Fitstory of Med:Tea-2

Similarities in Fatal VV.oundings of and

Lee Harvey Oswald.

JOHN K. LATTIMER, M.D.

Professor of Urology and Chairman, Department of Urology, College of Physicians and Surgeons of Colombia University •

UST ONE HUNDRED YEA Rs AGO, FIGURE 1. John Wilkes Booth, handsom s'. J Lructi - 4etialit John Wilkes Booth, restricted by his cessful, but short (5 feet ii inches) dramatic ac' and enemy (Confederate) sympathizer who st.' brolZen leg, shuffled forward, bathed in a President Lincoln and was himself shot down r. glare of brilliant light, surrounded by his Corbett twelve days later. Booth, restrict,- • captors. by broken leg, was shot through spinal cc.: — -- Suddenly, a single pistol shot rang out, probably with Colt revolver; in glare of light trc.• fire set by captors and died about two hours and Booth. crumpled to the floor, his !at,' . ashen and • his limbs dangling limply.face Within two hourS, he was dead, silenced, but waited before he chose his moment t never having been brought to trial, never shoot.' Corbett. had fancied himself as . having provided society with a chance to lay preacher, and while working as a b. , provoke.from this recognition-hungry show- finisher in the city from which he took h: first name, had an encounter with ty man any information as to his motivation, , or words which might have implicated .ladies of the street,, which upset him cot... others, or to bring forth any data in his own .siderably.' defense. It was a frustrating, unlawful, • He then went home, according bitter moment (Fig. 1). Prichard and Herring. and "to be holy," The man who then stepped forward to he put it, cut off bc.th his testicles wick confess the shooting was an unstable, pair of scissors. The records of the Ma.- fanatical exhibitionist, frequently in sachusetts General Hospital for July V trouble, who later was committed. to an 1858, describe the incident as follows: insane asylum. His name was Boston Is a Methodist, and having perused ti Corbett (Fig. 2). Like Jack Ruby,• he ad- eighteenth and nineteenth chapters of Ali' mitted having been still closer to his victim, thew, he took a pair of scissors and mad, opening one inch long in the lower part of a Presented at the 16001 Annual Meeting of the Medical Society scrotum. He then drew down the testes a- • of the State of New York, New York City, session on History of Diferlicine, February 14, 1968. cut them oil. He Liam went to prayer rn,:' • ing, walked about some, and ate a heir:: 1782 New Yoik State Journal of Medicine / July 1,1966 Secretary of War Stanton's National Police Detectives, a 'kind of secret police, in the at tempt to capture Booth, whose trail had finally been picked up twelve days after the shooting of President Lincoln. The detail galloped to Bowling Green, Kentucky, to interrogate three ex-Confederate soldiers to whom Booth had made himself known, in the mistaken belief that they would sym- pathize with him and help him escape. They told Major Conger and Lieutenant Doherty Nvherv, they had left Booth, at the farm of a Mr. Garret t, three miles south of the ferry across the Rappahanock River, • near Port Royal, . They then re- turned to the Garrett farm. The events which followed can best be described in the ...■ ••=:: 2. Boston Corbett, religious fanatic, also ;.,::ntly in difficulties, who had castrated him- words of Sergeant Corbett and Major ! o moment of religious fervor, deliberately shot Conger, testifying at the trial of the con- ...•; Booth after other opportunities had passed spirators. Corbett= described the scene as orders. Corbett later declared insane follows: act of armed offense. Lieutenant-Doherty told me that Booth was in that house saying, "I want you o deploy the men right•and left around the di.1111.1% TIRTC W118 111,1 numb external hemor- house and see that no one escapes," which .11;me. but a clot. had filled the opening so was done. After making inquiry at. the house t LI the blood was confined in the scrotum, it. was found that Booth was in the barn. A was swelled enormously and was black. guard was then left upon the house and the I!, called on Dr. Hodges, (R. M.), who laid it main portion of the men thrown around the :1 and removed the blood; he tied the cord barn, closely investing it, with orders to sent. him here. allow no one to escape. We had previously When followed concise • progress notes been cautioned to see that-eur-arms were in readiness for use. After being ordered to sur- . dicating an uneventful course. render and told the barn would be fired in This previous history of instability did not five minutes if lie did not do so, Booth made -evil it his getting into the Army, however, many replies. lie wanted to know who we ::,1 ultimately finding his way into the 16th took him for; he said that his leg was bioken; .t.w York Cavalry where he fought with and what did we want with him; and he was told that it made no difference. His name • natical zeal. During his service career, was not mentioned in the whole affair. They •.• v. as frequently in difficulty because of his were told that they must surrender as !::zious fanaticism, however. At the time prisoners. Booth wanted to know where we -Itot Booth, in direct disobedience to the would take them, if they would give them- , selves up as prisoners. He received no satis- nding order for the capture of the as- faction but was told that he must surrender . in alive, he claimed he did so on divine unconditionally, or else the barn would be .-• nut ion. He was so unstable he was not fired. The parley lasted much longer than rinillcd to march with his regiment in the time first set; probably a full half hour, funeral procession and was still but he positively declared he would not sur- render. At one Lime he made the remark, ;imp when the order came for a hastily "Well my brave boys, you can prepare a dazed patrol to go out on an emergency stretcher for me," and at another time, .:SAOIL "Well, Captain, make quick work of it; shoot me through the heart," or words to . that effect; and thereby I knew that he was capture perfectly desperate and did not expect that he would surrender. After a while, we heard ()11 I he date with which we are concerned, the whispering of another person --although IA, 1865, he was assigned to the pick- Booth had previously declared there wes no detail of cavalrymen under Lt. Edward one there but himself—who proved to be the prisoner Herold. Although we could not "'"y which was to accompany distinguish the words. Herold seemed to he We (Major) Everton J. Conger, of trying to persuade Booth to surrender. After

