The Pneumothorax in JFK's Right Lung

[Bob Prudhomme]

https://www.youtube.com/watch?v=DX58vrL5ZiA

It is interesting to note that, at about 4:22 of this interview, Dr. Jenkins describes the insertion of a chest drainage tube into JFK's left chest. The reason he gives for this is, according to Dr. Jenkins, the fact that one doctor had listened to that side of the chest, while Dr. Jenkins was performing artificial respiration with a bag valve mask, and had heard no breath sounds.

As this oration by Dr. Jenkins is obviously many years after the assassination, he can be forgiven a certain degree of confusion but, the fact remains that in his medical report (Appendix VIII of the WCR) Dr. Jenkins clearly states the chest tube was inserted in the RIGHT chest.

"Doctors Charles Baxter, Malcolm Perry, and Robert McClelland arrived at the same time and began a tracheostomy and started the insertion of a right chest tube, since there was also obvious tracheal and chest damage. Doctors Paul Peters and Kemp Clark arrived simultaneously and immediately thereafter assisted respectively with the insertion of the right chest tube and with manual closed chest cardiac compression to assure circulation."

Note also he states there was "obvious chest damage".

From the Warren Commission testimony of Dr. Marion T. Jenkins:

"About this time Drs. Kemp Clark and Paul Peters came in, and Dr. Peters because of the appearance of the right chest, the obvious physical characteristics of a pneumothorax, put in a closed chest drainage chest tube. Because I felt no peripheral pulse and was not aware of any pulse, I reported this to Dr. Clark and he started closed chest cardiac massage."

A pneumothorax is usually an indication of serious damage to a lung, and results in the collapse of that lung. This is why the doctors were unable to hear breath sounds, and elected to insert a drainage tube in the right chest.

While it is likely that JFK was also suffering a haemothorax of the right lung (accumulation of blood and fluid), the most serious condition of the lungs was the pneumothorax. As JFK was lying on his back, the back entrance wound, unknown to the Parkland doctors, was likely sealed by the back being in contact with the table. As the lung was compromised (ruptured) each breath, assisted or otherwise, would be pulled through the rupture in the lung, and the lung would not inflate. Instead, the air would pass into the pleural cavity between the lung and the chest wall and be trapped there, as the lung would flatten out on expiration and not allow the air to be expelled. With each breath, the amount of air in this cavity, with the back wound sealed off, would increase, until the pressure began exerting itself on the heart, major blood vessels and the left lung.

This condition is known as a "tension" pneumothorax and, unless the pressure in the pleural cavity is relieved with a chest tube, this condition is invariably fatal as the function of the other organs of the chest is so badly impaired. The chest tube is connected to a water seal chamber that prevents air returning through the tube to the pleural cavity during inspiration. In the field, first responders use the Asherman Chest Seal to seal off punctures of the chest. It seals off the wound, preventing air from entering the pleural cavity during inspiration (open pneumothorax) but has a one way valve that allows any pressure built up in the pleural cavity (tension pneumothorax) to escape.



Another classic sign of a tension pneumothorax is deviation of the trachea (windpipe) away from the affected lung. Several doctors noted this on JFK when he arrived at Trauma Room One, and I believe this to be one of the "obvious physical characteristics of a pneumothorax" Dr. Jenkins was referring to.

Of course, everyone realizes that the type of damage to the right lung indicated here was contrary to the findings at the autopsy.

[Gordon Gray]

I know you believe the pneumothorax was a result of the back wound, but is it possible it was the result of the throat wound?

[Bob Prudhomme]

I know you believe the pneumothorax was a result of the back wound, but is it possible it was the result of the throat wound?

Hi Gordon

Only if the bullet that caused the throat wound, or a part of it, managed to get deflected and ended up in JFK's right lung. However, if it struck the right side of JFK's trachea first, and then proceeded downward, we should expect to see more damage to the trachea and the bronchi branches below it. That Dr. Malcolm Perry was able to perform a successful tracheostomy at the level of the throat wound pretty much rules out, but by no means eliminates, the possibility of further damage below the throat wound.



The real question here, what could the bullet have struck that would have made it do an almost 90° turn downward?

[Bob Prudhomme]

Exactly the same problem arises when the theory is proposed that the throat wound was caused by a fragment exiting the bottom of the skull. While there is an opening in the base of the skull, known as the "foramen magnum", just above the top of the spinal column, and there is sufficient room between the foramen magnum and C1 vertebra for a bullet fragment to pass, it is a rather circuitous route from there to the throat wound. Also, for the fragment to make such a neat and round exit wound, one would expect it to be travelling straight outward from the throat. It would be expected that a fragment travelling downward from the skull would make a much longer exit wound.

Of course, though, there is always this from the deposition of Jerrol Custer to the Assassination Records Review Board in 1997. As you know, he was the x-ray technician on duty at Bethesda the night of JFK's autopsy.

