Chapter XXV: Part 25

Mr. CALLAWAY. No, sir; I didn't go to Korea. I was at Camp Pendleton as a troop trainer.

Mr. DULLES. Off the record.

(Discussion off the record.)

Mr. DULLES. Back on the record.

Mr. BALL. I would like to offer to Exhibit 539, inclusive.

Mr. DULLES. Can you tell me what the numbers are?

Mr. BALL. 537, 538, and 539.

Mr. DULLES. Exhibits 537, 538, and 539 previously identified will now be admitted in evidence.

(The documents heretofore marked for identification as Commission Exhibits Nos. 537 through 539 were received in evidence.)

Mr. DULLES. Thank you very much. We appreciate your coming.

(Whereupon, at 12:40 p.m., the President's Commission recessed.)

_Monday, March 30, 1964_

TESTIMONY OF DR. CHARLES JAMES CARRICO AND DR. MALCOLM OLIVER PERRY

The President's Commission met at 9:10 a.m. on March 30, 1964, at 200 Maryland Avenue NE., Washington, D.C.

Present were Chief Justice Earl Warren, Chairman; Representative Hale Boggs, Representative Gerald R. Ford, John J. McCloy, and Allen W. Dulles, members.

Also present were Arlen Specter, assistant counsel; Charles Murray, observer; and Dean Robert G. Storey, special counsel to the attorney general of Texas.

TESTIMONY OF DR. CHARLES JAMES CARRICO

The CHAIRMAN. All right, Dr. Carrico, you know the reason why we are here, what we are investigating.

If you will raise your right hand, please, and be sworn, sir.

You solemnly swear the testimony you give before this Commission shall be the truth, the whole truth and nothing but the truth, so help you God?

Dr. CARRICO. I do.

The CHAIRMAN. Mr. Specter will conduct the examination.

Mr. SPECTER. Dr. Carrico, will you state your full name for the record please?

Dr. CARRICO. Charles James Carrico.

Mr. SPECTER. And what is your address, Dr. Carrico?

Dr. CARRICO. Home address?

Mr. SPECTER. Please.

Dr. CARRICO. It is 2605 Ridgwood in Irving.

Mr. SPECTER. What is your professional address?

Dr. CARRICO. Parkland Memorial Hospital in Dallas, Tex.

Mr. SPECTER. How old are you, sir?

Dr. CARRICO. 28.

Mr. SPECTER. Will you outline briefly your educational background?

Dr. CARRICO. I attended grade school and high school in Denton, Tex.; received a Bachelor of Science in Chemistry from North Texas State University in 1947; received my M.D. from the University of Texas Southwestern Medical School in 1961; served an internship at Parkland Memorial Hospital from 1961 to 1962; and then did a year of fellowship at the surgery department at Southwestern Medical School, followed by my surgery residency at Parkland Hospital.

Mr. SPECTER. Are you duly licensed to practice medicine in the State of Texas, Dr. Carrico?

Dr. CARRICO. Yes; I am.

Mr. SPECTER. Are you board certified at the present time or are you working toward the board certification in surgery?

Dr. CARRICO. I am engaged in surgery residency which will qualify me for board certification.

Mr. SPECTER. What experience have you had, if any, with gunshot wounds?

Dr. CARRICO. In the emergency room at Parkland, during my residence school and internship and residency, we have seen a fair number of gunshot wounds.

Mr. SPECTER. Could you approximate the number of gunshot wounds you have treated in the course of those duties?

Dr. CARRICO. In all probably 150, 200, something in that range.

Mr. SPECTER. What were your duties at Parkland Memorial Hospital on November 22, 1963?

Dr. CARRICO. At that time I was assigned to the elective surgery service, which is the general surgery service treating the usual surgical cases. I was in the emergency room evaluating some patient for admission.

Mr. SPECTER. What were you doing specifically in the neighborhood of 12:30 p.m. on that day?

Dr. CARRICO. At that time I had been called to the emergency room to evaluate a patient for admission to the hospital.

Mr. SPECTER. Were you notified that an emergency case involving President Kennedy was en route to the hospital?

Dr. CARRICO. Yes, sir.

Mr. SPECTER. What is your best estimate as to the time that you were notified that President Kennedy was en route to the hospital?

Dr. CARRICO. Shortly after 12:30 is the best I can do.

Mr. SPECTER. How long thereafter was it that he actually did arrive at Parkland, to the best of your recollection?

Dr. CARRICO. Within 2 minutes approximately.

Mr. SPECTER. And precisely where were you at Parkland when you first observed him?

Dr. CARRICO. When I first observed him I was in the emergency room, seeing--actually Governor Connally had been brought in first, as you know, Dr. Dulany and I had gone to care for Governor Connally and when the President was brought in I left Governor Connally and went to care for the President.

Mr. SPECTER. Will you describe briefly the physical layout of Parkland with respect to the point where emergency cases are brought up to the building and the general layout of the building into the emergency room.

Dr. CARRICO. The emergency entrance is at the back of the building. There is an ambulance ramp. Then immediately adjacent to the ambulance ramp are, of course, double doors, swinging doors and a corridor which is approximately 30 feet long and empties directly into the emergency room.

Then inside the emergency room are several areas, the surgical area consists of about eight booths for treating, examination and treatment of patients, and four large emergency operating rooms.

Two of these are specifically set aside for acutely ill, severely ill, patients and these are referred to as trauma rooms.

Mr. SPECTER. And were these trauma rooms used in connection with the treatment of President Kennedy and Governor Connally?

Dr. CARRICO. Yes, sir.

Mr. SPECTER. What precisely was the point where you met at his arrival?

Dr. CARRICO. The President was being wheeled into trauma room one when I saw him.

Mr. SPECTER. Who else, if anyone, was present at that time?

Dr. CARRICO. At that time, Dr. Don Curtis, Martin White.

