Fatal wounding of President John F Kennedy 1968 Panel review The Kings Cross Sting is investigating

1968 Panel Review of Photographs, X-Ray Films,
Documents and Other Evidence Pertaining to the
Fatal Wounding of President John E Kennedy on
November 22, 1963, in Dallas, Texas




At the request of The Honorable Ramsay Clark, Attorney General of
the United States, four physicians (hereafter sometimes referred
to as The Panel) met in Washington, DC on February 26 and 27 to
examine various photographs, X-ray films documents and other
evidence pertaining to the death of President Kennedy, and to
evaluate their significance in relation to the medical
conclusions recorded in the Autopsy Report on the body of
President Kennedy signed by Commander J. J. Humes, Medical Corps,
US Navy; Commander J. Thornton Boswell, Medical Corps, US Navy
and Lt. Col. Pierre A. Finck, Medical Corps, US Army and in the
Supplemental Report signed by Commander Humes.

     These appear in the Warren Commission Report at pages 538 to
545.

     The four physicians constituting The Panel were:

     1) Carnes, William H., MD, Professor of Pathology,
University of Utah, Salt Lake City, UT, Member of Medical
Examiner's Commission, State of Utah, nominated by Dr. J. E.
Wallace Sterling, President of Stanford University.

     2) Fisher, Russell S., MD, Professor of Forensic Pathology,
University of Maryland and Chief Medical Examiner of the State of
Maryland, Baltimore, MD, nominated by Dr. Oscar B. Hunter, Jr.,
President of the College of American Pathologists.

     3) Morgan, Russell H., MD, Professor of Radiology, School of
Medicine and Professor of Radiological Sciences, School of
Hygiene and Public Health, The Johns Hopkins University,
Baltimore, MD, nominated by Dr. Lincoln Gordon, President of The
Johns Hopkins University.

     4) Mortiz, Alan R., MD, Professor of Pathology, Case Western
Reserve University, Cleveland, OH and former Professor of
Forensic Medicine, Harvard University, nominated by Dr. John A.
Hannah, President of Michigan State University.

     Bruce Bromley, a member of the New York Bar who had been
nominated by the President of the American Bar Association and
thereafter requested by the Attorney General to act as legal
counsel to The Panel, was present throughout The Panel's
examination of the exhibits and collaborated with The Panel in
the preparation of this report.

     No one of the undersigned has had any previous connection
with prior investigations of, or reports on this matter, and each
has acted with complete and unbiased independence, free of
preconceived views as to the correctness of the medical
conclusions reached in the 1963 Autopsy report and Supplementary
Report.

PREVIOUS REPORTS

     The Autopsy Report stated that X-rays had been made of the
entire body of the deceased.  The Panel's inventory disclosed
X-ray films of the entire body except for the lower arms, wrists
and hands and the lower legs, ankles and feet.

     The Autopsy Report also described the decedent's wounds as
follows:

     "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 sagittal
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
suprascapular and the supraclavicular 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."

     The medical conclusions of the Warren Commission Report (p.
19) concerning President Kennedy's wounds are as follows:         

     "The nature of the bullet wounds suffered by President
Kennedy and the location of the car at the time of the shots
establish that the bullets were fired from above and behind the
Presidential limousine, striking the President as follows:

     President Kennedy was first struck by a bullet which entered
at the back of his neck and exited through the lower front
portion of his neck, causing a wound which would not necessarily
have been lethal. The President was struck a second time by a
bullet which entered the right rear portion of his head, causing
a massive and fatal wound."


