John F. Kennedy autopsy

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The autopsy of President John F. Kennedy was performed, beginning about 8 p.m. and ending about midnight EST, on Nov. 22, 1963, the day of his assassination, at the then Bethesda Naval Hospital in Bethesda, Maryland. The choice of autopsy hospital in the Washington, D.C. area was made at the request of Mrs. Kennedy, on the basis that John F. Kennedy had been a naval officer.

In 1963, Texas law required that the autopsy of a person murdered in Texas was to be conducted in Texas, unless the murder occurred in places owned, possessed, or controlled by the U.S. government. Thus, the murder and subsequent medical examination of President Kennedy was legally under the sole jurisdiction of the State of Texas. Texas law required an inquest by a justice of the peace for all homicides, and then, if ordered, an autopsy. Dr. Earl Rose, the Dallas County medical examiner, attempted to enforce this law as the Secret Service was removing President Kennedy's body from Parkland Memorial Hospital for immediate return to Washington, D.C. with Jacqueline Kennedy and President Lyndon B. Johnson. A justice of the peace arrived to support Dr. Rose, but the Dallas County district attorney, Henry Wade, told the justice in a telephone call that he had no objection to the removal of the president's body.

Contents 1 Earlier testimony from Dallas doctors 1.1 The back wound 2 Official findings of the autopsy 2.1 The gunshot wound in the back 2.2 The gunshot wound to the head 3 Later government investigations 3.1 Ramsey Clark Panel Analysis (1968) 3.2 Rockefeller Commission analysis (1975) 3.3 HSCA analysis (1979) 4 Personnel present during autopsy 5 References 5.1 Primary sources 5.2 Secondary sources

[edit] Earlier testimony from Dallas doctors

[edit] The back wound

The death certificate, signed by the President's personal physician Dr. Burkley, an Admiral in the U.S. Navy, gave a location for the back wound lower than found by the later autopsy (either its photographs or measurements). Dr. Burkley believed a bullet to have hit Kennedy at "about" the level of the third thoracic vertebra.^[1] Supporting the location of Dr. Burkley is a diagram from the autopsy report of Kennedy,^[2] which shows a bullet hole in the upper back. However, this diagram is freehand, and not drawn with any attention to landmarks — a criticism made of it by the later HSCA analysis.

Burkley's location at T3 is also about the same location of the bullet hole in the President's shirt^[3] and the bullet hole in the suit jacket worn by Kennedy^[4] which show bullet holes between 5 and 6 inches below the top of Kennedy's collar.^[5] However, again there has been controversy on the matter of whether or not the holes in the president's clothing should be expected to correspond to the location of his back wound, since he was sitting with a raised arm at the time of the assassination, and multiple photographs taken of the motorcade show his suit jacket bunched at the back of his neck and shoulder, so that it did not lie closely against his skin.^[6]

[edit] Official findings of the autopsy

[edit] The gunshot wound in the back

1. The Bethesda autopsy physicians attempted to probe the bullet hole in the base of Kennedy's neck above the scapula, but were unsuccessful as it passed through neck strap muscle. They did not perform a full dissection or persist in tracking, as throughout the autopsy, they were unaware of the exit wound at about the same level, at the front of the throat. Emergency room physicians had obliterated it when they performed the tracheotomy.
2. At Bethesda, the autopsy report of the president, Warren Exhibit CE 386^[7] described the back wound as being oval, 6 x 4 mm, and located "above the upper border of the scapula" [shoulder blade] at a location 14 cm (5.5 in) from the tip of the right acromion process, and 14 cm (5.5 in) below the right mastoid process (the boney prominence behind the ear).
3. The concluding page of the Bethesda autopsy report,^[8] states: "The other missile [the bullet to the back] 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.
4. The report also reported contusion (bruise) of the apex (top tip) of the right lung in the region where it rises above the clavicle, and noted that although the apex of the right lung and the parietal pleural membrane over it had been bruised, they were not penetrated, indicating passage of a missile close to them, but above them.

   The report noted that the thoracic cavity was not penetrated.

