyers tried to argue that their client was not guilty by reason of insanity. The defense was unsuccessful, and he was hanged on June 30, 1882.

Guiteau himself repeatedly criticized Garfields doctors, suggesting that they were the ones who had killed the president.

I just shot him, Guiteau said.

A clever defense.

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#1 Comment By frank uible On August 29, 2006 @ 12:37 pm

This year’s crop of Williams football players is an emphatic reminder of the obvious effects of long continuing improvements in the quality and quantity of U.S. societal medical care and nutrition.

#2 Comment By George On August 29, 2006 @ 2:52 pm

What progress?

Nosocomial (hospital-acquired) infection rates in the 21st century are still staggering.

Literally millions of patients a year acquire a new infection during hospitalization, and an estimated 90,000 of them die of the infection.

In 2004 in the State of Pennsylvania, such infections were responsible for more than $2 Billion in extra medical charges. Just imagine how much these infections cost the country as a whole.

Over 65% of the cost ($1.37 B) was for patients receiving “free medical care” — through Medicare or Medicaid. Medicaid patients in PA who contracted a nosocomial infection were 14.5 times more likely to die.

Is this progress? The only progress I see is that the health care industry is better at making more money when hospital patients get sicker.

The poorest people in America receive medical care that too often kills them — just as you point out that his medical care was responsible for killing Garfield. That’s not the “progress of mankind” worth celebrating.

#3 Comment By Loweeel On August 29, 2006 @ 4:13 pm

George,

Imagine what kind of care the poor got in those days, if any. Surely you’re not suggesting that people should just avoid hospitals altogether. The question is not the gross number of infections acquired in hospitals, but instead the net effect of hospitals on infection rates.

Progress is the poor in America today having to worry about obesity, rather than starvation; about health, rather than survival; about amenities, rather than placing food on the table.

#4 Comment By frank uible On August 29, 2006 @ 5:13 pm

Do the “poor” bring to the hospitals the infections, which are subsequently acquired by others there, at a disproportionately high rate?

#5 Comment By Ken Thomas ’93 On August 29, 2006 @ 7:11 pm

George,

Serious questions. The NYT ran an interesting article on increasing lifespans within a few days of the Garfield article, pinning key factors on child care and nutrition.

I just spend the weekend in Chicago for my uncle’s 80th birthday, and got to listen to memories of the neighborhood where I spent those critical years, from my first playmates.

Just about the time I began to write this, my mother was undergoing a dye-injection CAT scan; if the blockage it charts, first revealed by a more routine procedure two weeks before our trip, is critical, she will undergo surgery this week. If not, she will meet my sister and uncle in Las Vegas, then spend the next month in Denver, then be back here for the surgery.

She is 84. Even a decade ago, her blockage would have led to an eventual stroke. And of course, a decade ago, she would not have lived until 84, to face such a challenge.

If this were the world of a century ago, Vanessa would have died in Mexico City some weeks ago, or been left severely crippled. I might well have died from the consequences of a broken nose and concussion suffered on the frosh quad, or similarly been left with lifetime injuries– and at the very least, with some rather nasty scars instead of the minimal ones I have.

Again, if either of us had made it to those incidents and experiences.

Such thoughts make me think of the people of Mexico, especially in the countryside, and of their very different life prospects and the challenges they (and we, see below) face. But I won’t go on…

The infection issues you raise, along with those of other preventable patient deaths (drug interactions and incorrect dosages, obvious diagnoses that were ignored, etc), are staggering indeed. (I had a chance to talk a few of them over, this Saturday, with a head nurse who took care of me when she was six…) And most obviously– they affect the poor disproportionately, for a number of reasons.

Regardless, how do we change the situation?

Better hygenic practices come to mind. I wear a mask and wash my hands very carefully in doctor’s offices; but how many of the population can you convince to do that?

Beyond that, unless you have more to tell me, I think we move to the complex. What is the path of infection in an office or hospital, and how do we change that? Answers may range from redesigning the waiting room, to autonomous robotic detectors. Why not?

And what are you waiting for? If there’s a problem, and you want to fix it, and you think there are clear paths, then declare that as you mission, get the word out, say that you want to form a company to do X, that you need so much to support the initial effort, and do it.

I’d be glad to be on the board (from France; within an hour of David’s post about “hours of devotion,” Vanessa informed me that “we” had been accepted to INSEAD).

“We…”, as I remember the twin graves of my great-grandmother’s daughters, both dead at thirteen, a few days apart, that we may be given so many years to explore the meaning of that utterance, seems such an amazing gift.

What shall we do with it?

(And how odd that some people think that this forum is about David Kane!)

#6 Comment By George On August 30, 2006 @ 12:07 am

The day this forum stops being (mostly) about Dave Kane is the day that it becomes eligible for that precious Wikipedia link.

In no way did I mean to imply that there have not been remarkable advances in medical technology. Of course there have been. But “progress” was not defined by the original post in that context.

My comments were entirely directed at Dave’s comment that the poorest in the land receive free medical care (if I were not so charitable, I’d ascribe a political motive to his phrasing, but then we would digress) that is so much better than what Garfield got.

Distilled, Garfield got infection and malpractice. Every day, I see firsthand how the poor in this country too often get little more. And I am frustrated as I watch the medical community fight to maintain the status quo.

Ken, I have recently supported the work of the Coalition for Patients Rights (CPR) here in Maryland (http://www.coalitionforpatientsrights.org). I invite you to support them as well.

I supported their legislation, Senate Bill 535, to mandate stricter infection control in Maryland, modelled after the international SHEA Guidelines. If you want to know how the path of infection can be changed, you need only look at the data from countries (not ours) that have adopted and implemented those guidelines.

The Maryland hospitals — yes, even Johns Hopkins — fought and defeated CPR’s bill.

And our Governor vetoed a companion bill that was intended to collect and publicize data about nosocomial infections.

Presently, I work alongside CPR to replace the short-sighted politicians who impede the progress that they offer. And next year, I will be back in Annapolis to support that legislation again.

I remain hopeful that, eventually, we will see real progress in medical care — when what happened to Garfield doesn’t happen anymore to people simply because they can’t afford better care.