Mr. Specter. What operative procedures did you employ in caring for the wound of the chest, Dr. Shaw.
Dr. Shaw. The first measure was to excise the edges of the wound of exit in an elliptical fashion, and then this incision was carried in a curved incision along the lateral portion of the right chest up toward the right axilla in order to place the skin incision lower than the actual path of the bullet through the chest wall.
After this incision had been carried down to the level of the muscles attached to the rib cage, all of the damaged muscle which was chiefly the serratus anterior muscle which digitates along the fifth rib at this position, was cleaned away, cut away with sharp dissection.
As soon as—of course, this incision had been made, the opening through the parietal pleura, which is the lining of the inside of the chest was very obvious. It was necessary to trim away several small fragments of the rib which were still hanging to tags of periosteum, the lining of the rib, and the ragged ends of the rib were smoothed off with a rongeur.
Mr. Specter. What damage had been inflicted upon a rib, if any, Dr. Shaw?
Dr. Shaw. About 10 centimeters of the fifth rib starting at the, about the mid-axillary line and going to the anterior axillary line, as we describe it, or that would be the midline at the armpit going to the anterior lateral portion of the chest had been stripped away by the missile.
Mr. Specter. What is the texture of the rib at the point where the missile struck?
Dr. Shaw. The texture of the rib here is not of great density. The cortex of the rib in the lateral portions of our ribs, is thin with the so-called cancellus portion of the rib being very spongy, offering very little resistance to pressure or to fracturing.
Mr. Specter. What effect, if any, would the striking of that rib have had to the trajectory of the bullet?
Dr. Shaw. It could have had a slight, caused a slight deflection of the rib, but probably not a great deflection of the rib, because of the angle at which it struck and also because of the texture of the rib at this time.