Dr.Carrico. At 1 o'clock.
Mr.Specter. Who pronounced the death of the President?
Dr.Carrico. Dr. Clark, I believe.
Mr.Specter. Was that a precise time fixed or a general time fixed for the point of death?
Dr.Carrico. This was a general time, sir.
Mr.Specter. What, in your opinion, was the cause of death?
Dr.Carrico. The head wound, the head injury.
Mr.Specter. Will you describe as specifically as you can the head wound which you have already mentioned briefly?
Dr.Carrico. Sure.
This was a 5- by 71-cm defect in the posterior skull, the occipital region. There was an absence of the calvarium or skull in this area, with shredded tissue, brain tissue present and initially considerable slow oozing. Then after we established some circulation there was more profuse bleeding from this wound.
Mr.Specter. Was any other wound observed on the head in addition to this large opening where the skull was absent?
Dr.Carrico. No other wound on the head.
Mr.Specter. Did you have any opportunity specifically to look for a small wound which was below the large opening of the skull on the right side of the head?
Dr.Carrico. No, sir; at least initially there was no time to examine the patient completely for all small wounds. As we said before, this was an acutely ill patient and all we had time to do was to determine what things were life-threatening right then and attempt to resuscitate him and after which a more complete examination would be carried out and we didn't have time to examine for other wounds.
Mr.Specter. Was such a more complete examination ever carried out by the doctors in Parkland?
Dr.Carrico. No, sir; not in my presence.
Mr.Specter. Why not?
Dr.Carrico. As we said initially this was an acute emergency situation and there was not time initially and when the cardiac massage was done this prevented any further examination during this time this was being done. After the President was pronounced dead his wife was there, he was the President, and we felt certainly that complete examination would be carried out and no one had the heart, I believe, to examine him then.
Mr.Specter. Will you describe, as specifically as you can then, the neck wounds which you heretofore mentioned briefly?
Dr.Carrico. There was a small wound, 5- to 8-mm. in size, located in the lower third of the neck, below the thyroid cartilage, the Adams apple.
Mr.Dulles. Will you show us about where it was?
Dr.Carrico. Just about where your tie would be.
Mr.Dulles. Where did it enter?
Dr.Carrico. It entered?
Mr.Dulles. Yes.
Dr.Carrico. At the time we did notknow——
Mr.Dulles. I see.
Dr.Carrico. The entrance. All we knew this was a small wound here.
Mr.Dulles. I see. And you put your hand right above where your tie is?
Dr.Carrico. Yes, sir; just where thetie——
Mr.Dulles. A little bit to the left.
Dr.Carrico. To the right.
Mr.Dulles. Yes; to the right.
Dr.Carrico. Yes. And this wound was fairly round, had no jagged edges, no evidence of powder burns, and so forth.
RepresentativeFord. No evidence of powder burns?
Dr.Carrico. So far as I know.
RepresentativeFord. In the front?
Dr.Carrico. Yes.
Mr.Specter. Have you now described that wound as specifically as you can based upon your observations at the time?
Dr.Carrico. I believe so.
Mr.Specter. And your recollection at the time of those observations?
Dr.Carrico. Yes; an even round wound.
Mr.Dulles. You felt this wound in the neck was not a fatal wound?
Dr.Carrico. That is right.
Mr.Specter. That is, absent the head wound, would the President have survived the wound which was present on his neck?
Dr.Carrico. I think very likely he would have.
Mr.Specter. Based on your observations on the neck wound alone did you have a sufficient basis to form an opinion as to whether it was an entrance or an exit wound?
Dr.Carrico. No, sir; we did not. Not having completely evaluated all the wounds, traced out the course of the bullets, this wound would have been compatible with either entrance or exit wound depending upon the size, the velocity, the tissue structure and so forth.
Mr.Specter. Permit me to add some facts which I shall ask you to assume as being true for purposes of having you express an opinion.
First of all, assume that the President was struck by a 6.5 mm. copper-jacketed bullet from a rifle having a muzzle velocity of approximately 2,000 feet per second at a time when the President was approximately 160 to 250 feet from the weapon, with the President being struck from the rear at a downward angle of approximately 45 degrees, being struck on the upper right posterior thorax just above the upper border of the scapula 14 centimeters from the tip of the right acromion process and 14 centimeters below the tip of the right mastoid process.
Assume further that the missile passed through the body of the President striking no bones, traversing the neck and sliding between the large muscles in the posterior aspect of the President's body through a fascia channel without violating the pleural cavity, but bruising only the apex of the right pleural cavity and bruising the most apical portion of the right lung, then causing a hematoma to the right of the larynx which you have described, and creating a jagged wound in the trachea, then exiting precisely at the point where you observe the puncture wound to exist.
Now based on those facts was the appearance of the wound in your opinion consistent with being an exit wound?
Dr.Carrico. It certainly was. It could have been under the circumstances.
Mr.Specter. And assuming that all the facts which I have given you to be true, do you have an opinion with a reasonable degree of medical certainty as to whether, in fact, the wound was an entrance wound or an exit wound?
Dr.Carrico. With those facts and the fact as I understand it no other bullet was found this would be, this was, I believe, was an exit wound.
Mr.Specter. Were any bullets found in the President's body by the doctors at Parkland?
Dr.Carrico. No, sir.
Mr.Specter. Was the President's clothing ever examined by you, Dr. Carrico?
Dr.Carrico. No, sir; it was not.
Mr.Specter. What was the reason for no examination of the clothing?
Dr.Carrico. Again in the emergency situation the nurses removed the clothing after we had initially unbuttoned enough to get a look at him, at his chest, and as the routine is set up, the nurses remove the clothing and we just don't take time to look at it.
Mr.Specter. Was the President's body then ever turned over at any point by you or any of the other doctors at Parkland?
