DEVELOPMENT OF PRESIDENTIAL PROTECTION
This third assassination of a President in a little more than a generation—it was only 36 years since Lincoln had been killed—shook the nation and aroused it to a greater awareness of the uniqueness of the Presidency and the grim hazards that surrounded an incumbent of that Office. The first congressional session after the assassination of McKinley gave more attention to legislation concerning attacks on the President than had any previous Congress but did not pass any measures for the protection of the President.[A7-32] Nevertheless, in 1902 the Secret Service, which was then the only Federal general investigative agency of any consequence, assumed full-time responsibility for the safety of the President. Protection of the President now became one of its major permanent functions, and it assigned two men to its original full-time White House detail. Additional agents were provided when the President traveled or went on vacation.[A7-33]
Theodore Roosevelt, who was the first President to experience the extensive system of protection that has surrounded the President ever since, voiced an opinion of Presidential protection that was probably shared in part by most of his successors. In a letter to Senator Henry Cabot Lodge in 1906, from his summer home, he wrote:
The Secret Service men are a very small but very necessary thorn in the flesh. Of course, they would not be the least use in preventing any assault upon my life. I do not believe there is any danger of such an assault, and if there were, as Lincoln said, “though it would be safer for a President to live in a cage, it would interfere with his business.” But it is only the Secret Service men who render life endurable, as you would realize if you saw the procession of carriages that pass through the place, the procession of people on foot who try to get into the place, not to speak of the multitude of cranks and others who are stopped in the village.[A7-34]
Roosevelt, who had succeeded to the Presidency because of an assassin’s bullet, himself became the object of an assassination attempt a few years after he left office and when he was no longer under Secret Service protection. During the Presidential campaign of 1912, just as he was about to make a political speech in Milwaukee on October 14, he was shot and wounded in the breast by John N. Schrank, a 36-year-old German-born ex-tavern keeper. A folded manuscript of his long speech and the metal case for his eyeglasses in the breast pocket of Roosevelt’s coat were all that prevented the assassination.[A7-35]
Schrank had had a vision in 1901, induced possibly by McKinley’s assassination, which took on meaning for him after Roosevelt, 11 years later, started to campaign for the Presidency. In this vision the ghost of McKinley appeared to him and told him not to let a murderer (i.e., Roosevelt, who according to the vision had murdered McKinley) become President. It was then that he determined upon the assassination. At the bidding of McKinley’s ghost, he felt he had no choice but to kill Theodore Roosevelt. After his attempt on Roosevelt, Schrank was found to be insane and was committed to mental hospitals in Wisconsin for the rest of his life.[A7-36]
The establishment and extension of the Secret Service authority for protection was a prolonged process. Although the Secret Service undertook to provide full-time protection for the President beginning in 1902, it received neither funds for the purpose nor sanction from the Congress until 1906 when the Sundry Civil Expenses Act for 1907 included funds for protection of the President by the Secret Service.[A7-37] Following the election of William Howard Taft in 1908, the Secret Service began providing protection for the President-elect. This practice received statutory authorization in 1913, and in the same year, Congress authorized permanent protection of the President.[A7-38] It remained necessary to renew the authority annually in the Appropriations Acts until 1951.
As in the Civil and Spanish-American Wars, the coming of war in 1917 caused increased concern for the safety of the President. Congress enacted a law, since referred to as the threat statute, making it a crime to threaten the President by mail or in any other manner.[A7-39] In 1917 Congress also authorized protection for the President’s immediate family by the Secret Service.[A7-40]
As the scope of the Presidency expanded during the 20th century, the Secret Service found the problems of protection becoming more numerous. In 1906, for the first time in history, a President traveled outside the United States while in office. When Theodore Roosevelt visited Panama in that year, he was accompanied and protected by Secret Service men.[A7-41] In 1918-19 Woodrow Wilson broadened the precedent of Presidential foreign travel when he traveled to Europe with a Secret Service escort of 10 men to attend the Versailles Peace Conference.[A7-42]
The attempt on the life of President-elect Franklin D. Roosevelt in 1933 further demonstrated the broad scope and complexity of the protection problems facing the Secret Service. Giuseppe Zangara was a bricklayer and stonemason with a professed hatred of capitalists and Presidents. He seemed to be obsessed with the desire to kill a President. After his arrest he confessed that he had first planned to go to Washington to kill President Herbert Hoover, but as the cold climate of the North was bad for his stomach trouble, he was loath to leave Miami, where he was staying. When he read in the paper that President-elect Roosevelt would be in Miami, he resolved to kill him.[A7-43]
On the night of February 15, 1933, at a political rally in Miami’s Bayfront Park, the President-elect sat on the top of the rear seat of his automobile with a small microphone in his hand as he made a short informal talk. Fortunately for him, however, he slid down into the seat just before Zangara could get near enough to take aim. The assassin’s arm may have been jogged just as he shot; the five rounds he directed at Roosevelt went awry. However, he mortally wounded Mayor Anton Cermak, of Chicago, and hit four other persons; the President-elect, by a miracle, escaped. Zangara, of course, never had any chance of escaping.[A7-44]
Zangara was electrocuted on March 20, 1933, only 33 days after his attempt on Roosevelt. No evidence of accomplices or conspiracy came to light, but there was some sensational newspaper speculation, wholly undocumented, that Zangara may have been hired by Chicago gangsters to kill Cermak.[A7-45]
The force provided since the Civil War by the Washington Metropolitan Police for the protection of the White House had grown to 54 men by 1922.[A7-46] In that year Congress enacted legislation creating the White House Police Force as a separate organization under the direct control of the President.[A7-47] This force was actually supervised by the President’s military aide until 1930, when Congress placed supervision under the Chief of the Secret Service.[A7-48] Although Congress transferred control and supervision of the force to the Secretary of the Treasury in 1962,[A7-49] the Secretary delegated supervision to the Chief of the Secret Service.[A7-50]
The White House detail of the Secret Service grew in size slowly from the original 2 men assigned in 1902. In 1914 it still numbered only 5, but during World War I it was increased to 10 men. Additional men were added when the President traveled. After the war the size of the detail grew until it reached 16 agents and 2 supervisors by 1939. World War II created new and greater protection problems, especially those arising from the President’s trips abroad to the Grand Strategy Conferences in such places as Casablanca, Quebec, Tehran, Cairo, and Yalta. To meet the increased demands, the White House detail was increased to 37 men early in the war.[A7-51]
The volume of mail received by the White House had always been large, but it reached huge proportions under Franklin D. Roosevelt. Presidents had always received threatening letters but never in such quantities. To deal with this growing problem, the Secret Service established in 1940 the Protective Research Section to analyze and make available to those charged with protecting the President, information from White House mail and other sources concerning people potentially capable of violence to the President. The Protective Research Section undoubtedly permitted the Secret Service to anticipate and forestall many incidents that might have been embarrassing or harmful to the President.[A7-52]
