Article 32 Hearing
Volume 12

August 10, 1970

Paul Manson

MR. SEGAL:  Call Dr. Manson, please.

(Dr. Paul V. Manson was called as a witness for the defense, was sworn, and testified as follows.)

Questions by MR. SEGAL:
Q  Dr. Manson, would you state your full name and home address, please?
A  Paul Velas Manson.  My address is 1025 Hancock Street in Quincy, Massachusetts.
Q  What is your profession, Dr. Manson?
A  I'm a physician.
Q  A medical doctor?
A  A surgeon.
Q  And I ask what is your education background, sir.
A  I went to undergraduate school at Northwestern University in Evanston, Illinois.  I was educated at -- my medical training at Northwestern University Medical School.
Q  When did you complete your medical training?
A  In 1968.
Q  And thereafter, what were your activities?  In medicine.
A  I went to the Harvard Surgical Service at the Boston Clinic program and I've been there ever since.
Q  Does that mean you served your internship and other training there?
A  Yes.  I'm now senior assistant resident in surgery there.
Q  At Northwestern Medical School, what was your standing in your class upon graduation?
A  Fifth out of 134.
Q  Did you have occasion to come in contact with or come to know the accused in this case, Captain Jeffrey R. MacDonald?
A  Yes, I did.  We were lab partners and we know each other very well.  I would see him approximately twice a week.  My wife and I and Jeff and his wife were together very much socially through all of medical school.
Q  Let me ask you, Dr. Manson, you say "lab partners."  What exactly are you referring to?  What kind of laboratory?  Where is the laboratory located?
A  The laboratory is located in medical school.  Our first year we spent most of our time in the laboratory.
Q  Then do I understand that you were a classmate of Captain MacDonald's or Captain MacDonald was a classmate of yours?
A  Yes.
Q  And during that period of time when you were at Northwestern Medical School with Captain MacDonald, were you married during the entire period?
A  No, I was not.
Q  For what period of time were you married?
A  I was married immediately after medical school.
Q  During the three years you were at medical school, did you have occasion to see Captain MacDonald socially, though?
A  Yes.  We saw each other, I would say, at least twice a week socially, in addition to the time that we spent together in the laboratory.
Q  How often did you see Captain MacDonald in the laboratory or in any other place in medical school?
A  Oh, I would estimate the first two years, about 4 to 6 hours a day.
Q  After you went to the Harvard Clinic in Boston, have you had any contact with Captain MacDonald since that time?
A  Yes, we went down to New York on two occasions in August, and in June of my internship year, where we spent a few days with Captain MacDonald and his family and he came up to Boston and visited with us, I think it was in February of my internship year, and visited with us for a few days.
Q  Excuse me.  You say "we" visited Captain MacDonald.  Who are you referring to?
A  My wife and myself.
Q  Now did you have occasion to see Captain MacDonald on or after February 17th, 1970?
A  Yes.  I saw him in Womack Army Hospital on Friday, I believe it was, the 20th, after my wife and I heard of the incident and had come down.
Q  And for how long did you see -- or how long were you with Captain MacDonald on February the 20th?
A  We were there for most of the afternoon, Friday afternoon, Friday evening, and for a couple hours on Saturday morning.
Q  And how long a period of time would you say that was, altogether, that you were with Captain MacDonald on the 20th and 21st?
A  Six to eight hours.
Q  Was there anyone else other than you and your wife, who were there with Captain MacDonald for any length of time?
A  Yes, Dr. McGann.
Q  Is Dr. McGann here today at Fort Bragg?
A  Yes.
Q  Did you have occasion to observe any injuries on or about Captain MacDonald's head?
A  Yes, I did.
Q  Would you describe to Colonel Rock, the investigating officer, what injuries you saw on his head, where they were located, please?
A  He had a large contusion on his forehead, slightly to the left of center, and he had another smaller contusion in the interior portion of his temple region on the right.
Q  In regard to the second of those, which you described on the interior portion of the right, would you point your finger as to where that would be?
A  It would be about right in here.  Just immediately behind the hairline.
Q  Was that injury in any way obscured by anything at the time you saw it?
A  It was just hard to see because of the hairline.
Q  Did you have occasion to observe any body injuries on Captain MacDonald?
A  Yes, I did.  He had a very large hematoma of his left eye and he had a puncture wound in the lower portion of his right chest anteriorly, and he had some scratches on his abdomen and another puncture wound, near his -- umbilicus on his abdomen.