The CHAIRMAN. Was he a doctor, too?

Dr. CARRICO. Yes, sir; Miss Bowron.

Mr. SPECTER. Who is Miss Bowron?

Dr. CARRICO. She is one of the nurses on duty at the emergency room.

Mr. SPECTER. Who was the first doctor to actually see the President?

Dr. CARRICO. I was.

Mr. SPECTER. Now, what did you observe as to the condition of President Kennedy when you first saw him?

Dr. CARRICO. He was on an ambulance cart, emergency cart, rather. His color was blue white, ashen. He had slow agonal respiration, spasmodic respirations without any coordination. He was making no voluntary movements. His eyes were open, pupils were seen to be dilated and later were seen not to react to light. This was the initial impression.

Mr. SPECTER. What was the status of his pulse at the time of arrival?

Dr. CARRICO. He had no palpable pulse.

Mr. SPECTER. And was he making any movements at the time of arrival?

Dr. CARRICO. No voluntary movements, only the spasmodic respirations.

Mr. SPECTER. Was any heartbeat noted at his arrival?

Dr. CARRICO. After these initial observations we opened his shirt, coat, listened very briefly to his chest, heard a few sounds which we felt to be heartbeats and then proceeded with the remainder of the examination.

Mr. SPECTER. In your opinion was President Kennedy alive or dead on his arrival at Parkland.

Dr. CARRICO. From a medical standpoint I suppose he was still alive in that he did still have a heartbeat?

Mr. SPECTER. What action, if any, was taken with respect to the removal of President Kennedy's clothing?

Dr. CARRICO. As I said after I had opened his shirt and coat, I proceeded with the examination and the nurses removed his clothing as is the usual procedure.

Mr. SPECTER. Was President Kennedy wearing a back brace?

Dr. CARRICO. Yes; he was.

Mr. SPECTER. Would you describe as precisely as you can that back brace?

Dr. CARRICO. As I recall, this was a white cotton or some sort of fiber standard brace with stays and corset, in a corset-type arrangement and buckles.

Mr. SPECTER. How far up on his body did it come?

Dr. CARRICO. Just below his umbilicus, as I recall.

Mr. SPECTER. How far down on his body did it go?

Dr. CARRICO. I did not examine below his belt at that time.

Mr. SPECTER. Did you at any time examine below his belt?

Dr. CARRICO. I did not; no, sir.

Mr. SPECTER. Do you know if anyone else did?

Dr. CARRICO. Not in a formal manner.

Mr. SPECTER. What action did you take by way of treating President Kennedy on his arrival?

Dr. CARRICO. After what we have described we completed an initial emergency examination, which consisted of, as we have already said, his color, his pulse, we felt his back, determined there were no large wounds which would be an immediate threat to life there. Looked very briefly at the head wound and then because of his inadequate respirations inserted an endotracheal tube to attempt to support these respirations.

Mr. SPECTER. Specifically what did you do with respect to the back, Dr. Carrico?

Dr. CARRICO. This is a routine examination of critically ill patients where you haven't got time to examine him fully. I just placed my hands just above the belt, but in this case just above the brace, and ran my hands up his back.

Mr. SPECTER. To what point on his body?

Dr. CARRICO. All the way up to his neck very briefly.

Mr. SPECTER. What did you feel by that?

Dr. CARRICO. I felt nothing other than the blood and debris. There was no large wound there.

Mr. SPECTER. What source did you attribute the blood to at that time?

Dr. CARRICO. As it could have come from the head wound, and it certainly could have been a back wound, but there was no way to tell whether this blood would have come from a back wound and not from his head.

Mr. SPECTER. What action did you next take then?

Dr. CARRICO. At that time the endotracheal tube was inserted, using a curved laryngoscopic blade, inserting an endotracheal tube, it was seen there were some contusions, hematoma to the right of the larynx, with a minimal deviation of the larynx to the left, and ragged tissue below indicating tracheal injury.

The tube was inserted past this injury, and the cuff inflater was connected to a Bennett machine which is a respiratory assistor using positive pressure.

Mr. SPECTER. Will you describe briefly what you mean in lay terms by a cuffed endotracheal tube?

Dr. CARRICO. This is a plastic tube which is inserted into the trachea, into the windpipe, to allow an adequate airway, adequate breathing. The cuff is a small latex cuff which should prevent leakage of air around the tube, thus insuring an adequate airway.

Mr. SPECTER. Will you continue, then, to describe what efforts you made to revive the President.

Dr. CARRICO. After the endotracheal tube was inserted and connected, I listened briefly to his chest, respirations were better but still inadequate.

Dr. Perry arrived, and because of the inadequate respirations the presence of a tracheal injury, advised that the chest tube was to be inserted, this was done by some of the other physicians in the room.

At the same time we had been getting the airway inserted Dr. Curtis and Dr. White were doing a cutdown, venous section using polyethylene catheters through which fluid, medicine and blood could be administered.

Mr. SPECTER. Will you describe in lay language what you mean by a cutdown in relationship to what they did in this case?

Dr. CARRICO. This was a small incision over his ankle and a tube was inserted into one of his veins through which blood could be given, fluid.

Mr. SPECTER. Is the general purpose of that to maintain a circulatory system?

Dr. CARRICO. Right.

Mr. SPECTER. In wounded parties?

Dr. CARRICO. Yes.

(At this point, Representative Ford entered the hearing room.)

Mr. SPECTER. Would you now proceed again to describe what else was done for the President in an effort to save his life?

Dr. CARRICO. Sure. Dr. Perry then took over supervision and treatment, and the chest tubes were inserted, another cutdown was done by Dr. Jones on the President's arm.

Fluid, as I said, was given, blood was given, hydrocortisone was given. Dr. Clark, the chief neurosurgeon, Dr. Bashour, cardiologist, was there or arrived, and a cardiac monitor was attached and although I never saw any electro-activity, Dr. Clark said there was some electrical activity of the heart which means he was still trying to----

Mr. SPECTER. What is Dr. Clark's position in the hospital?