INVENTORY OF MATERIAL EXAMINED

Black and White and Colored Prints and transparencies

Head viewed from above

#5(9JB), 8(7JB), 13(6JB), 16(10JB), 32, 33, 34, 35, 36, 37

Head viewed from right and above to include part of face, neck,
shoulder and upper chest

#3(14JB), 4(13JB), 11(6JB), 12(5JB), 26, 27, 28, 40, 41

Head and neck viewed from left side
#6(3JB), 15(4JB), 17(2JB), 18(1JB), 29, 30, 31

Head viewed from behind
#7(16JB), 14(15JB), 42, 43

Cranial cavity with brain removed viewed from above and in front
#1(18JB), 2(17JB), 44, 45

Back of body including neck
#9(11JB), 10(12JB), 38, 39

Brain viewed from above
#50, 51, 52

brain viewed from below
#46, 47, 48, 49

     The black and white and color negatives corresponding to the
above were present and there were also seven black and white
negatives of the brain without corresponding prints. These were
numbered 19 through 25(JTB) and appeared to represent the same
views as #46 through 52.  All of the above were listed in a
memorandum of transfer, located in the National Archives, and
dated Apr. 26, 1965.

X-ray Films

     (The films bore the number 21296 and an inscription
indicating that they have been made at the US Naval Hospital,
Bethesda, MD on 11/22/63.)

Skull, A-P view
#1

Skull, left lateral
#2,3

Skull, fragments of
#4, 5, 6

Thoracolumbar region, A-P view
#7, 11

Chests, A-P view
#9

Right hemithorax, shoulder and upper arm, A-P view
#8

Left hemithorax, shoulder and upper arm, A-P view
#10

Pelvis, A-P view
#13

Lower femurs and knees, A-P view
#12

Upper legs, A-P view
#14


Bullets

CE 399--A whole bullet
CE 567--Portion of nose of a bullet
CE 569--Portion of base segment of a bullet
CE 840--3 fragments of lead

Motion Picture Films

CE 904--Zapruder film
CE 905--Nix film
CE 906--Muchmore film

Series of single frames (215 through 334) from Zapruder film

Clothing
CE 393--Suit coat
CE 394--Shirt
CE 395--Neck tie

Documents

     The Warren Commission's Report and the accompanying volumes
of Exhibits and Hearings. (Study of these Documents was limited
to those portions deemed pertinent by The Panel.)

EXAMINATION OF PHOTOGRAPHS OF HEAD

     Photographs 7, 14, 42, and 43 show the back of the head, the
contours of which have been grossly distorted by extensive
fragmentation of the underlying calvarium.  There is an
elliptical penetrating wound of the scalp situated near the
midline and high above the hairline. The position of this wound
corresponds to the hole in the skull seen in the lateral X-ray
film #2. (See description of X-ray films.) The long axis of this
wound corresponds to the long axis of the skull. The wound was
judged to be approximately six millimeters wide and 15
millimeters long. The margin of this wound shows an ill-defined
zone of abrasion.

     Photographs 5, 8, 13, 16, 32, 33, 34, 35, 36 and 37 show the
top of the head with multiple gaping irregularly stellate
lacerations of the scalp over the right parietal, temporal and
frontal regions.

     Photographs 1, 2, 44 and 45 show the frontal region of the
skull and a portion of the internal aspect of the back of the
skull. Due to lack of contrast of structures portrayed and lack
of clarity of detail in these photographs, the only conclusion
reached by The Panel from study of this series was that there was
no existing bullet defect in the supraorbital region of the
skull.

     Photographs 46, 47, 48 and 49 are of the inferior aspect of
the brain and show extensive deformation with laceration and
fragmentation of the right cerebral hemisphere. Irregularly
shaped areas of contusion with minor loss of cortex are seen on
the inferior surface of the first left temporal convolution. The
orbital gyri on the left show contusion with some underlying loss
of cortex.  The sylvian fissure on the right side has been
opened, revealing a rolled-up mass of arachnoid and blood clot
which is dark brown to black in color.  The mid-temporal region
is depressed and its surface lacerated. The peduncles have been
lacerated, probably incident to the removal of the contents from
the cranium.

