The JFK Autopsy Observations of Lt. Richard Lipsey

[Robert Prudhomme]

From the WC testimony of Dr. Malcolm Perry:

<quote on, emphasis added>

Mr. SPECTER - What is pneumothorax?

Dr. PERRY - Hemothorax would be blood in the free chest cavity and pneumothorax would be air in the free chest cavity underlying collapse of the lungs.

Mr. SPECTER - Would that have been caused by the injury which you noted to the President's trachea?

Dr. PERRY - There was no evidence of a hemothorax or a pneumothorax my examination; only it is sufficient this could have been observed because of the free blood in the mediastinum.

<quote off>

Cliff,

Why so you suppose the subject of pneumothorax even came up? It's obvious from everything we know (all the testimony presented by Robert) that Kennedy was treated for pneumothorax. It's obvious (from further testimony presented by Robert) that Humes tried to make the pneumothorax disappear. And now, it's obvious (from the testimony you are providing) that the WC got Perry to sign off on this disappearing act. Or at least play a little dumb.

Thanks, Sandy. Here is a little more from Perry's testimony to the WC:

"Mr. SPECTER - Now, you described a condition in the right mediastinum. Would you elaborate on what your views were of the condition at the time you were rendering this treatment?

Dr. PERRY - The condition of this area?

Mr. SPECTER - Yes, sir.

Dr. PERRY - There was both blood, free blood and air in the right superior mediastinum. That is the space that is located between the lungs and the heart at that level.

As I noted, I did not see any underlying injury of the pleura, the coverings of the lungs or of the lungs themselves. But in the presence of this large amount of blood in this area, one would be unable to detect small injuries to the underlying structures. The air was indicated by the fact that there was some frothing of this blood present, bubbling which could have been due to the tracheal injury or an underlying injury to the lung.

Since the morbidity attendant upon insertion of an anterior chest tube for sealed drainage is negligible and the morbidity which attends a pneumothorax is considerable, I elected to have the chest tube put in place because we were giving him positive pressure oxygen and the possibility of inducing a tension on pneumothorax would be quite high in such instances."

I think it fair to say that Perry was put into a bit of a dilemma by Specter, and Specter took complete advantage of the situation.

As a trauma room surgeon, Perry was not able to make complete diagnoses of everything he observed in his patient, nor was he able to do anything for JFK except the most basic of critical interventions in order to establish basic life support. Once JFK was declared dead, Perry et al no longer felt it was their task to investigate the underlying causes of JFK's death. Had JFK lived, even for a few more hours, Perry likely would have known everything there was to know about JFK's injuries; including the nature and cause of his pneumothorax. But, this was not the case. He was too involved in basic life support, and did not have time for further diagnoses.

Unfortunately, when Specter interrogated Perry, asking for cold hard facts, Perry had nothing concrete to give him. Perry could not actually say with certainty JFK had a pneumothorax, even though JFK was displaying several unmistakeable signs of a pneumothorax. It's a shame the autopsy was not conducted in Dallas.

[James DiEugenio]

I agree.

But we know that the Sibert ONeill report is wrong on this from a direct witness who was intricately involved.

His name is Pierre Finck.

Part of the pure gold he dispensed at the Clay Shaw trial was the fact that there were both Admirals and Generals in the room and they were interfering with the autopsy. (Destiny Betrayed, pgs. 300-301)

I mean does't anyone read my books here? There is some good info in them.

I read Destiny Betrayed Jim. And found it agreed with what I'd already learned, and it added much more to my knowledge. It was probably from Destiny Betrayed that I learned of the Admirals and Generals interfering with the autopsy.

Quick question for you: Did Pierre Finck reveal that JFK's personal physician Admiral George Burkley pretty much took charge of the autopsy? Someone mentioned that being the case the other day. (Ashton Gray I believe.)

Not that I can see.

He keeps on referring to an Army General that he says was controlling what Humes was doing.

[Chris Newton]

I thought I remembered reading about the pneumothorax in the WC and here's an extract including it from the ARRB with Dr. Jones written statement (last page of the document).

Bob does Jones's testimony support Perry's?

https://maryferrell.org/showDoc.html?docId=359#relPageId=5&tab=page

[Ron Ecker]

Many thanks for finding that, Pat.

Ditto, Pat.

[Cliff Varnell]

I thought I remembered reading about the pneumothorax in the WC and here's an extract including it from the ARRB with Dr. Jones written statement (last page of the document).

Bob does Jones's testimony support Perry's?

https://maryferrell.org/showDoc.html?docId=359#relPageId=5&tab=page

Yes it does!

