They argued that Garfield died from a late rupture of a splenic artery pseudoaneurysm, which developed secondary to the path of the bullet adjacent to the splenic artery. They also argued that his sepsis was actually caused by post-traumatic acute acalculous cholecystitis. Based on the autopsy report, the authors speculate that his gallbladder subsequently ruptured, leading to the development of a large bile-containing abscess adjacent to the gallbladder. Pappas and Joharifard say this caused the septic decline in Garfield's condition that was visible starting from July 23, 1881. Pappas and Joharifard also state that they don't believe that Garfield's doctors could have saved him even if they had been aware of his cholecystitis, since the first successful cholecystectomy (surgical removal of the gallbladder) was performed a year after Garfield's death.[234]
Guiteau was indicted on October 14, 1881, for the murder of the president. During his trial, Guiteau declared that he was not responsible for Garfield's death, admitting to the shooting but not the killing. In his defense, Guiteau wrote: "General Garfield died from malpractice. According to his own physicians, he was not fatally shot. 