Any prevailing theories on the back wound?

[Sandy Larsen]

Since we're talking about the back wound...O'Connor has drawn several bullet fragments, and the sketch is labelled "bullet" fragments, does it seem peculiar that a FMJ bullet has 'fragmented' after penetrating only soft tissue?

Tom

I just found what Paul O'Connor had to say regarding the above drawing. Doug Horne wrote:

Paul O’Connor told the HSCA staff that after he returned to the morgue after some period of time, after being ordered to leave, he was informed by one of his Navy colleagues that an intercostal bullet (i.e., a bullet taken from the tissue between two ribs) had been found and removed. This [witness A being unaware of what Witness B saw] all indicates that some Navy personnel were banned from the morgue during certain procedures performed early that night: namely, post-mortem surgery to sanitize the crime scene.

According to the official story, only two bullet fragments were recovered from the body, both from the head. Yet at least 16 fragment were actually found. Horne wrote:

Tom Robinson told the ARRB staff in 1996 that he was shown a vial or test tube containing about 10 small metallic fragments; Dennis David has consistently stated ever since 1979 that he held in his hand, and typed a receipt for, 4 bullet fragments that night, which constituted more mass than one bullet, but less total mass than two bullets.

This supports the notion that fragments were indeed found in the shallow back wound. And not only that wound, but in the neck wound as well. Because, according to Horne:

....x-ray technician Jerrol Custer did see a bullet fragment fall from the thorax onto the examining table.

(I wasn't aware of this before reading what Horne wrote here: http://insidethearrb.livejournal.com/10811.html )

For completeness sake, I'll record here the apparent existence of a complete bullet -- irrelevant to this discussion -- that was also reportedly found. Horne wrote:

....the infamous Belmont FBI memo from 11/22/63 stated that there was a bullet lodged behind JFK’s ear, which the FBI was going to obtain.

[Tom Neal]

...the pleura was intact and that x-rays of the chest revealed nothing.

And that there are no chest x-rays. Gee, I wonder why.)

James Jenkins, who said he saw the pleural membrane as Humes probed it with his finger, and that it was intact. If Jenkins is the only witness to have seen and reported that, then he could be mistaken and your theory could be right.

At Parkland, a pneumothorax was diagnosed, and chest tubes were inserted for drainage. However, Humes insists he carefully examined the pleura and it was NOT violated. Why is this so important to Humes that he would tell an obvious lie about the incisions for the chest tubes? It appears that for whatever reasons, he (they) can NOT admit that either the "Throat Wound", or the "Back Wound" penetrated the pleura.

The simplest explanation is that the pleura actually WAS penetrated, and they are covering this up, but overselling the lie. Humes COULD have said, the only violations to the pleura were the chest tube incisions. Certainly those scalpel cuts could be distinguished from bullet holes. But, what if false x-rays were used (like the intact brain that was autopsied), and these x-rays did not include the chest tube incisions? This would prove the x-rays were false. When this was realized the fake chest x-rays vanished.

I've read that chest x-rays were taken, and of course they should have been, but I've never located any. If the actual chest x-rays revealed a 'constellation' of bullet fragments as the head x-rays do, this would prove that frangible ammo was used. If so, then JFK was not hit with a round fired by LHO.

pneumothorax (punctured lung)

Sandy,

It may or may not matter in this specific case, but a pneumothorax is not a punctured lung. It is a wound through the pleura that allows air, blood, fluid, into the sac that contains the lung. When the lung is collapsed during exhalation, air and fluid fills the space around the lung and the lung cannot re-expand during inhalation.

Tom

Edited October 19, 2015 by Tom Neal

[Sandy Larsen]

Could a 'deformed' bullet inflict the type of back wound reported? (length and diameter of Humes' little finger)

FWIW, my little finger is 3/4" in diameter at the 2nd knuckle, and from 2nd knuckle to the tip is 2". I am 6' tall with a medium build, and Humes was 6'4" with a large build.

Tumbling or not, 3/4" is rather a large hole for a Carcano bullet, isn't it?