Dr. CARRICO. He is chief of the neurosurgery department and professor of the neurosurgery.

Mr. SPECTER. Dr. Carrico, will you continue to tell us then what treatment you rendered the President?

Dr. CARRICO. When this electrocardiac activity ceased, close cardiac massage was begun. Using this, and fluids and airway we were able to maintain fairly good color, apparently fairly good peripheral circulation as monitored by carotid and radial pulses for a period of time. These efforts were abandoned when it was determined by Dr. Clark that there was no continued cardiac response. There was no cerebral response, that is the pupils remained dilated and fixed; there was evidence of anoxia.

Mr. SPECTER. Will you describe in lay language what anoxia means?

Dr. CARRICO. No oxygen.

Mr. SPECTER. Was cardiac massage applied in this situation?

Dr. CARRICO. Yes, sir; it was, excellent cardiac massage.

Mr. SPECTER. Were bloods administered to the President?

Dr. CARRICO. Yes, sir.

(At this point, Mr. Dulles entered the hearing room.)

Mr. SPECTER. Dr. Carrico, was any action taken with respect to the adrenalin insufficiency of President Kennedy?

Dr. CARRICO. Yes, sir; he was given 300 milligrams of hydrocortisone which is an adrenal hormone.

Mr. SPECTER. And what was the reason for the administration of that drug?

Dr. CARRICO. It was recalled that the President had been said to have adrenal insufficiency.

Mr. SPECTER. Now, at what time was the death of the President pronounced, Doctor?

Dr. CARRICO. At 1 o'clock.

Mr. SPECTER. Who pronounced the death of the President?

Dr. CARRICO. Dr. Clark, I believe.

Mr. SPECTER. Was that a precise time fixed or a general time fixed for the point of death?

Dr. CARRICO. This was a general time, sir.

Mr. SPECTER. What, in your opinion, was the cause of death?

Dr. CARRICO. The head wound, the head injury.

Mr. SPECTER. Will you describe as specifically as you can the head wound which you have already mentioned briefly?

Dr. CARRICO. Sure.

This was a 5- by 71-cm defect in the posterior skull, the occipital region. There was an absence of the calvarium or skull in this area, with shredded tissue, brain tissue present and initially considerable slow oozing. Then after we established some circulation there was more profuse bleeding from this wound.

Mr. SPECTER. Was any other wound observed on the head in addition to this large opening where the skull was absent?

Dr. CARRICO. No other wound on the head.

Mr. SPECTER. Did you have any opportunity specifically to look for a small wound which was below the large opening of the skull on the right side of the head?

Dr. CARRICO. No, sir; at least initially there was no time to examine the patient completely for all small wounds. As we said before, this was an acutely ill patient and all we had time to do was to determine what things were life-threatening right then and attempt to resuscitate him and after which a more complete examination would be carried out and we didn't have time to examine for other wounds.

Mr. SPECTER. Was such a more complete examination ever carried out by the doctors in Parkland?

Dr. CARRICO. No, sir; not in my presence.

Mr. SPECTER. Why not?

Dr. CARRICO. As we said initially this was an acute emergency situation and there was not time initially and when the cardiac massage was done this prevented any further examination during this time this was being done. After the President was pronounced dead his wife was there, he was the President, and we felt certainly that complete examination would be carried out and no one had the heart, I believe, to examine him then.

Mr. SPECTER. Will you describe, as specifically as you can then, the neck wounds which you heretofore mentioned briefly?

Dr. CARRICO. There was a small wound, 5- to 8-mm. in size, located in the lower third of the neck, below the thyroid cartilage, the Adams apple.

Mr. DULLES. Will you show us about where it was?

Dr. CARRICO. Just about where your tie would be.

Mr. DULLES. Where did it enter?

Dr. CARRICO. It entered?

Mr. DULLES. Yes.

Dr. CARRICO. At the time we did not know----

Mr. DULLES. I see.

Dr. CARRICO. The entrance. All we knew this was a small wound here.

Mr. DULLES. I see. And you put your hand right above where your tie is?

Dr. CARRICO. Yes, sir; just where the tie----

Mr. DULLES. A little bit to the left.

Dr. CARRICO. To the right.

Mr. DULLES. Yes; to the right.

Dr. CARRICO. Yes. And this wound was fairly round, had no jagged edges, no evidence of powder burns, and so forth.

Representative FORD. No evidence of powder burns?

Dr. CARRICO. So far as I know.

Representative FORD. In the front?

Dr. CARRICO. Yes.

Mr. SPECTER. Have you now described that wound as specifically as you can based upon your observations at the time?

Dr. CARRICO. I believe so.

Mr. SPECTER. And your recollection at the time of those observations?

Dr. CARRICO. Yes; an even round wound.

Mr. DULLES. You felt this wound in the neck was not a fatal wound?

Dr. CARRICO. That is right.

Mr. SPECTER. That is, absent the head wound, would the President have survived the wound which was present on his neck?

Dr. CARRICO. I think very likely he would have.

Mr. SPECTER. Based on your observations on the neck wound alone did you have a sufficient basis to form an opinion as to whether it was an entrance or an exit wound?

Dr. CARRICO. No, sir; we did not. Not having completely evaluated all the wounds, traced out the course of the bullets, this wound would have been compatible with either entrance or exit wound depending upon the size, the velocity, the tissue structure and so forth.

Mr. SPECTER. Permit me to add some facts which I shall ask you to assume as being true for purposes of having you express an opinion.

First of all, assume that the President was struck by a 6.5 mm. copper-jacketed bullet from a rifle having a muzzle velocity of approximately 2,000 feet per second at a time when the President was approximately 160 to 250 feet from the weapon, with the President being struck from the rear at a downward angle of approximately 45 degrees, being struck on the upper right posterior thorax just above the upper border of the scapula 14 centimeters from the tip of the right acromion process and 14 centimeters below the tip of the right mastoid process.