Although there was no advance warning of the attempt on Harry S. Truman’s life on November 1, 1950, the protective measures taken by the Secret Service availed, and the assassins never succeeded in firing directly at the President. The assassins—Oscar Collazo and Griselio Torresola, Puerto Rican Nationalists living in New York—tried to force their way into Blair House, at the time the President’s residence while the White House was being repaired. Blair House was guarded by White House policemen and Secret Service agents. In the ensuing gun battle, Torresola and one White House policeman were killed, and Collazo and two White House policemen were wounded. Had the assassins succeeded in entering the front door of Blair House, they would probably have been cut down immediately by another Secret Service agent inside who kept the doorway covered with a submachine gun from his vantage point at the foot of the main stairs. In all, some 27 shots were fired in less than 3 minutes.[A7-53]
Collazo was brought to trial in 1951 and sentenced to death, but President Truman commuted the sentence to life imprisonment on July 24, 1952. Although there was a great deal of evidence linking Collazo and Torresola to the Nationalist Party of Puerto Rico and its leader, Pedro Albizu Campos, the Government could not establish that the attack on the President was part of a larger Nationalist conspiracy.[A7-54]
The attack on President Truman led to the enactment in 1951 of legislation that permanently authorized the Secret Service to protect the President, his immediate family, the President-elect, and the Vice President, the last upon his request. Protection of the Vice President by the Secret Service had begun in January 1945 when Harry S. Truman occupied the office.[A7-55]
In 1962 Congress further enlarged the list of Government officers to be safeguarded, authorizing protection of the Vice President (or the officer next in order of succession to the Presidency) without requiring his request therefor; of the Vice President-elect; and of a former President, at his request, for a reasonable period after his departure from office. The Secret Service considered this “reasonable period” to be 6 months.[A7-56]
Amendments to the threat statute of 1917, passed in 1955 and 1962, made it a crime to threaten to harm the President-elect, the Vice President, or other officers next in succession to either office. The President’s immediate family was not included in the threat statute.[A7-57]
Congressional concern regarding the uses to which the President might put the Secret Service—first under Theodore Roosevelt and subsequently under Woodrow Wilson—caused Congress to place tight restrictions on the functions of the Service and the uses of its funds.[A7-58] The restrictions probably prevented the Secret Service from developing into a general investigative agency, leaving the field open for some other agency when the need arose. The other agency proved to be the Federal Bureau of Investigation (FBI), established within the Department of Justice in 1908.[A7-59]
The FBI grew rapidly in the 1920’s, and especially in the 1930’s and after, establishing itself as the largest, best equipped, and best known of all U.S. Government investigative agencies. In the appropriations of the FBI there recurred annually an item for the “protection of the person of the President of the United States,” that had first appeared in the appropriation of the Department of Justice in 1910 under the heading “Miscellaneous Objects.”[A7-60] But there is no evidence that the Justice Department ever exercised any direct responsibility for the protection of the President. Although it had no prescribed protection functions, according to its Director, J. Edgar Hoover, the FBI did provide protection to Vice President Charles Curtis at his request, when he was serving under Herbert Hoover from 1929 to 1933. Over the years the FBI contribution to Presidential protection was confined chiefly to the referral to the Secret Service of the names of people who might be potentially dangerous to the President.[A7-61]
In recent years the Secret Service has remained a small and specialized bureau, restricted to very limited functions prescribed by Congress. In 1949, a task force of the Commission on Organization of the Executive Branch of the Government (Hoover Commission), recommended nonfiscal functions be removed from the Treasury Department.[A7-62] The recommendation called for transfer of the White House detail, White House Police Force, and Treasury Guard Force from the Secret Service to the Department of Justice. The final report of the Commission on the Treasury Department omitted this recommendation, leaving the protective function with the Secret Service.[A7-63] At a meeting of the Commission, ex-President Hoover, in a reference to the proposed transfer, expressed the opinion that “the President will object to having a ‘private eye’ looking after these fellows and would rather continue with the service.”[A7-64]
In 1963 the Secret Service was one of several investigative agencies in the Treasury Department. Its major functions were to combat counterfeiting and to protect the President, his family, and other designated persons.[A7-65] The Chief of the Secret Service administered its activities through four divisions: Investigation, Inspection, Administrative, and Security, and 65 field offices throughout the country, each under a special agent in charge who reported directly to Washington. The Security Division supervised the White House detail, the White House Police, and the Treasury Guard Force. During fiscal year 1963 (July 1, 1962-June 30, 1963) the Secret Service had an average strength of 513, of whom 351 were special agents. Average strength of the White House Police during the year was 179.[A7-66]
APPENDIX VIII
Medical Reports From Doctors at Parkland Memorial Hospital, Dallas, Tex.
The president arrived in the Emergency Room at exactly 12:43 p.m. in his limousine. He was in the back seat, Gov. Conally was in the front seat of the same car, Gov. Connally was brought out first and was put in room two. President was brought out next and put in room one. Dr. Clark pronounced the President dead at 1 p.m. exactly. All of the President’s belongings except his watch were given to the Secret Service. His watch was given to Mr. C. P. Wright. He left the Emergency Room, the President, at about 2 p.m. in an O’Neal ambulance. He was put in a bronze colored plastic casket after being wrapped in a blanket and was taken out of the hospital. He was removed from the hospital. The Gov. was taken from the Emergency room to the Operating Room.
The President’s wife refused to take off her bloody gloves, clothes. She did take a towel and wipe her face. She took her wedding ring off and placed it on one of the President’s fingers.
Commission Exhibit No. 392
SUMMARY
The President arrived at the Emergency Room at 12:43 P.M., the 22nd of November, 1963. He was in the back seat of his limousine. Governor Connally of Texas was also in this car. The first physician to see the President was Dr. James Carrico, a Resident in General Surgery.
Dr. Carrico noted the President to have slow, agonal respiratory efforts. He could hear a heartbeat but found no pulse or blood pressure to be present. Two external wounds, one in the lower third of the anterior neck, the other in the occipital region of the skull, were noted. Through the head wound, blood and brain were extruding. Dr. Carrico inserted a cuffed endotracheal tube. While doing so, he noted a ragged wound of the trachea immediately below the larynx.
At this time, Dr. Malcolm Perry, Attending Surgeon, Dr. Charles Baxter, Attending Surgeon, and Dr. Ronald Jones, another Resident in General Surgery, arrived. Immediately thereafter, Dr. M. T. Jenkins, Director of the Department of Anesthesia, and Doctors Giesecke and Bunt, two other Staff Anesthesiologists, arrived. The endotracheal tube had been connected to a Bennett respirator to assist the President’s breathing. An Anesthesia machine was substituted for this by Dr. Jenkins. Only 100% oxygen was administered.