As it turns out, it looks like Doug Horne misspoke when he said that James Jenkins could see Hume's little finger push on the pleural membrane. Here is what Jenkins said in an early interview (his first, I think) with David Lifton. From Best Evidence:

[Jenkins] remembered very clearly Humes’ probing the back wound with his little finger. “What sticks out in my mind,” Jenkins told me, “is the fact that Commander Humes put his little finger in it, and, you know, said that.... he could probe the bottom of it with his finger, which would mean to me [it was] very shallow. .... I remember looking inside the chest cavity and I could see the probe.... through the pleura [the lining of the chest cavity]. .... You could actually see where it [the probe] was making an indentation.... where it was pushing the skin up. .... There was no entry into the chest cavity.... no way that could have exited in the front because it was then low in the chest cavity.

This resolves (to my satisfaction) a number of problematic things. First, it means that there is no reason to believe that Humes probed deeply with his finger, and so the question of how his finger could possibly fit becomes a non-issue. Second, if the official size of the wound (4 mm by 7 mm) is correct or near that, Humes could not have probed very deeply at all, and yet was able to hit bottom. Which means the wound was very shallow indeed. This could be a important clue as to what exactly made the wound. Third, apparently Humes did indeed probe the pleural membrane with a probe, just as he (and at least one other autopsy physician) had testified. This gives me more confidence in Jenkins as a witness.

Edited October 19, 2015 by Sandy Larsen

[Tom Neal]

Here is what Jenkins said in an early interview:

[Jenkins] remembered very clearly Humes probing the back wound with his little finger. What sticks out in my mind, Jenkins told me, is the fact that Commander Humes put his little finger in it, and, you know, said that.... he could probe the bottom of it with his finger, which would mean to me [it was] very shallow.

This resolves (to my satisfaction) a number of problematic things. First, it means that there is no reason to believe that Humes probed deeply with his finger, and so the question of how his finger could possibly fit becomes a non-issue. Second, if the official size of the wound (4 mm by 7 mm) is correct or near that, Humes could not have probed very deeply at all, and yet was able to hit bottom. Which means the wound was very shallow indeed. This could be a important clue as to what exactly made the wound..

Here's an illustration of something that has bothered me since I first read Humes' testimony: In the illustration above is a red 7mm x 4mm ellipse representing JFK's back wound as reported by Humes. Correct me if I'm wrong, but he states that he inserted his little finger up to the 2nd knuckle. Humes was a MUCH larger person that me, so the 3/4" diameter at the 2nd knuckle of my little finger, and 2 inch length from tip to 2nd knuckle is likely less than his. The yellow 3/4" diameter circle represents a reasonable estimate as to the size of the 2nd knuckle of Humes little finger.

Skin is elastic, but you certainly don't want to damage the wound. So, with a tray full of metal probes at his beck and call, he decides to stick his finger into a hole 1/3 the size of his finger. He states that he was able to "probe the bottom of it with his little finger."

Does anyone else find this difficult to believe?

Tom

[Robert Prudhomme]

From Tom Neal

"It may or may not matter in this specific case, but a pneumothorax is not a punctured lung. It is a wound through the pleura that allows air, blood, fluid, into the sac that contains the lung. When the lung is collapsed during exhalation, air and fluid fills the space around the lung and the lung cannot re-expand during inhalation."

Hi Tom

You are quite correct in pointing out that a pneumothorax is not necessarily synonymous with a punctured lung although, in the case of a bullet wound (especially a frangible bullet), there is inevitably a compromise in the lung underlying the affected pleura, through which air can escape from the lung into the pleural cavity.

This would be a good time to distinguish between the two types of pneumothoraces, open and closed (tension).