5. 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."
6. The single bullet theory of the Warren Commission Report places a bullet wound at the sixth cervical vertebra of the vertebral column, which is consistent with 5.5 inches (14 cm) below the ear. The Warren Report itself does not conclude bullet entry at the sixth cervical vertebra, but this conclusion was made in a 1979 report on the Kennedy assassination by the House Select Committee on Assassinations (HSCA), which noted a defect in the C6 vertebra in the Bethesda X-rays, which the Bethesda autopsy physicians had missed and did not note.

   Even without this information, the original Bethesda autopsy report, included in the Warren Commission report, concluded that this bullet had passed entirely through the president's neck, from a level over the top of the scapula and lung (and the parietal pleura over the top of the lung), and through the lower throat.

   Claims that anyone on the commission "moved the wound" are subject to discussion, because Gerald Ford publicly admitted to re-naming the location of the wound, so as "to make things clearer". The Bethesda autopsy had merely noted that JFK was hit in the upper thorax above the scapula (this is in the soft area at the top of the shoulder) and Ford changed this to "the base of the neck"^[9][10][11]

7. The Commission report, as amended by Ford, then found the bullet to have passed through the base of the neck, and not to have been in the back. However, Ford's change is consistent with a bullet hit in the shoulder at the C6 vertebral body, where the HSCA and the photograph placed the wound on the basis of X-damage of the vertebrae and tiny lead fragments in that location. The neck formally begins (and thorax ends) at the level of C7, the first cervical vertebral body above the thorax, and thus the original autopsy report is technically in error.

[edit] The gunshot wound to the head

1. The wound to the back of the head is described by the Bethesda autopsy as being a laceration measuring 15 x 6 mm, situated to the right and slightly above the external occipital protuberance. In the underlying bone is a corresponding wound through the skull showing beveling (a cone-shaped widening) of the margins of the bone when viewed from the interior of the skull.^[12]
2. The large, irregularly shaped defect in the right side of the head (chiefly to the parietal bone, but also involving the temporal and occipital regions) is described as being about 13 cm (5 inches) wide at the largest diameter.^[13]
3. Three fragments of skull bone were received as separate specimens, roughly corresponding to the dimensions of the large defect. In the largest of the fragments is a portion of the perimeter of a roughly circular wound presumably of exit, exhibiting beveling of the exterior of the bone, and measuring about 2.5 to 3.0 cm in diameter. X-rays revealed minute particles of metal in the bone at this margin.^[14]
4. Minute fragments of the projectile were found by X-ray along a path from the rear wound to the parietal area defect.^[15]

[edit] Later government investigations

[edit] Ramsey Clark Panel Analysis (1968)

At the request of The Honorable Ramsey Clark, Attorney General of the United States, four physicians (hereafter sometimes referred to as The Panel) met in Washington, DC on February 26 and 27 to examine various photographs, X-ray films documents and other evidence pertaining to the death of President Kennedy, and to evaluate their significance in relation to the medical conclusions recorded in the Autopsy Report on the body of President Kennedy signed by Commander J. J. Humes, Medical Corps, US Navy; Commander J. Thornton Boswell, Medical Corps, US Navy and Lt. Col. Pierre A. Finck, Medical Corps, US Army and in the Supplemental Report signed by Commander Humes. These appear in the Warren Commission Report at pages 538 to 545.

The Clark panel reviewed the original autopsy records, photos, and X-rays, as well as clothing, films, motion pictures, and bullet fragments. They also reviewed the Warren Commission report. The Clarke panel concluded the following:

Major findings regarding the two missile wounds:

Skull There are multiple fractures of the bones of the calvarium bilaterally. These fractures extend into the base of the skull and involve the floor of the anterior fossa on the right side as well as the middle fossa in the midline. With respect to the right frontoparietal region of the skull, the traumatic damage is particularly severe with extensive fragmentation of the bony structures from the midline of the frontal bone anteriorly to the vicinity of the posterior margin of the parietal bone behind Above the fragmentation extends approximately 25 mm. across the midline to involve adjacent portions of the left parietal bone; below, the changes extend into the right temporal bone. Throughout this region, many of the bony pieces have been displaced outward; several pieces are missing. Distributed through the right cerebral hemisphere are numerous small, irregular metallic fragments most of which are less than 1 mm. in maximum dimension.

