Part 14

Dr. WHITE. He is a surgical resident here at this hospital.

Mr. SPECTER. Who else was present?

Dr. WHITE. I can't be sure that I saw anyone else, although, as I say--many people were there whose faces I can't recall.

Mr. SPECTER. Can you identify any of the nurses who were present?

Dr. WHITE. Yes; one of the nurses--there were two there, Jeanette, and her last name--I don't know at the present time, and she is chief nurse in the emergency room.

Mr. SPECTER. Doris Nelson?

Dr. WHITE. Yes.

Mr. SPECTER. Jeanette Standridge?

Dr. WHITE. Yes; Jeanette Standridge was the other nurse.

Mr. SPECTER. Do you have anything to add which you think might be of help to the Commission?

Dr. WHITE. No; I don't.

Mr. SPECTER. Thank you very much, Dr. White for coming.

Dr. WHITE. All right, thank you.

TESTIMONY OF DR. ROBERT SHAW

The testimony of Dr. Robert Shaw was taken at 6 p.m., on March 23, 1964, at Parkland Memorial Hospital, Dallas, Tex., by Mr. Arlen Specter, assistant counsel of the President's Commission.

Mr. SPECTER. May the record show that Dr. Robert Shaw is present, having responded to a request to have his deposition taken in connection with the President's Commission on the Assassination of President Kennedy, which is investigating all facts relating to the medical care of President Kennedy and Governor Connally, and Dr. Shaw has been requested to appear and testify concerning the treatment on Governor Connally.

Dr. Shaw, will you rise and raise your right hand, please.

Do you solemnly swear that the testimony you give before the President's Commission in the course of this deposition proceeding will be the truth, the whole truth, and nothing but the truth, so help you God?

Dr. SHAW. I do.

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

Dr. SHAW. Robert Roeder Shaw.

Mr. SPECTER. And what is your profession, sir?

Dr. SHAW. Physician and surgeon.

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

Dr. SHAW. I received my B.A. degree from the University of Michigan in 1927 and M.D. degree in 1933. My surgical training was obtained at Roosevelt Hospital in New York City, July 1934 to July 1936, and my training in thoracic surgery at the University Hospital, Ann Arbor, Mich., July 1936 to July 1938. Do you want me to say what happened subsequent to then?

Mr. SPECTER. Yes; will you outline your medical career in brief form subsequent to that date, please?

Dr. SHAW. I entered private practice, limited to thoracic surgery, August 1, 1938. I have continuously practiced this specialty in Dallas, with the exception of the period from June 1942 to December 1945, when I was a member of the Medical Corps of the Army of the United States, serving almost all of this period in the European theatre of operations. I was again absent from Dallas from December 1961 until June 1963, when I headed the medico team and performed surgery at the Avicenna Hospital at Kabul, Afghanistan.

Mr. SPECTER. Are you Board certified, Dr. Shaw?

Dr. SHAW. Yes. I am certified by the Board of Thoracic Surgery, date of certification--1948. At the present time I am professor of thoracic surgery and chairman of the division of thoracic surgery at the University of Texas, Southwestern Medical School.

Mr. SPECTER. Did you have occasion to perform any medical care for President Kennedy on November 22, 1963?

Dr. SHAW. No.

Mr. SPECTER. Did you have occasion to care for Governor Connally?

Dr. SHAW. Yes.

Mr. SPECTER. Would you relate the circumstances of your being called in to care for the Governor, please?

Dr. SHAW. I was returning to Parkland Hospital and the medical school from a conference I had attended at Woodlawn Hospital, which is approximately a mile away, when I saw an open limousine going past the intersection of Industrial Boulevard and Harry Hines Boulevard under police escort. As soon as traffic had cleared, I proceeded on to the medical school. On the car radio I heard that the President had been shot at while riding in the motorcade. Upon entering the medical school, a medical student came in and joined three other medical students. He stated that President Kennedy had been brought in dead on arrival to the emergency room of Parkland Hospital and that Governor Connally had been shot through the chest. Upon hearing this, I proceeded immediately to the emergency room of the hospital and arrived at the emergency room approximately 5 minutes after the President and Governor Connally had arrived.

