By 10:00 a.m., it had risen to 104. “He is feverish and quite restless,” one of Bliss’s attending physicians noted, “and has vomited three times this morning a fluid tinged with bile.”
Quietly, Bliss sent for his surgeons, David Hayes Agnew and Frank Hamilton, who arrived in Washington by a quarter past eight that evening. As Garfield lay in his bed, “drenched with a profuse perspiration,” the two surgeons examined his back and found a small pus sac about three inches below the wound. Using only a sulphuric ether, sprayed directly onto the site, to lessen the pain, Agnew made a deep incision into Garfield’s back and inserted a large drainage tube.
Bliss’s bulletin that day announced that “the President bore the operation well,” and was “much relieved.” Garfield’s condition, however, continued to deteriorate. He vomited repeatedly and was constantly bathed in sweat. Two days after the first surgery, Agnew again operated on the president, enlarging the opening he had earlier made over his rib and pulling out fragments of muscle, connective tissue, and bone, one piece of which was an inch long.
Bliss, Agnew, and Hamilton would later insist that, as they examined and operated on the president, they used an adequate degree of antisepsis. Occasionally, they sprayed Garfield’s back with carbolic acid or rinsed the wound with a “weak solution of car bolic [sic] acid (one-fourth of 1 per cent).” Like the surgeons who sterilized their knives and then held them in their teeth, however, the doctors’ efforts did little more than give the appearance of antisepsis. Each time they inserted an unsterilized finger or instrument into Garfield’s back, something that happened several times every day, they introduced bacteria, which not only caused infection at the site of the wound, but entered Garfield’s bloodstream.
Unbeknownst to his doctors, cavities of pus had begun to ravage the president’s body. One cavity in particular, which began at the site of the wound, would eventually burrow a tunnel that stretched past Garfield’s right kidney, along the outer lining of his stomach, and down nearly to his groin. An enormous cavity, six inches by four inches, would form under his liver, filling with a greenish-yellow mixture of pus and bile.
Nearly a month had passed since the shooting, but Bliss and his team of doctors were still probing Garfield’s wound in the hope of answering one question: Where was the bullet? Eager to help solve the mystery, Americans flooded the White House with letters not just of concern and sympathy but medical advice. “We received every morning literally bushels of letters,” one doctor in the White House would later recall. “Every crank … in the country seemed to think himself called upon to offer to cure the president.” One man sent the doctors plans for a suction device that he assured them would suck the bullet right out of Garfield. Another suggested that they simply hang the president upside down until the bullet fell out. A man in Maryland wrote to Bliss saying that there was no reason for concern. The bullet was not in Garfield at all, but with him in Annapolis.
Although Bliss admitted that he could not be certain where the bullet lay, he had made it clear from the moment he took charge of the case that he believed it was in or near Garfield’s liver. In this belief, he was joined by nearly every other doctor who had examined the president. While Garfield was still at the train station, one doctor had claimed that he could feel his liver as he probed the wound with his little finger. Hamilton had told a reporter that he “had a suspicion, founded upon a good deal of evidence, that the ball was in the right iliac region, not far above the right groin.” So convincing were the doctors that, soon after the shooting, the New York Times had announced that the “bullet has pierced the liver, and it is a fatal wound.”
At least one doctor in Washington, however, believed strongly that the bullet wasn’t anywhere near the president’s liver—that it was, in fact, on the opposite side of his body. Frank Baker, a young man who had recently completed his medical degree and taken a position as an “assistant demonstrator of anatomy” at Columbian University (now George Washington University), had been carefully following Garfield’s case since the day of the shooting. After considering the president’s symptoms and applying some of the basic theories he had learned in medical school, he concluded that, although the bullet had