The majority of these fragments lie anteriorly and superiorly. None can be visualized on the left side of the brain and none below a horizontal plane through the floor of the anterior fossa of the skull. On one of the lateral films of the skull (#2), a hole measuring approximately 8 mm. in diameter on the outer surface of the skull and as much as 20 mm. on the internal surface can be seen in profile approximately 100 mm. above the external occipital protuberance. The bone of the lower edge of the hole is depressed. Also there is, embedded in the outer table of the skull close to the lower edge of the hole, a large metallic fragment which on the anteroposterior film (#1) lies 25 mm. to the right of the midline. This fragment as seen in the latter film is round and measures 6.5 mm in diameter immediately adjacent to the hole on the internal surface of the skull, there is localized elevation of the soft tissues. Small fragments of bone lie within portions of these tissues and within the hole itself. These changes are consistent with an entrance wound of the skull produced by a bullet similar to that of exhibit CE 399. The metallic fragments visualized within the right cerebral hemisphere fall into two groups. One group consists of relatively large fragments, more or less randomly distributed. The second group consists of finely divided fragments, distributed in a posteroanterior direction in a region 45 mm. long and 8 mm. wide.

As seen on lateral film #2, this formation overlies the position of the coronal suture; its long axis, if extended posteriorly, passes through the above-mentioned hole. It appears to end anteriorly immediately below the badly fragmented frontal and parietal bones just anterior to the region of the coronal suture. The foregoing observations indicate that the decedent's head was struck from behind by a single projectile. It entered the occipital region 25 mm to the right of the midline and 100 mm. above the external occipital protuberance. The projectile fragmented on entering the skull, one major section leaving a trail of fine metallic debris as it passed forward and laterally to explosively fracture the right frontal and parietal bones as it emerged from the head. In addition to the foregoing, it is noteworthy that there is no evidence of projectile fragments in the left cerebral tissues or in the right cerebral hemisphere below a horizontal plane passing through the floor of the anterior fossa of the skull.

Also, although the fractures of the calvarium extend to the left of the midline and into the anterior and middle fossa of the skull, no bony defect, such as one created by a projectile either entering or leaving the head, is seen in the calvarium to the left of the midline or in the base of the skull. Hence, it is not reasonable to postulate that a projectile passed through the head in a direction other than that described above. Of further note, when the X-ray films of the skull were presented to The Panel, film #1 had been damaged in two small regions by what appears to be the heat from a spotlight. Also, on film #2, a pair of converging pencil lines had been drawn on the film. Neither of these artifacts interfered with the interpretation of the films.

Neck Region Films #8, 9 and 10 allowed visualization of the lower neck. Subcutaneous emphysema is present just to the right of the cervical spine immediately above the apex of the right lung. Also, several, small metallic fragments are present in this region. There is no evidence of fracture of either scapula or of the clavicles, or of the ribs or of any of the cervical and thoracic vertebrae. The foregoing observations indicate that the pathway of the projectile involving the neck was confined to a region to the right of [t]he spine and superior to a plane passing through the upper margin of the right scapula, the apex of the right lung and the right clavicle. Any other pathway would have almost certainly fractured one or more bones of the right shoulder girdle and thorax.

DISCUSSION The information disclosed by the joint examination of the foregoing exhibits by the members of The Panel supports the following conclusions; The decedent was wounded by two bullets, both of which entered his body from behind. One bullet struck the back of the decedent's head well above the external occipital protuberance. Based upon the observation that he was leaning forward with his head turned obliquely to the left when this bullet struck, the photographs and X-rays indicate that it came from a site above and slightly to his right. This bullet fragmented after entering the cranium, one major piece of it passing forward and laterally to produce an explosive fracture of the right side of the skull as it emerged from the head. The absence of metallic fragments in the left cerebral hemisphere or below the level of the frontal fossa on the right side together with the absence of any holes in it the skull to the left of the midline or in its base and the absence of any penetrating injury of the left hemisphere, eliminate with reasonable certainty the possibility of a projectile having passed through the head in any direction other than from back to front as described in preceding sections of this report.