July 1, 1966 / New York State Journal of Medicine 1783

on, +4,1,0,11,, • • ••■•••• a while he sang out, "Certainly," seeming to hear him speak a word after he was stye disdain to do so himself. Said he, "Cap, cept to cry or shout as he fell. Others, there is a man in here who wants to surrender were near hint and watching him const:!ty mighty bad." Then I suppose words fol- said that he did utter the words whitAt lowed inside that we could not hear. Herold published. perhaps thought he had better stand by him, or something to that effect. Then Booth said, National Police Detective Ever tot, "Oh, go out and save yourself, my boy, if you Conger,' who was in charge of the can" and then he said, "I declare before my des:. also testifying at the trial of the Maker that this man here is innocent of any c, crime whatever," seeming willing to take all spirators, said, concerning the shootil the blame on himself and trying to clear I went around to the corner of the b.s. Herold. He was told to hand out his arms. Herold declared that he had no arms, and pulled some hay out, twisted up a little Booth declared that all the arms belonged to set fire to it and stuck it back through on ; hint and that the other man was unarmed. of the hay. It was loose, broken up hay, Fie was finally taken out. without his arms. blazed very rapidly—lit right up at 05, Immediately after Herold was taken out, .r put my eye up to the crack next to the the detective, Mr. Conger, came around to the tire was put through and looked in, a!: the side of the barn where I was, and passing heard something drop to the floor wind, me, set fire to the hay through one of the supposed to be Booth's crutch. He turf cracks of the boards a little to my right. I around toward me. When I first got had previously said to Mr. Conger, though, glimpse of hint he stood with his back par- and also to my commanding officer, that the to me, turning toward the front door, i: position in which I stood left me in front of a came back within five feet of the cornet large crack--you might put your hand through the barn. The only thing I noticed he had his hands when he came it—and I knew that Booth could distingui4h was a carbine. i 7 me and the others through these cracks in the came badk, and looked along the cracks, barn; and could pick us off if ha chose to do after another, rapidly. He could not see :IL, so. In fact, he made a remark to that effect thing. He looked at the fire, and from at one time. Said he, "Cap, I could have expression on hiS face I ant satisfied picked off three or four of your men already looked to see if he could Put it out and IA if I wished to do so. Draw your men off satisfied he could not do it, it was burning t. fifty yards, and I will come out," or such much. He dropped his arm, relaxed I. words. Ho used such language many times. Muscles, turned around and started for ti Then the fire was lit, which was almost im- door at .the front of the barn. I ran aroto • mediately after Herold was taken out of the to the other side and when about half aro-J. barn. As the flames rose, he was seen. We I heard the report of a pistol. I went rig! could then distinguish him about in the middle to the door, and found Lieutenant Ba.• of the barn, turning toward the fire, either to looking at Booth, holding hint or raising hf. put the fire out or else to shoot the one who up, I do not know which. I said to hint "I; shot himself." He said, "No, he did a.. started it: I did not know which;"-but- was then coining toward me, as it were, a either." Said I, "Whereabouts is he shot the head or neck?" little to my right--a full front breast view. I raised him then, 41- • I could have shot him then much easier than looked on the right side of his neck, and sass when I afterward did, but as long as he was place where the blood was running. I sat.. there, making no demonstration to hurt any- "Yes, Sir, he shot himself." Lieutena: one, I did not shoot him, but kept my eye on Baker replied very earnestly that he did ne him steadily. Finding the fire gaining upon I then said, "Let us carry him out of he. him, he turned to the other side of the barn this will soon be burning." We took hint I and got toward where the door was, and as he and carried him out on the grass, underne.s got there I saw him make a movement to- the locust trees, a little way front the do., ward the door. I supposed that he was going I went back into the barn immediately to,, to fight his way out. One of the men who if the fire could be put out and tried sornewl. • was watching him told me that he aimed the myself to put it out,- but I could not; it a• carbine at me. He was taking aim with the burning so fast, and there was no water . carbine, but at whom I could not say. My nothing to help with. I then went bac mind was upon hint attentively to see that he Before this, I supposed hint to be dead. did no harm, and when I became impressed had all the appearance of a dead man, he that it was time, I shot him. I took steady when I got back to him, his eyes and 1140e. aim on my arm, and shot him through a large were moving. I called immediately for crack in the barn. When he was brought out water, and put it on his face, and he sun.: what revived, and attempted to speak. I I found that the wound was made in the I''- neck, a little back of the ear, and came out a my ear down close to his mouth. and he me- little higher up on the other side of the head. several efforts to speak, and finally I tut& • He lived, I should think, until about seven stood hint to say, "Tell mother I died for r country." I said to him, "Is that what s o'clock that morning; perhaps two or three say?" repeating it to him. He said "Yts hours after he was shot. I did not myself They carried him front there to the porch , 1784 New York State Journal of Medicine / July 1, 1966 Carrett's house and laid him on an old shoot at the boys. Corbett was (hereafter ...raw bed or something'. By that time, he ved considerably; he could then talk in a declared insane and committed to a hi-per, so as to be intelligibly understood;. mental institution. Sometime later be es- could not speak above a whisper. lie caped from this institution and was!never et] water, we gave it to him. Ile wanted heard from again. It was presumed that. he hr turned on his face. I said to hiin, "You may have died while walking across the ■•:,imot lie on your face," and he wanted to he plains in an attempt to escape to Mexico, t.irtied on his side; we turned him upon his ,ide three times, I think, but he could not lie although legends arose about his being a th any comfort., and tvanted to be turned successful patent medicine man in the immediately back. He asked me to put my South in later years.' on his throat and press down, which I did. and he said "I larder." I pressed down hard as T felt necessary, and he made very Booth's autopsy exertions to cough, but was unable to . do so • -no muscular exertion could he make. Booth, sunburned and haggard from ,opposed he thought something was in his twelve days of hiding in the underbrush !hr..■itt, and I said to him, "Open Your mouth .:rot put out your tongue, and I will see if it from searching cavalry patrols, had lost his hi,vds," which he did. I said to him; 'There handsome theatrical appearance, but; was in blood in your throat; it has. not gone identified by several persons by a per- ;hrough any part of it. there." lie repeated manent scar on the back of his neck which two or three times. "Kill me, kill me." The r,ply was made to him, "We don't want to apparently had a large cicatrix because it. till you; we want you to get well.;" I the had been broken open by the careless t“ok what things were in his pockets, and Booth before it wag entirely healed.' them up in a piece of paper. He was not This scar was the subject. of an article by then quite dead. lie would--once, perhaps, May,7 the man who had originally sutured m five minutes - -gasp; his heart would almost die out, and then it would commence again, the wound and later identified it. ..ad by a few rapid beats would make a Identification was further confirmed by -light. motion. I left the body and the Booth's initials, which he had tattooed on risoner Ilemld in charge of Lieutenant his own hand in scrawling-letters-as a child. Raker. 1 told him to wait an hour if Booth , His dentist, Dr. Merrill, who had filled two a. re not dead; if he recovered, to wait there :old send over to Belle Plain for a surgeon teeth for Booth the week before, forced from one of the gunships, and, if he died in Booth's mouth open and identified his ;lie space of an hour, to get the best convey- fillings., However, we can find no written :mm.0 he could and bring him on. I stayed report of the dental examination. Booth's 01,4, some ten minutes after that was said, family later accepted the body as his, with lum the doctor there said that he was dead. • I think we grit to Garrett's barn about two no question, even though the question was "'dock in the morning, and it was about raised as to how they could be sure it was tifi.,en minutes past three that Booth was his body. and carried out on the grass. The autopSy was performed by Janvier Subsequent to his admission of the Woodward, M.D., of the Army Institute '.:sting, Boston Corbett was placed under of Pathology, the same man who had per- :;,;:t because the orders of his detail had formed the .autopsy on Booth's victim, • :(.nsibly been to capture Booth alive. President Lincoln, twelve days before, at ' 1 .• was very shortly released, however, and the White House. His report" on Booth's • !..-d was somewhat lionized, and was autopsy is as follows: Ay given some $2,500 of the reward 'icy which had been offered for Booth's Case JWB: Was killed April 26, 1865, by a 1 colloidal pistol ball, fired at the distance of a ,1 ore, dead or alive. He was later made few yards, from a cavalry revolver. The ,,,r1;:eeper and sergeant-at-arms of the missile perforated the base of the right .:.tIsas State Legislature, listening in- lamina of the 4th lumbar vertebra, fracturing .. :Illy to the proceedings. On one fateful it longitudinally and separating it by a fissure from the spinous process, at the same time 'Y. while he was listening to the page fracturing t he 5th vertebra I hrough its starting a mock session of the legisla- pellicle, and involving that transverse process. '• .•• he heard one boy mock the chaplain's The projectile thew traversed the spinal canal sing prayer. This heresy instantly en- almost horizontally but with a slight inclina- ..ed him, and he suddenly leaped • to his tion downward and backward, perforating the cord which was found much torn and dis- Pulled out his pistol, and began to colored with blood (see specimen 9087 sect. I