A cutdown was performed in the right ankle, and a polyethylene catheter inserted in the vein. An infusion of lactated Ringer’s solution was begun. Blood was drawn for type and crossmatch, but unmatched type “O” RH negative blood was immediately obtained and begun. Hydrocortisone 300 mgms was added to the intravenous fluids.
Dr. Robert McClelland, Attending Surgeon, arrived to help in the President’s care. Doctors Perry, Baxter, and McClelland began a tracheostomy, as considerable quantities of blood were present from the President’s oral pharynx. At this time, Dr. Paul Peters, Attending Urological Surgeon, and Dr. Kemp Clark, Director of Neurological Surgery, arrived. Because of the lacerated trachea, anterior chest tubes were placed in both pleural spaces. These were connected to sealed underwater drainage.
Neurological examination revealed the President’s pupils to be widely dilated and fixed to light. His eyes were divergent, being deviated outward; a skew deviation from the horizontal was present. No deep tendon reflexes or spontaneous movements were found.
There was a large wound in the right occipito-parietal region, from which profuse bleeding was occurring. 1500 cc. of blood were estimated on the drapes and floors of the Emergency Operating Room. There was considerable loss of scalp and bone tissue. Both cerebral and cerabellar tissue were extruding from the wound.
Further examination was not possible as cardiac arrest occurred at this point. Closed chest cardiac massage was begun by Dr. Clark. A pulse palpable in both the carotid and femoral arteries was obtained. Dr. Perry relieved on the cardiac massage while a cardiotachioscope was connected. Dr. Fouad Bashour, Attending Physician, arrived as this was being connected. There was electrical silence of the President’s heart.
President Kennedy was pronounced dead at 1300 hours by Dr. Clark.
Kemp Clark, M.D,
Director
Service of Neurological Surgery
KC:ca
cc to Dean’s Office, Southwestern Medical School
cc to Medical Records, Parkland Memorial Hospital
Commission Exhibit No. 392—Continued
Commission Exhibit No. 392—Continued
Commission Exhibit No. 392—Continued
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Commission Exhibit No. 392—Continued
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Commission Exhibit No. 392—Continued
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Commission Exhibit No. 392—Continued
Commission Exhibit No. 392—Continued
Commission Exhibit No. 392—Continued
Commission Exhibit No. 392—Continued
THE UNIVERSITY OF TEXAS
SOUTHWESTERN MEDICAL SCHOOL
DALLAS
M. T. JENKINS. M. D.
PROFESSOR AND CHAIRMAN
Department of Anesthesiology
Clinical Departments of Anesthesia
PARKLAND MEMORIAL HOSPITAL
CHILDREN’S MEDICAL CENTER
November 22, 1963
1630
| To: | Mr. C. J. Price, Administrator |
| Parkland Memorial Hospital | |
| From: | M. T. Jenkins, M.D., Professor and Chairman |
| Department of Anesthesiology | |
| Subject: | Statement concerning resuscitative efforts for |
| President John F. Kennedy |
Upon receiving a stat alarm that this distinguished patient was being brought to the emergency room at Parkland Memorial Hospital, I dispatched Doctors A. H. Giesecke and Jackie H. Hunt with an anesthesia machine and resuscitative equipment to the major surgical emergency room area, and I ran down the stairs. On my arrival in the emergency operating room at approximately 1230 I found that Doctors Carrico and/or Delaney had begun resuscitative efforts by introducing an orotracheal tube, connecting it for controlled ventilation to a Bennett intermittent positive pressure breathing apparatus. Doctors Charles Baxter, Malcolm Perry, and Robert McClelland arrived at the same time and began a tracheostomy and started the insertion of a right chest tube, since there was also obvious tracheal and chest damage. Doctors Paul Peters and Kemp Clark arrived simultaneously and immediately thereafter assisted respectively with the insertion of the right chest tube and with manual closed chest cardiac compression to assure circulation.
For better control of artificial ventilation, I exchanged the intermittent positive pressure breathing apparatus for an anesthesia machine and continued artificial ventilation. Doctors Gene Akin and A. H. Giesecke assisted with the respiratory problems incident to changing from the orotracheal tube to a tracheostomy tube, and Doctors Hunt and Giesecke connected a cardioscope to determine cardiac activity.
During the progress of these activities, the emergency room cart was elevated at the feet in order to provide a Trendelenburg position, a venous cutdown was performed on the right saphenous vein, and additional fluids were begun in a vein in the left forearm while blood was ordered from the blood bank. All of these activities were completed by approximately 1245, at which time external cardiac massage was still being carried out effectively by Doctor Clark as judged by a palpable peripheral pulse. Despite these measures there was no electrocardiographic evidence of cardiac activity.
These described resuscitative activities were indicated as of first importance, and after they were carried out attention was turned to all other evidences of injury. There was a great laceration on the right side of the head (temporal and occipital), causing a great defect in the skull plate so that there was herniation and laceration of great areas of the brain, even to the extent that the cerebellum had protruded from the wound. There were also fragmented sections of brain on the drapes of the emergency room cart. With the institution of adequate cardiac compression, there was a great flow of blood from the cranial cavity, indicating that there was much vascular damage as well as brain tissue damage.
It is my personal feeling that all methods of resuscitation were instituted expeditiously and efficiently. However, this cranial and intracranial damage was of such magnitude as to cause the irreversible damage. President Kennedy was pronounced dead at 1300.
Sincerely,
M. T. Jenkins, M.D.
COMMISSION EXHIBIT No. 392—Continued
Commission Exhibit No. 392—Continued
PARKLAND MEMORIAL HOSPITAL
OPERATIVE RECORD
DATE: 11-22-63 Thoracic Surg
ROOM: 220
STATUS: Pvt
NAME: John Connally
Unit # 26 36 99
AGE:
RACE: W/M
PRE-OPERATIVE DIAGNOSIS: Gunshot wound of the chest with comminuted fracture of the 5th rib
POST-OPERATIVE DIAGNOSIS: Same with laceration right middle lobe, hematoma lower lobe of lung
OPERATION: Thoractomy, removal rib fragment, debridement of wound
BEGAN: 1335
ENDED: 1520
ANESTHETIC: General
BEGAN: 1300
ANESTHESIOLOGIST: Giesecke
SURGEON: Robert Shaw. M.D
ASSISTANTS: Drs. Boland and Duke
SCRUB NURSE: King/Burkett
CIRC. NURSE: Johnson
SPONGE COUNTS: 1ST Correct
2ND Correct
DRUGS
I.V. FLUIDS AND BLOOD
111-500 cc whole blood
11-1000cc D-5-RL
COMPLICATIONS: None
CONDITION OF PATIENT: Satisfactory
Clinical Evaluation: The patient was brought to the OR from the EOR. In the EOR a sucking wound of the right chest was partially controlled by an occlusive dressing supported by manual pressure. A tube had been placed through the second interspace in the mid-clavicular line connected to a waterseal bottle to evacuate the right pneumothorax and hemathorax. An IV infusion of RL solution had already been started. As soon as the patient was positioned on the OR table the anesthesia was Induced by Dr. Giesecke and an endotracheal tube was in place. As soon as it was possible to control respiration with positive pressure the occlusive dressing was taken from the right chest and the extent of the wound more carefully determined. It was found that the wound of entrance was just lateral to the right scapula close the the axilla yet had passed through the latysmus dorsi muscle shattered approximately ten cm of the lateral and anterior portion of the right fifth rib and emerged below the right nipple. The wound of entrance was approximately three cm in its longest diameter and the wound of exit was a ragged wound approximately five cm in its greatest diameter. The skin and subcutaneous tissue over the path of the missile moved in a paradoxical manner with respiration indicating softening of the chest. The skin of the whole area was carefully cleansed with Phisohex and Iodine. The entire area including the wound of entrance and wound of exit was draped partially excluding the wound of entrance for the first part of the operation. An elliptical incision was made around the wound of exit removing the torn edges of the skin and the damaged subcutaneous tissue. The incision was then carried in a downward curve up toward the right axilla so as to not have the skin incision over the actual path of the missile ban through the chest wall. This incision was carried down through the subcutaneous tissue to expose the Serratus anterior muscle and the anterior border of the latissimus dorsi muscle. The fragmented and damaged portions of the Serratus anterior muscle were excised. Small rib fragments that were adhering to periosteal tags were carefully removed preserving as much periosteum as possible. The fourth intercostal muscle bundle and fifth intercostal muscle bundle were not appreciably damaged.