Assume further that the missile passed through the body of the President striking no bones, traversing the neck and sliding between the large muscles in the posterior aspect of the President's body through a fascia channel without violating the pleural cavity, but bruising only the apex of the right pleural cavity and bruising the most apical portion of the right lung, then causing a hematoma to the right of the larynx which you have described, and creating a jagged wound in the trachea, then exiting precisely at the point where you observe the puncture wound to exist.

Now based on those facts was the appearance of the wound in your opinion consistent with being an exit wound?

Dr. CARRICO. It certainly was. It could have been under the circumstances.

Mr. SPECTER. And assuming that all the facts which I have given you to be true, do you have an opinion with a reasonable degree of medical certainty as to whether, in fact, the wound was an entrance wound or an exit wound?

Dr. CARRICO. With those facts and the fact as I understand it no other bullet was found this would be, this was, I believe, was an exit wound.

Mr. SPECTER. Were any bullets found in the President's body by the doctors at Parkland?

Dr. CARRICO. No, sir.

Mr. SPECTER. Was the President's clothing ever examined by you, Dr. Carrico?

Dr. CARRICO. No, sir; it was not.

Mr. SPECTER. What was the reason for no examination of the clothing?

Dr. CARRICO. Again in the emergency situation the nurses removed the clothing after we had initially unbuttoned enough to get a look at him, at his chest, and as the routine is set up, the nurses remove the clothing and we just don't take time to look at it.

Mr. SPECTER. Was the President's body then ever turned over at any point by you or any of the other doctors at Parkland?

Dr. CARRICO. No, sir.

Mr. SPECTER. Was President Kennedy lying on the emergency stretcher from the time he was brought into trauma room one until the treatment at Parkland Hospital was concluded?

Dr. CARRICO. Yes; he was.

Mr. SPECTER. At what time was that treatment concluded, to the best of your recollection?

Dr. CARRICO. At about 1 o'clock.

Mr. SPECTER. At approximately what time did you leave the trauma room where the President was brought?

Dr. CARRICO. I left right at one when we decided that he was dead.

Mr. SPECTER. And did the other doctors leave at the same time or did any remain in the trauma room?

Dr. CARRICO. I left before some of the other doctors, I do not remember specifically who was there. I believe Dr. Baxter was, Dr. Jenkins was still there, I believe. And I think Dr. Perry was.

Mr. SPECTER. You have described a number of doctors in the course of your testimony up to this point. Would you state what other doctors were present during the time the President was treated, to the best of your recollection?

Dr. CARRICO. Well, I have already mentioned Dr. Don Curtis, the surgery resident; Martin White, an interne; Dr. Perry was there, Dr. Baxter, Dr. McClelland, a member of the surgery staff; Dr. Ronald Jones, chief surgery resident; Dr. Jenkins, chief of anesthesia; several other physicians whose names I can't remember at the present. Admiral Burkley, I believe was his name, the President's physician, was there as soon as he got to the hospital.

Mr. SPECTER. What is your view, Dr. Carrico, as to how many bullets struck the President?

Dr. CARRICO. At the time of the initial examination I really had no view. In view of what we have been told by you, and the Commission, two bullets would be my opinion.

Mr. SPECTER. Based on the additional facts which I have asked you to assume----

Dr. CARRICO. Yes, sir.

Mr. SPECTER. And also based on the autopsy report from Bethesda----

Dr. CARRICO. Right.

Mr. SPECTER. Which was made available to you by me.

Dr. CARRICO. Right.

Mr. SPECTER. Now, who, if any one, has talked to you representing the Federal Government in connection with the treatment which you assisted in rendering President Kennedy at Parkland on November 22?

Dr. CARRICO. We have talked to some representatives of the Secret Service, whose names I do not remember.

Mr. SPECTER. On how many occasions, if there was more than one?

Dr. CARRICO. Two occasions, a fairly long interview shortly after the President's death, and then approximately a month or so afterwards a very short interview.

Representative FORD. When you say shortly after the President's death, you mean that day?

Dr. CARRICO. No, sir. Within a week maybe.

Mr. SPECTER. And what was the substance of the first interview with the Secret Service which you have described as occurring within 1 week?

Dr. CARRICO. This was a meeting in Dr. Shires' office, Dr. Shires, Dr. Perry, Dr. McClelland and myself, and two representatives of the Secret Service in which we went over the treatment.

They discussed the autopsy findings as I recall it, with Dr. Shires, and reviewed the treatment with him, essentially.

Mr. SPECTER. And what questions were you asked specifically at that time, if any?

Dr. CARRICO. I don't recall any specific questions I was asked. In general, I was asked some questions pertaining to his treatment, to the wounds, what I thought they were, and et cetera.

Mr. SPECTER. What opinions did you express at that time?

Dr. CARRICO. Again, I said that on the basis of our initial examination, this wound in his neck could have been either an entrance or exit wound, which was what they were most concerned about, and assuming there was a wound in the back, somewhere similar to what you have described that this certainly would be compatible with an exit wound.

Mr. SPECTER. Were your statements at that time different in any respect with the testimony which you have given here this morning?

Dr. CARRICO. Not that I recall.

Mr. SPECTER. Were your views at that time consistent with the findings in the autopsy report, or did they vary in any way from the findings in that report?

Dr. CARRICO. As I recall, the autopsy report is exactly as I remember it.

Mr. SPECTER. Were your opinions at that time consistent with the findings of the autopsy report?

Dr. CARRICO. Yes.

Mr. SPECTER. Will you identify Dr. Shires for the record, please?

Dr. CARRICO. Dr. Shires is chief of the surgery service at Parkland, and chairman of the Department of Surgery at Southwestern Medical School.