July 1, 1966 / New York State Journal of Medicine 1785 were properly prepared and placed in museum (Fig. 3). The specimens 1 1, been wrapped in stout brown paper. that time, there was a rage for relics souvenirs of all kinds, and, influenced this feeling, Dr. Schaeffer cut off and served, duly labeled, a portion of the bli,, stained paper as a somewhat gh FIGURE 3. Photograph of John Wilkes Booth's a,• third, fourth, and fifth cervical vertebrae and souvenir of the tragedy. He placed it spinal cord, showing transverse bullet hole going his cabinet and had forgotten it wb. from right to left through spinal canal, penetrating about fifteen years afterward, in search: spinal cord at level of fourth cervical vertebra. for some specimens of dried human blood (Photo courtesy Armed Forces Institute of Pa- . thology, Washington, D.C.) illustrate to his private class in micros(.,. cal technics, he remembered the paper; submitting it to the proper treatment AMM) (Fig. 3). The ball then shattered the macerating and teasing with needles, bases of the left 4th and 5th laminae, driving bring out any structure that might bony fragments among the muscles, and made rema: its exit at the left side of the neck, nearly op- much to his pleasure and rather to his posite the point of entrance. It avoided the prise, the red corpuscles were seen with large cervical vessels and the filaments of the vi 'id distinctness, often sought in vain 2nd and 3rd cervical nerves. These facts ;Ore recent cases.? were determined at autopsy which was made on April 28. Immediately after the receptiOn Qn Aptil 29, 1865, Surgeon-Gene: of the injury, there was very general paraly- JoSeph K. Barnes deposited in the medi• sis. The phrenic nerves performed their func- museum a portion of the spinal cord in t: tions, but the respiration was diaphragmatic, section of the third, fourth, and fit of course, and labored and slow. Deglutition Cervical vertebrae which were remov, was impracticable, and one or two attempts at autopsy from the body of the assass.. at articulation warn unintelligible. Death, from asphyxia, took place about two hours John Wilkes Booth (Fig. 3). The spit: after the reception of the injury. cord was perforated from right to left al J. J. WOODWARD the laminae of the fourth •and fifth yen, brae were fractured by a conoidal pistol b. When it was mentioned that the photo- graphic division of the Army Institute of fired at a distance of a few yards. Boo• Pathology had reproduced the picture died two hours after the injury." of John Wilkes Booth for distribution to An additional small fragment of Jeb• aid in his capture after the death' of Wilkes Booth's body was discovered I , President Lincoln in April 1865, Dr. the author in a bottle in the Mutt.• Medical Museum of the College of W.. Woodward's associate, E. M. Schaeffer, sicians of Philadelphia, in the care of M.D., was reminded of one of his first Cur. duties at the museum as a hospital steward tor Ella N. Wade (Fig. 4). This is a fra.:. meat approximately 1 V of the Army." This was to mount on e by 3/4 inche. which resembles a fragment of rib cartilat: cardboard several hundred of these copies and bears the following label: "PART OF TI:" which had been made by Edward Curtis, 1%/I.D. Not long after this, Dr. Woodward THORAX (CAVITY OF THE CHEST) OF WILKES BOOTH, APRIL 14, 1865, TD received a message from the War Depart- ASSASSIN OF PRESIDENT LINCOLN PROCTIRT ment directing him to take his postmortem case and repair to the arsenal. When he re- PRES. BY THE MESSENGER OF SURGEON' turned to the museum, he said that he had GENERAL." made an autopsy on Booth, whom he would have recognized from the photo- The weapon graphs, although the face was much freck- While the revolver mentioned by led and tanned by exposure to the sun. Co: Dr. Woodward brought with bett was not described in detail at the tri.ti him the there seems little reason to doubt that i cervical vertebrae and spinal cord show- . was the standard .44-caliber Colt "Army' ing the track of the bullet 'that had killed revolver Booth; after further examination, these . (Fig. 5), a percussion-cap weapo! which was loaded with a substantial char; 1786 New York State Journal of Medicine / July 1, 1966 FIGURE 5. Colt .44-caliber "Army" revolver carried by Booth of type with which hp was shot. (Photo courtesy National Park Service, U.S. Depart- ment of the Interior.)