An open pneumothorax, or "sucking" chest wound is, as you say, merely a hole in the pleural lining through which air can pass. When the injured person inhales, the pleural cavity grows in volume, creating a vacuum. Normally, air at atmospheric pressure will rush in through the trachea and bronchi to equalize this vacuum; filling the lung and inflating it in the process. However, with a hole in the pleura, air will rush in through this hole on inhalation, and fill the pleural cavity outside of the lung with air, and prevent the lung from expanding. Without treatment, the lung will collapse, and the patient may be in danger of dying from lack of perfusion. The immediate treatment, by first responders, is to place a rubber gloved hand over the wound to seal it. (always look for a matching through and through wound on the other side of the chest....easy to miss). At this point, it would seem as simple as placing a piece of duct tape over the hole and rushing the patient to the hospital. This is where the possibility of a punctured lung must be considered. If there is a hole in the lung, and the chest wound is sealed, each time the patient inhales, air rushing into a partially inflated lung will be drawn through the hole in the lung into the pleural cavity. When the patient exhales, the lung collapses again, sealing the hole in the lung and trapping the air in the pleural cavity. With each breath, this volume of air in the pleural cavity grows, until it begins exerting pressure on the other lung, the heart and superior and inferior venae cavae. At this point, our open pneumothorax has become a closed or "tension" pneumothorax.

I've always been a bit puzzled by the autopsy doctors reporting bilateral scalpel incisions made in preparation for the insertion of chest tubes, but also reporting no chest tubes had actually been inserted. It is disturbing to read the medical report of Dr. M.T. Jenkins. written only a few hours after JFK's death, in which he states only a right chest tube was inserted AND connected to a closed chest drainage tube. As the chest tube is inevitably inserted first, and then connected to drainage, it seems very odd for Jenkins to say this if the tube(s) were never inserted. My licence does not allow me to insert a chest tube (for relief from tension pneumothorax) but I have gone over this procedure many times with higher licenced paramedics. While it may have been a common practice in 1963, I have never heard of anyone making a scalpel incision in the chest, in advance of inserting a chest tube. It is a rather quick routine involving nothing more than a large bore needle inserted through the intercostal space between the 2nd and 3rd rib, at about the midclavicular line.

Does anyone recall the Parkland surgeons speaking of making scalpel incisions for chest tubes? It was definitely mentioned in the autopsy report, and the claim that the incisions were made, but no tubes inserted, seemed to lessen the importance of chest tubes; as if they were an afterthought.

To allow air to escape from an open pneumothorax and prevent air from going back in, the dressing seen below is used.

Asherman Chest Seal. The rubber tip opens from inside pressure and closes on inhalation, effectively allowing air pressure to escape the pleural cavity and preventing its return. This dressing is adhesive and is applied directly over the wound.

Back to the closed or tension pneumothorax. Just as an open pneumothorax can have an opening in the pleura, but no puncture in the lung, a tension pneumothorax can have an opening in the lung, but no hole in the pleura, making it necessary to insert a chest tube to vent accumulated pleural air that would go out through the hole in the pleura in an open pneumothorax. One of the mechanisms of injury for a tension pneumothorax is the sharp end of a broken rib poking its way through the pleura into a lung. Although the rib end opens the pleura, there is no avenue to the surface of the skin to allow air to escape, and pressure will build in the pleural cavity.

In the case of JFK, I believe he would have had a right open pneumothorax as well as a hole(s) in the right lung. While he was in the limo, it would have continued to be an open pneumothorax, unless of course the back wound was of such a nature that it could seal itself. However, once JFK was lying on his back on the ER table, there is a very good chance the weight of his body would seal the wound against the surface of the table, creating the necessary conditions for a tension pneumothorax. Once sealed, incoming air would pass through the hole(s) in his right lung and into his right pleural cavity. With no way to escape, this volume of air would increase until it put harmful pressure on his left lung, heart and large blood vessels. The situation would be further exacerbated by positive pressure ventilation, as this is forcing air into the lungs at greater than atmospheric pressure.

There are definite signs of a tension pneumothorax that first responders are taught to observe. Unequal expansion of the chest, lack of breath sounds in the affected lung, jugular vein distension, tachycardia (abnormally rapid heart rate), hypotension (low blood pressure), hypoxia (oxygen deficiency) and, most importantly in this case, visible deviation of the trachea (windpipe) away from the affected lung. Without immediate intervention (ie. chest tube), this patient can die in a matter of a couple of minutes.

The deviation of the trachea (windpipe) away from the affected lung is important, as we can see in this excerpt from the WC testimony of Dr. Malcolm Perry, in which he describes the tracheostomy procedure:

"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."

