Table of Contents, Appendix VIII, Appendix X
Appendix IX - Autopsy Report and Supplemental Report
Clinical Record - Autopsy ProtocolDate 11/22/63 1300
Prosecuter: CDR J. J. Humes, MC, USA
Assistant: CDR "J" Thornton
Boswell, MC, USN, LCOL, Pierre A. Finck, MC, USA (04 043 322)
Ht. - 72 1/2 inches
Wt. - 170 pounds
Eyes - blue
Pathological diagnosis: Cause of Death: Gunshot wound, head.
Signature: J. J. Eumes, CDS, MC, USN
Military organization: President,
Patient's Identification: Kennedy, John F., Naval Medical School
Clinical SummaryAccording 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
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 BodyThe 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 subcutnaeous
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.
- 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
From the irregular margins of the above scalp defect tears extend in
stellate fashion into the more or less intact scalp as follows:
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.
- From the right inferior temporo-parietal margin anterior to the right
ear to a point slightly above the tragus.
- From the anterior parietal margin anteriorly on the forehead to
approximately 4 cm. above the right orbital ridge.
- From the left margin of the main defect across the midline
antero-laterally for a distance of approximately 8 cm.
- From the same starting point as c. 10 cm. postero-laterally.
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
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
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
- 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.
IncisionsThe scalp wounds are extended in the coronal plane to examine
the cranial content and the customary (Y) shaped incision is used to examine the
Thoracic CavityThe 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.
LungsThe 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.
HeartThe 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
Abdominal CavityThe 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
Skeletal SystemAside from the above described skull wounds there are no
significant gross skeletal abnormalities.
PhotographyBlack 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).
RoentgenogramsRoentgenograms 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).
SummaryBased 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.
J. J. HUMES
CDR, MC, USN (497831)
"J" THORNTON BOSWELL
CDR, MC, USN (489878)
PIERRE A. FINCK
LT COL, MC, USA
Supplementary Report of Autopsy Number A63-272 President John F.
KennedyPathological Examination Report No. A63-272
Gross Description of the BrainFollowing formalin fixation the brain
seighs 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
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:
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).
- From the margin of the laceration in the right parietal lobe.
- From the margin of the laceration in the corpus callosum.
- From the anterior portion of the laceration in the right frontal lobe.
- From the contused left fronto-parietal cortex.
- From the line of transection of the spinal cord.
- From the right cerebellar cortex.
- From the superficial laceration of the basilar aspect of the left temporal
BrainMultiple 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
HeartSections show a moderate amount of sub-epicardial fat. The
coronary arteries, myocardial fibers, and endocardium are unremarkable.
LungsSections 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.
LiverSections 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
SpleenSections show no significant abnormalities.
KidneysSections show no significant abnormalities aside from dilatation
and engorgement of blood vessels of all calibers.
Skin WoundsSections 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 SummaryThis 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.
J. J. HUMES
CDR, MC, USN, 497831
Date: 6 December 1963
From: Commanding Officer, U. S. Naval Medical School
To: The White House
Via: Commanding Officer, National Naval Medical Center
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
J. H. STOVER, JR.
6 December 1963
From: Commanding Officer, National Naval Medical Center
To: The White
C. B. GALLOWAY
Table of Contents, Appendix VIII, Appendix X