carbine, which might have been the standard armament for a trooper in his military unit." The fact that he apparently was the sergeant in charge of the patrol and that this was a detail especially designated to undertake the capture of the man whom the whole world was waiting to see capture& certainly would have justified the additional armament. Corbett's reason for using a pistol rather Than the more accurate carbine is un- explained, but he may have felt that he could get his eye closer to the crack be- tween the boards with the pistol, thus improving his field of vision within the barn, as he decided whether or not to shoot. Actually, if he had used his more powerful 50-caliber Spencer carbine, the wound might have been much larger than • ?. it was, as seen by the perforations in the vertebrae. FIGURE 4. Specimen and label of bottle con- Still another argument has been raised :n,ning portion of Booth's thorax. (Courtesy by those who believe that Lieutenant Con- '•' otter Medical Museum, College of Physicians of ger had been sent out by Stanton's Secret Ph, iadelphia.) Service men deliberately to silence Booth, rather than to take him alive and permit f black powder and fired a conoidal bullet him to implicate others wild might have with more than enough velocity to per- been behind the plot." It has been men- forate Booth's neck and vertebrae as de- tioned that Corbett was at the back of the ribed." Corbett"- spoke of steadying his barn whereas Conger, by his own testimony, ).1,%t al by resting it on his arm, which was a i.,, was at the side of the barn, when the shot polar way for cavalrymen to provide a was fired. Since the bullet hole went 7,.1 for the otherwise heavy and difficult transversely through Booth's neck, it has The fact that he hit Booth been argued that Conger would have been yN:a(.tly in the spinal cord, and in the neck, in the position to fire the bullet in such a a sheer stroke of luck, considering the lateral direction, rather than Corbett. Iltit•rent inaccuracies of pistols and the fa, One must remember, however, that Corbett -t that, he almost certainly would have stated that Booth was appearing to raise aiming at Booth's thorax. his carbine to fire toward the front door The quest ion has been brought up as to just. as he was shot. Just before a man takes :A !wilier Sergeant. Corbett. was actually . aim with a carbine, he ordinarily turns his ,,rtned with a pistol, rather than only a body sideways toward the target, so that

July 1, 1966 / New York State Journal of Medicine 1787 the right side of his neck might have been presented toward Corbett, for a moment, after all, as this author sees it. At least one outstanding student, Col. J. E. Raymond,” reasoning 'inferentially, agrees with Conger that Booth probably shot himself. The fact that the course of the bullet ranged slightly downward might be taken as support of this theory, but a "glance" from the bone at the point of entry into the spinal canal might also ac- count for the direction. It is hard to con-' ceive that Booth would not have put the pistol to his brain, however, if he did indeed intend suicide. Conger', stated that he marked and unloaded Booth's carbine but did not mention examining Booth's pistols to see if one chamber had been fired. Neither did Dr. Woodward, who did Booth's autopsy, mention powder burns on the skin as from a suicide. Neverthe- less, Colonel Raymond poses impressive Morning N. and persuasive arguments in favor of FIGURE 6. Lee Harvey Oswald, enemy (Con suicide, quoting Booth's remarks "Prepare munist) sympathizer, who shot President Kenne..: a eteetcher for me," and postulating that but was himself shot doim by Jack Ruby two Booth shot himself in the neck to spare his later With Colt revolver. Oswald was restricted t. handsome face. Colonel Raymond's views handduffs while surrounded by his captors ar bathed in glare of light for television units. H e. Will bear some further investigation, cer- pleurae, spleen, stomach, aorta, vena ca tainly.'" superior mesenteric and renal vessels, kidne. These arguments are in no way meant to liver, and ribs were all hit by single bullet, and f negate the impressive circumstantial evi- died about two hours later. dence that Stanton may have been behind the plot to assassinate Lincoln, as accumu:._, (Fig. 6) crumpled to the floor, ashen, wit!: lated by the late Otto Eisenschiml," Shel- his limbs dangling loosely. Two hour- ton," Neff," and Roscoe," all quoted in later he, too, was dead, despite the herei, 7%, moil War Times of February and efforts of a skilled trauma team (Fig. i July, 1965,14.2" which suggest that Stanton's Here again, an attention-hungry chief of National Police Detectives, Gen. accused of having slain a President, had bea r. Lafayette C. Baker, may have written to silenced before society had had a chance Booth only one month before the assassina- draw from him any information concerniti tion and may have transferred some $16,000 his motives, any possible implication to Booth in Canada via a dummy cor- higher-ups, or to bring forth any inform.:' poration in New York. tion in his own defense. This time th., • shooting was seen by millions, on television. Fatal wounding of Oswald so that the nation's sense cf outrage an frustration was compounded a thousami Just ninety-eight years later, another- times more than in the case of Bowl- accused presidential assassin shuffled for- where the circumstances of the shootir. ward onto the stage of history, also sur- were not so well known to the public. rounded by his captors, restricted by his Here again, the man Jack Ruby (Fig. fetters, but truculent and defiant, into a born Jacob Rubenstein, who stepped fcr• brilliant glare of light. This time the light ward to do the shooting, was an unstah:t was from television flood-lights, in the person, crav tug s La-tow-Ill ion, basement-garage of the Dallas, given to OW. Texas, bursts of emotion, temper, and aci 11:1! Police Department. Again, a single pistol violence, and chronically in trouble with shot rang out, and Lee Harvey Oswald authorities.' He appears to have go inc.!'

1788 New York State Journal of Medicine Z July 1, 1966

• . \ ''(' '',.'il \S ‘..- "Th , t4 --..- 1

( Photo by Bob Jackson )in Dallas Times Herald) .6URE 7. Oswald grimaces as Ruby's bullet , _ roes his body.

