The (JFK) OFFICIAL PATHOLOGICAL EXAMINATION REPORT A63-272

PATHOLOGICAL EXAMINATION REPORT A63-272 PAGE 2

CLINICAL SUMMARY

According to the 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 December 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 was Mrs.
Connally. The vehicle was moving at a slow rate of speed down an
include 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 ans 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 lower anterior 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. Intravaneous 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 ht e Baval 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 liver mortis
of the dorsum, and early algor mortis. The hair is reddish brown and
abundant, the eyes are blus, the right pupil meassuring 8 mm. in
diameter, the left 4mm. There is adema and ecchymosis of the inner
canthus region of the left eyelid measuring approximately 1.5 cm. in
greatest diameter. There is edem 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,
nose, and mouth are essentially unremarkable. The teeth are in
excellent repair and there is some pallor of the oral muccus 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 abterior 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 is 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 transverse incision into the subcutaneous tissue.

There is an old well healed 8 cm. McBurney abdominal incision. Over the
lumbar spince in the midline is an old, well healed 15 cm. scavr.
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 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-perietal margin anterior to the
right ear to a point slightly above the trague.

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 through the skull shich 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 the the falx cerebri is extensively lacerated with
disruption of the superior saggital sinus.

Upon reflection the scalp muliple complete fracture lines are seen to
radiate from both the large defect at 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 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 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
perietal 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 the
trachea.

INCISIONS:

The scalpe wounds area 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 orgams 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
hte 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
purpleish 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 overlaying parietal
pleura. Incision to this region 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 250 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 acrdiac 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 sugically absent and there are a few adhesions joing 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 seperately
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 upon 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 the 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
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 it 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 out 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

(signed) (signed) (signed)
J.J. HUMES "J" THORNTON BOSWELL PIERRE A. FINCK
CDR, MC, USN (497831) CDR, MC, USN (489878) LT COL, MC, USA
(04-043-322)