Dr.Carrico. No, sir.
Mr.Specter. Was President Kennedy lying on the emergency stretcher from the time he was brought into trauma room one until the treatment at Parkland Hospital was concluded?
Dr.Carrico. Yes; he was.
Mr.Specter. At what time was that treatment concluded, to the best of your recollection?
Dr.Carrico. At about 1 o'clock.
Mr.Specter. At approximately what time did you leave the trauma room where the President was brought?
Dr.Carrico. I left right at one when we decided that he was dead.
Mr.Specter. And did the other doctors leave at the same time or did any remain in the trauma room?
Dr.Carrico. I left before some of the other doctors, I do not remember specifically who was there. I believe Dr. Baxter was, Dr. Jenkins was still there, I believe. And I think Dr. Perry was.
Mr.Specter. You have described a number of doctors in the course of your testimony up to this point. Would you state what other doctors were present during the time the President was treated, to the best of your recollection?
Dr.Carrico. Well, I have already mentioned Dr. Don Curtis, the surgery resident; Martin White, an interne; Dr. Perry was there, Dr. Baxter, Dr. McClelland, a member of the surgery staff; Dr. Ronald Jones, chief surgery resident; Dr. Jenkins, chief of anesthesia; several other physicians whose names I can't remember at the present. Admiral Burkley, I believe was his name, the President's physician, was there as soon as he got to the hospital.
Mr.Specter. What is your view, Dr. Carrico, as to how many bullets struck the President?
Dr.Carrico. At the time of the initial examination I really had no view. In view of what we have been told by you, and the Commission, two bullets would be my opinion.
Mr.Specter. Based on the additional facts which I have asked you toassume——
Dr.Carrico. Yes, sir.
Mr.Specter. And also based on the autopsy report fromBethesda——
Dr.Carrico. Right.
Mr.Specter. Which was made available to you by me.
Dr.Carrico. Right.
Mr.Specter. Now, who, if any one, has talked to you representing the Federal Government in connection with the treatment which you assisted in rendering President Kennedy at Parkland on November 22?
Dr.Carrico. We have talked to some representatives of the Secret Service, whose names I do not remember.
Mr.Specter. On how many occasions, if there was more than one?
Dr.Carrico. Two occasions, a fairly long interview shortly after the President's death, and then approximately a month or so afterwards a very short interview.
RepresentativeFord. When you say shortly after the President's death, you mean that day?
Dr.Carrico. No, sir. Within a week maybe.
Mr.Specter. And what was the substance of the first interview with the Secret Service which you have described as occurring within 1 week?
Dr.Carrico. This was a meeting in Dr. Shires' office, Dr. Shires, Dr. Perry, Dr. McClelland and myself, and two representatives of the Secret Service in which we went over the treatment.
They discussed the autopsy findings as I recall it, with Dr. Shires, and reviewed the treatment with him, essentially.
Mr.Specter. And what questions were you asked specifically at that time, if any?
Dr.Carrico. I don't recall any specific questions I was asked. In general, I was asked some questions pertaining to his treatment, to the wounds, what I thought they were, and et cetera.
Mr.Specter. What opinions did you express at that time?
Dr.Carrico. Again, I said that on the basis of our initial examination, this wound in his neck could have been either an entrance or exit wound, which was what they were most concerned about, and assuming there was a wound in the back, somewhere similar to what you have described that this certainly would be compatible with an exit wound.
Mr.Specter. Were your statements at that time different in any respect with the testimony which you have given here this morning?
Dr.Carrico. Not that I recall.
Mr.Specter. Were your views at that time consistent with the findings in the autopsy report, or did they vary in any way from the findings in that report?
Dr.Carrico. As I recall, the autopsy report is exactly as I remember it.
Mr.Specter. Were your opinions at that time consistent with the findings of the autopsy report?
Dr.Carrico. Yes.
Mr.Specter. Will you identify Dr. Shires for the record, please?
Dr.Carrico. Dr. Shires is chief of the surgery service at Parkland, and chairman of the Department of Surgery at Southwestern Medical School.
Mr.Specter. Now, approximately when, to the best of your recollection, did the second interview occur with the Secret Service?
Dr.Carrico. This was some time in February, probably about the middle of February, and the interview consisted of the agent asking me if I had any further information.
I said I did not.
Mr.Specter. Was that the total context of the interview?
Dr.Carrico. Yes, sir.
Mr.Specter. Now, did I interview you and take your deposition in Dallas, Tex., last Wednesday?
Dr.Carrico. Yes, sir.
Mr.Specter. And has that deposition transcript been made available to you this morning?
Dr.Carrico. It has.
Mr.Specter. And were the views you expressed to me in our conversation before the deposition and on the record during the course of the deposition different in any way with the testimony which you have provided here this morning?
Dr.Carrico. No, sir; they were not.
Mr.Specter. Dr. Carrico, have you changed your opinion in any way concerning your observations or conclusions about the situation with respect to President Kennedy at any time since November 22, 1963?
Dr.Carrico. No.
Mr.Specter. Do you have any notes or writings of any sort in your possession concerning your participation in the treatment of President Kennedy?
Dr.Carrico. None other than the letter to my children I mentioned to you.
Mr.Specter. Will you state briefly the general nature of that for the Commission here today, please.
Dr.Carrico. This is just a letter written to my children to be read by them later, saying what happened, how I felt about it. And maybe why it happened, and maybe it would do them some good later.
Mr.Specter. Did you also make a written report which was made a part of the records of Parkland Hospital which you have identified for the record during the deposition proceeding?
Dr.Carrico. Yes; I did.
Mr.Specter. Do those constitute the total of the writings which you made concerning your participation in the treatment of the President?
Dr.Carrico. Right.