     Photographs 50, 51 and 52 show the superior aspect of the
brain.  The left cerebral hemisphere is covered by a
generally-intact arachnoid with evidence of subarachnoid
hemorrhage especially over the parietal and frontal gyri and in
the sulci.  The right cerebral hemisphere is extensively
lacerated.  It is transected by a broad canal running generally
in a posteroanterior direction and to the right of the midline.
Much of the roof of this canal is missing, as are most of the
overlying frontal and parietal gyri.  In the central portion of
its base, there can be seen a gray-brown, rectangular structure
measuring approximately 13 x 20 mm.  Its identity cannot be
established by The Panel.  In addition to the superficial and
deep cortical destruction, it can be seen that the corpus
callosum is widely torn in the midline.

     These findings indicate that the back of the head was struck
by a single bullet travelling at high velocity, the major portion
of which passed forward through the right cerebral hemisphere,
and which produced an explosive type of fragmentation of the
skull and laceration of the scalp. The appearance of the entrance
wound in the scalp is consistent with its having been produced by
a bullet similar to that of exhibit CE 399. The photographs do
not disclose where this bullet emerged from the head although
those showing the interior of the cranium with the brain removed
indicate that it did not emerge from the supraorbital region.
Additional information regarding the course of the bullet is
presented in the discussion of the X-ray films.

     Examination of photographs of anterior and posterior views
of thorax, and anterior, posterior and lateral views of neck
(Photographs 3, 4, 6, 9, 10, 11, 12, 15, 17, 18, 26, 27, 28, 29,
30, 31, 38, 39, 40, 41).

     There is an elliptical penetrating wound of the skin of the
back located approximately 15 cm. medial to the right acromial
process, 5 cm. lateral to the mid-dorsal line and 14 cm. below
the right mastoid process. This wound lies approximately 5.5 cm.
below a transverse fold in the skin of the neck. This fold can
also be seen in a lateral view of the neck which shows an
anterior tracheotomy wound. This view makes it possible to
compare the levels of these two wounds in relation to that of the
horizontal plane of the body.

     A well defined zone of discoloration of the edge of the back
wound, most pronounced on its upper and outer margins, identifies
it as having the characteristics of the entrance wound of a
bullet. The wound with its marginal abrasion measures
approximately 7 mm. in width by 10 mm. in length. The dimensions
of this cutaneous wound are consistent with those of a wound
produced by a bullet similar to that which constitutes exhibit CE
399.

     At the site of and above the tracheotomy incision in the
front of the neck, there can be identified the upper half of the
circumference of a circular cutaneous wound the appearance of
which is characteristic of that of the exit wound of a bullet. 
The lower half of this circular wound is obscured by the
surgically produced tracheotomy incision which transects it. The
center of the circular wound is situated approximately 9 cm.
below the transverse fold in the skin of the neck described in a
preceding paragraph.  This indicates that the bullet which
produced the two wounds followed a course downward and to the
left in its passage through the body.


EXAMINATION OF X-RAY FILMS

     The films submitted included: an anteroposterior film of the
skull (#1), two left lateral views of the skull taken in slightly
different projections (#2 and 3), three views of a group of three
separate bony fragments from the skull (#4, 5 and 6), two
anteroposterior views of the thoracolumbar region of the trunk
(#7 and 11), one anteroposterior view of the right hemithorax,
shoulder and upper arm (#8), one anteroposterior view of the
chest (#9), one anteroposterior view of the left hemithorax,
shoulder and upper arm (#10), one anteroposterior view of the
lower femurs and knees (#12), one anteroposterior view of the
pelvis (#13) and one anteroposterior view of the upper legs
(#14).

Skull

     There are multiple fractures of the bones of the calvarium
bilaterally. These fractures extend into the base of the skull
and involve the floor of the anterior fossa on the right side as
well as the middle fossa in the midline. With respect to the
right frontoparietal region of the skull, the traumatic damage is
particularly severe with extensive fragmentation of the bony
structures from the midline of the frontal bone anteriorly to the
vicinity of the posterior margin of the parietal bone behind
Above the fragmentation extends approximately 25 mm. across the
midline to involve adjacent portions of the left parietal bone;
below, the changes extend into the right temporal bone.
Throughout this region, many of the bony pieces have bean
displaced outward; several pieces are missing.