Q  Of all those injuries, which was the more serious injury, taken by itself?
A  It most certainly would have been the puncture wound in his -- lower portion of his right chest.
Q  Was this injury, in your judgment, a life-threatening injury?
A  Because of the possibility of a tension pneumothorax laceration of a major blood vessel or a laceration of the liver.
Q  Assuming that a trained medical person, a doctor, was to inflict the wound in that location you've just described, could he know the medical consequences of such injury, if he did inflict it upon himself?
A  No.
Q  Why would he not be able to anticipate the medical consequences of that injury?
A  It's just impossible to predict whether or not one will get a tension pneumothorax from a penetrating wound in the chest.  It is impossible to predict where the liver is in relation to any wound in the area and likewise where any of the great veins that run in that area.
Q  You say the tension pneumothorax.  How is it distinguished from any other type of thoracic injury?  Is there a pneumothorax as opposed to a tension pneumothorax?
A  Yes, there is.
Q  Describe what they are, please?
A  Pneumothorax occurs when there is a vent in the lung and air escapes into the -- normally a potential space, the thoracic cavity.  Pneumothorax becomes a tension pneumothorax when a one-way valve effect occurs at the point in which the air is leaking from the lung, so that the air gets outside of the lung and cannot return to the main breathing passages, to escape.  Pressure builds up inside the chest to the point where circulatory, respiratory embarrassment occurs.
Q  What does respiratory embarrassment mean, doctor?
A  It means that the patient is not able to breathe and circulatory embarrassment, the heart stops beating because the pressure inside the chest will not let the heart fill with blood.
Q  How rapidly does the condition become dangerous from the development of a tension pneumothorax?
A  If a tension pneumothorax occurs, it is dangerous within 3 to 5 minutes.
Q  Now over how long a period of time did you know Mrs. MacDonald, Colette MacDonald?
A  I knew her almost as long as I knew Jeff.  Shortly after I knew Captain MacDonald in medical school, he had us over for dinner.
Q  Over how many years did that span?
A  Six years.
Q  Did you have occasion to meet with Captain MacDonald and his wife at the same time on a number of occasions?
A  Many, many occasions.
Q  Did you ever have occasion to observe the relationship between Captain MacDonald and his wife and his children?
A  Yes, I did.
Q  How would you characterize Captain MacDonald's attitude toward to his wife, Colette?
A  He always demonstrated to me a great deal of love and respect that he had for her.
Q  Did you ever hear or see him threaten violence or actually commit violence upon her?
A  No.
Q  How would you characterize Captain MacDonald's attitude towards his children?
A  He was a very wonderful father.  He spent a lot of time with his children, something which is difficult to do in medical school, and he always treated them with a great deal of love, which was obvious to anyone around him.  He was what I considered to be an ideal father.
Q  Did he ever commit any violence or threaten any physical violence to his children?
A  No.
Q  What was Mrs. MacDonald's attitude toward Captain MacDonald?
A  It was identical to his, toward her.
Q  What was Mrs. MacDonald's attitude toward her children?
A  Similar to her husband.
Q  Did Mrs. MacDonald ever threaten violence or threaten to commit violent act or actually commit violence on her husband?
A  No, never.
Q  Did Mrs. MacDonald ever threaten violence or commit violence against her children?
A  Never.
Q  How recent, before February 17th, 1970, did you have any contact with either Captain MacDonald or Mrs. MacDonald?
A  We had exchanged letters, telephone calls on a number of occasions throughout the years and approximately a week before February 17th, we had called and talked to them -- we talked to all of his family.  My wife and I had called.
Q  Did you speak to Captain MacDonald at that time?
A  Yes, we spoke to them both and the children.
Q  How would you characterize Mrs. MacDonald's attitude or feelings at that time as she expressed them to you?
A  I think this was a particularly enjoyable time for them.  He had a chance to spend a lot of time with the family, which was something he had not done, which he was unable to do much being an intern and being away every other night.  Mrs. MacDonald was, to me, enjoying this a great deal and she was particularly proud of the fact that she had gone back to school.
Q  One question further, please.  How would you rate Dr. MacDonald as to his qualities as a physician?
A  I think he's an outstanding doctor.
Q  Would you work with him if you had a chance to do so now?
A  Yes.