.:,'tees to Oswald by energetically ingratiat- :ag himself with the crowd of newsmen, :ISLA • World Wide Photos IO interviewers, and policemen who sur- r..unded Oswald following the arrest, by FIGURE 8. Jack Ruby, violent fifty-five-year-old nightclub operator, frequently in difficulties,*who - winging in sandwiches and soft. drinks to dis-, repeatedly achieved place Close to 'Oswald by :rihute among the newsmen and police.22•" acting like reporter's assistant, before shooting I le also posed as an interpreter for newsmen him down just as he was about to be transferred :n.tn lsrael.==.23 Photographs from the to more secure quarters. Ruby presently pleading rcport of the Warren 'Commission show insanity in effort to escape death sentence already passed on him. 1:,thy in the crowd of newsmen before whom ■,wald was interrogated on one or more ,!.lys liriur to his shooting of Oswald.23 Front title, it seems probable that Ruby police fashion, so that the pistol would be LA at least one even better opportunity to less obvious, would be firmly held, and boot the handcuffed Oswald during this would be better protected from any blow pt.riod than he had at the moment he from an onlooker or protector •of Os-:- which came after the police had been wald.23,=2 He then advanced quickly until krted to assassination attempts and were the tip of his gun practically touched the :ding Oswald to an especially protective victim and fired his single shot into Os-- ,snored car in recognition of this peri1.21,2b weld's lower thorax and abdomen.'• `:inilarly, Boston Corbett commented that Unlike Corbett, Ruby was neither !., had had an even easier chance to shoot leased from his imprisonment nor. re:--7 prior to the moment he selected.2 warded; no time had elapsed for a reward -- Like Corbett, Ruby employed a some- to be offered because of the alertness of the sophisticated technic, adapted to the late Police Officer Tippitt, of the Dallas c of weapon he used. Ruby's was a very Police Force, in locating Oswald on a very -fr,,rt-barrelled revolver, of the type made inconspicuous back street near Oswald's !,•• easy concealment, as in the pocket, which rooming house, within forty-five minutes - !Ind a fairly advanced type of cartridge, of the assassination of President. Kennedy. 'tiled a ".38 Special," now standard in It should be noted, however, that. Ruby's nmst police weapons in the United States. death sentence has not yet been carried out. ;h. did not extend his arm at full length Booth, of course, had made good his :ral at tempt to aim his shot from a distance, escape, wit h or without col l a borat ion;. the usual amateur might, but bent. his was armed; and was at large for some dy slightly forward and advanced his twelve days before he was captured, during • !loc,ting liana only part way, in approved which time a large reward was offered for

July 1, 1966 / New York State Journal of Medicine 1789 his apprehension and during which time moved. The bullet pathway was then idol, the temper of the nation to see him brought fled as having shattered the upper medial face of the spleen, then entered the re!, in, dead or alive, grew in intensity. The peritoneal area, where there was a large re:. fact that Corbett had caused him to be peritoneal hematotna in the area of the r brought in dead, under these circumstances, cress. Following this, bleeding was se..n • probably made Corbett's crime seem some- be coming from the right side, and on bIst tion, there was seen to be an exit to the what less heinous than that of Ruby, whose through the inferior vena cave, tho' victim (Oswald) was thoroughly enmeshed through the superior pole of the right k,,, • in the due process of law at the time he ney, the lower portion of the right lobe of •: was shot. The present generation of liver, and to the right lateral body Americans was looking forward to a First the right kidney, which was blee1i was identified, dissected free, retracted it.. thoroughgoing examination of the cir- tnediately (sic), and the inferior vena ca% cumstances surrounding his act, with the was clamped with a partial occlusion clamt.. hope that many questions about it might the Satinsky type. Following this hoe, have been answered. bilization (sic), packing controlled the bl,. ing from the right, kidney. Attention a.. then turned to the left, as bleeding was th,.. Oswald operative findings piVe from the left side. The inspection of t! retroperitoneal area revealed a huge hem.. While Oswald was on the operating tome in the midline. The spleen was da table at the Parkland Memorial hospital, mobilized, as was thti left colon, and the reir, peritoneal approach' was made to the and was opened within approximately structures. The pancreas was seen to I twenty minutes after the shooting, he was !Mattered in its midportion; bleeding a.: already in deep shock due obviously to seen to be coming from the aorta. This ie.. Massive internal blood loss. George dissected free. Bleeding was controlled Wii; Thomas Shires, M.D., Malcolm 0. Perry, finger pressure by Dr. Perry, on identificati,- of this injury.The superior mesentec M.D., Robert N. McClelland, M.D., and artery had been shared off the norla; the.- Ronald C. Jones, M.D., opened his abdo- was bleeding from the superior mosentol. men through a xyphoid-to-pubis midline artery. This was cross-clamped with a stna' incision at 11 : 44 A.M., in the same curved Dellakey clamp. The aorta was tiv . occluded with a straight DeBakey clan:: emergency suite • where his victims, above and a Potts clamp below. At this point President Kennedy and Governor Connally, all major bleeding was controlled, blood on-- had lain two days before, and in the same sure was reported to be in the neighborhoci hospital where Oswald's second child had of 100 systolic, Shortly thereafter, howevc recently been born. The actual acconnt.ef the pulse rate, which had been in the 80 to it range, was found to be 40, and a few secord- the operation follows": later found to be 0. No pulse was found the aorta at this time. Consequently, th• Operative record. Date: 11/24/63. Park- - land Memorial Hospital left side of the cheat was opened through a Name. Oswald, Lee Harvey intercostal incision in approximately 0: Age. Twenty-four years fourth intercostal space. A Finochietto Pt. No. 25260 tractor was inserted; the heart was seen t Previous inspection be flabby and not beating at all. There w..- Clinical evaluation. . had revealed an entrance wound over the left no hemopericardium. There was a hole in 0 lower lateral chest cage and a near exit was diaphragm but no hemothorax. A left cloy : chest tube had been introduced in the emer- identified by subcutaneous palpation of the - bullet over the right lower lateral chest cage. gency room prior to surgery, so that the: At the time he was first seen preoperatively, was no significant hemothorax on the he was without blood pressure, heart was aide. The pericardium was opened, cardi.: • heard infrequently at 130 beats per minute, massage was started, and a pulse was obtai:' and preoperatively had endotracheal tube able with massage. The heart was flabby placed and was receiving oxygen by anes- consequently calcium chloride followed b.. thesia at the time he was moved to the epinephrine-lidocaine were injected into th operating room. Measured blood loss: left ventricle without success. However, th standstill was converted into fibrillatio, 8,378 cc. Description of operation. Under endotra- Following this, defibrillation was done, usi..-7 cheat oxygen anesthesia, a long midline ab- 240, 360, 500, and 750 volts, and finall;. dominal incision was made. Bleeders were successful defibrillation was accompli het • However, no effective heartbeat could I not apparent and none were clamped or tied. ,. On opening the peritoneal cavity, approxi- instituted. A pacemaker was then insert mately 2 to 3 L. of blood, both liquid and in into the Wall of the right ventricle a!7 , clots, were encountered. These were re- grounded on the skin, and pacemaking wr