The ragged ends of the damaged fifth rib were cleaned out with the rongeur. The plura had been torn open by the secondary missiles created by the fragmented fifth rib. The wound was open widely and exposure was obtained with a self retaining retractor. The right plural cavity was then carefully inspected. Approximately 200 cc of clot and liquid blood was removed from the pleural cavity. The middle lobe had a linear rent starting at its peripheral edge going down towards itshilum separating the lobe into two segments. There was an open bronchus in the depth of this wound. Since the vascularlty and the bronchial connections to the lobe were intact it was decided to repair the lobe rather then to remove it. The repair was accomplished with a running suture of #000 chromic gut on atraumatic needle closing both plural surfaces as well as two runnin sutures approximating the tissue of the central portion of the lobe. This almost completely sealed off the air leaks which were evident in the torn portion of the lobe. The lower lobe was next examined and found to be engorged with blood and at one point a laceration of allowed the oozing of blood. This laceration had undoubtedly been caused by a rib fragment. This laceration was closed with a single suture of #3-O chromic gut on atraumatic needle. The right pleural cavity was now carefully examined and small ribs fragments were removed, the diaphram was found to be uninjured. There was no evidence of injury of the mediastinum and its contents. Hemostasis had been accomplished within the plural cavity with the repair of the middle lobe and the suturing of the laceration in the lower lobe. The upper lobe was found to be uninjured. The drains which had previously been placed in the second interspace in the midclavicular line was found to be longer than necessary so approximately ten cm of it was cut away and the remaining portion was demonstrated with two additional openings. An additional drain was placed through a stab wound in the eighth interspace in the posterior axillary line. Both these drains were then connected to a waterseal bottle. The fourth and fifth intercostal muscles were then approximated with interrupted sutures of #O chromic gut. The remaining portion of the Serratus anterior muscle was then approximated across the closure of the intercostal muscle. The laceration of the latissimus dorsi muscle on its intermost surface was then closed with several interrupted sutures of #O chromic gut. The subcutaneous tissue was th Before closing the subcutaneous tissue one million units of Penicillin and one gram of Streptomycin in 100 cc normal saline was instilled into the wound. The stab wound was then made in the most dependent portion of the wound coming out near the angle of the scapula. A large Penrose drain was drawn out through this stab wound to allow drainage of the wound of the chest wall. The subcutaneous tissue was then closed with interrupted #O chromic gut inverting the knots. Skin closed with interrupted vertical mattress sutures of black silk. Attention was next turned to the wound of entrance. It was excised with an elliptical incision. It was found that the latissimus dorsi muscle although lacerated was not badly damaged so that the opening was closed with sutures of #O chromic gut in the fascia of the muscle. Before closing this incision the palpation with the index finger the Penrose drain could be felt immediately below in the space beneath the latissimus dorsi muscle. The skin closed with interrupted vertical mattress sutures of black silk. Drainage tubes were secured with safety pens and adhesive tape and dressings applied. As soon as the operation on the chest had been concluded Dr. Gregory and Dr. Shires started the surgery that was necessary for the wounds of the right wrist and left thigh.
Dr. Robert Shaw
RS:bl
* There was also a comminuted fracture of the right radius secondary to the same missile and in addition a small flesh wound of the left thigh. The operative notes concerning the management of the right arm and left thigh will be dictated by Dr. Charles Gregory and Dr. Tom Shires.
Commission Exhibit No. 392—Continued
Commission Exhibit No. 392—Continued
PARKLAND MEMORIAL HOSPITAL
OPERATIVE RECORD
DATE: 11-22-63 Ortho
ROOM: 220
STATUS: Pvt.
NAME: Governor John Connally
UNIT: 26 36 99
AGE: W/M
RACE:
PRE-OPERATIVE DIAGNOSIS: Comminuted fracture of the right distal radius, open secondary to gunshot wound
POST-OPERATIVE DIAGNOSIS: Same
OPERATION: Debridement of gunshot wound of right wrist, reduction of fracture of the radius
BEGAN: 1600
ENDED: 1650
ANESTHETIC: General
BEGAN: 1300
ANESTHESIOLOGIST: Giesecke
SURGEON: Dr. Charles Gregory
ASSISTANTS: Drs. Osborne and Parker
SCRUB NURSE: Rutherford
CIRC. NURSE: Schroeder
COMPLICATIONS: None
CONDITION OF PATIENT: Fair
(handwritten: also a partial transection of the superficial radial nerve or Ext. Pol Brevis)
CLINICAL EVALUATION: While still under general anesthesia and following a thoracotomy and repair of the chest injury by Dr. Robert Shaw, the right upper extremity was thoroughly prepped in the routine fashion after shaving. he was draped in the routine fashion using stockinette, the only addition was the use of a debridement pan. The wound of entry on the dorsal aspect of the right wrist over the junction of the distal fourth of the radius and shaft was approximately two cm in length and rather oblique with the loss of tissue with some considerable contusion at the margins of it. There was a wound of exit along the volar surface of the wrist about two cm above the flexion crease of the wrist and in the midline. The wound of entrance was carefully excised and developed through the muscles and tendons from the radial side of the bone to the bone itself where the fracture was encountered. It was noted that the tendon of the abductor palmaris longus was transected, only two small fragments of bone was were removed, one approximately one cm in length and consisted of lateral cortex which lay free in the wound and had no soft tissue connections, another much smaller fragment perhaps 3 mm in length was subsequently removed. Small bits of metal were encountered at various levels throughout the wound and these were wherever they were identified and could be picked up were picked up and have been submitted to the Pathology department for identification and examination. Throughout the wound it was not and especially in the superficial layers and to some extent in the tendon and tendon sheaths on the radial side of the arm small fine bits of cloth consistent with fine bits of Mohair. It is our understanding that the patient was wearing a Mohair suit at the time of the injury and this accounts for the deposition of such organic material within the wound. After as careful and complete a debridement as could be carried out and with an apparent integrity of the flexor tendons and the median nerve in the volar side, and after thorough irrigation the wound of exit on the volar surface of the wrist was closed primarily with wire sutures while the wound of entrance on the radial side of the forearm was only partially closed being left open for the purpose of drainage should any make spontaneous appearance.