Mr. SPECTER. Now, approximately when, to the best of your recollection, did the second interview occur with the Secret Service?

Dr. CARRICO. This was some time in February, probably about the middle of February, and the interview consisted of the agent asking me if I had any further information.

I said I did not.

Mr. SPECTER. Was that the total context of the interview?

Dr. CARRICO. Yes, sir.

Mr. SPECTER. Now, did I interview you and take your deposition in Dallas, Tex., last Wednesday?

Dr. CARRICO. Yes, sir.

Mr. SPECTER. And has that deposition transcript been made available to you this morning?

Dr. CARRICO. It has.

Mr. SPECTER. And were the views you expressed to me in our conversation before the deposition and on the record during the course of the deposition different in any way with the testimony which you have provided here this morning?

Dr. CARRICO. No, sir; they were not.

Mr. SPECTER. Dr. Carrico, have you changed your opinion in any way concerning your observations or conclusions about the situation with respect to President Kennedy at any time since November 22, 1963?

Dr. CARRICO. No.

Mr. SPECTER. Do you have any notes or writings of any sort in your possession concerning your participation in the treatment of President Kennedy?

Dr. CARRICO. None other than the letter to my children I mentioned to you.

Mr. SPECTER. Will you state briefly the general nature of that for the Commission here today, please.

Dr. CARRICO. This is just a letter written to my children to be read by them later, saying what happened, how I felt about it. And maybe why it happened, and maybe it would do them some good later.

Mr. SPECTER. Did you also make a written report which was made a part of the records of Parkland Hospital which you have identified for the record during the deposition proceeding?

Dr. CARRICO. Yes; I did.

Mr. SPECTER. Do those constitute the total of the writings which you made concerning your participation in the treatment of the President?

Dr. CARRICO. Right.

Mr. DULLES. You spoke of a letter to your children. I don't want to invade your privacy in this respect in any way, but is there anything in that letter that you think would bear on our considerations here by this Commission?

Dr. CARRICO. No; I don't believe so. This thing doesn't mention the treatment other than to say probably by the time they read the letter it will be archaic.

Mr. DULLES. You spoke about the causes of it all, I don't know whether----

Dr. CARRICO. Just a little homespun philosophy. I just said that there was a lot of extremism both in Dallas and in the Nation as a whole, and in an attitude of extremism a warped mind can flourish much better than in a more stable atmosphere.

Mr. DULLES. Thank you.

Mr. SPECTER. Dr. Carrico, was the nature of the treatment affected, in your opinion, in any way by the fact that you were working on the President of the United States?

Dr. CARRICO. I don't believe so, sir. We have seen a large number of acutely injured people, and acutely ill people, and the treatment has been carried out enough that this is almost reflex, if you will. Certainly everyone was emotionally affected. I think, if anything, the emotional aspect made us think faster, work faster and better.

Mr. SPECTER. Do you have anything to add which you think would be helpful to the Commission in its inquiry on the assassination of President Kennedy?

Dr. CARRICO. No, sir.

Mr. SPECTER. Those conclude my questions, Mr. Chief Justice.

The CHAIRMAN. Mr. Dulles, have you any questions to ask of the Doctor?

Mr. DULLES. Looking back on it, do you think it was probable that death followed almost immediately after this shot in the head?

Dr. CARRICO. Yes, sir; as I said----

Mr. DULLES. I was absent, I am sorry, at that time.

Dr. CARRICO. Yes, sir. Medically, I suppose you would have to say he was alive when he came to Parkland. From a practical standpoint, I think he was dead then.

The CHAIRMAN. Congressman Ford?

Representative FORD. When did you say that he arrived, when you first started working on the President?

Dr. CARRICO. It would only be a guess. Probably about 12:35. It was about 12:30 when I got in the emergency room, and I was there 2 or 3 minutes when we were called, and he was there within 2 or 3 minutes.

Representative FORD. So approximately from 12:35 until 1 the President was examined and treatment was given by you and others?

Dr. CARRICO. Yes.

Representative FORD. Have you read and analyzed the autopsy performed by the authorities at Bethesda?

Dr. CARRICO. I have not read it carefully. I have seen it. Mr. Specter showed me parts of it, and I had seen a copy of it earlier, briefly.

Representative FORD. Is there anything in it that you have read that would be in conflict with your observation?

Dr. CARRICO. Nothing at all in conflict. It certainly adds to the observations that we made.

Representative FORD. Have you been interviewed by the press and, if so, when?

Dr. CARRICO. I think I have talked to the press twice.

Mr. Burrus, a reporter for the Dallas Times Herald, talked to me about 5 minutes, probably 3 or 4 days after the President's death, and then a reporter from Time called about 3 or 4 weeks after the President's death, and I talked to him for a very few minutes.

Representative FORD. Did you make any statements in either of these interviews that are different from the observations you have made here this morning?

Dr. CARRICO. Not that I recall.

Representative FORD. That is all.

Mr. DULLES. Mr. Chief Justice, could I--off the record.

(Discussion off the record.)

The CHAIRMAN. Well, Doctor, thank you very much. We appreciate your help.

Dr. CARRICO. Certainly. Glad to be here.

TESTIMONY OF DR. MALCOLM PERRY

The CHAIRMAN. Dr. Perry, will you be sworn now, please?

Would you raise your right hand and be sworn, please?

Do you solemnly swear the testimony you are about to give before the Commission will be the truth, the whole truth, and nothing but the truth, so help you God?

Dr. PERRY. I do.

The CHAIRMAN. Will you be seated, please?

Mr. Specter will conduct the examination.

Mr. SPECTER. Will you state your full name for the record, please?

Dr. PERRY. Malcolm Oliver Perry.

Mr. SPECTER. What is your residence address?

Dr. PERRY. 4115 Parkland, Dallas, Tex.

Mr. SPECTER. Your professional address?