1190 New York State Journal of Medicine / July 1, 1966

tt.d. A very feeble, small, localized, to aid in attempts at fluid replacement. The • lar response was obtained with the abdominal incision was made at 11:44 a.m., maker but still no effective beat. At this and by 12:15 p.m., he had received 3,000 ml. le• we were informed by Marion T. Jenkins, of blood and 800 ml. of 5 per cent dextrose in •,t : hi., the anesthetist, that. there was no sign lactated Ringer solution. By 12:30 P.m., he • : in that. the pupils were fixed and dilated, had received 6,000 ml. of blood, and his •:.,.:4 was no retinal blood flow, no respire- measured blood loss was 5,000 ml., except • eafort., and no effective pulse could be that it was obvious that there was additional .,,;,:::tined even with cardiac massage. The loss in the tissues. Five per cent dextrose in .:e•at was pronounced dead at 1:07 P.M. lactated Ringer solution was again started, a tic t he tic agent consisted entirely of and the patient's pulmonary status seemed vgen. No anesthetics as such were ad- satisfactory. At 12:37 P.M., the heart sound nt The patient, was never conscious became weaker and the pulse rate slowed from :•• .•111 t he t ime of his arrival in the Emergency its previously 80 to 60, 40, and then became j : en until his death at 1:07 P.M. (He had imperceptible, confirmed by the cardioscope. briefly in the ambulance, en route By this time,. the patient had received '151/2 . hospital--author.) The subcutaneous units of blood and 4,200 ml. of 5 per cent !Ict was extracted from the right side dur- dextrose in lactated Ringer solution. It was • ,.t the attempts at defibrillation, which were judged that the period of cerebral hypoida •. :.rated among the surgeons. The cardiac during the period between the gunshot wound is,tge and defibrillation attempts were and the time effective ventilation was started .rt it•ti out by Dr. McClelland, Dr. Perry, had caused irreparable damage to the cardio- at Dr. Jones. Assistance was obtained from vascular center of the brain, introducing the cardiologist, Found Bashour, M.D.— final cardiac asystole, despite all resuscitative Torn Shires. measures. lit preparation for the operation, the ,.:;.t•rbly organized trauma group of the 1..irkland Hospital, who had been informed It is certainly well known to military Oswald was on his way after having been and trauma surgeons that bullets which •:lot, had assembled a resuscitative team in perforate both the aorta and the yens cava emergency operating room surgical room." are uniformly fatal. A review of the records t ht his arrival, Dr. Akon introduced a no. 36 „of the Parkland Hospital revealed that this .tired, endotracheal tube and connected it to the anesthesia machine for assisted ventila- was true in their experience also, in a long ti.:11 and oxygen. It was obvious that the list of gunshot wounds which they have ttient was in extremis as judged by his treated over the years, as the trauma center t•, neral pallor, dusky or ashen gray nail beds, for the Dallas area. c•Ji extremities, gasping respirations, dilated at tits, and dry conjunctiva. Three members the staff were performing venous cut- Autopsy report .h.was, one in each of the lower extremities .0;d one in the left forearm (Charles D. Coln, Earl F. Rose, M.D., and Sidney C. M.D., Charles A. Crenshaw, M.D., and Stewart, M.D., of the Dallas County f;,rald E. Gustafson; M.D.). Because of the ..livious chest wound and the appearance of Medical Examiner's Office, performed an rcumothorax on the left, Dr. Jones inserted autopsy, no. 1163-356, on November 24, the chest tube and connected it to a closed 1963, at 3:45 P.M. The relevant portions .,ater-sealed drainage bottle, as had been read as follows': (late in the case of President Kennedy. The brad of the emergency room cart was lowered into a Trendelenburg position. There was no External examination. External examina- :•.:rceptible peripheral arterial pulsation. tion reveals' a five foot nine inch white male: I lowever, the cardioscope tracing showed an estimated weight 150 pounds. Rigor is not .I...ctrical cardiac activity with a heart rate of present, slight cooling of the body. There is roximately 130 per minute. Blood was faint posterior mottling and lividity. The ....la. to the blood bank for immediate typing. hair is brown, slightly wavy. Small amounts .0a1 erossmatch, and two units of uncross- of dried blood in the hair which has run from al:Itched. type 0, Rh negative blood were the hairline to the right and backward. :•::a-ted by pressure infusions by plastic blood There is a left periorbital hematoma which is ..,,ittainers. William Risk,.M.D., the urology purple in the central portion, fading at the ;-,•,Itlent, had inserted a Foley catheter into margins to a faint lemon-yellow. Total diam- :he urinary bladder, obtaining only a scanty eter of this is 1'/4 inches by 1,/, inches. The ioant it y of urine which. was not blood-tinged, irides are gray-blue, the pupils are equal at 8 t:,•spit e the massive wound to the right .kid- ml. The sclerae and conjunctiva are not re- The abdominal incision was made ex- markable. '":tly twelve minutes after the patient first .::tered the emergency operating room. A Various other scratches and abrasions of tan in the right forearm was also cannulated minor type are then described in detail.