MR. SEGAL:  Cross examine.

Questions by CPT SOMERS:
Q  Dr. Manson, are you certified by the National Board of Surgeons?
A  No, I'm not.
Q  How far are you along in your surgical training?
A  Senior Assistant Resident.
Q  How far are you short of being certified?
A  Two years.
Q  Do you consider yourself a friend of Captain MacDonald's?
A  Yes, I do.
Q  How close a friendship do you have with him?  Can you answer that question?
A  I would say it's close.
Q  Did you happen to see CPT MacDonald on the 17th of February 1970?
A  No, I did not.
Q  Did you see the injuries that he sustained on the day that he sustained them?
A  No, I did not.
Q  Now you've described an injury to the right side of the head.  Is that correct?
A  Yes, sir.
Q  Do you know how he sustained that injury?
A  No, I do not.
Q  Do you know when?
A  No, I do not.
Q  Can you describe that injury in detail to us?  For instance, was the skin broken?
A  The skin was not broken.  It was a contusion with only a small amount of hemorrhage and edema, but the hemorrhage was not significant.  There was mostly edema.
Q  Did you probe this puncture in the lower right chest area?
A  No, sir.
Q  Then how do you know that it was the most dangerous of the injuries?
A  It was the one which was responsible for his hemopneumothorax.
Q  How do you know that?
A  Because of the treatment which had been instituted.  
Q  Well, how do you know what the treatment was?
A  He had a -- when I saw him in the hospital, he had a chest tube hooked up to suction, drainage.
Q  You were not the treating physician for Dr. MacDonald, were you?
A  No, sir.
Q  In fact, your capacity in the hospital was not that of a professional, was it?
A  No, sir.
Q  At Womack, you were there as a friend, were you not?
A  Yes, sir.
Q  You spoke about a tension pneumothorax.  And you have differentiated this from an ordinary pneumothorax.  What did you call that ordinary pneumothorax?
A  It's a pneumothorax.  A pneumo -- Captain MacDonald actually had a hemopneumothorax, which means there was both blood and air in the potential space that exists between the pleural -- between the pleural.  A pneumothorax is simply air.  A tension pneumothorax can occur with either.
Q  But your description of it as a hemopneumothorax is not based on your observation but on something you were told, is that correct?
A  Yes, sir.
Q  Who told you that?
A  Captain MacDonald.
Q  Have you ever seen a tension pneumothorax?
A  Yes, sir.
Q  How many?
A  I would imagine, anywhere from a dozen to two dozen, somewhere in there.
Q  Tension pneumothorax?
A  That's tension pneumothorax; pneumothorax is a common thing.
Q  How many common pneumothorax have you seen?
A  A few hundred.
Q  In other words, you've seen hundreds of pneumothorax?
A  Yes.
Q  And out of these, approximately two dozen were tension pneumothorax?
A  Yes.
Q  Do you know what percentage of pneumothorax are, in fact, tension pneumothorax?

MR. SEGAL:  That's objected to.

CPT SOMERS:  Well, if he knows --

MR. SEGAL:  I don't know what unit he's talking about on which he's going to base his percentage.  Is it Boston to be equated, the State of Massachusetts, North Carolina?

CPT BEALE:  Give a little bit more clarity to your question, Captain Somers.