Edited October 19, 2015 by Robert Prudhomme

[Chris Davidson]

But I do believe the shot may have come from the TSBD.)

Sandy,

One of Connally's wounds at the least.

chris

Edited October 19, 2015 by Chris Davidson

[Chris Davidson]

https://spideroak.com/browse/share/JFKFILES/JFKVIDEOS

Password: assassination

Recreation from 6th floor SE corner:

Queen Mary stabilized (not the cross-hairs), I have it traveling approx 13.6 mph then abruptly slowing to half that speed as it approaches the extant Z313 location.

chris

[Tom Neal]

Does anyone recall the Parkland surgeons speaking of making scalpel incisions for chest tubes?

WC Testimony of COMMANDER HUMES: [T]hese were knife wounds, these were incised wounds on either side of the chest... . Their intention was to incise through the President's chest to place tubes into his chest. We examined those wounds very carefully, and found that they, however, did not enter the chest cavity. They only went through the skin. I presume that as they were performing that procedure it was obvious that the President had died, and they didn't pursue this

Would it be normal procedure to first cut through the skin only, stop, and then soon after cut through the chest? If this is NOT standard procedure, then why did two doctors do this? See testimony below of Drs. Peters and Jones:

The testimony of Dr. Paul Conrad Peters, March 24, 1964, Parkland Memorial Hospital by Arlen Specter:

Dr. PETERS - Dr. Perry and Dr. Baxter were doing the tracheotomy ... and Perry noted also that there appeared to be a bubbling sensation in the chest and recommended that chest tubes be put in. Dr. Ron Jones put a chest tube in on the left side and Dr. Baxter and I put it in on the right side I made the incision in the President's chest, and I noted that there was no bleeding from the wound.

Mr. SPECTER - Did you put that chest tube all the way in on the right side?

Dr. PETERS - That's our presumption--yes.

WC testimony of Dr. Ronald Jones:

DR. JONES: Dr. Perry was performing the tracheotomy ... they thought they saw some gush of air and the possibility of a pneumothorax [collapsed lung] on one side or the other was entertained, and since I was to the left of the President, I went ahead and put in the anterior chest tube in the second intercostal space.

MR. SPECTER: Was that tube fully inserted, Doctor?

DR. JONES: I felt that the tube was fully inserted, and this was immediately connected to underwater drainage.

The hedging by both doctors when asked by Specter if the chest tube was fully inserted troubles me. Looks like I will be doing some some reading re the "chest tubes"...

Tom

[Robert Prudhomme]

Could a 'deformed' bullet inflict the type of back wound reported? (length and diameter of Humes' little finger)

FWIW, my little finger is 3/4" in diameter at the 2nd knuckle, and from 2nd knuckle to the tip is 2". I am 6' tall with a medium build, and Humes was 6'4" with a large build.

Tumbling or not, 3/4" is rather a large hole for a Carcano bullet, isn't it?

As it turns out, it looks like Doug Horne misspoke when he said that James Jenkins could see Hume's little finger push on the pleural membrane. Here is what Jenkins said in an early interview (his first, I think) with David Lifton. From Best Evidence:

[Jenkins] remembered very clearly Humes’ probing the back wound with his little finger. “What sticks out in my mind,” Jenkins told me, “is the fact that Commander Humes put his little finger in it, and, you know, said that.... he could probe the bottom of it with his finger, which would mean to me [it was] very shallow. .... I remember looking inside the chest cavity and I could see the probe.... through the pleura [the lining of the chest cavity]. .... You could actually see where it [the probe] was making an indentation.... where it was pushing the skin up. .... There was no entry into the chest cavity.... no way that could have exited in the front because it was then low in the chest cavity.

This resolves (to my satisfaction) a number of problematic things. First, it means that there is no reason to believe that Humes probed deeply with his finger, and so the question of how his finger could possibly fit becomes a non-issue. Second, if the official size of the wound (4 mm by 7 mm) is correct or near that, Humes could not have probed very deeply at all, and yet was able to hit bottom. Which means the wound was very shallow indeed. This could be a important clue as to what exactly made the wound. Third, apparently Humes did indeed probe the pleural membrane with a probe, just as he (and at least one other autopsy physician) had testified. This gives me more confidence in Jenkins as a witness.