July 1, 1966 / New York State Journal of Medicine 1791 The incisions for the insertion of the chest tube on the! left, the thoracotoinA! for the cardiac massage, the midline laparotomy . incision, and the various cutdown incisions on the limbs are next described hi detail. Twenty/411mo inches from the top of the end and 33(, inches to the left of the midline teriorly and 10',", inches to the left of the rzpidline potteriorly over the lower aspect of the I left' cheilt.,ri 'There, is an entrance-type wound which' Ofisures 1 /4 by 1/1.1 inch in diameter, TbizA'aurroundecl by a contusion ring; the totalidllwilieter of the contusion ring is 4/$ inch. ..,1i ) " ! FIGURE 9. Colt ,38 "special Cobra" revolver Twenty4Woi)tches from `-'the op of the protective shroud over hammer to permit fir, head, end ;91'1 inches to the righp f the mid- from inside pocket if necessary. This type pi; line 'anteriorly and 81./4 inches to e right of used to kill Oswald. (Photo courtesy Colt Mai the midlihe of the back, there is a vertical 2- facturing Company.) by 1-inch gaping wound (bullet removed via this incision). Posteriorly to this by t;'2 inch, there is a 3/4- by 3,18-inch irregular contused with the superior mesenteric artery bei area (this appears to be the place where the ; severed. The .right renal artery shows bullet had come to rest after perforating the atruction and hemorrhage along the cephal fractured eleventh rib). portion. The right renal vein is torn and I Incisions, The standard "Y" thoraco- tear involves the inferior vena cave, the dor abdominal ' and interroastoid incisions 'are surface'. It courses through the upper polc utilized. Reflecting the skin, there is found the right kidney along the anterior surfa to' be a wound between the fourth and fifth causing a jagged and irregular lamer: ribs which extends through the soft tissue and covering a distrince of 5 by 2 cm,,, with pc! measures 6 inches in length, This conforms, tration into the? calyces. It becomes pc to' the thoracotomy wound in the left chest. tonealized in the hepatorenal pouch, The incision is continued through the ! ab- there ill a jagged and irregular laceration dominal wall as well as the thoracotomy the liver covering a distance of 9.5 by 2 by wound to the left of the midline of the chest. cm. From the liver, it penetrates the d Serous cauities. Examination of the serous phragm posteriorly on the right side. It th cavities is made. In the left pleural space, passes adjacent to the lung in the pleural sp: approximately 175 cc. of blood. In the right and the right lung is not penetrated. T pleural space, there is in excess of 600 cc. of eleventh rib to the right of the midline blood. In the peritoneal cavity, there is in irregularly fractured with an exit type won excess of 1,000 cc. of blood, with chit forma- in this region, and in the soft tissues along tion. In addition, there is massive retro- posterior axillary line, right side, there is peritoneal hemorrhage. The omentum adja- incised wound and fragmentation of the ril cent to the transverse colon and stomach is hemorrhagic and irregularly torn. The remainder of the. autopsy accou Course of wound is followed. It is found to describes no other abnormalities, and 1 notch the undersurfaCe of the seventh rib at microscopic findings tiro only those of r! the costochondral junction; this is Sur- rounded by hemorrhage. In its course, it ruption and fresh hemorrhage in the ar:. notches the diaphragmatic attachment in this previously mentioned. The pancreas %% region. However, the left lung is not pene- apparently not penetrated after all but trated. The course is found to go from the surrounded by hemorrhage. Its dui' left to the right and backward. In its course, system was not remarkable. The adre it is found to strike the inferior edge of the spleen, and there is a cruciate laceration of glands were both surrounded by hem, the spleen measuring approximately 1.5 by 2 rhage, but both were intact. The br: cm. The missile is found to penetrate the weighed 1,450 Gm. and showed no abn. stomach along the greater curvature of the malities grossly. Further sections; body of the stomach, the penetration measur- special studies were to be done on it.: ing 9 mm. It exits from the stomach along the posterior wall, lesser curvature, 2 cm. distal to the cardioesophageal junction. This penetration measures 8 mm. It pursues a Ruby's weapon course backward and to the right, slightly caudal to the celiac axis, and there is extensive The pistol employed by Ruby to sl: hemorrhage in this area. The anterior and Oswald was a Colt revolver, caliber ••• right anterolateral aspect of the aorta is torn, Special," of the model known as • A 1792 New York State Journal of Medicine / July 1, 191i11 14-a." (Fig. 9). It had a 2-inch barrel, bank. Ruby is quoted by Police Officer of bitted steel with brown plastic McMillin, who helped subdue him, as left grip chipped), serial number saying to Oswald: "You rat, son of a bitch, ; This pistol was equipped With you shot. the President," and then firing his ial shield for the hammer so that it shot.. During the scuffle to subdue him, he c:.1 be tired from inside the pocket, if quoted Ruby as saying repeatedly, "I hope .-nary, with the shield protecting the I killed the son of bit ch." When Ruby .:.Aner from being caught in the cloth was told Oswald would probably die, Ruby of the pocket.,1 A "piece" (gangland then said, "I meant to shoot him three .::ance for a firearm) with such a short times but you police moved too fast and .rrd is notoriously inaccurate, except at prevented me from doing so,"32 '1 a -blank range. fact that Ruby was able to kill his at with a single bullet from his Colt Summary was surprisingly analogous to the John Wilkes Booth and Lee Harvey of his historical predecessor, Boston Oswald were both shot down deliberately, .rhett, for perhaps Booth himself, if it while confined, in the glare of bright light's indeed suicide, as Raymond" believes.), provided by their captors and by persona ing Booth with a single shot, probably •acting against orders or against the law. -., from a Colt pistol, nearly a hundred Booth was restricted by his broken leg and earlier. The fact that Ruby struck Oswald by his handcuffs. Both men who • I: the vena cave and the aorta; • de- were accused of shooting them were later la d t he superior mesenteric artery; per- characterized as insane and Were re- ded the right renal artery and vein, as markably similar in many ways. Each 1 as the spleen, the stomach, the right man bided his time before firing his shot, and the liver; and holed the and the technic of both appeared to reveal .tra in the costophrenic angle both a certain degree of expertise in the way in loriorly and posteriorly, is nothing short which they handled their weapons. While remarkable. It was probably even more both shootings may well have been the than jibe had struck Oswald directly actions of excited men in attacking what . the heart.....The fact that it struck a rib they considered to be a national enemy, cartilage anteriorly and the eleventh there are many sophisticated observers who posteriorly was probably the only regard this point of view as being unduly : -on that it did not exit. from the body naive. They believe that since both ac- 1 strike some of the police officers cused presidential assassins were active 'Ain directly behind and to the right enemy sympathizers (Booth for the Con- !. )scald. It was equally remarkable that federacy and Oswald for the Commu- net is one bullet hit Booth exactly in nists),"" and since both shootings took • spinal cord. The fact that Ruby did place during an era of large-scale undercover get off additional shots resulted from operations, psychological persuasion, philo- alacrity and vigor with which the sophic rivalry, and intelligence activity, omen in the room seized his gun and that both men may have been silenced as !: hand and wrestled him to the floor. part of a larger design. • .•:r grip on the gun probably immobilized It is interesting that information is now •• cylinder so that it could not turn again, being put forth which suggests that Booth he weight of the several men who was on the payroll of a "dummy" company • itil be dearly seen to jump on Ruby, in in New York City which was a "front" !decision films, probably prevented him for the "undercover" operations of Gen. firing more shots. LaFayette C. Baker, chief of the National ku by reported that he had purchased the Police Detectives, which was Secretary of !'l about three years before, for the War Stanton's "secret police" type of :rinse of protecting himself because he operation during the Civil War.17-19 •r fed considerable amounts of cash in the r • 1, Furthermore, the compendium of circum- :action of his night club business. stantial evidence accumulated by the late ordinarily carried it in t he trunk of his Otto Eisenschiml" makes wonderful rend- which lie also used as his temporary ing and made him firmly of the opinion

