Texas State Journal of Medicine, Volume 60, Number 1, January 1964 Page: 74

                                
Ventricular fibrillation ensued. Manual
cardiac systole (cardiac massage) was begun
by Dr. Perry while the internal defibrilla-
tion apparatus was readied. Four attempts
at ventricular defibrillation were made, with
Dr. McClelland applying the defibrillation
paddles to the heart, utilizing successively
voltages of 240, 360, 500, and 750 without
successfully effecting defibrillation. Between
the applications of the defibrillation paddles,
manual cardiac systole was continued alter-
nately by Drs. Perry and McClelland.
At 12:55 p.m., the internal pacemaker,
provided by Dr. Bashour, was attached to
the heart, but the electrical stimulus pro-
vided by this pacemaker was not effective
in producing visible cardiac systole. Two
other attempts at internal defibrillation were
made. The second defibrillating current pro-
duced asystole, but the internal pacemaker
still did not stimulate effective cardiac ac-
tivity.
Manual cardiac systole was re-started,
causing palpable carotid pulse, but the pa-
tient's obvious external appearance was that
circulation was ineffective as judged by the
development of an ashen gray cyanosis. With
an ophthalmoscope, Dr. Jenkins had periodi-
cally checked the retina for circulation dur-
ing the resuscitative processes, and the reti-
na could be visualized until 1:05 p.m., when

it was apparent that the lens had become
opaque, and retinal circulation was not ob-
served. The patient was pronounced dead at
1:07 p.m. The bullet which was palpable in
the right posterior axillary line was removed
and sent out by the operating room super-
visor, Miss Audrey Bell, to be turned over
to the legal authorities.
As a summary of fluid replacement, this
patient received 15 and '/ units of blood and
4200 ml. of 5 per cent dextrose in lactated
Ringer's solution.
It is Dr. Jenkins personal feeling that all
methods of resuscitation were instituted ex-
peditiously and efficiently. Having observed
this patient from the time he was wheeled
into the emergency operating room, Dr.
Jenkins felt that Oswald sustained a period
of cerebral hypoxia or anoxia for the period
of time lapsing between the gunshot wound
which he received and the time that effective
ventilation with oxygen was started in the
emergency operating room. Considering the
cerebral changes which would begin at the
time of initial anoxia, notably cerebral
edema, Dr. Jenkins felt that many vital cen-
ters, including the cardiovascular center,
were irreparably damaged, despite all resus-
citative measures, introducing the final car-
diac asystole. The trauma which patient Os-
wald had sustained was too great for resus-
citation.

Medical History
Gunshot Wounds of Four Presidents

A S LONG AS man tries to understand his
environment, historians will probably com-
pare one great event to similar preceding
ones. Physicians, too, will evaluate signifi-
cant medical events and try to put them in
perspective.
Up until Nov. 22, 1963, physicians who
studied gunshot wounds pondered over the
aspects of medical care given to three assas-
sinated Presidents of the United States. Now,
the type of injury and the treatment of a
fourth President has been entered into jour-
nals for comparison. In addition, the treat-
ment of Governor John Connally of Texas
may be studied and compared in the same
books because of the event that linked him
with President Kennedy.
Dr. S. B. Harper, reporting in the Pro-

seedings of the Staff Meetings of the Mayo
Clinic in January, 1944, described the in-
juries and treatment of Presidents Lincoln,
Garfield, and McKinley.
Lincoln
The fatal bullet which struck Abraham
Lincoln entered the occipital bone at the
level of the transverse sinus about an inch
to the left of the midline. "The path of the
bullet," reports Dr. Harper, "was then ob-
liquely forward across the brain, ending in
the right frontal lobe. Extensive comminuted
fractures of both orbital plates occurred,
these apparently were the result of contre-
coup since the dura over the frontal lobe was

TEXAS State Journal of Medicine

74