I still find it somewhat odd that Humes would declare his finger had bottomed out in the back wound, and then still attempt to explore this wound with a probe after the lungs had been removed. If Humes knew anything about human anatomy, which I assume he did, being a doctor, he would know the thickness between the outer back and the pleural lining was not very thick, and a probe could not have gone any further than his finger without entering the pleural cavity. Was he trying to determine if there was a bullet hole in the pleura? A quick look with a flashlight inside the pleural cavity would have determined that.

While something very odd was taking place with regard to the back wound one thing is certain; Jenkins observations definitely put the lie to Specter's Single Bullet Theory.

Edited October 19, 2015 by Robert Prudhomme

[Chris Newton]

Sandy Larsen, on 16 Oct 2015 - 4:28 PM, said:

Mark Knight, on 15 Oct 2015 - 11:42 AM, said:

But I do believe the shot may have come from the TSBD.)

Sandy,

One of Connally's wounds at the least.

chris

I have believed that there could be a scenario where shots could have been fired from the open window at the far left (west side) of the sixth floor. This location could have allowed for shots to be taken at a more extreme angle and could maybe account for a back shot with a strange entry angle after the President had fallen over. This would also be the window Byrd was rumored to have removed. Additionally, there is testimony of a shooter being seen in that location prior to the motorcade's arrival. The late Gary M. told me that the window was currently unaccessible because it was behind their conspiracy exhibit, if that adds to the irony.

[Ron Ecker]

I have believed that there could be a scenario where shots could have been fired from the open window at the far left (west side) of the sixth floor. This location could have allowed for shots to be taken at a more extreme angle and could maybe account for a back shot with a strange entry angle after the President had fallen over. This would also be the window Byrd was rumored to have removed. Additionally, there is testimony of a shooter being seen in that location prior to the motorcade's arrival. The late Gary M. told me that the window was currently unaccessible because it was behind their conspiracy exhibit, if that adds to the irony.

There are two things new to me here, both amazing. Byrd removed the wrong window? And the museum has a conspiracy exhibit?

[Brian Schmidt]

Byrd removed the East window frame--the one all the shots supposedly came from--and put it on display at his house.

I wasn't aware that the museum has a conspiracy exhibit, but I haven't been there in 15+ years.

[Sandy Larsen]

At Parkland, a pneumothorax was diagnosed, and chest tubes were inserted for drainage. However, Humes insists he carefully examined the pleura and it was NOT violated. Why is this so important to Humes that he would tell an obvious lie about the incisions for the chest tubes? It appears that for whatever reasons, he (they) can NOT admit that either the "Throat Wound", or the "Back Wound" penetrated the pleura.

The simplest explanation is that the pleura actually WAS penetrated, and they are covering this up, but overselling the lie. Humes COULD have said, the only violations to the pleura were the chest tube incisions. Certainly those scalpel cuts could be distinguished from bullet holes. But, what if false x-rays were used (like the intact brain that was autopsied), and these x-rays did not include the chest tube incisions? This would prove the x-rays were false. When this was realized the fake chest x-rays vanished.

You make some good points, Tom. And I'm inclined to agree with you were it not for what James Jenkins said in a fairly early interview, that he could see Humes probe the pleural membrane (with a probe, not his finger) and that the membrane was intact. Jenkins is considered to be a reliable witness.

I

pneumothorax (punctured lung)

Sandy,

It may or may not matter in this specific case, but a pneumothorax is not a punctured lung. It is a wound through the pleura that allows air, blood, fluid, into the sac that contains the lung. When the lung is collapsed during exhalation, air and fluid fills the space around the lung and the lung cannot re-expand during inhalation.

Yes of course. I actually meant punctured lung.... oops, I mean collapsed lung (see, there I did it again) but miswrote it.