This is because of the presence of Mohair and organic material deep into the wound which is prone to produce tissue reactions and to encourage infection and this precaution of not closing the wound was taken in correspondence with our experience in that regard.
In view of the urgency of the Governor’s original chest injury it was impossible to definitely ascertain the status of the circulation and the nerve supply to the hand and wrist on the right side. Accordingly, it was determined as best we could at the time of operation and the radial artery was found to be intact and pulsating normally. The integrity of the median nerve and the ulnar nerve is not clearly established but it is presumed to be present. Following closure of the volar wound and partial closure of the radial wound, dry sterile dressings were applied and a long arm cast was then applied with skin tape traction, rubber band variety, attached to the thumb and index finger of the right hand. The-righ An attitude of flexon was created at the right elbow, and post operatively the limbus suspended from an overhead frame using tape traction. The post operative diagnosis for the right forearm remains the same and again I suggest that you incorporate this particular dictation together with other dictations which will be given to you by the surgeons concerned with this patient.
Charles Gregory, M.D.
CG:bl
Commission Exhibit No. 392—Continued
Commission Exhibit No. 392—Continued
PARKLAND MEMORIAL HOSPITAL
OPERATIVE RECORD
DATE: NOV. 22, 1963
ROOM: 220
STATUS: Pvt.
NAME: Connally, John
UNIT #: 263699
A #24842
RACE: W/M
PRE-OPERATIVE DIAGNOSIS: Gunshot Wound, Right Chest, Right Wrist, Left Thigh
POST-OPERATIVE DIAGNOSIS: Same
OPERATION: Exploration and Debridement of Gunshot Wound of Left Thigh (*See below)
BEGAN: 16:00
ENDED: 16:20
ANESTHETIC: General
BEGAN: 13:00
ANESTHESIOLOGIST: Geisecke
SURGEON: Dr. Shires
ASSISTANTS: Drs. McClelland, Baxter and Patman
SCRUB NURSE: Oliver
CIRC. NURSE: Deming and Schroder
SPONGE COUNTS: 1ST Correct PS
COMPLICATIONS: *This portion of the operation is involved only with the operation on the left thigh. The chest injury has been dictated by Dr. Shaw, the orthopedic injury to the arm by Dr. Gregory.
CONDITION OF PATIENT:
CLINICAL EVALUATION: There was a 1 cm. punctate missile wound over the juncture of the middle and lower third, medial aspect, of the left thigh. X-rays of the thigh and leg revealed a bullet fragment which was imbedded in the body of the femur in the distal third. The leg was prepared with Phisohex and I.O. Prep and was draped in the usual fashion.
Following this the missile wound was excised and the bullet tract was explored. The missile wound was seen to course through the subcutaneous fat and into the vastus medialis. The necrotic fat and muscle were debrided down to the region of the femur. The direction of the missile wound was judged not to be in the course of the femoral vessel, since the wound was distal and anterior to Hunter’s canal. Following complete debridement of the wound and irrigation with saline, the wound was felt to be adequately debrided enough so that three simple through-and-through, stainless steel Aloe #28 wire sutures were used encompassing skin, subcutaneous tissue, and muscle fascia on both sides. Following this a sterile dressing was applied. The dorsalis pedis and posterior tibial pulses in both lags were quite good. The thoracic procedure had been completed at this time, the debridement of the compound fracture in the arm was still in progress at the time this soft tissue injury repair was completed.
Tom Shires, M.D.
fa
Commission Exhibit No. 392—Continued
PARKLAND MEMORIAL HOSPITAL
OPERATIVE RECORD
DATE: 11/24/63 Surg.
ROOM:
STATUS: S
NAME: Oswald, Lee Harvey
EOR UNIT # 25260
AGE: 24 Yr.
RACE: W/M
PRE-OPERATIVE DIAGNOSIS: GSW of upper abdomen and chest with massive bleeding
POST-OPERATIVE DIAGNOSIS: Major vascular injury in abdomen and chest
OPERATION: Exploratory laparotomy, thoracotomy, efforts to repair aorta 1’15”
BEGAN: 1142
ENDED: 1307
ANESTHETIC: General
BEGAN: 1142
ANESTHESIOLOGIST:
Dr. M.T. Jenkins
Dr. Gene Akin
Dr. Curtis Spier
SURGEON: Dr. Tom Shires
ASSISTANTS: Dr. Perry, Dr. McClelland, Dr. Ron Jones
SCRUB NURSE: Schrader-Lunsford
CIRC. NURSE: Schrader-Bell-Burkett-Simpson
2 counted sponges missing when body closed. Square pack count correct.
DRUGS
Ca chloride—3 vials
Cedilanid—12
One molar lactate—6
Isuprel—24
Adrenalin 1:1000—3
I.V. FLUIDS AND BLOOD
3-1000 cc. lactated Ringer’s solution
16—500cc. whole blood
6—1000cc. 5% dextrose in lactated Ringer’s solution
CONDITION OF PATIENT: Expired at 1307
Measured blood loss—8,376 cc.
CLINICAL EVALUATION: Previous inspection had revealed an entrance wound over the left lower lateral chest cage, and an exit was identified by subcutaneous palpation of the bullet over the right lower lateral chest cage. At the time he was seen preoperatively he was without blood pressure, heart beat was heard infrequently at 130 beats per minute, And preoperatively had endotracheal tube placed and was receiving oxygen by anesthesia at the time he was moved to the operating room.