The other bullet struck the decedent's back at the right side of the base of the neck between the shoulder and spine and emerged from the front of his neck near the midline. The possibility that this bullet might have followed a pathway other than one passing through the site of the tracheotomy wound was considered. No evidence for this was found. There is a track between the two cutaneous wounds as indicated by subcutaneous emphysema and small metallic fragments on the X-rays and the contusion of the apex of the right lung and laceration of the trachea described in the Autopsy Report. In addition, any path other than one between the two cutaneous wounds would almost surely have been intercepted by bone and the X-ray films show no bony damage in the thorax or neck.

The possibility that the path of the bullet through the neck might have been more satisfactorily explored by the insertion of a finger or probe was considered. Obviously the cutaneous wound in the back was too small to permit the insertion of a finger. The insertion of a metal probe would have carried the risk of creating a false passage in part, because of the changed relationship of muscles at the time of autopsy and in part because of the existence of postmortem rigidity. Although the precise path of the bullet could undoubtedly have been demonstrated by complete dissection of the soft tissue between the two cutaneous wounds, there is no reason to believe that the information disclosed thereby would alter significantly the conclusions expressed in this report.

SUMMARY Examination of the clothing and of the photographs and X- rays taken at autopsy reveal that President Kennedy was struck by two bullets fired from above and behind him, one of which traversed the base of the neck on the right side without striking bone and the other of which entered the skull from behind and exploded its right side. The photographs and X-rays discussed herein support the above-quoted portions of the original Autopsy Report and the above-quoted medical conclusions of the Warren Commission Report.^[16]

Major differences with, and support of, conclusions in the Bethesda autopsy and Warren Report:

• The Clark report places the head bullet wound 100 mm (4 inches) above the reported occipital protuberance wound of the Bethesda report. This is important, because it is consistent with a high angle rear entry wound to the skull.
• The Clark report places the back wound squarely in the neck above the scapula and passing through the throat, passing over the TOP of the right lung, in keeping with the Bethesda conclusions. However, this finding is bolstered by additional findings of metallic fragments along the higher bullet trail.

[edit] Rockefeller Commission analysis (1975)

The five-member Rockefeller Commission, which included three pathologists, a radiologist, and a wound ballistics expert, did not address the back and throat wounds, writing in its report, "The investigation was limited to determining whether there was any credible evidence pointing to CIA involvement in the assassination of President Kennedy," and that "The witnesses who presented evidence believed sufficient to implicate the CIA in the assassination of President Kennedy placed much stress upon the movements of the President's body associated with the head wound that killed the President."

The Commission examined the Zapruder, Muchmore, and Nix films, the 1963 autopsy report, the autopsy photographs and X-rays, President Kennedy's clothing and back brace, the bullet and bullet fragments recovered, the 1968 Clark Panel report, and other materials. The five panel members came to the unanimous conclusion that President Kennedy was struck by only two bullets, both of which were fired from the rear, including one that struck the back of the head. Three of the physicians reported that the backward and leftward motion of the President's upper body following the head shot was caused by a "violent straightening and stiffening of the entire body as a result of a seizure-like neuromuscular reaction to major damage inflicted to nerve centers in the brain."

The report added that there was "no evidence to support the claim that President Kennedy was struck by a bullet fired from either the grassy knoll or any other position to his front, right front or right side … No witness who urged the view [before the Rockefeller Commission] that the Zapruder film and other motion picture films proved that President Kennedy was struck by a bullet fired from his right front was shown to possess any professional or other special qualifications on the subject."^[17]

[edit] HSCA analysis (1979)

Main article: HSCA

The United States House of Representatives Select Committee on Assassinations (HSCA) contained a forensic panel which undertook the unique task of reviewing original autopsy photographs and X-rays and interviewed autopsy personnel, as to their authenticity. The Panel and HCSA then went on to make medical conclusions based on this evidence.

