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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/
1.B. GALLOWAY
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