James Garfield, the 20th President of the United States, died on September 19, 1881, after being shot on July 2, 1881. How much Garfield suffered is hard to imagine–the pain of the injury itself and the ravages of bacterial infection. Without modern antibiotics, pain management, imaging devices, and the understanding of sterilization and bacteriology, Garfield’s doctors had few options at their disposal. During a ceremony on May 19, 1890, Garfield’s casket was lowered into the crypt of the Garfield Monument in Lakeview Cemetery. In this picture, downtown Cleveland and Lake Erie are about 5 miles from the Monument.