Continued questions by CPT SOMERS:
Q  What percentage of the normal pneumothorax you've seen have been tension pneumothorax?
A  From my experience, you could compare the numbers I've just told you.
Q  Then I gather that a tension pneumothorax is the more serious sort of thing, is that correct?  Than a regular pneumothorax?
A  Yes.
Q  And it is more likely to be hospitalized with this, is it not?
A  I would say that you have to hospitalize a pneumothorax.  Even a simple pneumothorax.  A tension pneumothorax needs immediate hospitalization and treatment.
Q  How would you differentiate between a tension pneumothorax and a normal pneumothorax, if you found this in a patient?  What indications would you have that you're not dealing with a common pneumothorax?
A  His blood pressure would be decreasing, the patient is getting cyanotic.
Q  Excuse me.  If you will, define that term and any other technical ones you're going to be using.
A  He suffers from an acute, intense lack of oxygen, partly because of respiratory embarrassment, because of circulatory embarrassment.

CPT BEALE:  Captain Somers, the witness has covered this area sufficiently for Colonel Rock.  He'd like you to move on to another area, unless you have something specific to be brought out here.

Q  Is shock a normal composite of a pneumothorax?
A  Yes, it can be a composite of a pneumothorax.
Q  Is it more likely with a tension --
A  It's invariably present with a tension pneumothorax.
Q  What is the difference, in terms of the causation, between a tension pneumothorax and a common pneumothorax?
A  They can occur with the same cause and it's not possible to predict when a penetrating wound in the chest will cause one or another.
Q  Is there any way that might be more likely to cause them?  For instance, would a quick thrust to the chest wall be more likely to cause one than a slow penetration?
A  I don't think this would have anything to do with it.  It would depend on the amount of damage to the underlying wall.
Q  The less damage, the less likely to be a tension pneumothorax?
A  Not necessarily true at all.
Q  Well, then, what do you mean by the qualification you just made about the damage?
A  Well, as I said, I don't think it's possible to predict when you would not get a tension pneumothorax from a penetrating thoracic injury.  I think the majority of those that I have seen have been in the more simple wounds of the thoracic cavity.

COL ROCK:  Counsel, I fail to get the point of this inquiry at the present time.  I think we've had plenty of comment on this by Dr. Manson and other physicians who have been here.  Is there some particular point that you're driving at?

CPT SOMERS:  I'm through, sir.  Not with my questions, but with that subject.

Continued questions by CPT SOMERS:
Q  I gather, Dr. Manson, that you've had an opportunity to see Captain MacDonald around his family and children?
A  Yes, sir.
Q  Would you describe for us what sort of disciplinarian he is?
A  His children were always cooperative and obedient.  I think unusually so.  
Q  Did you ever have an opportunity to see CPT MacDonald discipline his children?
A  Yes, I have.
Q  How does he go about that?
A  At the time I saw him, he would take the child or children aside and talk with them.
Q  Did you ever see Colette MacDonald discipline her children?
A  Yes.  Yes, I did.
Q  And how did she go about it?
A  In the same manner.
Q  Now you say that Colette MacDonald never threatened her children with -- threatened them or offered to do violence to them.  Is that correct?
A  Yes, sir.
Q  Now I presume by that you mean never in your presence?
A  Yes, sir.
Q  Is it fair to say then that you are a close friend with the MacDonald family and you consider them to be an ideal family.  Is that correct?
A  Yes, sir.
Q  How long have you been associated with Captain MacDonald in the actual practice of medicine, as opposed to medical school?
A  Since 1968.
Q  In other words, you were together after medical school?
A  We spent some time together on occasions.
Q  Where were you practicing medicine together?
A  We weren't practicing medicine together.
Q  Have you actually seen him practice medicine, as opposed to being in medical school?
A  What do you mean practicing medicine?
Q  I mean seeing patients, treating patients in the normal day-to-day practice of medicine.
A  I have had many occasions to see him do this during medical school.  During the last two years when -- you are pretty much an intern.
Q  Have you had an opportunity to see him do this since medical school?
A  I've had on the occasion when I went to see him at Columbia.
Q  Under what circumstances did this occur?
A  I was curious to see the facilities Columbia had, so I went with him one day to look around, made rounds with him and saw him with his patients.
Q  Since medical school, the extent of your observation of Captain MacDonald's practice in medicine was limited to one day.  Is that correct?
A  Physically, yes.
Q  In your opinion of him, doctor, is that based on what you saw, as a doctor, on what you saw in medical school?