DESCRIPTION OF OPERATION: Under endotracheal oxygen anesthesia, a long mid-line abdominal incision was made. Bleeders were not apparent and none were clamped or tied. Upon opening the peritoneal cavity, approximately 2 to 3 liters of blood, both liquid and in clots, were encountered. These were removed. The bullet pathway was then identified as having shattered the upper medial surface of the spleen, then entered the retroperitoneal area where there was a large retroperitoneal hematoma in the area of the pancreas. Following this, bleeding was seen to be coming from the right side, and upon inspection there was seen to be an exit to the right through the inferior vena cava, thence through the superior pole of the right kidney, the lower portion of the right lobe of the liver, and into the right lateral body wall. First the right kidney, which was bleeding, was identified, dissected free, retracted immediately, and the inferior vena cava hole was clamped with a partial occlusion clamp of the Satinsky type. Following this immobilization, packing controlled the bleeding from the right kidney. Attention was then turned to the left, as bleeding was massive from the left side. The inspection of the retroperitoneal area revealed a huge hematoma in the mid-line. The spleen was then mobilized, as was the left colon, and the retroperitoneal approach was made to the mid-line structures. The pancreas was seen to be shattered in its mid portion, bleeding was seen to be coming from the aorta. This was dissected free. Bleeding was controlled with finger pressure by Dr. Malcolm O. Perry. Upon identification of this injury, the superior mesenteric artery had been sheared off of the aorta, there was back bleeding from the superior mesenteric artery. This was cross-clamped with a small, curved DeBakey clamp. The aorta was then occluded with a straight DeBakey clamp above and a Potts clamp below. At this point all major bleeding was controlled, blood pressure was reported to be in the neighborhood of 100 systolic. Shortly thereafter, however, the pulse rate, which had been in the 80 to 90 range, was found to be 40 and a few seconds later found to be zero. No pulse was felt in the aorta at this time. Consequently the left chest was opened through an intercostal incision in approximately the fourth intercostal space. A Finochietto retractor was inserted, the heart was seen to be flabby and not beating at all. There was no hemopericardium. There was a hole in the diaphragm but no hemothorax. A left closed chest tube had been introduced in the Emergency Room prior to surgery, so that there was no significant pneumothorax on the left side. The pericardium was opened, cardiac massage was started, and a pulse was obtainable with massage. The heart was flabby, consequently calcium chloride followed by epinephrine-Xylocaine® were injected into the left ventricle without success. However, the standstill was converted to fibrillation. Following this, defibrillation was done, using 240, 360, 500, and 750 volts and finally successful defibrillation was accomplished. However, no effective heart beat could be instituted. A pacemaker was then inserted into the wall of the right ventricle and grounded on skin, and pacemaking was started. A very feeble, small, localized muscular response was obtained with the pacemaker but still no effective beat. At this time we were informed by Dr. Jenkins that there were no signs of life in that the pupils were fixed and dilated, there was no retinal blood flow, no respiratory effort, and no effective pulse could be maintained even with cardiac massage. The patient was pronounced dead at 1:07 P.M. Anesthesia consisted entirely of oxygen. No anesthetic agents as such were administered. The patient was never conscious from the time of his arrival in the Emergency Room until his death at 1:07 P.M. The subcutaneous bullet was extracted from the right side during the attempts at defibrillation, which were rotated among the surgeons. The cardiac massage and defibrillation attempts were carried out by Dr. Robert N. McClelland, Dr. Malcolm O. Perry, Dr. Ronald Jones. Assistance was obtained from the cardiologist, Dr. Fouad Bashour.
Tom Shires, M.D.
Commission Exhibit No. 392—Continued
Commission Exhibit No. 392—Continued
APPENDIX IX
Autopsy Report and Supplemental Report
CLINICAL RECORD AUTOPSY PROTOCOL A63-272 (JJH:ec)
DATE AND HOUR DIED 22 November 1963 1300 (CST)
DATE AND HOUR AUTOPSY PERFORMED 22 November 1963 2000 (EST)
FULL AUTOPSY X
PROSECTOR (497831) CDR J.J. HUMES, MC., USN
ASSISTANT (439878) CDR “J” THORNTON BOSWELL, MC, USN
LCOL PIERRE A. FINCK, MC, USA (04 043 322)
Ht.—72½ inches
Wt.—170 pounds
Eyes—Blue
Hair—Reddish brown
PATHOLOGICAL DIAGNOSES
CAUSE OF DEATH: Gunshot wound, head.
APPROVED-SIGNATURE J.J. HUMES, CDR, MC, USN
MILITARY ORGANIZATION (When required) PRESIDENT, UNITED STATES
AGE 46
SEX M
RACE Cauc.
AUTOPSY NO. A63-272
PATIENT’S IDENTIFICATION
KENNEDY, JOHN F.
NAVAL MEDICAL SCHOOL
CLINICAL SUMMARY:
According to available information the deceased, President John F. Kennedy, was riding in an open car in a motorcade during an official visit to Dallas, Texas on 22 November 1963. The President was sitting in the right rear seat with Mrs. Kennedy seated on the same seat to his left. Sitting directly in front of the President was Governor John B. Connolly of Texas and directly in front of Mrs. Kennedy sat Mrs. Connolly. The vehicle was moving at a slow rate of speed down an incline into an underpass that leads to a freeway route to the Dallas Trade Mart where the President was to deliver an address.
Three shots were heard and the President fell forward bleeding from the head. (Governor Connolly was seriously wounded by the same gunfire.) According to newspaper reports (“Washington Post” November 23, 1963) Bob Jackson, a Dallas “Times Herald” Photographer, said he looked around as he heard the shots and saw a rifle barrel disappearing into a window on an upper floor of the nearby Texas School Book Depository Building.
Shortly following the wounding of the two men the car was driven to Parkland Hospital in Dallas. In the emergency room of that hospital the President was attended by Dr. Malcolm Perry. Telephone communication with Dr. Perry on November 23, 1963 develops the following information relative to the observations made by Dr. Perry and procedures performed there prior to death.
Dr. Perry noted the massive wound of the head and a second much smaller wound of the low anterior neck in approximately the midline. A tracheostomy was performed by extending the latter wound. At this point bloody air was noted bubbling from the wound and an injury to the right lateral wall of the trachea was observed. Incisions were made in the upper anterior chest wall bilaterally to combat possible subcutaneous emphysema. Intravenous infusions of blood and saline were begun and oxygen was administered. Despite these measures cardiac arrest occurred and closed chest cardiac massage failed to re-establish cardiac action. The President was pronounced dead approximately thirty to forty minutes after receiving his wounds.
The remains were transported via the Presidential plane to Washington, D.C. and subsequently to the Naval Medical School, National Naval Medical Center, Bethesda, Maryland for postmortem examination.
GENERAL DESCRIPTION OF BODY:
The body is that of a muscular, well-developed and well nourished adult Caucasian male measuring 72½ inches and weighing approximately 170 pounds. There is beginning rigor mortis, minimal dependent livor mortis of the dorsum, and early algor mortis. The hair is reddish brown and abundant, the eyes are blue, the right pupil measuring 8 mm. in diameter, the left 4 mm. There is edema and ecchymosis of the inner canthus region of the left eyelid measuring approximately 1.5 cm. in greatest diameter. There is edema and ecchymosis diffusely over the right supra-orbital ridge with abnormal mobility of the underlying bone. (The remainder of the scalp will be described with the skull.) There is clotted blood on the external ears but otherwise the ears, nares, and mouth are essentially unremarkable. The teeth are in excellent repair and there is some pallor of the oral mucous membrane.
