JFK's "SHALLOW" BACK WOUND REVISITED (FOR THE UMPTEENTH TIME)

[Tom Neal]

...if some people don't like some views that were posted about the wound, that's too bad.

There's logic for all of us. What does the thread starter know about the intent of his own thread? This guy says HE knows better...

BTW, the same goes for you and your own opinion. Something that historically never occurs to you.

Edited July 31, 2016 by Tom Neal

[Ron Ecker]

...if some people don't like some views that were posted about the wound, that's too bad.

There's logic for all of us. What does the thread starter know about the intent of his own thread? This guy says HE knows better...

Why don't you read the title of the thread? Where does it say "No darts allowed, this is just about bullets"?

BTW, the same goes for you and your own opinion. Something that historically never occurs to you.

I have no idea what you're talking about. But don't bother to explain because I don't care.

[Tom Neal]

...if some people don't like some views that were posted about the wound, that's too bad.

There's logic for all of us. What does the thread starter know about the intent of his own thread? This guy says HE knows better...

Why don't you read the title of the thread? Where does it say "No darts allowed, this is just about bullets"?

Why don't YOU read the part where BOB states what HE wants on HIS thread? Which I clearly was referring to, rather than the title which I did NOT mention. But here you are, always eager to point out the flaw in something I did NOT say.

BTW, the same goes for you and your own opinion. Something that historically never occurs to you.

I have no idea what you're talking about.

You NEVER did before, why should today be different?

[Robert Prudhomme]

Well, here goes nothing.

I am going to attempt to show, using the medical reports and WC testimonies of the surgeons attending to JFK in Trauma Room One, that JFK was suffering from a respiratory emergency known as a "tension pneumothorax". It likely began as an "open pneumothorax (sucking chest wound)" but, once JFK was laid on his back on a gurney in Trauma Room One, effectively sealing his back wound, and positive pressure ventilation was applied, the open pneumothorax likely developed into a tension pneumothorax rather quickly.

So, what is a pneumothorax? To explain this, it is necessary to understand the basics of how the lungs draw air in and expel it roughly 16-24 times per minute for us. The basic physical description of a lung is an airtight rubber bag inside of a plastic bag that is also sealed. When we increase the volume of this plastic bag, by moving our diaphragm muscle downward, we create a partial vacuum outside of the rubber bag (lung). Naturally, as air pressure equalizes, air rushes in through our nose and mouth, filling the rubber bag (lung) and occupying the vacuum in the plastic bag (pleural cavity).Exhalation is just the opposite; the diaphragm muscle moves upward, decreasing the volume in the pleural cavity and raising the air pressure in the pleural cavity. to compensate, and equalize the air pressure, air rushes out of the lung and through the nose and mouth.

If you look at this diagram, you will see that each lung has its own pleural lining that envelops each lung individually like a sack.

When the diaphragm (labelled) moves downward, the pleural cavity (labelled) increases in volume. It is important to note that each lung is enveloped in its own "visceral pleura" and those are contained in two separate "parietal pleura". The lungs are separated by an area called the "mediastinum", which contains the heart and major blood vessels leading to and from the heart.

The reason I am making a point of demonstrating the two lungs are each in their own separate sack is because it is possible to have an injury in one lung that shows no signs, initially, in the other lung.

An "open pneumothorax" (sucking chest wound) is a puncture or tear in the parietal (outer) pleural lining that allows outside air access to the pleural cavity between the two pleura. If such a tear or puncture occurs, outside air will enter through this opening when the diaphragm moves downward; equalizing air pressure with the outside air. Of course, if air enters through this opening, the lung does not inflate in the normal fashion, and the patient is said to have a "collapsed lung". This is a very serious respiratory condition and, unless addressed, can kill the patient within a short time.

The quickest method of dealing with an open pneumothorax, on scene, is simply to seal the opening with a rubber gloved hand, until an occlusive dressing can be fashioned. Once sealed, the lung, if not compromised also, should inflate in a normal fashion.

The occlusive dressing for sealing an open pneumothorax must be designed carefully, and the dressing NOT to be applied is one that is sealed all around. Below is a diagram of the traditional three sided dressing to be used in this situation:

Note that one corner of the plastic is not taped down. As the diagram explains, upon inhalation, the plastic gets sucked against the skin and seals the hole in the chest, allowing the lung to fill. On exhalation, the plastic moves away from the skin, and air in the pleural cavity escapes through the wound and passes out the gap in the tape.

Where is the air in the pleural cavity coming from? The same mechanism of injury that put a hole in the parietal (outer) pleural lining often will put a hole in the visceral pleural lining and the lung itself. When this compromised lung inflates, a portion of the air in this lung will escape into the pleural cavity outside the lung. On exhalation, the damaged part of the lung may flatten somewhat; acting as a one-way valve and trapping the air in the pleural cavity. With each breath, this trapped volume of air will grow, especially if the patient is on positive pressure ventilation (ie. respirator machine) that is forcing air into his lungs at greater than atmospheric pressure. The reason for the open edge in the three sided dressing becomes obvious.

