The Assassination of John F. Kennedy
Warren Report
Appendix IX - Autopsy Report and
Supplemental Report
Clinical Record - Autopsy Protocol
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/
- B. GALLOWAY