Dr. PERRY. 5323 Harley Hines Boulevard.

Mr. SPECTER. Is that the address of Parkland Memorial Hospital?

Dr. PERRY. That is the address of the University of Texas Southwestern Medical School.

Mr. SPECTER. Is that situated immediately adjacent to Parkland Memorial Hospital?

Dr. PERRY. That is correct.

Mr. SPECTER. Would you state your age, sir?

Dr. PERRY. 34.

Mr. SPECTER. What is your profession?

Dr. PERRY. I am a physician and surgeon.

Mr. SPECTER. Were you duly licensed to practice medicine by the State of Texas?

Dr. PERRY. Yes.

Mr. SPECTER. Would you outline briefly your educational background, please?

Dr. PERRY. After graduation from Plano High School in 1947, I attended the University of Texas and was duly graduated there in January of 1951 with a degree of Bachelor of Arts.

I subsequently graduated from the University of Texas Southwestern Medical School in 1956 with a degree of Doctor of Medicine. I served an internship of 12 months at Letterman Hospital in San Francisco, and after 2 more years in the Air Force I returned to Parkland for a 4-year residency in general surgery.

I completed that in----

Mr. DULLES. Where did you serve in the Air Force, by the way?

Dr. PERRY. I was in Spokane, Wash., Geiger Field.

At the completion of my surgery residency in June of 1962, I was appointed an instructor in surgery at the Southwestern Medical School.

But in September 1962, I returned to the University of California at San Francisco to spend a year in vascular surgery. During that time, I took and passed my boards for the certification for the American Board of Surgery.

I returned to Parkland Hospital and Southwestern in September of 1963, was appointed an assistant professor of surgery, attending surgeon and vascular consultant for Parkland Hospital and John Smith Hospital in Fort Worth.

Mr. SPECTER. What experience have you had, Dr. Perry, if any, in gunshot wounds?

Dr. PERRY. During my period in medical school and my residency, I have seen a large number, from 150 to 200.

Mr. SPECTER. What were your duties at Parkland Memorial Hospital, if any, on November 22d, 1963?

Dr. PERRY. On that day I had come over from the medical school for the usual 1 o'clock rounds with the residents, and Dr. Ronald Jones and I, he being chief surgical resident, were having dinner in the main dining room there in the hospital.

Mr. SPECTER. Will you describe how you happened to be called in to render assistance to President Kennedy?

Dr. PERRY. Somewhere around 12:30, and I cannot give you the time accurately since I did not look at my watch in that particular instant, an emergency page was put in for Dr. Tom Shires, who is chief of the emergency surgical service in Parkland. I knew he was in Galveston attending a meeting and giving a paper, and I asked Dr. Jones to pick up the page to see if he or I could be of assistance.

The CHAIRMAN. Doctor, at this time I must leave for a session at the Supreme Court, and the hearing will continue. Congressman Ford, I am going to ask you if you will preside in my absence. If you are obliged to go to the Congress, Commissioner Dulles will preside, and I will be available as soon as the Court session is over to be here with you.

(At this point, Mr. Warren withdrew from the hearing room.)

Representative FORD. Will you proceed, please?

Mr. SPECTER. What action did you take after learning of the emergency call, Dr. Perry?

Dr. PERRY. The emergency room is one flight of stairs down from the main dining cafeteria, so Dr. Jones and I went immediately to the emergency room to render what assistance we could.

Representative FORD. May I ask this: In the confirmation of the page call, was it told to you that the President was the patient involved?

Dr. PERRY. It was told to Dr. Jones, who picked up the page, that President Kennedy had been shot and was being brought to Parkland. We went down immediately to the emergency room to await his arrival. However, he was there when we reached it.

Mr. SPECTER. Who else was present at the time you arrived on the scene with the President?

Dr. PERRY. When Dr. Jones and I entered the emergency room, the place was filled with people, most of them officers and, apparently, attendants to the Presidential procession. Dr. Carrico was in attendance with the President in trauma room No. 1 when I walked in. There were several other people there. Mrs. Kennedy was there with some gentleman whom I didn't know. I have the impression there was another physician in the room, but I cannot recall at this time who it was. There were several nurses there.

Mr. SPECTER. Were any other doctors present besides Dr. Carrico?

Dr. PERRY. I think there was another doctor present, but I don't know who it was, I don't recall.

Mr. DULLES. Can I ask a question here, Mr. Specter?

Mr. SPECTER. Certainly.

Mr. DULLES. What is the procedure for somebody taking command in a situation of this kind? Who takes over and who says who should do what? I realize it is an emergency situation. Maybe that is an improper question.

Dr. PERRY. No, sir.

Mr. DULLES. But it would be very helpful to me----

Dr. PERRY. No, sir; it is perfectly proper.

Mr. DULLES. In reviewing the situation to see how you acted.

In a military situation, you have somebody who takes command.

Dr. PERRY. We do, too. And it essentially is based on the same kind of thing.

Mr. DULLES. I would like to hear about that.

If it doesn't fit in here----

Mr. SPECTER. It is fine.

Dr. PERRY. It is based on rank and experience, essentially. For example, Dr. Carrico being the senior surgical resident in the area, at the time President Kennedy was brought in to the emergency suite, would have done what we felt was necessary and would have assumed control of the situation being as there were interns and probably medical students around the area, but being senior would take it. This, of course, catapulted me into this because I was the senior attending staff man when I arrived and at that time Dr. Carrico has noted I took over direction of the care since I was senior of all the people there and being as we are surgeons, the department of surgery operates that portion of the emergency room and directs the care of the patients.

Mr. DULLES. Did you try to clear the room of unnecessary people?

Dr. PERRY. This was done, not by me, but by the nurse supervisor, I assume, but several of the people were asked to leave the room. Generally, this is not necessary. In an instance such as this, it is a little more difficult, as you can understand.