[Sandy Larsen]

Here's an illustration of something that has bothered me since I first read Humes' testimony: In the illustration above is a red 7mm x 4mm ellipse representing JFK's back wound as reported by Humes. Correct me if I'm wrong, but he states that he inserted his little finger up to the 2nd knuckle. Humes was a MUCH larger person that me, so the 3/4" diameter at the 2nd knuckle of my little finger, and 2 inch length from tip to 2nd knuckle is likely less than his. The yellow 3/4" diameter circle represents a reasonable estimate as to the size of the 2nd knuckle of Humes little finger.

Skin is elastic, but you certainly don't want to damage the wound. So, with a tray full of metal probes at his beck and call, he decides to stick his finger into a hole 1/3 the size of his finger. He states that he was able to "probe the bottom of it with his little finger."

Does anyone else find this difficult to believe?

Tom

Tom,

I quoted some of Humes back-wound testimony early on in the thread, which does not say anything about probing deeply with his finger. HOWEVER, in the course of things I came across further testimony from Humes on the back wound. I was surprised that he would testify twice, so I remember looking to make sure it was WC testimony, not HSCA. Now, I could be wrong, but I remember seeing that it was indeed WC testimony. I mean, that was the reason for my surprise.

Anyway, I wonder if that might be the testimony you're thinking of. I sure wish I would have posted it. I didn't because it contained nothing relevant to the thread at the time. But I really should have, just for general reference.

You go on to say:

[Humes] states that he was able to "probe the bottom of [the back wound] with his little finger."

That's also what Jenkins says. But Jenkins elaborates by saying that, to him, that meant that the wound had to have been very shallow. Precisely your conclusion, and mine.

Then Jenkins continues by saying Humes used a probe. So apparently the wound continued on beyond the shallow part. Right?

I guess this oddity is what Robert was getting at when he asked why Humes would use a probe after finding a bottom. In my mind I just assumed that a fragment could travel beyond where the majority of the bullet stops.

Edited October 19, 2015 by Sandy Larsen

[Sandy Larsen]

I've always been a bit puzzled by the autopsy doctors reporting bilateral scalpel incisions made in preparation for the insertion of chest tubes, but also reporting no chest tubes had actually been inserted. It is disturbing to read the medical report of Dr. M.T. Jenkins. written only a few hours after JFK's death, in which he states only a right chest tube was inserted AND connected to a closed chest drainage tube. As the chest tube is inevitably inserted first, and then connected to drainage, it seems very odd for Jenkins to say this if the tube(s) were never inserted. My licence does not allow me to insert a chest tube (for relief from tension pneumothorax) but I have gone over this procedure many times with higher licenced paramedics. While it may have been a common practice in 1963, I have never heard of anyone making a scalpel incision in the chest, in advance of inserting a chest tube. It is a rather quick routine involving nothing more than a large bore needle inserted through the intercostal space between the 2nd and 3rd rib, at about the midclavicular line.

Does anyone recall the Parkland surgeons speaking of making scalpel incisions for chest tubes? It was definitely mentioned in the autopsy report, and the claim that the incisions were made, but no tubes inserted, seemed to lessen the importance of chest tubes; as if they were an afterthought.

Dr. Peters did insert a right chest tube, as you noted on page 1 of this topic. So of course an incision was made there. As for the left side, I don't know.

Maybe Humes (falsely) reported such an incision being made on both sides in an attempt to make it sound like doing so was standard practice and nothing to ask questions about. Because an incision on just one side naturally would indicate something being wrong... on just that side. Dr. Humes would mislead like this because the presence of a collapsed lung would have been problematic to the WC.

I have two questions related to this, for you Robert:

1. How could the Parkland doctors have known which lung, left or right, was affected based upon symptoms they saw, like agonal breathing? Dr. Jenkins said that there was "obvious tracheal and chest damage." What kind of chest damage would indicate which lung is affected?

2. Jenkins said there was "obvious tracheal ... damage." Could this damage have been the cause of the Kennedy's pneumothorax, rather than something from the back wound? After all, Jenkins himself said, "...a tracheotomy tube was put in. This is one way of avoiding pushing air out through a fractured trachea and down into each chest cavity, which would cause a pneumothorax or a collapse of the lungs"