One of the most bizarre mysteries of the Kennedy assassination is how the throat incision --- described by the Parkland Hospital doctors as only 2 to 3 centimeters wide --- became 6.5 to 8 centimeters by the time Kennedy was brought to the morgue. [1, 2]
Only two explanations for this discrepancy come to mind: (a) "body alteration," as proposed by David Lifton, author of Best Evidence, who believes persons unknown took the body on a secret detour during which time the body was searched for bullets and the wounds were altered to disguise their nature, [1] or (b) the incision was that wide in the first place.
For me, the mystery deepened when, in 1992, the pathologist in charge of the autopsy indicated the incision was small - the size of an ordinary tracheotomy [3] - the way Parkland described it to David Lifton.
Why would the pathologist, Commander James Humes, contradict both his earlier testimony and the autopsy photographs?
In 1992, during a "landmark" interview, Humes told Dennis Breo of the Journal of the American Medical Association (JAMA):
"The tracheostomy was a gaping wound, about 3 to 4 centimeters around... [3]
Only 3 to 4 centimeters "around"? This is how one describes a perimeter. Translated, this would make the incision no more than 2 centimeters in horizontal width - which is just how the Parkland doctors described it. A very interesting match.
Humes claimed he had no idea there was any such trauma to the throat, that he thought there was nothing there but a standard tracheotomy. [4]
Had Humes admitted an awareness of a trauma to the throat --- one that involved a bullet wound --- he would have been obliged to deal with it, to dissect its path and document its characteristics with detailed description and close up photographs. Above all, he would have been obliged to document his reasons for declaring the wound an exit - placing the sniper behind. Better to pretend - while the body was still available further inspection - that no bullet wound was seen in the throat. Better to acknowledge the wound after it was too late to document its nature (entrance or exit), and its connection with the wound in the back.
We now know that the autopsy team was well aware of a bullet hole in the throat. J. Thornton Boswell, a pathologist who assisted Humes, actually described what remained of the bullet hole itself - a little semi-circular notch on the upper lip of the incision. [5,6] And the head photographer, John Stringer, described the pathologists putting their fingers into the gaping hole trying to feel for anything sharp. [7] (Neither gentleman seemed aware he was contradicting Humes.)
There was nothing about the bullet wound, nor its still-apparent remains, that would justify calling it an exit, as opposed to an entrance.
Would it occur to you that perhaps the bullet exited a few inches away in the front where you see the wide incision? Or would your first thought be: the bullet went down into his thigh or buttock?
"And we wondered, where's the bullet? You know. Should have called Dallas right then and there. It would have saved me a lot of worry and grief for several hours, because x-rays hadn't found it for us. Like it could have been in his thigh or it could have been in his buttock. It could have been any damn place..." [8]
Any damn place but out the big hole in the front?
"We didn't know where it went. It was obvious after we talked to the doctors the next morning where it went. It went out. That's why we couldn't find it. And we weren't going to spend the rest of the night there, you know. Meantime, George Burkley is telling me, you know, the family wants to get out of here sometime tonight. Then we proceeded with the dissection of the lungs, heart and abdominal contents and so forth." [8]
Note: Kennedy was not shot in the abdomen.
But Kennedy had a bullet hole in his neck. This was not a patient with a piece of steak lodged in his throat. And this bullet hole raises a question that is central to understanding what probably happened at Parkland: What was the standard emergency response to a penetrating injury of the throat - whether or not the trachea (windpipe) was injured, and whether or not there is another life-threatening wound?
In the presence of a deeply penetrating neck, it was (and is) standard to create a wide incision - with or without a tracheotomy, and with or without other life-threatening wounds, such as a head injury like Kennedy's. This is in preparation for what is known as "exploratory surgery."
A small, 2-3 centimeter opening does not permit adequate visualization of the vital structures inside, or the maneuvering necessary for treating any damage found. Such damage can be more life-threatening in the short term than a head wound.