Mr. DULLES. Yes.

Dr. PERRY. But this care of an acutely injured and acutely injured patients goes on quite rapidly. Over 90,000 a year go through that emergency room, and, as a result, people are well trained in the performance of their duties. There is generally no problem in asking anyone to leave the room because everyone is quite busy and they know what they have to do and are proceeding to do it.

Mr. DULLES. Thank you very much.

Mr. SPECTER. Upon your arrival in the room, where President Kennedy was situated, what did you observe as to his condition?

Dr. PERRY. At the time I entered the door, Dr. Carrico was attending him. He was attaching the Bennett apparatus to an endotracheal tube in place to assist his respiration.

The President was lying supine on the carriage, underneath the overhead lamp. His shirt, coat, had been removed. There was a sheet over his lower extremities and the lower portion of his trunk. He was unresponsive. There was no evidence of voluntary motion. His eyes were open, deviated up and outward, and the pupils were dilated and fixed.

I did not detect a heart beat and was told there was no blood pressure obtainable.

He was, however, having ineffective spasmodic respiratory efforts.

There was blood on the carriage.

Mr. DULLES. What does that mean to the amateur, to the unprofessional?

Dr. PERRY. Short, rather jerky contractions of his chest and diaphragm, pulling for air.

Mr. DULLES. I see.

Mr. SPECTER. Were those respiratory efforts on his part alone or was he being aided in his breathing at that time?

Dr. PERRY. He had just attached the machine and at this point it was not turned on. He was attempting to breathe.

Mr. SPECTER. So that those efforts were being made at that juncture at least without mechanical aid?

Dr. PERRY. Those were spontaneous efforts on the part of the President.

Mr. SPECTER. Will you continue, then, Dr. Perry, as to what you observed of his condition?

Dr. PERRY. Yes, there was blood noted on the carriage and a large avulsive wound on the right posterior cranium.

I cannot state the size, I did not examine it at all. I just noted the presence of lacerated brain tissue. In the lower part of the neck below the Adams apple was a small, roughly circular wound of perhaps 5 mm. in diameter from which blood was exuding slowly.

I did not see any other wounds.

I examined the chest briefly, and from the anterior portion did not see anything.

I pushed up the brace on the left side very briefly to feel for his femoral pulse, but did not obtain any.

I did no further examination because it was obvious that if any treatment were to be carried out with any success a secure effective airway must be obtained immediately.

I asked Dr. Carrico if the wound on the neck was actually a wound or had he begun a tracheotomy and he replied in the negative, that it was a wound, and at that point----

Mr. DULLES. I am a little confused, I thought Dr. Carrico was absent. That was an earlier period.

Dr. PERRY. No, sir; he was present.

Mr. DULLES. He was present?

Dr. PERRY. Yes; he was present when I walked in the room and, at that point, I asked someone to secure a tracheotomy tray but there was one already there. Apparently Dr. Carrico had already asked them to set up the tray.

Mr. SPECTER. Dr. Perry, backtracking just a bit from the context of the answer which you have just given, would you describe the quantity of blood which you observed on the carriage when you first came into the room where the President was located?

Dr. PERRY. Mr. Specter, this is an extremely difficult thing. The estimation of blood when it is either on the floor or on drapes or bandages is grossly inaccurate in almost every instance.

As you know, many hospitals have studied this extensively to try to determine whether they were able to do it with any accuracy but they cannot. I can just tell you there was considerable blood present on the carriage and some on his head and some on the floor but how much, I would hesitate to estimate. Several hundred CC's would be the closest I could get but it could be from 200 to 1,500 and I know by experience you cannot estimate it more accurately.

Mr. SPECTER. Would you characterize it as a very substantial or minor blood loss?

Dr. PERRY. A substantial blood loss.

Mr. SPECTER. Now, you mentioned the President's brace. Could you describe that as specifically as possible?

Dr. PERRY. No, sir; I did not examine it. I noted its presence only in an effort to reach the femoral pulse and I pushed it up just slightly so that I might palpate for the femoral pulse, I did no more examination.

Mr. SPECTER. In the course of seeking the femoral pulse, did you observe or note an Ace bandage?

Dr. PERRY. Yes, sir.

Mr. SPECTER. In the brace area?

Dr. PERRY. Yes, sir. It was my impression, I saw a portion of an Ace Bandage, an elastic supporting bandage on the right thigh. I did not examine it at all but I just noted its presence.

Mr. SPECTER. Did the Ace Bandage cover any portion of the President's body that you were able to observe in addition to the right thigh?

Dr. PERRY. No, sir; I did not go any further. I just noted its presence right there at the junction at the hip. It could have been on the lower trunk or the upper thigh, I don't know. I didn't care any further.

Mr. SPECTER. Would you continue to describe the resuscitative efforts that were undertaken at that time?

Dr. PERRY. At the beginning I had removed my coat and watch as I entered the room and dropped it off in the corner, and as I was talking to Dr. Carrico in regard to the neck wound, I glanced cursorily at the head wound and noted its severe character, and then proceeded with the tracheotomy after donning a pair of gloves. I asked that someone call Dr. Kemp Clark, of neurosurgery, Dr. Robert McClelland, Dr. Charles Baxter, assistant professors of surgery, to come and assist. There were several other people in the room by this time, none of which I can identify. I then began the tracheotomy making a transverse incision right through the wound in the neck.

Mr. SPECTER. Why did you elect to make the tracheotomy incision through the wound in the neck, Dr. Perry?

Dr. PERRY. The area of the wound, as pointed out to you in the lower third of the neck anteriorly is customarily the spot one would electively perform the tracheotomy.

This is one of the safest and easiest spots to reach the trachea. In addition the presence of the wound indicated to me there was possibly an underlaying wound to the neck muscles in the neck, the carotid artery or the jugular vein. If you are going to control these it is necessary that the incision be as low, that is toward the heart or lungs as the wound if you are going to obtain adequate control.