The HSCA's major medical-forensic conclusion was that "President Kennedy was Struck by Two Rifle Shots Fired from Behind Him."^[18] (The committee found acoustic evidence of a second shooter, but concluded that this shooter did not contribute to the president's wounds, and therefore was irrelevant to the autopsy results).

The committee's forensic pathology panel was composed of nine members, eight of whom were chief medical examiners in major local jurisdictions in the United States. As a group, they had been responsible for more than 100,000 autopsies, an accumulation of experience the committee deemed invaluable in the evaluation of the medical evidence — including the autopsy X-rays and photographs — to determine the cause of death of the President and the nature and location of his wounds.

The committee also employed experts to authenticate the autopsy materials. Neither the Clark Panel nor the Rockefeller Commission undertook to determine if the X-rays and photographs were, in fact, authentic. The committee, in light of the numerous issues that had arisen over the years with respect to autopsy X-rays and photographs, believed authentication to be a crucial step in the investigation. The authentication of the autopsy X-rays and photographs was accomplished by the committee with the assistance of its photographic evidence panel as well as forensic dentists, forensic anthropologists and radiologists working for the committee. Two questions were put to these experts:

1. Could the photographs and X-rays stored in the National Archives be positively identified as being of President Kennedy?
2. Was there any evidence that any of these photographs or X-rays had been altered in any manner?

To determine if the photographs of the autopsy subject were in fact of the President, forensic anthropologists compared the autopsy photographs with ante-mortem pictures of the President. This comparison was done on the basis of both metric and morphological features. The metric analysis relied upon a series of facial measurements taken from the photographs, while the morphological analysis was focused on consistency of physical features, particularly those that could be considered distinctive (shape of the nose, patterns of facial lines, et cetera). Once unique characteristics were identified, posterior and anterior autopsy photographs were compared to verify that they, in fact, depicted the same person.

The anthropologists studied the autopsy X-rays in conjunction with premortem X-rays of the President. A sufficient number of unique anatomic characteristics were present in X-rays taken before and after the President's death to conclude that the autopsy X-rays were of President Kennedy. This conclusion was consistent with the findings of a forensic dentist employed by the committee. Since many of the X-rays taken during the course of the autopsy included the President's teeth, it was possible to determine, using the President's dental records, that the X-rays were of the President.

Once the forensic dentist and anthropologists had determined that the autopsy photographs and X-rays were of the President, photographic scientists and radiologists examined the original autopsy photographs, negatives, transparencies, and X-rays for signs of alteration. They concluded there was no evidence of the photographic or radiographic materials having been altered. Consequently, the committee determined that the autopsy X-rays and photographs were a valid basis for the conclusions of the committee's forensic pathology panel.

While the examination of the autopsy X-rays and photographs was the principal basis of its analysis, the forensic pathology panel also had access to all relevant witness testimony. In addition, all tests and evidence analyses requested by the panel were performed. It was only after considering all of this evidence that the panel reached its conclusions.

The forensic pathology panel concluded that President Kennedy was struck by two, and only two, bullets, each of which entered from the rear. The panel further concluded that the President was struck by one bullet that entered in the upper right of the back and exited from the front of the throat, and one bullet that entered in the right rear of the head near the cowlick area and exited from the right side of the head, toward the front. This second bullet caused a massive wound to the President's head upon exit. The panel concluded that there is no medical evidence that the President was struck by a bullet entering the front of the head, and the possibility that a bullet could have struck the President and yet left no evidence is extremely remote.

Because this conclusion appeared to be inconsistent with the backward motion of the President's head in the Zapruder film, the committee consulted a wound ballistics expert to determine what relationship, if any, exists between the direction from which a bullet strikes the head and subsequent head movement. The expert concluded that nerve damage from a bullet entering the President's head could have caused his back muscles to tighten which, in turn, could have caused his head to move toward the rear. He demonstrated the phenomenon in a filmed experiment which involved the shooting of goats. Thus, the committee determined that the rearward movement of the President's head would not be fundamentally inconsistent with a bullet striking from the rear.^[19]

The HCSA also voiced certain criticisms of the original Bethesda autopsy and handling of evidence from it. These included:

1. the "entrance head wound location was incorrectly described.”
2. The autopsy report was “incomplete”, prepared without reference to the photographs, and was “inaccurate” in a number of areas, including the entry in Kennedy's back.
3. The ”entrance and exit wounds on the back and front neck were not localized with reference to fixed body landmarks and to each other”.

