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 that point----
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
pneumothorax would 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
you have 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?