Mr.Dulles. You spoke of a letter to your children. I don't want to invade your privacy in this respect in any way, but is there anything in that letter that you think would bear on our considerations here by this Commission?
Dr.Carrico. No; I don't believe so. This thing doesn't mention the treatment other than to say probably by the time they read the letter it will be archaic.
Mr.Dulles. You spoke about the causes of it all, I don't knowwhether——
Dr.Carrico. Just a little homespun philosophy. I just said that there was a lot of extremism both in Dallas and in the Nation as a whole, and in an attitude of extremism a warped mind can flourish much better than in a more stable atmosphere.
Mr.Dulles. Thank you.
Mr.Specter. Dr. Carrico, was the nature of the treatment affected, in your opinion, in any way by the fact that you were working on the President of the United States?
Dr.Carrico. I don't believe so, sir. We have seen a large number of acutely injured people, and acutely ill people, and the treatment has been carried out enough that this is almost reflex, if you will. Certainly everyone was emotionally affected. I think, if anything, the emotional aspect made us think faster, work faster and better.
Mr.Specter. Do you have anything to add which you think would be helpful to the Commission in its inquiry on the assassination of President Kennedy?
Dr.Carrico. No, sir.
Mr.Specter. Those conclude my questions, Mr. Chief Justice.
TheChairman. Mr. Dulles, have you any questions to ask of the Doctor?
Mr.Dulles. Looking back on it, do you think it was probable that death followed almost immediately after this shot in the head?
Dr.Carrico. Yes, sir; as Isaid——
Mr.Dulles. I was absent, I am sorry, at that time.
Dr.Carrico. Yes, sir. Medically, I suppose you would have to say he was alive when he came to Parkland. From a practical standpoint, I think he was dead then.
TheChairman. Congressman Ford?
RepresentativeFord. When did you say that he arrived, when you first started working on the President?
Dr.Carrico. It would only be a guess. Probably about 12:35. It was about 12:30 when I got in the emergency room, and I was there 2 or 3 minutes when we were called, and he was there within 2 or 3 minutes.
RepresentativeFord. So approximately from 12:35 until 1 the President was examined and treatment was given by you and others?
Dr.Carrico. Yes.
RepresentativeFord. Have you read and analyzed the autopsy performed by the authorities at Bethesda?
Dr.Carrico. I have not read it carefully. I have seen it. Mr. Specter showed me parts of it, and I had seen a copy of it earlier, briefly.
RepresentativeFord. Is there anything in it that you have read that would be in conflict with your observation?
Dr.Carrico. Nothing at all in conflict. It certainly adds to the observations that we made.
RepresentativeFord. Have you been interviewed by the press and, if so, when?
Dr.Carrico. I think I have talked to the press twice.
Mr. Burrus, a reporter for the Dallas Times Herald, talked to me about 5 minutes, probably 3 or 4 days after the President's death, and then a reporter from Time called about 3 or 4 weeks after the President's death, and I talked to him for a very few minutes.
RepresentativeFord. Did you make any statements in either of these interviews that are different from the observations you have made here this morning?
Dr.Carrico. Not that I recall.
RepresentativeFord. That is all.
Mr.Dulles. Mr. Chief Justice, could I—off the record.
(Discussion off the record.)
TheChairman. Well, Doctor, thank you very much. We appreciate your help.
Dr.Carrico. Certainly. Glad to be here.
TheChairman. Dr. Perry, will you be sworn now, please?
Would you raise your right hand and be sworn, please?
Do you solemnly swear the testimony you are about to give before the Commission will be the truth, the whole truth, and nothing but the truth, so help you God?
Dr.Perry. I do.
TheChairman. Will you be seated, please?
Mr. Specter will conduct the examination.
Mr.Specter. Will you state your full name for the record, please?
Dr.Perry. Malcolm Oliver Perry.
Mr.Specter. What is your residence address?
Dr.Perry. 4115 Parkland, Dallas, Tex.
Mr.Specter. Your professional address?
Dr.Perry. 5323 Harley Hines Boulevard.
Mr.Specter. Is that the address of Parkland Memorial Hospital?
Dr.Perry. That is the address of the University of Texas Southwestern Medical School.
Mr.Specter. Is that situated immediately adjacent to Parkland Memorial Hospital?
Dr.Perry. That is correct.
Mr.Specter. Would you state your age, sir?
Dr.Perry. 34.
Mr.Specter. What is your profession?
Dr.Perry. I am a physician and surgeon.
Mr.Specter. Were you duly licensed to practice medicine by the State of Texas?
Dr.Perry. Yes.
Mr.Specter. Would you outline briefly your educational background, please?
Dr.Perry. After graduation from Plano High School in 1947, I attended the University of Texas and was duly graduated there in January of 1951 with a degree of Bachelor of Arts.
I subsequently graduated from the University of Texas Southwestern Medical School in 1956 with a degree of Doctor of Medicine. I served an internship of 12 months at Letterman Hospital in San Francisco, and after 2 more years in the Air Force I returned to Parkland for a 4-year residency in general surgery.
I completed thatin——
Mr.Dulles. Where did you serve in the Air Force, by the way?
Dr.Perry. I was in Spokane, Wash., Geiger Field.
At the completion of my surgery residency in June of 1962, I was appointed an instructor in surgery at the Southwestern Medical School.
But in September 1962, I returned to the University of California at San Francisco to spend a year in vascular surgery. During that time, I took and passed my boards for the certification for the American Board of Surgery.
I returned to Parkland Hospital and Southwestern in September of 1963, was appointed an assistant professor of surgery, attending surgeon and vascular consultant for Parkland Hospital and John Smith Hospital in Fort Worth.
Mr.Specter. What experience have you had, Dr. Perry, if any, in gunshot wounds?
Dr.Perry. During my period in medical school and my residency, I have seen a large number, from 150 to 200.