     Distributed through the right cerebral hemisphere are
numerous small, irregular metallic fragments most of which are
less than 1 mm. in maximum dimension. The majority of these
fragments lie anteriorly and superiorly. None can be visualized
on the left side of the brain and none below a horizontal plane
through the floor of the anterior fossa of the skull.

     On one of the lateral films of the skull (#2), a hole
measuring approximately 8 mm. in diameter on the outer surface of
the skull and as much as 20 mm. on the internal surface can be
seen in profile approximately 100 mm. above the external
occipital protuberance. The bone of the lower edge of the hole is
depressed. Also there is, embedded in the outer table of the
skull close to the lower edge of the hole, a large metallic
fragment which on the anteroposterior film (#1) lies 25 mm. to
the right of the midline. This fragment as seen in the latter
film is round and measures 6.5 mm in diameter immediately
adjacent to the hole on the internal surface of the skull, there
is localized elevation of the soft tissues. Small fragments of
bone lie within portions of these tissues and within the hole
itself.  These changes are consistent with an entrance wound of
the skull produced by a bullet similar to that of exhibit CE 399.

     The metallic fragments visualized within the right cerebral
hemisphere fall into two groups. One group consists of relatively
large fragments, more or less randomly distributed. The second
group consists of finely divided fragments, distributed in a
posteroanterior direction in a region 45 mm. long and 8 mm. wide.
As seen on lateral film #2, this formation overlies the position
of the coronal suture; its long axis, if extended posteriorly,
passes through the above-mentioned hole. It appears to end
anteriorly immediately below the badly fragmented frontal and
parietal bones just anterior to the region of the coronal suture.

     The foregoing observations indicate that the decedent's head
was struck from behind a single projectile. It entered the
occipital region 25 mm to the right of the midline and 100 mm.
above the external occipital protuberance. The projectile
fragmented on entering the skull, one major section leaving a
trail of fine metallic debris as it passed forward and laterally
to explosively fracture the right frontal and parietal bones as
it emerged from the head.

     In addition to the foregoing, it is noteworthy that there is
no evidence of projectile fragments in the left cerebral tissues
or in the right cerebral hemisphere below a horizontal plane
passing through the floor of the anterior fossa of the skull.
Also, although the fractures of the calvarium extend to the left
of the midline and into the anterior and middle fossa of the
skull, no bony defect, such as one created by a projectile either
entering or leaving the head, is seen in the calvarium to the
left of the midline or in the base of the skull. Hence, it is not
reasonable to postulate that a projectile passed through the head
in a direction other than that described above.

     Of further note, when the X-ray films of the skull were
presented to The Panel, film #1 had been damaged in two small
regions by what appears to be the heat from a spotlight. Also, on
film #2, a pair of converging pencil lines had been drawn on the
film. Neither of these artifacts interfered with the
interpretation of the films.

Neck Region

     Films #8, 9 and 10 allowed visualization of the lower neck.
Subcutaneous emphysema is present just to the right of the
cervical spine immediately above the apex of the right lung.
Also, several, small metallic fragments are present in this
region. There is no evidence of fracture of either scapula or of
the clavicles, or of the ribs or of any of the cervical and
thoracic vertebrae.

     The foregoing observations indicate that the pathway of the
projectile involving the neck was confined to a region to the
right of she spine and superior to a plane passing through the
upper margin of the right scapula, the apex of the right lung and
the right clavicle. Any other pathway would have almost certainly
fractured one or more bones of the right shoulder girdle and
thorax.

Other Regions Studied
     No bullets or fragments of bullets are demonstrated in
X-rayed portions of the body other than those described above. On
film #13, a small round opaque structure a little more than 1 mm.
in diameter, is visible just to the right of the midline at the
level of the sacral segment of the spine. Its smooth
characteristics are not similar to those of the projectile
fragments seen in the X-rays of the skull and neck.

