Report of the President's Commission on the Assassination of President John F. Kennedy

第二章 With the assistance of Agent in Charge Sorrels of the

Chapter II combines a detailed surgical narrative of the emergency operation performed on President John F. Kennedy at Parkland Memorial Hospital on 22 November 1963 with the official autopsy protocol conducted later that day at the Naval Medical School, National Naval Medical Center, Bethesda, Maryland. The chapter documents the operating-room intervention by Dr. Tom Shires, who worked alongside Drs. Malcolm O. Perry, Robert N. McClelland, Ronald Jones, and cardiologist Dr. Fouad Bashour, followed by the full autopsy report (A63-272) prepared by CDR J.J. Humes, MC, USN, with assistance from CDR “J” Thornton Boswell, MC, USN, and Lt. Col. Pierre A. Finck, MC, USA. Together, these records provide the complete clinical and pathological account of the wounds sustained by the President, the surgical attempts at resuscitation, and the postmortem determination that gunshot wounds of the head caused his death.

Description of Operation

The Description of Operation, signed by Dr. Tom Shires, recounts the emergency exploratory laparotomy performed under endotracheal oxygen anesthesia. A long mid-line abdominal incision exposed approximately 2 to 3 liters of liquid and clotted blood in the peritoneal cavity. The bullet pathway was traced as it shattered the upper medial surface of the spleen and entered the retroperitoneum, producing a large hematoma near the pancreas. The missile then exited through the inferior vena cava, traversed the superior pole of the right kidney and the lower right lobe of the liver, and lodged in the right lateral body wall. The right kidney was dissected free and the caval hole clamped with a Satinsky partial-occlusion clamp; packing controlled renal bleeding. On the left side, the spleen and left colon were mobilized to access a massive mid-line retroperitoneal hematoma, revealing a shattered mid-portion of the pancreas and aortic bleeding, which was controlled with finger pressure by Dr. Malcolm O. Perry. The superior mesenteric artery had been sheared off the aorta and was cross-clamped with a curved DeBakey clamp, after which the aorta was occluded above and below with straight DeBakey and Potts clamps. With major hemorrhage controlled, blood pressure reached approximately 100 systolic, but the pulse dropped from 80–90 to 40 and then to zero, with no aortic pulse. The left chest was opened through the fourth intercostal interspace using a Finochietto retractor; the heart was flabby and motionless, with no hemopericardium, no hemothorax, and a pre-existing left closed chest tube. The pericardium was opened, cardiac massage restored a pulse, and calcium chloride followed by epinephrine-Xylocaine were injected into the left ventricle. Standstill converted to fibrillation, and defibrillation was accomplished at progressively higher voltages (240, 360, 500, 750 volts), but no effective heartbeat could be established. A pacemaker inserted into the right ventricular wall produced only a feeble localized muscular response. Dr. Jenkins then confirmed absence of life: fixed and dilated pupils, no retinal blood flow, no respiratory effort, and no effective pulse even with massage. The President was pronounced dead at 1:07 P.M. Anesthesia was limited to oxygen; the patient was never conscious. The subcutaneous bullet was extracted from the right side during rotated defibrillation attempts, with cardiac massage and defibrillation carried out by Drs. McClelland, Perry, and Jones, and cardiologist Dr. Bashour providing assistance.