Mr. SPECTER. Where did you find Governor Connally at that time, Dr. Shaw?

Dr. SHAW. I found Governor Connally lying on a stretcher in emergency room No. 2. In attendance were several men, Dr. James Duke, Dr. David Mebane, Dr. Giesecke, an anesthesiologist. As emergency measures, the open wound on the Governor's right chest had been covered with a heavy dressing and manual pressure was being applied. A drainage tube had been inserted into the second interspace in the anterior portion of the right chest and connected to a water-sealed bottle to bring about partial reexpansion of the collapsed right lung. An intravenous needle had been inserted into a vein in the left arm and intravenous fluid was running.

I was informed by Dr. Duke that blood had already been drawn and sent to the laboratory to be crossmatched with 4 pints of blood, to be available at surgery. He also stated that the operating room had been alerted and that they were merely waiting for my arrival to take the Governor to surgery, since it was obvious that the wound would have to be debrided and closed.

Mr. SPECTER. At what time did the operation actually start, Dr. Shaw?

Dr. SHAW. That, I would have to refresh my memory on that--now, this, of course--the point he began the anesthesia--that would be about right--but I have to refresh my memory.

Mr. SPECTER. Permit me to make available on the record for you the operative record which has been heretofore marked as Commission Exhibit No. 392, with the exhibit consisting of the records of Parkland Hospital on President Kennedy as well as Governor Connally and I call your attention to a 2-page report which bears your name as the surgeon, under date of November 22, 1963, of thoracic surgery for Governor Connally, and, first, I ask you if in fact this report was prepared by you?

Dr. SHAW. It was.

Mr. SPECTER. Now, with that report, is your recollection refreshed as to the starting time of the operation on Governor Connally's chest?

Dr. SHAW. Yes; the anesthesia was begun at 1300 hours.

Mr. SPECTER. Which would be 1 p.m.?

Dr. SHAW. 1 p.m., and the actual incision was made at 1335 or 1:35 p.m.

Mr. SPECTER. And what time did that operation conclude?

Dr. SHAW. My operation was completed at 1520 hours, or 3:20.

Mr. SPECTER. Will you describe Governor Connally's condition, Dr. Shaw, directing your attention first to the wound on his back?

Dr. SHAW. When Governor Connally was examined, it was found that there was a small wound of entrance, roughly elliptical in shape, and approximately a cm. and a half in its longest diameter, in the right posterior shoulder, which is medial to the fold of the axilla.

Mr. SPECTER. What is the axilla, in lay language, Dr. Shaw?

Dr. SHAW. The arm pit.

Mr. SPECTER. Dr. Shaw, will you describe next the wound of exit?

Dr. SHAW. Yes; the wound of exit was below and slightly medial to the nipple on the anterior right chest. It was a round, ragged wound, approximately 5 cm. in diameter. This wound had obviously torn the pleura, since it was a sucking wound, allowing air to pass to and fro between the pleura cavity and the outside of the body.

Mr. SPECTER. Define the pleura, please, Doctor, in lay language.

Dr. SHAW. The pleura is the lining of the chest cavity with one layer of pleura, the parietal pleura lining the inside of the chest wall, diaphragm and the mediastinum, which is the compartment of the body containing the heart, its pericardial sac, and great vessels.

Mr. SPECTER. What were the characteristics of these two bullet wounds which led you to believe that one was a wound of entry and one was a wound of exit, Dr. Shaw?

Dr. SHAW. The wound of entrance is almost invariably the smaller wound, since it perforates the skin and makes a wound approximately or slightly larger than the missile. The wound of exit, especially if it has shattered any bony material in the body, will be the larger of the wounds.

Mr. SPECTER. What experience, Doctor, have you had, if any, in evaluating gunshot wounds?

Dr. SHAW. I have had considerable experience with gunshot wounds and wounds due to missiles because of my war experience. This experience was not only during the almost 2 years in England, but during the time that I was head of the Thoracic Center in Paris, France, for a period of approximately a year.

Mr. SPECTER. Would you be able to give an approximation of the total number of bullet wounds you have had occasion to observe and treat?

Dr. SHAW. Considering the war experience and the addition of wounds seen in civilian practice, it probably would number well over a thousand, since we had over 900 admissions to the hospital in Paris.