"On 28th October, 1997, Jerrol Custer provided a deposition to the Assassination Records Review Board(ARRB). He claimed he was certain he took x-rays of the C3/C4 region of the neck and that those x-rays showed numerous fragments. Custer added that he suspected the reason those x-rays disappeared was that they showed a large number of bullet fragments. According to researcher, Michael T. Griffith: "Custer is almost certainly correct. Why else would those x-rays have been suppressed? The missile fragments described by Custer are another fatal blow to the lone-gunman theory, which in turn means there must have been more than one shooter." "

[Drew Phipps]

Bob: Do you know how much time it takes for the deviation of the trachea to occur after the injury that causes the pneumothorax? Is it a matter of one breath or two, or does it take a more substantial period of time?

[Bob Prudhomme]

Bob: Do you know how much time it takes for the deviation of the trachea to occur after the injury that causes the pneumothorax? Is it a matter of one breath or two, or does it take a more substantial period of time?

Hi Drew

Long time no see!

It all depends on the breathing rate of the patient. If the patient is conscious and aware of his condition, he will be breathing rapidly and aggressively trying to consume oxygen. As the pleural cavity is the same basic size as the lung filling it, in less than a minute it is possible to draw and trap enough air through a tear in a lung to completely fill the pleural cavity and begin exerting pressure on the other side of the chest. If a patient is unconscious and breathing shallowly, it may take a few minutes more. Much also depends on the size of the compromise in the lung itself, and how much obstruction damaged lung tissue may provide to incoming air.

It is important to remember that the deviation of the trachea is entirely due to the build up of air pressure that is trapped in the affected lung, and this deviation can be used to gauge just how bad the condition of the patient is. A severely deviated trachea indicates the heart is being squeezed, the veins (superior and inferior vena cava) are being squeezed as well and the unaffected lung is being flattened inside its pleural cavity, pulling the bronchus and trachea over with it and giving us the deviated trachea. This patient will die within a couple of minutes due to impaired function of heart, lung and circulatory system.

However, if a patient requires assistance with breathing, things change dramatically, as positive pressure breathing, through a mechanical bag valve mask for example, is now forcing air into the pleural cavity under pressure (greater than inspiration by the diaphragm), and allows that pressure to stay there.

It would be likely that JFK's pneumothorax began as an "open" pneumothorax (sucking chest wound) and stayed as such all the time he was in the limo, simply because there was nothing to seal this wound. But, when he was laid on the table, just by fluke, the back entrance wound would have been in contact with the table, and the weight of his body would have effected a seal; thus beginning the tension pneumothorax.

As assisted ventilation was begun immediately on JFK, although only partly successful due to the tear in his trachea, it is more than possible that a certain volume of the oxygen being applied actually made it past the tear in the trachea and into the chest cavity. Under pressure, it would not have taken that many ventilations to inflate the right pleural cavity, although it should be noted the trachea was observed as being only "slightly deviated", indicating the tension pneumothorax was not as advanced as it could have been.

[Paul Rigby]

Paragraph 2:

Three shots are known to have been fired. Two hit the President. One did not emerge. Dr. Kemp Clark, who pronounced Mr. Kennedy dead, said one struck him at about the neck tie knot.

Paragraph 3:

"It ranged downward in his chest and did not exit," the surgeon said.

[Bob Prudhomme]

Paragraph 2:

Three shots are known to have been fired. Two hit the President. One did not emerge. Dr. Kemp Clark, who pronounced Mr. Kennedy dead, said one struck him at about the neck tie knot.

Paragraph 3:

"It ranged downward in his chest and did not exit," the surgeon said.

Hi Paul

The scenario from Paragraph 3 is definitely a possibility, but I am still puzzled as to what made the bullet do an almost 90° turn downward after entering JFK's throat. Along this line of thinking, though, it is interesting to read Jerrol Custer's deposition to the ARRB in 1997. He was the x-ray tech who took all of the x-rays of JFK's corpse at Bethesda.

Custer adamantly stated that there was an x-ray of JFK's neck that was missing from the Archives. He distinctly recalled this particular x-ray for the fact there were numerous small metallic fragments in the vicinity of cervical vertebrae C3/C4.

[Drew Phipps]

Hello Bob. Good to have you back.

So, assuming the standard WC/Zapruder assassination sequence, where JFK seems to be acting purposely for a short period, I'm guessing it is your opinion that the deviation of the trachea would not be accomplished between shots?

[Bob Prudhomme]

Hello Bob. Good to have you back.

So, assuming the standard WC/Zapruder assassination sequence, where JFK seems to be acting purposely for a short period, I'm guessing it is your opinion that the deviation of the trachea would not be accomplished between shots?

I tend not to think so, Drew, for two reasons. I don't think JFK could have drawn in that much air in a couple of seconds, and there is a good chance the wound in the back would have vented any build up of pressure. I could be wrong, though, and a small bullet hole could have been self sealing.

If the wound did not seal, and allowed air to enter the pleural cavity each time JFK's diaphragm attempted to draw air into the lungs, thus collapsing the right lung, JFK would have an open pneumothorax or sucking chest wound, identical to the condition Gov. Connally was experiencing.

P.S.

Interesting question, Drew. What are you thinking about?