MR. SEGAL:  The witness never said that.  That's objected to.

CPT SOMERS:  Is that correct or not?

MR. SEGAL:  It's a misstatement of what the witness said.  It's unfair characterization.

CPT BEALE:  Sustained.  Rephrase your question.

Q  Your opinion of Captain MacDonald, in the practice of medicine, is based on your observation of him in medical school and this one day.  Is that correct?
A  Yes, sir.
Q  Did you have an occasion to discuss with Captain MacDonald his injuries?
A  Yes, I did.  I discussed them with him, on the Friday -- when we first saw him at Womack Army Hospital.
Q  Did he describe them to you or not?
A  What do you mean "describe them"?
Q  The injuries.
A  They were readily apparent.
Q  But did Captain MacDonald describe them to you?
A  We didn't talk much about them.
Q  Did you conduct an actual examination of Captain MacDonald?
A  No, I didn't.
Q  Did Captain MacDonald describe his assailants to you?
A  In no more detail than what was in the papers about the time.
Q  Have you had occasion to read about this incident in the newspapers?
A  Yes, I've read about what little is published in Boston in the papers and what clippings were obtained from the New York papers.
Q  In other words, you've made an effort to obtain clippings on the subject?
A  Yes.

CPT SOMERS:  No further questions.

MR. SEGAL:  Just a couple of others, if I may, sir.

Questions by MR. SEGAL:
Q  Dr. Manson, on concluding medical school, you described having visited Captain MacDonald and he visited you.  On what occasion did you have occasions to talk about the practice of medicine, studies of medicine?
A  Surely, we always discussed interesting things that we'd seen and difficult problems.  We used to express opinions to each other regarding things that we -- patients that we'd taken care of.
Q  Did you or did you not consider the opinions expressed to you on the subject of medicine in making judgment as to what kind of physician you think Captain MacDonald is?
A  Would you repeat the question?
Q  Did or did not you include in your opinion, making up your opinion of Dr. MacDonald, the things he said to you in your discussions about medicine?
A  Surely.
Q  Would you perhaps help me by telling me a little bit more about what the last two years of medical school involved, as far as actual patient treatment at Northwestern?
A  The last two years were spent primarily inpatient treatment.  In the junior year there's a medical rotation which occupies one-third of the year in surgery, obstetrics and GYN, and rotation -- this is all patient work, and this rotation is -- the same is true for the senior year.
Q  And did you have contact with Captain MacDonald during those two years while you were in this clinical treatment type of assignment in the medical school?
A  Yes, sir.
Q  How often did you see him at those times?
A  On the rotations where we had contact, nearly as much as I'd seen him the first year in medical school.  In some locations we were not together as much.
Q  Did you ever see signs on the MacDonald children that they had apparently been beaten or physically mishandled in any way?

CPT SOMERS:  Object to that.

MR. SEGAL:  The government has suggested that the witness wasn't present all the time and therefore wouldn't know whether the children had been struck by the accused or his wife in his absence.  There is, however, indicia to such activity, including the signs, particularly which any medical person might observe.

CPT BEALE:  Objection is overruled, Captain Somers.  Answer the question, doctor.

A  I never saw such signs.
Q  Did you have an opportunity to observe Dr. MacDonald/Captain MacDonald under pressure or emotional stress?
A  During exams or --
Q  Well, you tell us on what occasion you've seen him, if you recall, in which he may have been under pressure or stress of any sort, professionally or academically.

CPT SOMERS:  I object to that.  That's calling for a conclusion outside the witness's expertise and it also is well outside the scope of any cross or direct.

MR. SEGAL:  It is outside the scope of cross and I'll ask leave to ask this question.  I'll admit that as far as it being beyond his expertise, you don't have to be a psychiatrist to know when a person is working under stress and pressure at times and to be able to express a view.  The doctor's view, in my judgment is probably worth a little bit more, perhaps, that some laymen and others --

CPT SOMERS:  It's all supposition.

CPT BEALE:  Objection overruled.  What is your answer, Dr. Manson?