Mr. SPECTER. What was the line of trajectory, Dr. Shaw, between the point in the back of the Governor and the point in the front of the Governor, where the bullet wounds were observed?

Dr. SHAW. Considering the wound of entrance and the wound of exit, the trajectory of the bullet was obliquely downward, considering the fact that the Governor was in a sitting position at the time of wounding.

Mr. SPECTER. As an illustrative guide here, Dr. Shaw----

Dr. SHAW. May I add one sentence there?

Mr. SPECTER. Please do.

Dr. SHAW. The bullet, in passing through the Governor's chest wall struck the fifth rib at its midpoint and roughly followed the slanting direction of the fifth rib, shattering approximately 10 cm. of the rib. The intercostal muscle bundle above the fifth rib and below the fifth rib were surprisingly spared from injury by the shattering of the rib, which again establishes the trajectory of the bullet.

Mr. SPECTER. Would the shattering of the rib have had any effect in deflecting the path of the bullet from a straight line?

Dr. SHAW. It could have, except that in the case of this injury, the rib was obviously struck so that not too dense cancellus portion of the rib in this position was carried away by the bullet and probably there was very little in the way of deflection.

Mr. SPECTER. At this time, Dr. Shaw, I would like to call your attention to an exhibit which we have already had marked as Dr. Gregory's Exhibit No. 1, because we have used this in the course of his deposition earlier today and this is a body diagram, and I ask you, first of all, looking at Diagram No. 1, to comment as to whether the point of entry marked on the right shoulder of Governor Connally is accurate?

Dr. SHAW. Yes. The point of entry as marked on this exhibit I consider to be quite accurate.

Mr. SPECTER. Is the size and dimension of the hole accurate on scale, or would you care to make any adjustment or modification in that characterization by picture?

Dr. SHAW. As the wound entry is marked on this figure, I would say that the scale is larger than the actual wound or the actual depicting of the wound should be. As I described it, it was approximately a centimeter and a half in length.

Mr. SPECTER. Would you draw, Dr. Shaw, right above the shoulder as best you can recollect, what that wound of entry appeared at the time you first observed it? Would you put your initials right beside that?

(The witness, Dr. Shaw, complied with the request of Counsel Specter.)

Mr. SPECTER. Now, directing your attention to the figure right beside, showing the front view, does the point of exit on the lower chest of the figure there correspond with the point of exit on the body of Governor Connally?

Dr. SHAW. Yes; I would say that it conforms in every way except that it was a little nearer to the right nipple than depicted here.

Off the record, just a minute.

(Discussion between Counsel Specter and the witness, Dr. Shaw, off the record.)

Mr. SPECTER. Dr. Shaw, in our off-the-record conversation, you called my attention to your thought that the nipple line is incorrectly depicted on that figure, would you, therefore, in ink mark on there the nipple line which would be more accurate proportionately to that body?

Dr. SHAW. Yes; I feel the nipple line as shown on this figure is a little high and should be placed at a lower point on the body, which would bring the wound of exit, which I feel is in the proper position, more in line with the actual position of the nipple.

Mr. SPECTER. Now, with the wound of exit as it is shown there, does that correspond in position with the actual situation on Governor Connally's body as you have redrawn the proportion to the nipple line?

Dr. SHAW. It does.

Mr. SPECTER. Would you put an "X" through the old nipple line so we have obscured that and put your initials beside those two marks, if you would, please?

Dr. SHAW. By the "X-1"?

Mr. SPECTER. Yes, please.

(The witness, Dr. Shaw, complied with request of Counsel Specter in drawing on the figure heretofore mentioned.)

Mr. SPECTER. Now, as to the proportion of the hole depicting the point of exit, is that correct with respect to characterizing the situation on Governor Connally?

Dr. SHAW. It is, and corresponds with the relative size of the two wounds as I have shown on the other figure.

Mr. SPECTER. Would you at this time, right above the right shoulder there, draw the appearances of the point of exit as nearly as you can recollect it on Governor Connally?

Dr. SHAW. This is right.

Mr. SPECTER. You say the hole which appears on Governor Connally is just about the size that it would have been on his body?

Dr. SHAW. Yes; it is drawn in good scale.