"[T]hey thought they saw some gush of air and the possibility of a pneumothorax on one side or the other was entertained."

Pretty much what Perry said.

Entertaining a possibility morphs into absolute certainty in the hands of Pet Theorists.

[Ron Ecker]

He keeps on referring to an Army General that he says was controlling what Humes was doing.

Chris raised the question of whether military officers there were in civvies or uniform. The impression from Finck's remarks as recounted in Jim's book is that this Army General was readily identifiable as such, i.e. in uniform, though of course it's possible that he was in civvies and identified himself by name (rather than "I'm an Army General"), which Finck could not remember. (I wonder what Army General other than Chairman of the Joint Chiefs Maxwell Taylor it could have been. And I wonder if Finck would not remember that name.) But Finck also said "there were others, there were Admirals." I doubt that each Admiral was in civvies, identifying himself as "I'm an Admiral" so that Finck would know. It seems to me that at least some of these meddling brass were in uniform, and thus easily recognizable as military by Lt. Lipsey.

I would say in sum that Lipsey's testimony and the related questions it raises are a mess, just like the autopsy itself.

Edited September 24, 2016 by Ron Ecker

[Sandy Larsen]

Just to clarify what I already told Cliff, I've added the word "treatment," in bold:

From the WC testimony of Dr. Malcolm Perry:

<quote on, emphasis added>

Mr. SPECTER - What is pneumothorax?

Dr. PERRY - Hemothorax would be blood in the free chest cavity and pneumothorax would be air in the free chest cavity underlying collapse of the lungs.

Mr. SPECTER - Would that have been caused by the injury which you noted to the President's trachea?

Dr. PERRY - There was no evidence of a hemothorax or a pneumothorax my examination; only it is sufficient this could have been observed because of the free blood in the mediastinum.

<quote off>

Cliff,

Why do you suppose the subject of pneumothorax even came up? It's obvious from everything we know (all the testimony presented by Robert) that Kennedy was treated for pneumothorax. It's obvious (from further testimony presented by Robert) that Humes tried to make the pneumothorax [treatment] disappear. And now, it's obvious (from the testimony you are providing) that the WC got Perry to sign off on this disappearing act. Or at least play a little dumb.

[Ron Ecker]

I would add that Finck's account of the goings-on in that room with its meddling Army General and Admirals makes the big event of that day sound for all the world like a military coup.

[Cliff Varnell]

Unfortunately, when Specter interrogated Perry, asking for cold hard facts, Perry had nothing concrete to give him. Perry could not actually say with certainty JFK had a pneumothorax,

Thank you. No further questions.

[Robert Prudhomme]

I thought I remembered reading about the pneumothorax in the WC and here's an extract including it from the ARRB with Dr. Jones written statement (last page of the document).

Bob does Jones's testimony support Perry's?

https://maryferrell.org/showDoc.html?docId=359#relPageId=5&tab=page

Yes, I would say it does, Chris. However, Dr. Jones was in the same boat as Perry, in that assumptions about JFK's respiratory condition could only be made from the very obvious signs and indications, despite the fact the sum total of his signs could not be interpreted as anything but a right tension pneumothorax.

I did notice something in Jones' WC testimony that I had not spotted before. Jones was to Perry's immediate left when Perry made the tracheotomy incision and, while Perry only testified to observing free air and blood in the right upper mediastinum, Jones testified that he understood Perry and Dr. Baxter (assisting Perry) observed a gush of air from the mediastinum. This gush of air would be typical of air trapped under pressure in the right pleural cavity, due to a tension pneumothorax, escaping through the hilum of the right lung and into the mediastinum, where pressure would continue to build.

"Mr. SPECTER - What further action was taken by the medical team in addition to that which you have described on the tracheotomy?

Dr. JONES - Well, as Dr. Perry started the tracheotomy, I started the cut down in the left arm to insert a large polyethylene catheter, to give an I.V. so that we could give I.V. solutions as well as blood, and at the same time another doctor or two were doing some cutdowns in the lower extremities around the ankle. We made the cutdown in the left arm in the cephalic vein very rapidly and I.V. fluids were started immediately and as I was doing this, Dr. Perry was performing the tracheotomy, and it was about this time that Dr. Baxter came in and went ahead to assist Dr. Perry with the tracheotomy, and as they made a deeper incision in the neck to isolate the trachea, they thought they saw some gush of air and the possibility of a pneumothorax 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."

I'm not sure if everyone understands the accepted method for relieving a tension pneumothorax. As Jones testified, he inserted an anterior chest tube in the 2nd intercostal space and this would have been at the mid-clavicular line.