Mr.Specter. What were your duties at Parkland Memorial Hospital, if any, on November 22d, 1963?
Dr.Perry. On that day I had come over from the medical school for the usual 1 o'clock rounds with the residents, and Dr. Ronald Jones and I, he beingchief surgical resident, were having dinner in the main dining room there in the hospital.
Mr.Specter. Will you describe how you happened to be called in to render assistance to President Kennedy?
Dr.Perry. Somewhere around 12:30, and I cannot give you the time accurately since I did not look at my watch in that particular instant, an emergency page was put in for Dr. Tom Shires, who is chief of the emergency surgical service in Parkland. I knew he was in Galveston attending a meeting and giving a paper, and I asked Dr. Jones to pick up the page to see if he or I could be of assistance.
TheChairman. Doctor, at this time I must leave for a session at the Supreme Court, and the hearing will continue. Congressman Ford, I am going to ask you if you will preside in my absence. If you are obliged to go to the Congress, Commissioner Dulles will preside, and I will be available as soon as the Court session is over to be here with you.
(At this point, Mr. Warren withdrew from the hearing room.)
RepresentativeFord. Will you proceed, please?
Mr.Specter. What action did you take after learning of the emergency call, Dr. Perry?
Dr.Perry. The emergency room is one flight of stairs down from the main dining cafeteria, so Dr. Jones and I went immediately to the emergency room to render what assistance we could.
RepresentativeFord. May I ask this: In the confirmation of the page call, was it told to you that the President was the patient involved?
Dr.Perry. It was told to Dr. Jones, who picked up the page, that President Kennedy had been shot and was being brought to Parkland. We went down immediately to the emergency room to await his arrival. However, he was there when we reached it.
Mr.Specter. Who else was present at the time you arrived on the scene with the President?
Dr.Perry. When Dr. Jones and I entered the emergency room, the place was filled with people, most of them officers and, apparently, attendants to the Presidential procession. Dr. Carrico was in attendance with the President in trauma room No. 1 when I walked in. There were several other people there. Mrs. Kennedy was there with some gentleman whom I didn't know. I have the impression there was another physician in the room, but I cannot recall at this time who it was. There were several nurses there.
Mr.Specter. Were any other doctors present besides Dr. Carrico?
Dr.Perry. I think there was another doctor present, but I don't know who it was, I don't recall.
Mr.Dulles. Can I ask a question here, Mr. Specter?
Mr.Specter. Certainly.
Mr.Dulles. What is the procedure for somebody taking command in a situation of this kind? Who takes over and who says who should do what? I realize it is an emergency situation. Maybe that is an improper question.
Dr.Perry. No, sir.
Mr.Dulles. But it would be very helpful tome——
Dr.Perry. No, sir; it is perfectly proper.
Mr.Dulles. In reviewing the situation to see how you acted.
In a military situation, you have somebody who takes command.
Dr.Perry. We do, too. And it essentially is based on the same kind of thing.
Mr.Dulles. I would like to hear about that.
If it doesn't fit inhere——
Mr.Specter. It is fine.
Dr.Perry. It is based on rank and experience, essentially. For example, Dr. Carrico being the senior surgical resident in the area, at the time President Kennedy was brought in to the emergency suite, would have done what we felt was necessary and would have assumed control of the situation being as there were interns and probably medical students around the area, but being senior would take it. This, of course, catapulted me into this because I was the senior attending staff man when I arrived and at that time Dr. Carrico has noted I took over direction of the care since I was senior of all the peoplethere and being as we are surgeons, the department of surgery operates that portion of the emergency room and directs the care of the patients.
Mr.Dulles. Did you try to clear the room of unnecessary people?
Dr.Perry. This was done, not by me, but by the nurse supervisor, I assume, but several of the people were asked to leave the room. Generally, this is not necessary. In an instance such as this, it is a little more difficult, as you can understand.
Mr.Dulles. Yes.
Dr.Perry. But this care of an acutely injured and acutely injured patients goes on quite rapidly. Over 90,000 a year go through that emergency room, and, as a result, people are well trained in the performance of their duties. There is generally no problem in asking anyone to leave the room because everyone is quite busy and they know what they have to do and are proceeding to do it.
Mr.Dulles. Thank you very much.
Mr.Specter. Upon your arrival in the room, where President Kennedy was situated, what did you observe as to his condition?
Dr.Perry. At the time I entered the door, Dr. Carrico was attending him. He was attaching the Bennett apparatus to an endotracheal tube in place to assist his respiration.
The President was lying supine on the carriage, underneath the overhead lamp. His shirt, coat, had been removed. There was a sheet over his lower extremities and the lower portion of his trunk. He was unresponsive. There was no evidence of voluntary motion. His eyes were open, deviated up and outward, and the pupils were dilated and fixed.
I did not detect a heart beat and was told there was no blood pressure obtainable.
He was, however, having ineffective spasmodic respiratory efforts.
There was blood on the carriage.
Mr.Dulles. What does that mean to the amateur, to the unprofessional?
Dr.Perry. Short, rather jerky contractions of his chest and diaphragm, pulling for air.
Mr.Dulles. I see.
Mr.Specter. Were those respiratory efforts on his part alone or was he being aided in his breathing at that time?
Dr.Perry. He had just attached the machine and at this point it was not turned on. He was attempting to breathe.
Mr.Specter. So that those efforts were being made at that juncture at least without mechanical aid?
Dr.Perry. Those were spontaneous efforts on the part of the President.
Mr.Specter. Will you continue, then, Dr. Perry, as to what you observed of his condition?
Dr.Perry. Yes, there was blood noted on the carriage and a large avulsive wound on the right posterior cranium.