Mr. SPECTER. In good scale to the body?

Dr. SHAW. Yes.

Mr. SPECTER. Would you draw it on another portion of the paper here in terms of its absolute size?

Dr. SHAW. Five cm. it would be--about like that--do you want me to mark that?

Mr. SPECTER. Put your initials right in the center of that circle.

Dr. SHAW. I'll just put "wound of exit."

Mr. SPECTER. Fine--just put "wound of exit--actual size" and put your initials under it.

(The witness, Dr. Shaw, complied with request of Counsel Specter.)

Mr. SPECTER. Let the record show that Dr. Shaw has marked "wound of exit--actual size" with his initials R.R.S. on the diagram 1.

Now, looking at diagram 2, Dr. Shaw, does the angle of declination on the figure correspond with the angle that the bullet passed through Governor Connally's chest?

Dr. SHAW. It does.

Mr. SPECTER. Is there any feature of diagram 3 which is useful in further elaborating that which you have commented about on diagram 1?

Dr. SHAW. No. Again off the record?

Mr. SPECTER. All right, off the record.

(Discussion between Counsel Specter and the witness, Dr. Shaw, off the record.)

Mr. SPECTER. You have just commented off the record, Dr. Shaw, that the wound of entry is too large proportionately to the wound of exit, but aside from that, is there anything else on diagram 3 which will be helpful to us?

Dr. SHAW. No.

Mr. SPECTER. Is there anything else on diagram 4 which would be helpful by way of elaborating that which appeared on diagram 2?

Dr. SHAW. No.

Mr. SPECTER. Now as to the treatment or operative procedure which you performed on Governor Connally, would you now describe what you did for him?

Dr. SHAW. As soon as anesthesia had been established and an endotracheal tube was in place so that respiration could be controlled with positive pressure, the large occlusive dressing which had been applied in the emergency room was removed. This permitted better inspection of the wound of exit, air passed to and fro through the damaged chest wall, there was obvious softening of the bony framework of the chest wall as evidenced by exaggerated motion underneath the skin along the line of the trajectory of the missile.

The skin of the chest wall axilla and back were thoroughly cleaned and aseptic solution was applied for further cleaning of the skin, the whole area was draped so as to permit access to both the wound of exit and the entrance wound. Temporarily, the wound of entrance was covered with a sterile towel.

First an elliptical incision was made to remove the ragged edges of the wound of exit. This incision was then extended laterally and upward in a curved direction so as to not have the incision through the skin and subcutaneous tissue directly over the line of the trajectory of the bullet where the chest had been softened.

It was found that approximately 10 cm. of the fifth rib had been shattered and the rib fragments acting as secondary missiles had been the major contributing factor to the damage to the anterior chest wall and to the underlying lung.

Mr. SPECTER. What do you mean, Doctor, by the words "fragments acting as secondary missiles"?

Dr. SHAW. When bone is struck by a high velocity missile it fragments and acts much like bowling pins when they are struck by a bowling ball--they fly in all directions.

Mr. SPECTER. Will you continue now and further describe the treatment which you performed?

Dr. SHAW. The bony fragments were removed along with all obviously damaged muscle. It was found that the fourth and fifth intercoastal muscle bundles were almost completely intact where the rib had been stripped out. There was damage to the latissimus dorsi muscle, but this was more in the way of laceration, so that the damage could be repaired by suture. The portion of parietal pleura which had not been torn by the injury was opened along the length of the resected portion of the fifth rib. The jagged ends of the fifth rib were cleaned with a rongeur; approximately 200 cc. of clot and liquid blood was removed from the pleura cavity; inspection of the lung revealed that the middle lobe had a long tear which separated the lobe into approximately two equal segments. This tear extended up into the hilum of the lobe, but had not torn a major bronchus or a major blood vessel. The middle lobe was repaired with a running No. 3 O chromic gut approximating the tissue of the depths of the lobe, with two sutures, and then approximating the visceral pleura on both the medial and lateral surface with a running suture of the same material--same gut.

Upon repair of the lobe it expanded well upon pressure on the anesthetic bag with very little in the way of peripheral leak.