Therefore, for expediency's sake I went directly to that level to obtain control of the airway.

Mr. SPECTER. Would you describe, in a general way and in lay terms, the purpose for the tracheotomy at that time?

Dr. PERRY. Dr. Carrico had very judicially placed an endotracheal tube but unfortunately due to the injury to the trachea, the cuff which is an inflatable balloon on the endotracheal tube was not below the tracheal injury and thus he could not secure the adequate airway that you would require to maintain respiration.

(At this point, Mr. McCloy entered the hearing room.)

Mr. SPECTER. Dr. Perry, you mentioned an injury to the trachea.

Will you describe that as precisely as you can, please?

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.

I noticed a small ragged laceration of the trachea on the anterior lateral right side. I could see the endotracheal tube which had been placed by Dr. Carrico in the wound, but there was evidence of air and blood around the tube because I noted the cuff was just above the injury to the trachea.

Mr. SPECTER. Will you now proceed to describe what efforts you made to save the President's life?

Dr. PERRY. At this point, I had entered the neck, and Dr. Baxter and Dr. McClelland arrived shortly thereafter. I cannot describe with accuracy their exact arrival. I only know I looked up and saw Dr. Baxter as I began the tracheotomy and he took a pair of gloves to assist me.

Dr. McClelland's presence was known to me at the time he picked up an instrument and said, "Here, I will hand it to you."

At that point I was down in the trachea. Once the trachea had been exposed I took the knife and incised the windpipe at the point of the bullet injury. And asked that the endotracheal tube previously placed by Dr. Carrico be withdrawn slightly so I could insert a tracheotomy tube at this level. This was effected and attached to an anesthesia machine which had been brought down by Dr. Jenkins and Dr. Giesecke for better control of circulation.

I noticed there was free air and blood in the right mediastinum and although I could not see any evidence, myself any evidence, of it in the pleura of the lung the presence of this blood in this area could be indicative of the underlying condition.

I asked someone to put in a chest tube to allow sealed drainage of any blood or air which might be accumulated in the right hemothorax.

This occurred while I was doing the tracheotomy. I did not know at the time when I inserted the tube but I was informed subsequently that Dr. Paul Peters, assistant professor of urology, and Dr. Charles Baxter, previously noted in this record, inserted the chest tube and attached it to underwater seal or drainage of the right pneumothorax.

Mr. DULLES. How long did this tracheotomy take, approximately?

Dr. PERRY. I don't know that for sure, Mr. Dulles. However, I have--a matter of 3 to 5 minutes, perhaps even less. This was very--I didn't look at the watch, I have done them at those speeds and faster when I have had to. So I would estimate that.

At this point also Dr. Carrico, having previously attached and assisting with the attaching of the anesthesia machine was doing another cut down on the right leg; Dr. Ronald Jones was doing an additional cut down, venous section on the left arm for the insertion of plastic cannula into veins so one may rapidly and effectively infuse blood and fluids. These were being done.

It is to Dr. Carrico's credit, I think he ordered the hydrocortisone for the President having known he suffered from adrenal insufficiency and in this particular instance being quite busy he had the presence of mind to recall this and order what could have been a lifesaving measure, I think.

Mr. SPECTER. Would you identify who Dr. Baxter is?

Dr. PERRY. Yes. Dr. Charles Baxter is, when I noted when I asked for the call, is an assistant professor of surgery also and Dr. McClelland.

Mr. SPECTER. And is Dr. McClelland occupying a similar position at Parkland Memorial Hospital as Dr. Baxter?

Dr. PERRY. That is correct.

Mr. SPECTER. Would you identify Dr. Jenkins?

Dr. PERRY. Dr. M. T. Jenkins is professor and chairman of the department of anesthesiology and chief of the anesthesia service, and Dr. Giesecke is assistant professor of anesthesiology at Parkland.

Mr. SPECTER. Have you now identified all of the medical personnel whom you can recollect who were present at the time the aid was being rendered to the President?

Dr. PERRY. No, sir; several other people entered the room. I recall seeing Dr. Bashour who is an associate professor of medicine and chief of the cardiology section at Parkland.

Dr. Don W. Seldin, who is professor and chairman of the department of medicine, and I previously mentioned Dr. Paul Peters, assistant professor of urology, and I believe that Dr. Jackie Hunt of the department of anesthesiology was also there, and there were other people, I cannot identify them, several nurses and several others.

Mr. SPECTER. Dr. William Kemp Clark arrived at about that time?

Dr. PERRY. Dr. Clark's arrival was first noted to me after the completion of the tracheotomy, and at this point, the cardiotachyscope had been attached to Mr. Kennedy to detect any electrical activity and although I did not note any, being occupied, it was related to me there was initially evidence of a spontaneous electrical activity in the President's heart.

However, at the completion of the tracheotomy and the institution of the sealed tube drainage of the chest, Dr. Clark and I began external cardiac massage. This was monitored by Dr. Jenkins and Dr. Giesecke who informed us we were obtaining a satisfactory carotid pulse in the neck, and someone whose name I do not know at this time, said they could also feel a femoral pulse in the leg. We continued external cardiac massage, I continued it as Dr. Clark examined the head wound and observed the cardiotachyscope. The exact time interval that this took I cannot tell you. I continued it until Dr. Jenkins and Dr. Clark informed me there was no activity at all, in the cardiotachyscope and that there had been no neurological or muscular response to our resuscitative effort at all and that the wound which the President sustained of his head was a mortal wound, and at that point we determined that he had expired and we abandoned efforts of resuscitation.

Mr. SPECTER. Would you identify Dr. Clark's specialty for the record, please?

Dr. PERRY. Dr. Clark is professor and chairman of the department of neurosurgery at the University of Texas Southwestern Medical School, and chief of the neurosurgical services at Parkland Hospital.

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?