Situated on the upper right posterior thorax just above the upper border of the scapula there is a 7 x 4 millimeter oval wound. This wound is measured to be 14 cm. from the tip of the right acromion process and 14 cm. below the tip of the right mastoid process.
Situated in the low anterior neck at approximately the level of the third and fourth tracheal rings is a 6.5 cm. long transverse wound with widely gaping irregular edges. (The depth and character of these wounds will be further described below.)
Situated on the anterior chest wall in the nipple line are bilateral 2 cm. long recent transverse surgical incisions into the subcutaneous tissue. The one on the left is situated 11 cm. cephalad to the nipple and the one on the right 8 cm. cephalad to the nipple. There is no hemorrhage or ecchymosis associated with these wounds. A similar clean wound measuring 2 cm. in length is situated on the antero-lateral aspect of the left mid arm. Situated on the antero-lateral aspect of each ankle is a recent 2 cm. transverse incision into the subcutaneous tissue.
There is an old well healed 8 cm. McBurney abdominal incision. Over the lumbar spine in the midline is an old, well healed 15 cm. scar. Situated on the upper antero-lateral aspect of the right thigh is an old, well healed 8 cm. scar.
MISSILE WOUNDS:
1. There is a large irregular defect of the scalp and skull on the right involving chiefly the parietal bone but extending somewhat into the temporal and occipital regions. In this region there is an actual absence of scalp and bone producing a defect which measures approximately 13 cm. in greatest diameter.
From the irregular margins of the above scalp defect tears extend in stellate fashion into the more or less intact scalp as follows:
a. From the right inferior temporo-parietal margin anterior to the right ear to a point slightly above the tragus.
b. From the anterior parietal margin anteriorly on the forehead to approximately 4 cm. above the right orbital ridge.
c. From the left margin of the main defect across the midline antero-laterally for a distance of approximately 8 cm.
d. From the same starting point as c. 10 cm. postero-laterally. Situated in the posterior scalp approximately 2.5 cm. laterally to the right and slightly above the external occipital protuberance is a lacerated wound measuring 15 x 6 mm. In the underlying bone is a corresponding wound through the skull which exhibits beveling of the margins of the bone when viewed from the inner aspect of the skull.
Clearly visible in the above described large skull defect and exuding from it is lacerated brain tissue which on close inspection proves to represent the major portion of the right cerebral hemisphere. At this point it is noted that the falx cerebri is extensively lacerated with disruption of the superior saggital sinus.
Upon reflecting the scalp multiple complete fracture lines are seen to radiate from both the large defect at the vertex and the smaller wound at the occiput. These vary greatly in length and direction, the longest measuring approximately 19 cm. These result in the production of numerous fragments which vary in size from a few millimeters to 10 cm. in greatest diameter.
The complexity of these fractures and the fragments thus produced tax satisfactory verbal description and are better appreciated in photographs and roentgenograms which are prepared.
The brain is removed and preserved for further study following formalin fixation.
Received as separate specimens from Dallas, Texas are three fragments of skull bone which in aggregate roughly approximate the dimensions of the large defect described above. At one angle of the largest of these fragments is a portion of the perimeter of a roughly circular wound presumably of exit which exhibits beveling of the outer aspect of the bone and is estimated to measure approximately 2.5 to 3.0 cm. in diameter. Roentgenograms of this fragment reveal minute particles of metal in the bone at this margin. Roentgenograms of the skull reveal multiple minute metallic fragments along a line corresponding with a line joining the above described small occipital wound and the right supra-orbital ridge. From the surface of the disrupted right cerebral cortex two small irregularly shaped fragments of metal are recovered. These measure 7 x 2 mm. and 3 x 1 mm. These are placed in the custody of Agents Francis X. O’Neill, Jr. and James W. Sibert, of the Federal Bureau of Investigation, who executed a receipt therefor (attached).
2. The second wound presumably of entry is that described above in the upper right posterior thorax. Beneath the skin there is ecchymosis of subcutaneous tissue and musculature. The missile path through the fascia and musculature cannot be easily probed. The wound presumably of exit was that described by Dr. Malcolm Perry of Dallas in the low anterior cervical region. When observed by Dr. Perry the wound measured “a few millimeters in diameter”, however it was extended as a tracheostomy incision and thus its character is distorted at the time of autopsy. However, there is considerable ecchymosis of the strap muscles of the right side of the neck and of the fascia about the trachea adjacent to the line of the tracheostomy wound. The third point of reference in connecting these two wounds is in the apex (supra-clavicular portion) of the right pleural cavity. In this region there is contusion of the parietal pleura and of the extreme apical portion of the right upper lobe of the lung. In both instances the diameter of contusion and ecchymosis at the point of maximal involvement measures 5 cm. Both the visceral and parietal pleura are intact overlying these areas of trauma.
INCISIONS:
The scalp wounds are extended in the coronal plane to examine the cranial content and the customary (Y) shaped incision is used to examine the body cavities.
THORACIC CAVITY:
The bony cage is unremarkable. The thoracic organs are in their normal positions and relationships and there is no increase in free pleural fluid. The above described area of contusion in the apical portion of the right pleural cavity is noted.
LUNGS:
The lungs are of essentially similar appearance the right weighing 320 Gm., the left 290 Gm. The lungs are well aerated with smooth glistening pleural surfaces and gray-pink color. A 5 cm. diameter area of purplish red discoloration and increased firmness to palpation is situated in the apical portion of the right upper lobe. This corresponds to the similar area described in the overlying parietal pleura. Incision in this region reveals recent hemorrhage into pulmonary parenchyma.
HEART:
The pericardial cavity is smooth walled and contains approximately 10 cc. of straw-colored fluid. The heart is of essentially normal external contour and weighs 350 Gm. The pulmonary artery is opened in situ and no abnormalities are noted. The cardiac chambers contain moderate amounts of postmortem clotted blood. There are no gross abnormalities of the leaflets of any of the cardiac valves. The following are the circumferences of the cardiac valves: aortic 7.5 cm., pulmonic 7 cm., tricuspid 12 cm., mitral 11 cm. The myocardium is firm and reddish brown. The left ventricular myocardium averages 1.2 cm. in thickness, the right ventricular myocardium 0.4 cm. The coronary arteries are dissected and are of normal distribution and smooth walled and elastic throughout.
ABDOMINAL CAVITY:
The abdominal organs are in their normal positions and relationships and there is no increase in free peritoneal fluid. The vermiform appendix is surgically absent and there are a few adhesions joining the region of the cecum to the ventral abdominal wall at the above described old abdominal incisional scar.
SKELETAL SYSTEM:
Aside from the above described skull wounds there are no significant gross skeletal abnormalities.