I cannot state the size, I did not examine it at all. I just noted the presence of lacerated brain tissue. In the lower part of the neck below the Adams apple was a small, roughly circular wound of perhaps 5 mm. in diameter from which blood was exuding slowly.
I did not see any other wounds.
I examined the chest briefly, and from the anterior portion did not see anything.
I pushed up the brace on the left side very briefly to feel for his femoral pulse, but did not obtain any.
I did no further examination because it was obvious that if any treatment were to be carried out with any success a secure effective airway must be obtained immediately.
I asked Dr. Carrico if the wound on the neck was actually a wound or had he begun a tracheotomy and he replied in the negative, that it was a wound, and at thatpoint——
Mr.Dulles. I am a little confused, I thought Dr. Carrico was absent. That was an earlier period.
Dr.Perry. No, sir; he was present.
Mr.Dulles. He was present?
Dr.Perry. Yes; he was present when I walked in the room and, at that point, I asked someone to secure a tracheotomy tray but there was one already there. Apparently Dr. Carrico had already asked them to set up the tray.
Mr.Specter. Dr. Perry, backtracking just a bit from the context of the answer which you have just given, would you describe the quantity of blood which you observed on the carriage when you first came into the room where the President was located?
Dr.Perry. Mr. Specter, this is an extremely difficult thing. The estimation of blood when it is either on the floor or on drapes or bandages is grossly inaccurate in almost every instance.
As you know, many hospitals have studied this extensively to try to determine whether they were able to do it with any accuracy but they cannot. I can just tell you there was considerable blood present on the carriage and some on his head and some on the floor but how much, I would hesitate to estimate. Several hundred CC's would be the closest I could get but it could be from 200 to 1,500 and I know by experience you cannot estimate it more accurately.
Mr.Specter. Would you characterize it as a very substantial or minor blood loss?
Dr.Perry. A substantial blood loss.
Mr.Specter. Now, you mentioned the President's brace. Could you describe that as specifically as possible?
Dr.Perry. No, sir; I did not examine it. I noted its presence only in an effort to reach the femoral pulse and I pushed it up just slightly so that I might palpate for the femoral pulse, I did no more examination.
Mr.Specter. In the course of seeking the femoral pulse, did you observe or note an Ace bandage?
Dr.Perry. Yes, sir.
Mr.Specter. In the brace area?
Dr.Perry. Yes, sir. It was my impression, I saw a portion of an Ace Bandage, an elastic supporting bandage on the right thigh. I did not examine it at all but I just noted its presence.
Mr.Specter. Did the Ace Bandage cover any portion of the President's body that you were able to observe in addition to the right thigh?
Dr.Perry. No, sir; I did not go any further. I just noted its presence right there at the junction at the hip. It could have been on the lower trunk or the upper thigh, I don't know. I didn't care any further.
Mr.Specter. Would you continue to describe the resuscitative efforts that were undertaken at that time?
Dr.Perry. At the beginning I had removed my coat and watch as I entered the room and dropped it off in the corner, and as I was talking to Dr. Carrico in regard to the neck wound, I glanced cursorily at the head wound and noted its severe character, and then proceeded with the tracheotomy after donning a pair of gloves. I asked that someone call Dr. Kemp Clark, of neurosurgery, Dr. Robert McClelland, Dr. Charles Baxter, assistant professors of surgery, to come and assist. There were several other people in the room by this time, none of which I can identify. I then began the tracheotomy making a transverse incision right through the wound in the neck.
Mr.Specter. Why did you elect to make the tracheotomy incision through the wound in the neck, Dr. Perry?
Dr.Perry. The area of the wound, as pointed out to you in the lower third of the neck anteriorly is customarily the spot one would electively perform the tracheotomy.
This is one of the safest and easiest spots to reach the trachea. In addition the presence of the wound indicated to me there was possibly an underlaying wound to the neck muscles in the neck, the carotid artery or the jugular vein. If you are going to control these it is necessary that the incision be as low, that is toward the heart or lungs as the wound if you are going to obtain adequate control.
Therefore, for expediency's sake I went directly to that level to obtain control of the airway.
Mr.Specter. Would you describe, in a general way and in lay terms, the purpose for the tracheotomy at that time?
Dr.Perry. Dr. Carrico had very judicially placed an endotracheal tube but unfortunately due to the injury to the trachea, the cuff which is an inflatable balloon on the endotracheal tube was not below the tracheal injury and thus he could not secure the adequate airway that you would require to maintain respiration.
(At this point, Mr. McCloy entered the hearing room.)
Mr.Specter. Dr. Perry, you mentioned an injury to the trachea.
Will you describe that as precisely as you can, please?
Dr.Perry. Yes. Once the transverse incision through the skin and subcutaneous tissues was made, it was necessary to separate the strap muscles covering the anterior muscles of the windpipe and thyroid. At that point the trachea was noted to be deviated slightly to the left and I found it necessary to sever the exterior strap muscles on the other side to reach the trachea.
I noticed a small ragged laceration of the trachea on the anterior lateral right side. I could see the endotracheal tube which had been placed by Dr. Carrico in the wound, but there was evidence of air and blood around the tube because I noted the cuff was just above the injury to the trachea.
Mr.Specter. Will you now proceed to describe what efforts you made to save the President's life?
Dr.Perry. At this point, I had entered the neck, and Dr. Baxter and Dr. McClelland arrived shortly thereafter. I cannot describe with accuracy their exact arrival. I only know I looked up and saw Dr. Baxter as I began the tracheotomy and he took a pair of gloves to assist me.
Dr. McClelland's presence was known to me at the time he picked up an instrument and said, "Here, I will hand it to you."