[edit] Personnel present during autopsy

List of personnel present at various times during the autopsy, with official function, from Sibert-O'Neill report list and Vincent Bugliosi.

Non-medical personnel from law-enforcement/security

• John J. O'Leary: Secret Service Agent.
• William Greer: Secret Service Agent.
• Roy Kellerman: Secret Service Agent.
• Francis X. O'Neill: FBI Agent
• James Sibert: FBI Agent, assisted Francis O'Neill

Medical personnel and assistants

• Chester H. Boyers: Chief Petty Officer in charge of the Pathology
• John T. Stringer: the autopsy medical photographer
• Paul Kelly O'Connor: laboratory technologist
• James Curtis Jenkins: laboratory technologist
• Edward Reed: X-ray technician
• Jerrol Custer: X-ray technician
• Jan Gail Rudnicki: Dr. Boswell's lab assistant on the night of the autopsy
• James E. Metzler: hospital corpsman
• James H. Ebersole: Assistant Chief of Radiology

• Dr. George Bakeman, U.S. Navy.
• Adm. George Burkley, M.D., U.S. Navy, the President’s personal physician
• Robert Frederick Karnei, M.D.: Bethesda pathologist
• Captain David P. Osborne: chief of surgery
• Commander J. Thornton Boswell: Chief of Pathology of Bethesda
• Commander James J. Humes: JFK's chief autopsy pathologist, conducting autopsy
• Lt. Col. Pierre A. Finck: chief of the wound ballistics pathology branch at Walter Reed Medical Center, entered while autopsy is in progress

Military personnel

• Brig. Gen. Godfrey McHugh, Air Force aide to the President
• Adm. Calvin B. Galloway, U.S. Navy, Commanding Officer of the U.S. Naval Medical Center, Bethesda
• Captain John H. Stover, Jr.: Commanding Officer of the U.S. Naval Medical School, Bethesda
• Maj. Gen. Philip C. Wehle: Commanding officer of the U.S. Military District of Washington, D.C., entered to make arrangements for the lying in state
• Richard A. Lipsey: Aide to General Wehle
• Lt. Cmdr. Gregory H. Cross, resident in surgery
• CPO Chester H. Boyers, U. S. Navy, in charge of the pathology division, visited the autopsy room during the final stages to type receipts given by FBI and Secret Service for items obtained
• Adm. Edward Kenney, surgeon general of the U.S. Navy
• Captain Robert O. Canada, commanding officer of Bethesa Naval Hospital

Others:

• Samuel A. Bird

At the termination of the autopsy, the following personnel from Gawler’s Funeral Home entered the autopsy room to prepare the President’s body for burial:

• John VanHoesen
• Edwin Stroble
• Thomas E. Robinson
• Joe Hagen

[edit] References

[edit] Primary sources

• Sibert/O'Neill FBI autopsy report original.
• A second cached version. This primary document preserves the notes of two FBI agents (Special Agents James W. Sibert and Francis X. O'Neill) who were present at the autopsy and took notes. It is helpful on times and personnel, but the agents were non-medically trained people who did not completely understand what they were seeing in the actual autopsy wounds. Moveover, the early report preserves genuine medical doctor confusion present actually during the autopsy, caused by apparent lack of an exit wound, which was cleared up later in the official report after new and more complete information became available. However, as a primary piece of observation by medical laymen, the report is useful.
• Official autopsy written report, taken from the Warren Commission report, CE (Commission Exhibit) 387.

[edit] Secondary sources

• JFK Assassination Medical Evidence

v • d • e John F. Kennedy assassination Timeline • Autopsy • Reaction • Funeral • Lee Harvey Oswald • Warren Commission • HSCA • Dictabelt evidence • Conspiracy theories • Zapruder film • Single bullet theory • In popular culture