PHOTOGRAPHY:
Black and white and color photographs depicting significant findings are exposed but not developed. These photographs were placed in the custody of Agent Roy H. Kellerman of the U. S. Secret Service, who executed a receipt therefore (attached).
ROENTGENOGRAMS:
Roentgenograms are made of the entire body and of the separately submitted three fragments of skull bone. These are developed and were placed in the custody of Agent Roy H. Kellerman of the U. S. Secret Service, who executed a receipt therefor (attached).
SUMMARY:
Based on the above observations it is our opinion that the deceased died as a result of two perforating gunshot wounds inflicted by high velocity projectiles fired by a person or persons unknown. The projectiles were fired from a point behind and somewhat above the level of the deceased. The observations and available information do not permit a satisfactory estimate as to the sequence of the two wounds.
The fatal missile entered the skull above and to the right of the external occipital protuberance. A portion of the projectile traversed the cranial cavity in a posterior-anterior direction (see lateral skull roentgenograms) depositing minute particles along its path. A portion of the projectile made its exit through the parietal bone on the right carrying with it portions of cerebrum, skull and scalp. The two wounds of the skull combined with the force of the missile produced extensive fragmentation of the skull, laceration of the superior saggital sinus, and of the right cerebral hemisphere.
The other missile entered the right superior posterior thorax above the scapula and traversed the soft tissues of the supra-scapular and the supra-clavicular portions of the base of the right side of the neck. This missile produced contusions of the right apical parietal pleura and of the apical portion of the right upper lobe of the lung. The missile contused the strap muscles of the right side of the neck, damaged the trachea and made its exit through the anterior surface of the neck. As far as can be ascertained this missile struck no bony structures in its path through the body.
In addition, it is our opinion that the wound of the skull produced such extensive damage to the brain as to preclude the possibility of the deceased surviving this injury.
A supplementary report will be submitted following more detailed examination of the brain and of microscopic sections. However, it is not anticipated that these examinations will materially alter the findings.
J. J. HUMES
CDR, MC, USN (497831)
“J” THORNTON BOSWELL
CDR, MC, USN (489878)
PIERRE A. FINCK
LT COL, MC, USA
(04-043-322)
Commission Exhibit No. 387
Commission Exhibit No. 387
Commission Exhibit No. 387
Commission Exhibit No. 387
Commission Exhibit No. 387
Commission Exhibit No. 387
SUPPLEMENTARY REPORT OF AUTOPSY NUMBER A63-272
PRESIDENT JOHN F. KENNEDY
PATHOLOGICAL EXAMINATION REPORT No. A63-272
GROSS DESCRIPTION OF BRAIN:
Following formalin fixation the brain weighs 1500 gms. The right cerebral hemisphere is found to be markedly disrupted. There is a longitudinal laceration of the right hemisphere which is para-sagittal in position approximately 2.5 cm. to the right of the of the midline which extends from the tip of the occipital lobe posteriorly to the tip of the frontal lobe anteriorly. The base of the laceration is situated approximately 4.5 cm. below the vertex in the white matter. There is considerable loss of cortical substance above the base of the laceration, particularly in the parietal lobe. The margins of this laceration are at all points jagged and irregular, with additional lacerations extending in varying directions and for varying distances from the main laceration. In addition, there is a laceration of the corpus callosum extending from the genu to the tail. Exposed in this latter laceration are the interiors of the right lateral and third ventricles.
When viewed from the vertex the left cerebral hemisphere is intact. There is marked engorgement of meningeal blood vessels of the left temporal and frontal regions with considerable associated sub-arachnoid hemorrhage. The gyri and sulci over the left hemisphere are of essentially normal size and distribution. Those on the right are too fragmented and distorted for satisfactory description.
When viewed from the basilar aspect the disruption of the right cortex is again obvious. There is a longitudinal laceration of the mid-brain through the floor of the third ventricle just behind the optic chiasm and the mammillary bodies. This laceration partially communicates with an oblique 1.5 cm. tear through the left cerebral peduncle. There are irregular superficial lacerations over the basilar aspects of the left temporal and frontal lobes.
In the interest of preserving the specimen coronal sections are not made. The following sections are taken for microscopic examination:
a. From the margin of the laceration in the right parietal lobe.
b. From the margin of the laceration in the corpus callosum.
c. From the anterior portion of the laceration in the right frontal lobe.
d. From the contused left fronto-parietal cortex.
e. From the line of transection of the spinal cord.
f. From the right cerebellar cortex.
g. From the superficial laceration of the basilar aspect of the left temporal lobe.
During the course of this examination seven (7) black and white and six (6) color 4x5 inch negatives are exposed but not developed (the cassettes containing these negatives have been delivered by hand to Rear Admiral George W. Burkley, MC, USN, White House Physician).
MICROSCOPIC EXAMINATION:
BRAIN:
Multiple sections from representative areas as noted above are examined. All sections are essentially similar and show extensive disruption of brain tissue with associated hemorrhage. In none of the sections examined are there significant abnormalities other than those directly related to the recent trauma.
HEART:
Sections show a moderate amount of sub-epicardial fat. The coronary arteries, myocardial fibers, and endocardium are unremarkable.
LUNGS:
Sections through the grossly described area of contusion in the right upper lobe exhibit disruption of alveolar walls and recent hemorrhage into alveoli. Sections are otherwise essentially unremarkable.
LIVER:
Sections show the normal hepatic architecture to be well preserved. The parenchymal cells exhibit markedly granular cytoplasm indicating high glycogen content which is characteristic of the “liver biopsy pattern” of sudden death.
SPLEEN:
Sections show no significant abnormalities.
KIDNEYS:
Sections show no significant abnormalities aside from dilatation and engorgement of blood vessels of all calibers.
SKIN WOUNDS:
Sections through the wounds in the occipital and upper right posterior thoracic regions are essentially similar. In each there is loss of continuity of the epidermis with coagulation necrosis of the tissues at the wound margins. The scalp wound exhibits several small fragments of bone at its margins in the subcutaneous tissue.
FINAL SUMMARY:
This supplementary report covers in more detail the extensive degree of cerebral trauma in this case. However neither this portion of the examination nor the microscopic examinations alter the previously submitted report or add significant details to the cause of death.
J. J. HUMES
CDR, MC, USN, 497831
Commission Exhibit No. 391
Commission Exhibit No. 391
6 December 1963
| From: | Commanding Officer, U. S. Naval Medical School |
| To: | The White House Physician |
| Via: | Commanding Officer, National Naval Medical Center |
| Subj: | Supplementary report of Naval Medical School autopsy No. A63-272, John F, Kennedy; forwarding of |
1. All copies of the above subject final supplementary report are forwarded herewith.
J. H. STOVER, JR.
- - - - - - - - - -
6 December 1963
FIRST ENDORSEMENT
| From: | Commanding Officer, National Naval Medical Center |
| To: | The White House Physician |
1. Forwarded.
C. B. GALLOWAY
Commission Exhibit No. 391