A  Would you repeat the question?  I lost it somewhere.
Q  Have you had occasion, during the period of time you've known Captain MacDonald, to see him under pressure or stress?
A  Yes, sir.
Q  What types of pressure or strain did you have occasion to observe him under?
A  I would say this would be mainly related to those occurring in medical school, examinations and so on.  Captain MacDonald is not the type of person to show he's being stressed.
Q  What did you conclude, if anything, about Captain MacDonald's emotional stability?

CPT SOMERS:  I object.  Based on what?

MR. SEGAL:  Based upon his observations of Captain MacDonald on the occasions he's already indicated.

CPT BEALE:  Objection overruled.

Q  Please answer, Dr. Manson.
A  He's an extremely reliable, stable person.
Q  Because you are a good friend of Captain MacDonald's, would that cause you to come here and under oath testify to a lie as to any material fact?
A  No, sir.

MR. SEGAL:  That's all.

Questions by CPT SOMERS:
Q  Doctor, do you think it is possible that because you are a good friend of CPT MacDonald's, it may subconsciously color your opinion as to anything you may testify to such as his character or his family?
A  I don't believe so.
Q  Are you saying that that's impossible?
A  Yes, sir.
Q  I see.  From this, doctor, did you consider Captain MacDonald to be emotionally expressive or did you find him to be the kind of man who is quiet and withdrawn, in fact?
A  What do you mean, emotionally expressive?
Q  Did he readily express his emotions?
A  He was a very friendly person.
Q  Well, let's see beyond that.  In these situations of stress you described, I gather you're saying that he's not emotional; he doesn't disclose signs of emotions as a result of these stressful situations.  Is that what you said?
A  No.  Could you redirect your question?
Q  All right.  I'll try.  You were asked a question as to Captain MacDonald's stability, particularly under emotional stress or stressful situations.  And you said that he doesn't show his emotions.
A  In situations like that, I meant to say that he doesn't show any anxiety.  In other words, someone under stress -- he's acting under stress, he does not seem to show anxiety, no.

CPT SOMERS:  No further questions.

Questions by COL ROCK:
Q  Doctor Manson, you have indicated that you saw a small contusion at the hairline.  How did you happen to observe that?  Were you examining his head or what?  
A  I was standing right next to him and he was complaining of a headache and I was -- you know -- just searching, just curiously, for why he would have such a headache.
Q  Now you have stated, I gather, if I may summarize that, he had what would be characterized as, potentially, rather, a serious wound in his chest.  Is that correct?
A  Yes, any puncture wound of the chest is potentially lethal.
Q  Right.  And I believe you also stated that a person would have no way, a medical doctor would have no way of knowing what the outcome would be in something of this severity.  Is that correct?
A  No, sir.
Q  Then would it be logical in your mind, that someone who was -- be logical for a doctor who wanted to commit suicide to stab himself in such a location, with the thought that maybe this would take his life?
A  Would you repeat the question, sir?
Q  Considering the severity of the wound and not knowing what the potential would be with such a wound, would it be possible that someone who wanted to commit suicide would stab himself in that position?
A  I would imagine it may occur.

COL ROCK:  I have no further questions.

MR. SEGAL:  In regard to that last question by Colonel Rock, in your judgment, would you as a physician, if you wanted to inflict death upon yourself, and you work in a hospital with a lot of facilities available, would you chose to do so, as the most effective and expeditious manner, of stabbing yourself in the lung about the place where Captain MacDonald was so injured?

A  If I wanted to take my own life, I think I would probably chose a different location, perhaps one directly over the heart.
Q  Why would that be so?
A  Its consequences would be -- you know -- absolute.  If you were really intent on taking your life, it would provide a very rapid means.

MR. SEGAL:  I have nothing further.

CPT SOMERS:  Nothing further.

COL ROCK:  Doctor, you are requested not to discuss your testimony with any other person, other than counsel for the government or counsel for the accused.  Do you understand that, sir?

WITNESS:  Yes, sir.

COL ROCK:  You are excused.

MR. SEGAL:  May Dr. Manson be permanently excused, Colonel, please.

COL ROCK:  Yes.  Thank you very much, doctor.