The 2nd intercostal space is the space between the 2nd and 3rd rib. Fifty-three years later, this is still the accepted site for placing a chest tube for the purpose of decompressing a tension pneumothorax. Connecting the chest tube to underwater sealed drainage, as described by Jones et al, allows air pressure and blood to drain out of the pleural cavity, via the chest tube, but does not allow air to return to the pleural cavity when the patient breathes in, acting like a one way valve.

I find it very odd that the doctors were not quicker to zero in on the right lung as the site of the pneumothorax, as Carrico turned up the most obvious clue when he listened to JFK's breathing with a stethoscope, following intubation and connection to a respirator, and heard greatly reduced breath sounds in JFK's right lung, in comparison to his left lung. There may have been some lack of communication in Trauma Room One but, it would not have made any difference in whether they inserted only a right chest tube or bilateral chest tubes. Without knowing precisely what was going on in JFK's chest, and whether both sides or only the right was damaged, the only safe course would be to insert bilateral tubes, in spite of onvious signs of damage to the right lung.

"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.

Mr. SPECTER - What do you mean by "connected to underwater drainage", Dr. Jones?

Dr. JONES - The tube is connected to a bottle whereby it aerates in the chest from a pneumothorax and as the patient breathes, the air is forced out under the water and produces somewhat of a suction so that the lung will reexpand and will not stay collapsed and this will give adequate aeration to the body, and we decided to go ahead and put in a chest tube on the opposite side; since I could not reach the opposite side due to the number of people that were working on the President. Dr. Baxter was over there helping Dr. Perry on that side, as well as Dr. Paul Peters, the assistant head of urology here, and the three of us then inserted the chest tube on the right side, primarily done by Dr. Baxter and Dr. Peters on the right side."

Dr. Jones confirms that he not only inserted the left anterior chest tube but that it was immediately connected to underwater sealed drainage. Much has been made by the Lone Nutters of Jones testifying " I felt that the tube was fully inserted....". While the LN's would have us believe this is proof of the chest tube not being inserted, it is merely, once again, the surgeon's way of saying the only way to really prove the tube was fully inserted would be to either 1) x-ray the chest or 2) open the chest up and visually inspect to see if the tube was fully inserted. I am quite sure someone would have been monitoring the drainage bottle and, if no air was seen in the bottle's water, it would have been brought to Jones' attention that, perhaps, the chest tube was not fully inserted into the pleural cavity.

Edited September 24, 2016 by Robert Prudhomme

[Cliff Varnell]

I thought I remembered reading about the pneumothorax in the WC and here's an extract including it from the ARRB with Dr. Jones written statement (last page of the document).

Bob does Jones's testimony support Perry's?

https://maryferrell.org/showDoc.html?docId=359#relPageId=5&tab=page

Yes, I would say it does, Chris. However, Dr. Jones was in the same boat as Perry, in that assumptions about JFK's respiratory condition could only be made from the very obvious signs and indications, despite the fact the sum total of his signs could not be interpreted as anything but a right tension pneumothorax.

Factually incorrect. His agonal breathing could have been caused by cardiac arrest.

[Sandy Larsen]

I thought I remembered reading about the pneumothorax in the WC and here's an extract including it from the ARRB with Dr. Jones written statement (last page of the document).

Bob does Jones's testimony support Perry's?

https://maryferrell.org/showDoc.html?docId=359#relPageId=5&tab=page

Yes, I would say it does, Chris. However, Dr. Jones was in the same boat as Perry, in that assumptions about JFK's respiratory condition could only be made from the very obvious signs and indications, despite the fact the sum total of his signs could not be interpreted as anything but a right tension pneumothorax.

Factually incorrect. His agonal breathing could have been caused by cardiac arrest.

His agonal breathing wasn't "the sum total of his signs" that Robert speaks of, Cliff. That was just one of the signs.

Edited September 24, 2016 by Sandy Larsen

[Robert Prudhomme]

Unfortunately, when Specter interrogated Perry, asking for cold hard facts, Perry had nothing concrete to give him. Perry could not actually say with certainty JFK had a pneumothorax,

Thank you. No further questions.

Cliff

On the ambulance a while back, we were dispatched to the home of a senior citizen, whose neighbour had dropped in on and found him in an altered level of consciousness. When we arrived, we found him sitting in an easy chair, complaining of a headache and difficulty focusing. His complaints were given in a slurred speech, and often inappropriate words found there way into his speech, making it a bit difficult to communicate with him.

