Review from the Journal of American Academy of Psychiatry and the Law

Destiny of the Republic: A Tale of Madness, Medicine, and the Murder of a President

By Candice Millard. New York: Doubleday, 2011. 352 pp. $28.95.


The Ballad of Guiteau

Charlie Guiteau

Drew a crowd to his trial,

Led them in prayer,

Said, “I killed Garfield.

I’ll make no denial.

I was just acting

For Someone up there.

The Lord’s my employer,

And now He’s my lawyer,

So do what you dare.”

—from Assassins by Stephen Sondheim1

American presidential assassinations continue to be a source of fascination for various reasons, not the least of which is attempting to understand the mentality of the perpetrator.2 We seem obsessed with reworking scenarios of these lives cut short. Indeed, at the time of this writing, there were current nonfiction books on Presidents Lincoln (Killing Lincoln by Bill O’Reilly and Martin Dugard) and Kennedy (Jack Kennedy: Elusive Hero by Chris Matthews and Killing Kennedy: The End of Camelot by Bill O’Reilly and Martin Dugard). One author took an “assassination vacation” to shadow places and things associated with these events.3

Bracketed by the murders of Lincoln and Kennedy, those of Garfield and McKinley, too, have their following. The killers and would-bes, as a group, took the stage in Stephen Sondheim’s Assassins, a 1990 musical (book by John Weidman).1 Garfield was shot by the pathologically obsessed Charles Guiteau,2,4 and McKinley by anarchist, Leon Czolgosz. Both were tried, convicted, and promptly executed (Guiteau by hanging and Czolgosz by electrocution). The Lincoln and Kennedy assassins, Booth and Oswald, were killed before coming to trial. Whereas Czolgosz refused a defense or even to speak with a psychiatrist, the trial of Guiteau brought out a battle of expert witnesses—a “Who’s Who” of psychiatry.2

President Garfield, an Ohio Republican reluctant to run for president, was in office for a few months before the shooting in Washington, D.C., on July 2, 1881. He died in New Jersey on September 19, 1881, 200 days after taking office. The interlude between the shooting and the president’s death is the central focus of Candice Millard’s book, Destiny of the Republic. In her tale of politics, insanity, and medical bungling, Millard treats us to an insightful and engrossing look at the dynamics between Garfield and Guiteau as well as those among the professionals charged with preserving the president’s life.

Millard’s narrative begins with an eerie prologue: Guiteau survived a steamship collision on Long Island Sound in 1880, exultant because God had chosen him to survive. This is a metaphor for the collision between the future assassin and the soon-to-be president. The destinies of Garfield and Guiteau make a wonderful side-by-side tableau. Vowell considered them “cracked mirror image[s] … Garfield … was everything Guiteau was not” (Ref. 3, p 136).

In the first chapter, Garfield tours the 1876 American Centennial Exposition in Philadelphia. Among the wonders of the sprawling show were Alexander Graham Bell’s telephone and the antiseptic surgical technique of Joseph Lister. Bell struggled with broken equipment, and Lister was rebuffed by incredulous Americans. Even the Exposition’s top physician, Samuel Gross, was openly hostile to antisepsis, despite Lister’s claim that it reduced mortality from infection. Later, while Bell labored in vain at Garfield’s bedside to find a bullet, Lister’s technique was nowhere to be found—an irony keenly developed by the author.

In Millard’s sober but entertaining account, we learn that physician William Bliss, not a devotee of Lister’s antiseptic technique, treated Garfield. Bliss was obsessed with locating the bullet that, unknown to him, had come to rest adjacent to the president’s first lumbar vertebra.5 Bell was recruited to locate the bullet with a crude metal detector. Dr. Bliss insisted the bullet was on the right, where it entered, but it was actually on the left, and all the probing only spread infection. The postmortem examination revealed that the bullet had been encapsulated by connective tissue, suggesting that, but for the iatrogenic infections, the president could have survived the gunshot wound.5 And had the doctors heeded their patient’s neurological symptoms, they would not have probed his pelvis continually.5 Guiteau was aware of the physicians’ contribution to Garfield’s demise, but his argument that he had only shot the president was not persuasive at trial, since legal and medical causation were the same.

There is much more to Destiny of the Republic than President Garfield’s medical course. We learn much about Guiteau’s life, his philosophy, and his spirituality. His deific delusions took on a determined concreteness, as he asserted he was “in the employ of Jesus Christ & Co., the very ablest and strongest firm in the universe.” Nevertheless, he was often ridiculed, was expelled from the Oneida (New York) Community, and engaged in shenanigans as a trial lawyer. It comes as no surprise, then, when he set his sights directly on Garfield, whom he saw as an impediment to his own ascension. Millard’s portrayals of Bell and Bliss, genius versus idiocy, are splendidly detailed and alive with the dynamic of the time.

Millard’s descriptions of Guiteau disclose a methodical and persistent man, a schemer who became a nuisance to the president, Secretary of State Blaine, and the First Lady. With instructions from on high, he believed that the Garfield administration owed him at least a prime ambassadorship. After all, he thought, his speeches were instrumental in Garfield’s election.2 Rejected, he took the matter to an extreme, formulating, for legal purposes, specific intent to kill. There is no question that he displayed psychotic grandiosity infused with religious ideas. Unrepentant and arrogant, he paraded his self-importance into the trial, ensuring an adverse outcome. His extreme narcissism was captured in Sondheim’s lyrics in the show Assassins, as Guiteau cheerfully extols the utility of a gun:

The Gun Song

What a wonder is a gun!

What a versatile invention!

First of all, when you’ve a gun

Everybody pays attention!

When you think what must be done.

Think of all that it can do:

Remove a scoundrel,

Unite a party,

Preserve the union,

Promote the sales of my book,

Insure my future,

My niche in history,

And then the world will see

That I am not a man to overlook!


—from Assassins by Stephen Sondheim1

Destiny of the Republic is as worthwhile a read as The Trial of the Assassin Guiteau4 for the forensic professional or general reader. Millard’s use of Garfield quotations and source material generally creates liveliness, and her humanization of all her characters is superb. For example, after Garfield’s inauguration in early March 1881, the author notes, as the president set out to work in the White House he was buoyed by the opportunity to see more of his five children (two had already perished), but was saddened by the fact that even his friends wanted something from him. Among the many who sought a position in the administration was one Charles Julius Guiteau—a man who “never said ‘never’ or heard the word ‘no’” (from Sondheim’s “The Ballad of Guiteau”).1


  • Disclosures of financial or other potential conflicts of interest: None.


  1. 1.
    Assassins. Music and lyrics, Stephen Sondheim. Book, John Weidman. Opened December 18, 1990
  2. 2.
    1. Phillips RTM

    : Assessing presidential stalkers and assassins. J Am Acad Psychiatry Law 34:154–64, 2006

  3. 3.
    1. Vowell S

    : Assassination Vacation. New York: Simon & Schuster, 2005

  4. 4.
    1. Rosenberg CE

    : The Trial of the Assassin Guiteau: Psychiatry and the Law in the Gilded Age. Chicago: University of Chicago Press, 1968

  5. 5.
    1. Paulson G

    : Death of a president and his assassin: errors in their diagnosis and autopsies. J Hist Neurosci 15:77–91, 2006


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