ashen, bluish, grey, cyanotic, he was making no spontaneous movements, I mean, no voluntary movements at all. We opened his shirt and coat and tie and observed a small wound in the anterior lower third of the neck, listened very briefly, heard a few cardiac beats, felt the President's back, and detected no large or sucking chest wounds, and then proceeded to the examination of his head. The large skull and scalp wound had been previously observed and was inspected a little more closely. There seemed to be a 4-5 cm. area of avulsion of the scalp and the skull was fragmented and bleeding cerebral and cerebellar tissue. The pupils were inspected and seemed to be bilaterally dilated and fixed. No pulse was present, and at that time, because of the inadequate respirations and the apparent airway injury, a cuffed endotracheal tube was introduced, employing a larynzo scope. Through the larynzo scope there seemed to be some hematoma around the larynx and immediately below the larynx was seen the ragged tracheal injury. The endotracheal tube was inserted past this injury, the cuff inflated, and the tube was connected to a
respirator to assist the inadequate respiration. At about this point the nurse reported that no blood pressure was obtained.
Mr. SPECTER. Dr. Carrico, with respect to this small wound in the anterior third of the neck which you have Just described, could you be any more specific in defining the characteristics of that wound?
Dr. CARRICO. This was probably a 4-7 ram. wound, almost in the midline, maybe a little to the right of the midline, and below the thyroid cartilage. It was, as I recall, rather round and there were no jagged edges or stellate lacerations.

Mr. Specter.

You said you felt the President's back?
Dr. CARRICO. Yes.
Mr. SPECTER. Would you describe in more detail just what the feeling of the back involved at that time ?
Dr. CARRICO. Without taking the time to roll him over and look or to wash off the blood and debris, and while his coat and shirt were still on his arms I just placed my hands at about his beltline or a little above and by slowly moving my hands upward detected that there was no large violation of the pleural cavity.

Mr. Specter.

Why did you not take the time to turn him over?

Dr. CARRICO. This man was in obvious extreme distress and any more thorough inspection would have involved several minutes-well, several--considerable time which at this Juncture was not available. A thorough inspection would have involved washing and cleansing the back, and this is not practical in treating an acutely injured patient. You have to determine which things, which are immediately life threatening and cope with them, before attempting to evaluate the full extent of the injuries.

Mr. Specter.

Did you ever have occasion to look at the President's back?
Dr. CARRICO. No, sir. Before well, in trying to treat an acutely injured patient, you have to establish an airway, adequate ventilation and, you have to establish adequate circulation. Before this was accomplished the President's cardiac activity had ceased and closed cardiac massage was instituted, which made it impossible to inspect his back.
Mr. SPECTER. Was any effort made to inspect the President's back after he had expired?
Dr. CARRICO. No, sir.

Mr. Specter.

And why was no effort made at that time to inspect his back?
Dr. CARRICO. I suppose nobody really had the heart to do it.

Mr. Specter.

You had begun to describe some of the action taken in order to endeavor to revive the President. Will you continue with that description, please ?

Dr. CARRICO. I believe we were to where the endotracheal tube had been inserted. After this, the President--his respirations were assisted by the Bennett machine. We again listened to .his chest to attempt to evaluate the respirations. Breath sounds were diminished, especially on the right, despite the fact that the endotracheal tube was in place and the cuff inflated, there continued to be some leakage around the tracheal wound. For this reason Dr. Perry elected to perform a tracheotomy, and instructed some of the other physicians in the room to