While I administered a blood glucose test to rule out complications from diabetes (a mandatory procedure for ambulance crews when altered LOC is encountered), my partner conducted the standard test we use to attempt to rule out or confirm a CVA; more commonly known as a "stroke". Using the acronym "FAST", my partner went through the following procedure:

F) He checked for facial droop, and found the left side of the patient's mouth and face to be sagging dramatically.

A) He asked the patient to raise both arms over his head. While he was able to raise his right arm the entire way, his left arm came part way up and then wandered off to the side.

S) The patient had already been observed to be having tremendous difficulty with his speech, and this was noted.

T) "T" stands for time. With the help of the neighbour, we were able to establish the time of this possible CVA or stroke as happening approximately one hour before we arrived.

At this point, my partner and I were more than convinced, by our patient's almost textbook signs and symptoms, that he had suffered a stroke affecting the left side of his body. I immediately contacted our Dispatch and requested a medevac helicopter be sent over that we might evacuate our patient to a centre equipped with a CAT SCAN machine.

The reason for getting our patient to a CAT SCAN machine is quite simple. Strokes are caused either by a ruptured blood vessel in the brain, which requires administration of a blood clotting agent, or by a blood clot blocking an artery in the brain, which requires administration of a clot busting agent. Needless to say, administration of the wrong agent could prove fatal, and no doctor will take the chance of administering either agent without confirmation of

1) Whether the stroke is a bleed or a clot

2) Whether or not the patient is indeed having a stroke at all, or is suffering from a completely different condition.

Our ambulance service recognizes there is a 4.5 hour window, from the time the stroke occurs, in which administration of the correct agent has the ability of reversing the permanently debilitating effects of a stroke, and this is why we were conducting all of our business with the utmost haste.

Now, as it turned out, this patient had indeed suffered a stroke, caused by a blood clot that was a direct result of a heart condition he had and not taking his blood thinners regularly. This was confirmed ONLY when he was given a CAT SCAN.

While my partner and I were wholly convinced that our patient had suffered a stroke, if Arlen Specter had me on the witness stand and asked me if I had conclusive evidence, at the patient's home, that my patient had suffered a stroke, I would have to answer "No".

I completely sympathize with Dr. Malcolm Perry.

Edited September 24, 2016 by Robert Prudhomme

[Robert Prudhomme]

I thought I remembered reading about the pneumothorax in the WC and here's an extract including it from the ARRB with Dr. Jones written statement (last page of the document).

Bob does Jones's testimony support Perry's?

https://maryferrell.org/showDoc.html?docId=359#relPageId=5&tab=page

Yes, I would say it does, Chris. However, Dr. Jones was in the same boat as Perry, in that assumptions about JFK's respiratory condition could only be made from the very obvious signs and indications, despite the fact the sum total of his signs could not be interpreted as anything but a right tension pneumothorax.

Factually incorrect. His agonal breathing could have been caused by cardiac arrest.

Cliff

I have dealt with children that possess better comprehension skills than you do. Grow up.

When I said the sum total of his signs, do you honestly think I meant the sum total of every sign JFK was displaying?? Including the massive haemorrhaging in his cranium?

Just for you, Cliff, let me say I was only referring to the signs related to a possible tension pneumothorax. Agonal breathing would be a sign independent of a pneumothorax, and is a sign displayed by many dying patients, regardless of the cause of death.

[Cliff Varnell]

I thought I remembered reading about the pneumothorax in the WC and here's an extract including it from the ARRB with Dr. Jones written statement (last page of the document).

Bob does Jones's testimony support Perry's?

https://maryferrell.org/showDoc.html?docId=359#relPageId=5&tab=page

Yes, I would say it does, Chris. However, Dr. Jones was in the same boat as Perry, in that assumptions about JFK's respiratory condition could only be made from the very obvious signs and indications, despite the fact the sum total of his signs could not be interpreted as anything but a right tension pneumothorax.

Factually incorrect. His agonal breathing could have been caused by cardiac arrest.

Cliff

I have dealt with children that possess better comprehension skills than you do. Grow up.

And yet you take Perry's qualified comments and run with them far beyond what the evidence supports.

When I said the sum total of his signs, do you honestly think I meant the sum total of every sign JFK was displaying?? Including the massive haemorrhaging in his cranium?

Your certainty on this issue is misplaced.

Just for you, Cliff, let me say I was only referring to the signs related to a possible tension pneumothorax. Agonal breathing would be a sign independent of a pneumothorax, and is a sign displayed by many dying patients, regardless of the cause of death.