If the trapped air is not released, the ensuing respiratory condition is known as a "tension pneumothorax" and it is even more dangerous than the open pneumothorax. As the air pressure builds in the pleural cavity, the affected lung is able to inflate less and less with each breath, until the lung is no longer able to inflate at all. As the condition progresses, pressure begins to be exerted on the mediastinum, preventing normal beating of the heart found there and normal return of blood to the heart through the major veins (superior and inferior vena cava). It will eventually get so bad that the other lung will begin to have difficulty inflating and, at this point, death is imminent.

The classic cause of a tension pneumothorax, just as an example, is a broken rib (or two or three) caused by a blow to the chest from a blunt object. While there is often no opening to the pleural cavity from the outside, the sharp end of a broken rib will often tear the visceral pleural lining and tear a hole in the lung itself. As demonstrated above, this will fill the pleural cavity with each breath and lead to a tension pneumothorax.

The accepted method of treating a tension pneumothorax is the insertion of a large bore needle or "tube" in the intercostal space between the 2nd and 3rd ribs, at about the "midclavicular line".

The mere insertion of this tube will provide instantaneous relief to a patient, as the impairment is removed from his heart and lung. In a hospital setting, this tube will now be connected to what is called "underwater sealed drainage". Think of a device similar to a hookah water pipe that will allow air and blood to escape through the chest tube, but not return. In the field, we now use the "Asherman Chest Seal", pictured below:

This is an extremely sticky dressing that is applied over a hole in the patient's chest, taking the place of the old three sided dressing, and can be used in conjunction with a chest tube. Upon inhalation, the rubber tube projecting up from the dressing seals it self flat, preventing air from entering the pleural cavity. On exhalation, outgoing air opens the rubber tube and escapes.

That pretty much covers the lungs and the two types of pneumothoraces. I would also like to refer again to the diagram of the lungs.

Note that, on the inside border of each lung, there is an opening referred to as the "hilum of the lung". This is the only opening in the lung, and through this portal must pass the bronchus and pulmonary arteries and veins (see below). The brochi (plural for bronchus) are the two airways that the trachea (windpipe) separates into once the trachea enters the chest.

(diagram of cross section of right lung hilum shown in next post)

As you can imagine, with all of the things entering the visceral pleural cavity through the hilum, sealing the hilum is difficult. When a tension pneumothorax is present, with air pressures above anything normally seen in the pleural cavity, some air leakage (as well as blood) through the hilum is inevitable, and this leakage of air and blood will be observed in the mediastinum.

That's all I'm going to write for today, other than to say that when a patient's breathing is listened to with a stethoscope, there will be severely reduced, often absent, breath sounds in the lung suffering a tension pneumothorax. Also, as the built up air pressure in the affected lung tends to push the mediastinum contents toward the other lung, a classic and universally observed sign of a tension pneumothorax is that the patient's trachea (observed on his lower neck) will be deviated away from the side of his chest that has the tension pneumothorax.

Please go back and read the selections from the Warren Commission testimony of Drs. Carrico and Perry that I posted earlier. If you keep in mind what I have typed in this post, I believe you will be able to see that these gentlemen did not believe they were addressing a simple through and through bullet wound of the lower neck.

Edited July 31, 2016 by Robert Prudhomme

[Robert Prudhomme]

I exceeded the limit of diagrams in my previous post. Here is the diagram of the cross section of the right lung hilum:

[Ron Ecker]

Why don't YOU read the part where BOB states what HE wants on HIS thread?

I read it. He stated what he wanted in his thread after I posted about a dart possibly causing the wound. He said he only wanted to talk about bullets in this thread, which is fine with me.

But here you are, always eager to point out the flaw in something I did NOT say.

Ha ha ha ha. Do you have some delusion that I'm "always eager" to read your posts and point out flaws in them?

I have no desire to play ping pong with you. Ciao.

[Tom Neal]

Why don't YOU read the part where BOB states what HE wants on HIS thread?

I read it. He stated what he wanted in his thread after I posted about a dart possibly causing the wound. He said he only wanted to talk about bullets in this thread, which is fine with me.

But here you are, always eager to point out the flaw in something I did NOT say.

Ha ha ha ha. Do you have some delusion that I'm "always eager" to read your posts and point out flaws in them?

I have no desire to play ping pong with you. Ciao.

So you say, yet ONCE AGAIN you started the game... Considering the fact that you always lose, "Ciao" is the best idea you've ever had.

Edited July 31, 2016 by Tom Neal

[Robert Prudhomme]

*sigh*

[Tom Neal]

Bob,

What do you think of the conflict between Parkland and Bethesda regarding the insertion of chest tubes? Parkland says they inserted chest tubes and set up sealed drainage, Bethesda says the two incisions only penetrated flesh and did not violate the pleura.

