Date 11/22/63 1300 (CST)
Prosecter: CDR J.J. Humes, MC, USA (497831)
Assistant: CDR "J" Thornton Boswell, MC, USN, (439878); LCOL, Pierre A. Finck, MC, USA (04 043 322)
Full Autopsy
Ht. - 72 1/2 inches Wt. - 170 pounds Eyes - blue Hair - Reddish brown
Pathological diagnosis: Cause of Death: Gunshot wound, head.
Signature: J.J. Humes, CDS, MC, USN
Military organization: President, United States
Age: 46 Sex: Male Race: Caucasian
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. Connally of Texas and directly
in front of Mrs. Kennedy sat Mrs. Connally. 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 Connally 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 the Body
The body is that of a muscular, well-developed
and well nourished adult Caucasian male measuring 72 1/2 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 proved. 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 eccymosis 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 are 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 E. 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 are 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.
/s/
J. J. HUMES
CDR, MC, USN (497831)
/s/
"J" THORNTON BOSWELL
CDR, MC, USN (489878)
/s/
PIERRE A. FINCK
LT COL, MC, USA
(04-043-322)
Supplementary Report of Autopsy Number A63-272 President John F. Kennedy
Pathological Examination Report No. A63-272
Gross Description of the 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.
/s/
J. J. HUMES
CDR, MC, USN, 497831
Date: 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.
/s/
J. H. STOVER, JR.
6 December 1963
First Endorsement
From: Commanding Officer, National Naval Medical Center
To: The White House Physician
1. Forwarded.
/s/
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