EXAMINATION OF THE CLOTHING

Suit Coat (CE 393)

     A ragged oval hole about 15 mm. long (vertically) is located
5 cm. to the right of the midline in the back of the coat at a
point about 12 cm. below the upper edge of the coal collar. A
smaller ragged hole, which is located near the midline and about
4 cm. below the upper edge of the collar, does not overlie any
corresponding damage to the shirt or skin and appears to be
unrelated to the wounds or their causation.

Shirt (CE 394)

     A ragged hole about 10 mm. long vertically and corresponding
to the first one described in the coat, is located 2.5 cm. to the
right of the midline in the back of the shirt at a point 14 cm.
below the upper edge of the collar. Two linear holes 15 mm. long
are found in the overlapping hems of the front of the shirt in a
position corresponding to the place where the knot of the necktie
would normally be.

Tie (CE 395)

     In the front component of the knot of the tie in the outer
layer of fabric, a ragged tear about 5 mm. in maximum diameter is
located 2.5 cm. below the upper edge of the knot and to the left
of the midline.


DISCUSSION

     The information disclosed by the joint examination of the
foregoing exhibits by the members of The Panel supports the
following conclusions;

     The decedent was wounded by two bullets, both of which
entered his body from behind.

     One bullet struck the back of the decedent's head well above
the external occipital protuberance. Based upon the observation
that he was leaning forward with his head turned obliquely to the
left when this bullet struck, the photographs and X-rays indicate
that it came from a site above and slightly to his right.  This
bullet fragmented after entering the cranium, one major piece of
it passing forward and laterally to produce an explosive fracture
of the right side of the skull as it emerged from the head.

     The absence of metallic fragments in the left cerebral
hemisphere or below the level of the frontal fossa on the right
side together with the absence of any holes in it  the skull to
the left of the midline or in its base and the absence of any
penetrating injury of the left hemisphere, eliminate with
reasonable certainty the possibility of a projectile having
passed through the head in any direction other than from back to
front as described in preceding sections of this report.

     The other bullet struck the decedent's back at the right
side of the base of the neck between the shoulder and spine and
emerged from the front of his neck near the midline. The
possibility that this bullet might have followed a pathway other
than one passing through the site of the tracheotomy wound was
considered. No evidence for this was found. There is a track
between the two cutaneous wounds as indicated by subcutaneous
emphysema and small metallic fragments on the X-rays and the
contusion of the apex of the right lung and laceration of the
trachea described in the Autopsy Report. In addition, any path
other than one between the two cutaneous wounds would almost
surely have been intercepted by bone and the X-ray films show no
bony damage in the thorax or neck.

     The possibility that the path of the bullet through the neck
might have been more satisfactorily explored by the insertion of
a finger or probe was considered. Obviously the cutaneous wound
in the back was too small to permit the insertion of a finger.
The insertion of a metal probe would have carried the risk of
creating a false passage in part, because of the changed
relationship of muscles at the time of autopsy and in part
because of the existence of postmortem rigidity. Although the
precise path of the bullet could undoubtedly have been
demonstrated by complete dissection of the soft tissue between
the two cutaneous wounds, there is no reason to believe that the
information disclosed thereby would alter significantly the
conclusions expressed in this report.
                                
                             SUMMARY

     Examination of the clothing and of the photographs and X-
rays taken at autopsy reveal that President Kennedy was struck by
two bullets fired from above and behind him, one of which
traversed the base of the neck on the right side without striking
bone and the other of which entered the skull from behind and
exploded its right side.

     The photographs and X-rays discussed herein support the
above-quoted portions of the original Autopsy Report and the
above-quoted medical concludions of the Warren Commission Report.

WILLIAM H. CARNES, MD
RUSSELL S. FISHER, MD
RUSSELL H. MORGAN, MD
ALAN R. MORITZ, MD