At that point I was down in the trachea. Once the trachea had been exposed I took the knife and incised the windpipe at the point of the bullet injury. And asked that the endotracheal tube previously placed by Dr. Carrico be withdrawn slightly so I could insert a tracheotomy tube at this level. This was effected and attached to an anesthesia machine which had been brought down by Dr. Jenkins and Dr. Giesecke for better control of circulation.
I noticed there was free air and blood in the right mediastinum and although I could not see any evidence, myself any evidence, of it in the pleura of the lung the presence of this blood in this area could be indicative of the underlying condition.
I asked someone to put in a chest tube to allow sealed drainage of any blood or air which might be accumulated in the right hemothorax.
This occurred while I was doing the tracheotomy. I did not know at the time when I inserted the tube but I was informed subsequently that Dr. Paul Peters, assistant professor of urology, and Dr. Charles Baxter, previously noted in this record, inserted the chest tube and attached it to underwater seal or drainage of the right pneumothorax.
Mr.Dulles. How long did this tracheotomy take, approximately?
Dr.Perry. I don't know that for sure, Mr. Dulles. However, I have—a matter of 3 to 5 minutes, perhaps even less. This was very—I didn't look at the watch, I have done them at those speeds and faster when I have had to. So I would estimate that.
At this point also Dr. Carrico, having previously attached and assisting with the attaching of the anesthesia machine was doing another cut down on the right leg; Dr. Ronald Jones was doing an additional cut down, venous section on the left arm for the insertion of plastic cannula into veins so one may rapidly and effectively infuse blood and fluids. These were being done.
It is to Dr. Carrico's credit, I think he ordered the hydrocortisone for the President having known he suffered from adrenal insufficiency and in this particular instance being quite busy he had the presence of mind to recall this and order what could have been a lifesaving measure, I think.
Mr.Specter. Would you identify who Dr. Baxter is?
Dr.Perry. Yes. Dr. Charles Baxter is, when I noted when I asked for the call, is an assistant professor of surgery also and Dr. McClelland.
Mr.Specter. And is Dr. McClelland occupying a similar position at Parkland Memorial Hospital as Dr. Baxter?
Dr.Perry. That is correct.
Mr.Specter. Would you identify Dr. Jenkins?
Dr.Perry. Dr. M. T. Jenkins is professor and chairman of the department of anesthesiology and chief of the anesthesia service, and Dr. Giesecke is assistant professor of anesthesiology at Parkland.
Mr.Specter. Have you now identified all of the medical personnel whom you can recollect who were present at the time the aid was being rendered to the President?
Dr.Perry. No, sir; several other people entered the room. I recall seeing Dr. Bashour who is an associate professor of medicine and chief of the cardiology section at Parkland.
Dr. Don W. Seldin, who is professor and chairman of the department of medicine, and I previously mentioned Dr. Paul Peters, assistant professor of urology, and I believe that Dr. Jackie Hunt of the department of anesthesiology was also there, and there were other people, I cannot identify them, several nurses and several others.
Mr.Specter. Dr. William Kemp Clark arrived at about that time?
Dr.Perry. Dr. Clark's arrival was first noted to me after the completion of the tracheotomy, and at this point, the cardiotachyscope had been attached to Mr. Kennedy to detect any electrical activity and although I did not note any, being occupied, it was related to me there was initially evidence of a spontaneous electrical activity in the President's heart.
However, at the completion of the tracheotomy and the institution of the sealed tube drainage of the chest, Dr. Clark and I began external cardiac massage. This was monitored by Dr. Jenkins and Dr. Giesecke who informed us we were obtaining a satisfactory carotid pulse in the neck, and someone whose name I do not know at this time, said they could also feel a femoral pulse in the leg. We continued external cardiac massage, I continued it as Dr. Clark examined the head wound and observed the cardiotachyscope. The exact time interval that this took I cannot tell you. I continued it until Dr. Jenkins and Dr. Clark informed me there was no activity at all, in the cardiotachyscope and that there had been no neurological or muscular response to our resuscitative effort at all and that the wound which the President sustained of his head was a mortal wound, and at that point we determined that he had expired and we abandoned efforts of resuscitation.
Mr.Specter. Would you identify Dr. Clark's specialty for the record, please?
Dr.Perry. Dr. Clark is professor and chairman of the department of neurosurgery at the University of Texas Southwestern Medical School, and chief of the neurosurgical services at Parkland Hospital.
Mr.Specter. Now, you described a condition in the right mediastinum. Would you elaborate on what your views were of the condition at the time you were rendering this treatment?
Dr.Perry. The condition of this area?
Mr.Specter. Yes, sir.
Dr.Perry. There was both blood, free blood and air in the right superior mediastinum. That is the space that is located between the lungs and the heart at that level.
As I noted, I did not see any underlying injury of the pleura, the coverings of the lungs or of the lungs themselves. But in the presence of this large amount of blood in this area, one would be unable to detect small injuries to the underlying structures. The air was indicated by the fact that there was some frothing of this blood present, bubbling which could have been due to the tracheal injury or an underlying injury to the lung.
Since the morbidity attendant upon insertion of an anterior chest tube for sealed drainage is negligible and the morbidity which attends a pneumothorax is considerable, I elected to have the chest tube put in place because we were giving him positive pressure oxygen and the possibility of inducing a tension on pneumothorax would be quite high in such instances.
Mr.Specter. What is pneumothorax?
Dr.Perry. Hemothorax would be blood in the free chest cavity and pneumothoraxwould be air in the free chest cavity underlying collapse of the lungs.
Mr.Specter. Would that have been caused by the injury which you noted to the President's trachea?
Dr.Perry. There was no evidence of a hemothorax or a pneumothorax through my examination; only it is sufficient this could have been observed because of the free blood in the mediastinum.
Mr.Specter. Were the symptoms which excited your suspicion causable by the injury to the trachea?
Dr.Perry. They were.
Mr.Specter. At what time was the pronouncement of death made?