Due to Bethesda's many exposed lies regarding JFK's body, I would expect Parkland to be telling the truth. More or less speculation, but IMO Humes was ordered to declare the pleura as unviolated. I believe that the right lung was peppered with the bits of a bullet that was designed to fragment. Only low resolution x-rays were taken of the lung and they were looking for a bullet or large bullet fragments, but the 'dust-like' constellation of fragments present in the skull x-rays would have told them to look for tiny fragments as well. They DID remove the right lung which could have been carried upstairs to a high-resolution x-ray but chose not to do so. Additionally, IIRC a notation about the lung x-ray states that many artifacts that 'look like metal' are 'actually dirt.' Kind of a stretch for me to believe a military hospital allowed that much dirt into a film cassette, and that they didn't redo these xrays until they found some 'clean' film. I mean this was an x-ray of their Commander-in-Chief who had been murdered.

Edited July 31, 2016 by Tom Neal

[Tom Neal]

*sigh*

I was defending the fact that you were right to declare an "OT."

But you're right, it's time to let that go, and move on with the thread...

[Robert Prudhomme]

Bob,

What do you think of the conflict between Parkland and Bethesda regarding the insertion of chest tubes? Parkland says they inserted chest tubes and set up sealed drainage, Bethesda says the two incisions only penetrated flesh and did not violate the pleura.

Due to Bethesda's many exposed lies regarding JFK's body, I would expect Parkland to be telling the truth. More or less speculation, but IMO Humes was ordered to declare the pleura as unviolated. I believe that the right lung was peppered with the bits of a bullet that was designed to fragment. Only low resolution x-rays were taken of the lung and they were looking for a bullet or large bullet fragments, but the 'dust-like' constellation of fragments present in the skull x-rays would have told them to look for tiny fragments as well. They DID remove the right lung which could have been carried upstairs to a high-resolution x-ray but chose not to do so. Additionally, IIRC a notation about the lung x-ray states that many artifacts that 'look like metal' are 'actually dirt.' Kind of a stretch for me to believe a military hospital allowed that much dirt into a film cassette, and that they didn't redo these xrays until they found some 'clean' film. I mean this was an x-ray of their Commander-in-Chief who had been murdered.

There is a definite contradiction between Parkland and Bethesda on the matter of chest tubes. It is almost ludicrous to read Humes' description of the "shallow" incisions that did not fully penetrate into the pleural cavity, when one considers the difference between a shallow incision and full penetration only amounts to a few millimeters.

The hundreds of dust like particles of metal seen in the x-ray of the skull is a dead giveaway as well. Lead bullets will break up into fragments but, seldom will they turn to dust. Lead is malleable, not brittle. The only lead bullet that will turn to dust is one that was made from compressed lead dust to begin with; ie. a frangible bullet. This is assuming the particles in the x-ray actually were lead. I don't believe this was actually ever proven.

[Robert Prudhomme]

*sigh*

I was defending the fact that you were right to declare an "OT."

But you're right, it's time to let that go, and move on with the thread...

Thank you.

[Tom Neal]

This is assuming the particles in the x-ray actually were lead. I don't believe this was actually ever proven.

The ONLY comment I ever found was the one I stated in my previous post. i.e. 'The fragments that look like metal, but are only dirt.' I've found ZERO evidence, comments, or statements explaining how it was determined these were in fact dirt. They clearly state that the fragments 'look like metal'. How can something that small 'look like metal' unless they are referring to the density factor? If the only indication they have indicates they are metallic, then to state that they are actually dirt requires evidence. No evidence is stated, so it appears to only be wishful thinking. Unless there was discussion that was deleted, if it is obviously only dirt, why state that looks like metal? We do know that editing out unwanted evidence was normal procedure in every investigation, so this is suspicious at best.

If the Clark Panel(?) saw these particles, then Humes should have seen them as well. If they were 'actually dirt' why not try another film cassette? OR better yet if you are desperately searching for internal damage, bullets, or fragments, and you have an indication that something is present, why not send the lung that has been removed upstairs to a high-res x-ray? Unless you fear you will find something you don't want to see, what do you have to lose?

[Robert Prudhomme]

Also, the only x-rays that somehow ended up with "dirt" on them that "look like metal, but are only dirt" are the x-rays of the chest.

How coincidental.

[Tom Neal]

Also, the only x-rays that somehow ended up with "dirt" on them that "look like metal, but are only dirt" are the x-rays of the chest.

How coincidental.

I don't think I ever dug into the other x-rays, but if I did I don't recall any artifacts due to dirt on the non-missing x-rays. Have you verified this? If so, that is Mighty Interesting!

Of course I can't remember who said it, but it was published in Doug Horne's 5 volume set, and the comment by one of the techs who worked there 11-22-1962 was that he 'couldn't imagine' how dirt could get into a film cassette, and it that ever happened someone(s) would have caught pure holy for it, but has no memory of that. Apparently Humes et al thought it happened every day because they never challenged the fact that it was dirt.

Although as a former member I recall seeing MANY "dirty films" in the USN, I can't say one way or another about "dirty film."

Edited August 3, 2016 by Tom Neal