I am not suggesting full exploratory surgery was performed on Kennedy, but the incision Perry made was probably not much smaller than the ones in the diagrams shown below. [10, 11]
According to the 1971 issue of the American Journal of Surgery, the performance of an "exploratory" in these circumstances had been standard since World War II:
"The general surgical principle of mandatory exploration of all penetrating wounds has become established during the past three decades." [12]
"The incision was planned to allow full exposure of the tract of injury. Proximal and distal control of the major vessels was also considered in the length and position of the incision. The sternocleidomastoid ("strap") muscle and/or other neck muscles were taken off the insertion or transected whenever necessary to provide adequate exposure." [13]
More clues to what Perry did that day in the trauma room can be found in the book, Principles of Trauma Care which contains a chapter written by Perry, "Penetrating Wounds of the Neck." [14] On Perry's list of findings that indicate the need for exploration, these applied to Kennedy:
Bleeding
Large hematoma
Shock
Respiratory distress
Subcutaneous emphysema
Blood in the oropharynx
An exploratory is even appropriate in the absence of these indications because internal structural damage can exist behind an innocent looking wound. The authors of the 1971 paper found that "one third of the patients with injury to a major structure had no clinical evidence for this. This latter group included one patient with a through and through bullet wound of the carotid artery." [12]
"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." [15]
What he means by "other side" is unclear. He seems to be describing surgery on two sets of muscles, those covering the deviated windpipe and, those on the "other side." Division of one set of muscles did not provide adequate exposure, so he severed those on the other side. [15] In an earlier testimony Perry only got as far as the separation of strap muscles on the left side. [16]
"How big it was, I don't know.... I made it big enough to control an underlying bleeding blood vessel if necessary and big enough to do a trach.
"It was bigger than I would make for an elective situation." [17]
Perry --- already a specialist in vascular surgery at the time he treated Kennedy and now a distinguished author of nearly 70 articles in peer-reviewed journals and book chapters --- would have been especially sensitive to the potential for vascular injury.
None of the above suggests that Kennedy's body did not take a secret detour, but apparently no one altered the remains of the actual bullet wound itself, the little semi-circular notch in the upper lip of the incisional wound. It is still recognizable as a bullet wound, even in a photograph. And no one mistook the wide incision (whoever made it) as a bullet wound at all.
Perry tailored his comments on the incision to be consistent with Humes' professed ignorance of any bullet wound in the throat.
Humes tailored his comments on the incision when speaking with JAMA for the same reason. A true description of the incision would have raised the question, how could he have been unaware of a bullet wound in the throat?
Had Humes acknowledged --- while the body was still available --- a bullet wound in the throat, he would have had the intellectually challenging task of fabricating medical reasons for concluding the wound was an exit. This was the same wound that, according to the Parkland doctors, had all the characteristics of an entrance.
Did Kennedy leave Parkland with the widely gaping wound seen in the "stare-of-death" autopsy photo --- or did he not? Jeremy Gunn could have shown the Parkland doctors this photo and asked the question point-blank. This did not happen. Gunn said, lamely, that he would have brought the autopsy photos (the originals) with him, but they were no longer available. As if copies did not exist. As if diagrams did not exist.
It is doubtful that Gunn could have cleared up the mystery behind all these discrepancies, but, with the right questions, he could have given them sharper definition. He could have, but didn't. That he didn't is one more discrepancy.
2. Humes, J.J. Humes, J.J. Warren Commission Hearings, Vol. II, p. 361 ("some 7 or 8 cm in length")
3. Breo, D.L. JFK's death-the plain truth from the MD's who did the autopsy. J American Medical Association 1992; 267:2794-2803, p.2798
4. Humes, J.J. HSCA Testimony, September 7, 1978, p.330
5. Boswell, J.T. HSCA Testimony, August 7, 1977, pp.8,12
6. Boswell, J.T. ARRB Testimony, February 26, 1996, pp.34, 45
7. Stringer, J. ARRB Testimony, July 16, 1996, pp. 191-2
8. Humes, J.J. ARRB Testimony, February 13, 1996, pp.112-113
9. Ibid. p.36
10. Saletta JD, Lowe RJ, Lim LT, Thornton J, Delk S, Moss GS. Penetrating trauma of the neck. J Trauma 1976; 16(7):579-587 (Diagram)
11. Blass DC, James EC, Reed RJ, Fedde CW, Watne AL. Penetrating wounds of the neck and upper thorax. J Trauma 1978; 18(1):2-7. (Diagram)
12. Ashworth C, Williams LF, Byrne JJ. Penetrating wounds of the neck. Re-emphasis of the need for prompt exploration. Am J Surgery 1971;121:387-391 (exploratory since WW II)
13. Jones RF, Terrell JC, Salyer KE. Penetrating wounds of the neck: an analysis of 274 cases. J Trauma 1967; 7(2):228-237. (Parkland experience)
14. Perry, M. Chapter 16. Penetrating Wounds of the Neck. In: Shires, G.T., (Ed.) Principles of Trauma Care, Third Edition. New York: McGraw-Hill Book Company, 1985.
15. Perry, M. Warren Commission Hearings, Vol. III, p.370 (severed strap muscles)
16. Perry, M. Warren Commission Hearings, Vol. VI, p.10 (earlier testimony)
17. Perry, M. ARRB Testimony, August 17, 1998, pp.24-25
18. Gardner, Gray, O'Rahilly. Anatomy. A Regional Study of Human Structures. 4th Ed. Toronto: W.B. Saunders Company, 1975 (Diagrams)
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