Dr.Perry. Approximately 1 o'clock.
Mr.Specter. By whom was death announced?
Dr.Perry. Dr. Kemp Clark.
Mr.Specter. Was there any special reason why it was Dr. Kemp Clark who pronounced the President had died?
Dr.Perry. It was the opinion of those of us who had attended the President that the ultimate cause of his demise was a severe injury to his brain with subsequent loss of neurologic function and subsequent massive loss of blood, and thus Dr. Clark, being a neurosurgeon, signed the death certificate.
Mr.Specter. In your opinion, would the President have survived the injury which he sustained to the neck which you have described?
Dr.Perry. Barring the advent of complications this wound was tolerable, and I think he would have survived it.
Mr.Specter. Have you now described all of the treatment which was rendered to the President by the medical team in attendance at Parkland Memorial Hospital.
Dr.Perry. In essence I have, Mr. Specter. I do not know the exact quantities of balance salt solutions or blood that was given. I mentioned the 300 mg. of hydrocortisone Dr. Carrico ordered and, of course, he was given oxygen under pressure which has been previously recorded. The quantities of substances or any other drugs I have no knowledge of.
Mr.Specter. In general you have recounted the treatment?
Dr.Perry. That is correct.
Mr.Specter. Have you now stated for the record all of the individuals who were in attendance in treating the President that you can recollect at this time?
Dr.Perry. Yes, sir; I have.
Mr.Specter. Will you now describe as specifically as you can, the injury which you noted in the President's head?
Dr.Perry. As I mentioned previously in the record, I made only a cursory examination of the President's head. I noted a large avulsive wound of the right parietal occipital area, in which both scalp and portions of skull were absent, and there was severe laceration of underlying brain tissue. My examination did not go any further than that.
Mr.Specter. Did you, to be specific, observe a smaller wound below the large avulsed area which you have described?
Dr.Perry. I did not.
Mr.Specter. Was there blood in that area of the President's head?
Dr.Perry. There was.
Mr.Specter. Which might have obscured such a wound?
Dr.Perry. There was a considerable amount of blood at the head of the cartilage.
Mr.Specter. Would you now describe as particularly as possible the neck wound you observed?
Dr.Perry. This was situated in the lower anterior one-third of the neck, approximately 5 mm. in diameter.
It was exuding blood slowly which partially obscured it. Its edges were neither ragged nor were they punched out, but rather clean.
Mr.Specter. Have you now described the neck wound as specifically as you can?
Dr.Perry. I have.
Mr.Specter. Based on your observations of the neck wound alone, do youhave a sufficient basis to form an opinion as to whether it was an entrance wound or an exit wound,
Dr.Perry. No, sir. I was unable to determine that since I did not ascertain the exact trajectory of the missile. The operative procedure which I performed was restricted to securing an adequate airway and insuring there was no injury to the carotid artery or jugular vein at that level and at that point I made the procedure.
Mr.Specter. Based on the appearance of the neck wound alone, could it have been either an entrance or an exit wound?
Dr.Perry. It could have been either.
Mr.Specter. Permit me to supply some additional facts, Dr. Perry, which I shall ask you to assume as being true for purposes of having you express an opinion.
Assume first of all that the President was struck by a 6.5-mm. copper-jacketed bullet fired from a gun having a muzzle velocity of approximately 2,000 feet per second, with the weapon being approximately 160 to 250 feet from the President, with the bullet striking him at an angle of declination of approximately 45 degrees, striking the President on the upper right posterior thorax just above the upper border of the scapula, being 14 cm. from the tip of the right acromion process and 14 cm. below the tip of the right mastoid process, passing through the President's body striking no bones, traversing the neck and sliding between the large muscles in the posterior portion of the President's body through a fascia channel without violating the pleural cavity but bruising the apex of the right pleural cavity, and bruising the most apical portion of the right lung inflicting a hematoma to the right side of the larynx, which you have just described, and striking the trachea causing the injury which you described, and then exiting from the hole that you have described in the midline of the neck.
Now, assuming those facts to be true, would the hole which you observed in the neck of the President be consistent with an exit wound under those circumstances?
Dr.Perry. Certainly would be consistent with an exit wound.
Mr.Specter. Now, assuming one additional fact that there was no bullet found in the body of the President, and assuming the facts which I have just set forth to be true, do you have an opinion as to whether the wound which you observed in the President's neck was an entrance or an exit wound?
Dr.Perry. A full jacketed bullet without deformation passing through skin would leave a similar wound for an exit and entrance wound and with the facts which you have made available and with these assumptions, I believe that it was an exit wound.
Mr.Specter. Do you have sufficient facts available to you to render an opinion as to the cause of the injury which you observed in the President's head?
Dr.Perry. No, sir.
Mr.Specter. Have you had an opportunity to examine the autopsy report?
Dr.Perry. I have.
Mr.Specter. And are the facts set forth in the autopsy report consistent with your observations and views or are they inconsistent in any way with your findings and opinions?
Dr.Perry. They are quite consistent and I noted initially that they explained very nicely the circumstances as we observed them at the time.
Mr.Specter. Could you elaborate on that last answer, Dr. Perry?
Dr.Perry. Yes. There was some considerable speculation, as you will recall, as to whether there were one or two bullets and as to from whence they came. Dr. Clark and I were queried extensively in respect to this and in addition Dr. Carrico could not determine whether there were one or two bullets from our initial examination.
I say that because we did what was necessary in the emergency procedure, and abandoned any efforts of examination at the termination. I did not ascertain the trajectory of any of the missiles. As a result I did not know whether there was evidence for 1 or 2 or even 3 bullets entering and at the particular time it was of no importance.
Mr.Specter. But based on the additional factors provided in the autopsy report, do you have an opinion at this time as to the number of bullets there were?