Attention was next turned to the lower lobe. There was a large hematoma in the anterior basal segment of the right lower lobe extending on into the median basal segment. At one point there was a laceration in the surface of the lobe approximating a centimeter in length, undoubtedly caused by one of the penetrating rib fragments. A single mattress suture No. 3 O chromic gut on an atromitac needle was used to close this laceration from which blood was oozing.

Next, the diaphragm and all parts of the right mediastinum was examined but no injury was found.

The portion of the drainage tube which had already been placed in the second interspace in the anterior axillary line which protruded into the chest was cut away, since it was deemed to be longer than necessary. A second drainage tube was placed through a stab wound in the eighth interspace in the posterior axillary line and both of these tubes were connected to a water sealed bottle. The fourth and fifth intercoastal muscle bundles were then approximated with interrupted sutures of No. O chromic gut.

The remaining portion of the serratus anterior muscle was then approximated across the closure of the intercostal muscles. The laceration at the latissimus dorsi muscle was then approximated with No. O chromic guts suture. Before closing the skin and subcutaneous tissue a stab wound approximately 2 cm. in length was made near the lower tip of the right scapula and a latex rubber drain was drawn up through this stab wound to drain subscapular space. This drain was marked with a safety pin. The subcutaneous tissue was then closed with interrupted sutures of No. O chromic gut, inverting the knots. The skin was closed with interrupted vertical mattress sutures of black silk.

Attention was next turned to the wound of entrance. The skin surrounding the wound was removed in an elliptical fashion, enlarging the incision to approximately 3 cm. Examination of the depths of this wound reveal that the latissimus dorsi muscle alone was injured, and the latex rubber drain could be felt immediately below the laceration in the muscle. A single mattress suture was used to close the laceration in the muscle. The skin was then closed with interrupted vertical mattress sutures of black silk. The drainage tubes going into the pleura cavity were then secured with safety pins and adhesive tape and a dressing applied to the entire incision. This concluded the operation for the wound of the chest, and at this point Dr. Gregory and Dr. Shires entered the operating room to care for the wounds of the right wrist and left thigh.

Mr. SPECTER. What did you observe, Dr. Shaw, as to the wound of the right wrist?

Dr. SHAW. Well, I would have to say that my observations are probably not accurate. I knew that the wound of the wrist had fractured the lower end of the right radius and I saw one large wound on the--I guess you would call it the volar surface of the right arm and a small wound on the dorsum of the right wrist.

Mr. SPECTER. Which appeared to you to be the point of entrance, Dr. Shaw?

Dr. SHAW. To me, I felt that the wound of entrance was the wound on the volar surface or the anterior surface with the hand held in the upright or the supine position, with the wound of exit being the small wound on the dorsum.

Mr. SPECTER. What were the characteristics of those wounds which led you to that conclusion?

Dr. SHAW. Although the wound of entrance, I mean, although the wound that I felt was a wound of entrance was the larger of the two, it was my feeling that considering the large wound of exit from the chest, that this was consistent with the wound that I saw on the wrist. May we go off the record?

Mr. SPECTER. Sure.

(Discussion between Counsel Specter and the witness Dr. Shaw off the record.)

Mr. SPECTER. Now, let's go back on the record.

Dr. SHAW. I'll start by saying that my examination of the wrist was a cursory one because I realized that Dr. Gregory was going to have the responsibility of doing what was necessary surgically for this wrist.

Mr. SPECTER. Had you conferred with him preliminarily to starting your operation on the chest so that you knew he would be standing by, I believe as you testified earlier, to perform the wrist operation?

Dr. SHAW. Yes--Dr. Gregory was in the hallway of the operating room before I went in to operate on Governor Connally and while I was scrubbing preparatory to the operation, I told him that there was a compound comminuted fracture of the radius of the Governor's right hand that would need his attention.

Mr. SPECTER. Let the record show that while we were off the record here a moment ago, Dr. Shaw, you and I were discussing the possible angles at which the Governor might have been sitting in relation to a trajectory of a bullet consistent with the observations which you recollect and consistent with what seems to have been a natural position for the Governor to have maintained, in the light of your view of the situation. And with that in mind, let me resume the questioning and put on the record very much of the comments and observations you were making as you and I were discussing off the record as this deposition has proceeded.