July 1, 1966 / New York State Journal of Medicine 1793 that Stanton encouraged the plot to as- New York, Wilfred Funk, Inc., 1910, p. 36. sassinate Lincoln. 9. Shuttle, J. W.: John Wilkes Booth at achy„,: Dramatic Mirror, (Feb. 20i 1911',; Baker, Both presidential assassins were strange, L. the United St Secret Service, Philadelphia,C.: la,;;11,, compulsive men, repeatedly in trouble with 10, Wood‘vanl, .1. J.: Booth autopsy report, j and Surgical 1 history of War of the Itebelho the authorities over a succession of minor Surgical Volume W44, Washington, D.C., Stu n• I. -14 infractions. Office, 1875, p. 452. ,01,C, 11. Schaeffer, E. M.: in Lamb, D. S.: W,,4, In any case, against this background of Medical Annals, a history, Washington, D.C., Army Museum, January, 1916 vol. 15, p. 3 similar features, it is no less than amazing 1. 12. Purtle, H. R.: Lincoln memorabilia in the that each of the accused presidential as- museum of the Armed Forces Bistituee of Patholo II sassins, Booth and Oswald, was successfully Hist. Med. 32: 68 (1958). gy, 13. Peterson. H.: National Park Service, Wash:. killed each by a single bullet probably fired D.C., personal communication, 1904. 14. Fowler, R. H.: Album of the Lin mln from a Colt revolver. Both men lingered War Times. Gettysburg, Pennsylvania, July, 1965,NIurik•r. p. for about two hours before dying. As most 15. Eh:emit:hind, 0.: Why Was Lincoln Mu:, Roston, Little, Brown and Company, 1937. military and accident 'room surgeons know, 16. Raymond, J. E.: Personal a great many pistol bullets are fired into 1966. communication, 17. Shelton, V.: Mask for Treason, 1965. people without hitting any structure which 18. Neff, R.: Civil War Times. Aug. 1961. 19. Roscoe, T.: The Web of Conspiracy, would bring about such rapid deaths. 1959. 20. Shelton, V.: in Fowler, It. The similarities In these two fatal wound- Gettysburg, Pennsylvania, Feb. 1965,H.: p. 4.Civil War T. 21. Arrusts and violations of Jock Ruby, ings merely add to the striking number of in Warrta port, Washington, D.C., U.S. Government Printing t) other coincidences which continue to appear 1964, p. 779. in the histories of the assassinations of two 22. Ruby bringing in food and posing as an interpren Warren Commission 1Hearings, Washington, D.C., ; of our martyred presidents, Abraham Lin- Government Printing Office, 19134, vol. 19. pp. 635, 23. Ruby posing ea a reporter, in Warren &- coln and John F. Kennedy. Washington, D.C., U.S. Government 341. Printing Office, 620 WEST 168TH STREET 24. Ruby stood near Oswald at press conferen. Warren Conimi$sion Hearings, , -Washington, D.C., I Government Printing 0ftice. 1964. vol. 19, 25, p. 176. ' -pp: 634, 916; References 25. Photographs of Ruby in police headquarters on of November 22, near t. powald, In Warren COmmission 1. Ruby present at ()mold press conference, in Warren ceedings, Washington, D.C., U.S. Government PC. Commission Hearings. Washington, D,C., U.S. Government Office, 1964, vol. 25, pp, 521, 570. Printing Office, L964. vol. 19, p. 634, 26, Police warned Oswald would be shot, in V. 2. Sergeant Boston Corbett: in Pitman, B.: Asaaasi- Commission Hearings, Washington, D.C., U.S. Govern, nation of President Lincoln and the Trial of Conspirators, Printing Office. 1964, vol. 13, p. 770. New York, Moore, Wistach, and Baldwin, 1865. p. 94. 27. Ruby crouched over his gun, in ibid., 3. Johnson. B. B.: and Boston Cor- 28. Operative report on Oswald, in vol, 19, p. bett. Boston, Lincoln and Smith Press, 1914. 211. Resuscitation efforts for Oswald,ibid., three vol. 17, p. 4. Herring, A. L., Jr.. and Prichard, Parkland. Texas J. Med. 60: 72 (Jan.) 11)6). Cain, Sum. Gynee. & OWL 03: 651 R. W.: Curse of 30. (1101). Oswald autopsy report, in Warren Comm • 5. Conger, R. J.: in Trial of John H. Surratt, the Hearings, Washington, D.(.'., U.S. Government Criminal Court of the District of Columbia, Washington, Office. 1964, vol. 26.p. 521. D.C., U.S. Government Printing Office, 1867. p. 31. Ruby's pistol, in 91. ibid., vol. 25, p. 520. 6. Barnes. J. 32. Ruby meant to shoot three times, K.: in ibid., p. 95. ibid.. vol. 7, May, J. F.: The Mark of the Scalpel, Records of the 408. Columbia Historical Society, Washington, D.C., 1910, vol. M. Oswald revokes his U.S. citizenship. 13, p. 51. p. 684. in ibid., vyi 8. Eiseuschiml, 0.: In the Shadow of Lincoln's Death, 34. Oswald plellgus allegiance to USSR. 97. in ibid., veil'

1794 New York State Journal of Medicine / July 1, 1966

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