Dr.Perry. The wounds as described from the autopsy report and coupled with the wounds I have observed it would appear there were two missiles that struck the President.
Mr.Specter. And based on the additional factors which I have provided to you by way of hypothetical assumption, and the factors present in the autopsy report from your examination of that report, what does the source of the bullets seem to have been to you?
Dr.Perry. That I could not say. I can only determine their pathway, on the basis of these reports within the President's body.
As to their ultimate source not knowing any of the circumstances surrounding it, I would not have any speculation.
Mr.Specter. From what direction would the bullets have come based on all of those factors?
Dr.Perry. The bullets would have come from behind the President based on these factors.
Mr.Specter. And from the level, from below or above the President?
Dr.Perry. Not having examined any of the wounds with the exception of the anterior neck wounds, I could not say. This wound, as I noted was about 5 mm., and roughly circular in shape. There is no way for me to determine.
Mr.Specter. Based upon a point of entrance in the body of the President which I described to you as being 14 cm. from the right acromion process and 14 cm. below the tip of the right mastoid process and coupling that with your observation of the neck wound, would that provide a sufficient basis for you to form an opinion as to the path of the bullet, as to whether it was level, up or down?
Dr.Perry. Yes, it would.
In view of the fact there was an injury to the right lateral portion of the trachea and a wound in the neck if one were to extend a line roughly between these two, it would be going slightly superiorly, that is cephalad toward the head, from anterior to posterior, which would indicate that the missile entered from slightly above and behind.
Mr.Specter. Dr. Perry, have you been a part of or participated in any press conferences?
Dr.Perry. Yes, sir; I have
Mr.Specter. And by whom, if anyone, were the press conferences arranged?
Dr.Perry. The initial press conference, to the best of my knowledge, was arranged by Mr. Hawkes who was identified to me as being of the White House Press, and Mr. Steve Landregan of the hospital administration there at Parkland, and Dr. Kemp Clark.
They called me, I was in the operating suite at the time to assist with the care of the Governor, and they called and asked me if it would be possible for me to come down to a press conference.
Mr.Specter. At about what time did that call come to you, Doctor?
Dr.Perry. I am not real sure about that but probably around 2 o'clock.
Mr.Specter. What action, if any, did you take in response to that call?
Dr.Perry. I put in a page for Dr. Baxter and Dr. McClelland since they were also involved, and went down to the emergency room where I met Mr. Hawkes and Dr. Clark. And from there we went up to classrooms one and two which had been combined into a large press room, and was packed with gentlemen and ladies of the press.
Mr.Specter. In what building was that located?
Dr.Perry. This was in Parkland Hospital, in the classroom section.
Mr.Specter. Are you able to identify which news media were present at that time?
Dr.Perry. No, sir; there were numerous people in the room. I would estimate maybe a hundred.
Mr.Specter. What doctors spoke at that press conference?
Dr.Perry. Dr. Clark and I answered the questions.
Mr.Specter. Who spoke first as between you and Dr. Clark?
Dr.Perry. I did.
Mr.Specter. Would you state as specifically as you can the questions which were asked of you at that time and the answers which you gave?
Dr.Perry. Mr. Specter, I would preface this by saying that, as you know, I have been interviewed on numerous occasions subsequent to that time, and I cannot recall with accuracy the questions that were asked. They, in general, were similar to the questions that were asked here. The press were given essentially the same, but in no detail such as have been given here. I was asked, for example, what I felt caused the President's death, the nature of the wound, from whence they came, what measures were taken for resuscitation, who were the people in attendance, at what time was it determined that he was beyond our help.
Mr.Specter. What responses did you give to questions relating to the source of the bullets, if such questions were asked?
Dr.Perry. I could not. I pointed out that both Dr. Clark and I had no way of knowing from whence the bullets came.
Mr.Specter. Were you asked how many bullets there were?
Dr.Perry. We were, and our reply was it was impossible with the knowledge we had at hand to ascertain if there were 1 or 2 bullets, or more. We were given, similarly, to the discussion here today, hypothetical situations. "Is it possible that such could have been the case, or such and such?" If it was possible that there was one bullet. To this, I replied in the affirmative, it was possible and conceivable that it was only one bullet, but I did not know.
Mr.Specter. What would the trajectory, or conceivable course of one bullet have been, Dr. Perry, to account for the injuries which you observed in the President, as you stated it?
Dr.Perry. Since I observed only two wounds in my cursory examination, it would have necessitated the missile striking probably a bony structure and being deviated in its course in order to account for these two wounds.
Mr.Specter. What bony structure was it conceivably?
Dr.Perry. It required striking the spine.
Mr.Specter. Did you express a professional opinion that that did, in fact, happen or it was a matter of speculation that it could have happened?
Dr.Perry. I expressed it as a matter of speculation that this was conceivable. But, again, Dr. Clark and I emphasized that we had no way of knowing.
Mr.Specter. Have you now recounted as specifically as you can recollect what occurred at that first press conference or is it practical for you to give any further detail to the contents of that press conference?
Dr.Perry. I do not recall any specific details any further than that.
RepresentativeFord. Mr. Specter—was there ever a recording kept of the questions and answers at that interview, Dr. Perry?
Dr.Perry. This was one of the things I was mad about, Mr. Ford. There were microphones, and cameras, and the whole bit, as you know, and during the course of it a lot of these hypothetical situations and questions that were asked to us would often be asked by someone on this side and recorded by some one on this, and I don't know who was recorded and whether they were broadcasting it directly. There were tape recorders there and there were television cameras with their microphones. I know there were recordings made but who made them I don't know and, of course, portions of it would be given to this group and questions answered here and, as a result, considerable questions were not answered in their entirety and even some of them that were asked, I am sure were misunderstood. It was bedlam.