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If a bullet exits from the skin without any resistance other than the tissue resistance, an exit hold with subsidiary tears results. . . . If, however, the bullet exits from the skin against pressure from a firm or hard object in contact with the skin, the appearances of the exit wounds are different. . . . If the object in contact with the skin is hard and the bullet exits against considerable resistance from it, the exit wound may not only be round but it may show a rim of abrasion in its margins. Such exit wounds could easily be mistaken for entrance wounds. Exit wounds of this nature may be seen when the victim is lying on the ground or standing against a wall when shot and the exited bullet is stopped by the ground or the wall. They may also be caused when the exited bullet hits a belt, buckle, tough clothing or a similar object in tight contact with the skin. (pp. 124-125).
But is this why Kennedy's neck wound was so small? Experiments conducted by Dr. John Lattimer strongly suggest it is. Lattimer's simulation of Kennedy's neck wound
Lattimer used pork legs, with the bone removed, to simulate Kennedy's neck. Around the pork he fastened a shirt and tie like the one Kennedy was wearing on the day of the assassination. Using a Mannlicher-Carcano rifle and ammunition identical to that used by Oswald, shot through the "neck" at an angle that caused the bullet to exit at the same place, relative to the tie and collar, that the Single Bullet exited Kennedy's neck. The resulting exit wound was very small, approximately ¼ in. in diameter (see top illustration at right).
When he did the same experiment, but shot so the bullet exited a quarter inch below the border of the collar, the wound was small, but showed stellate tears at the margins (second illustration). Finally, he removed the tie from his "victim," and put a bullet through that exited a half inch below the bottom margin of the collar. The resulting exit wound was large and jagged — a very typical exit wound (bottom illustration). (Kennedy and Lincoln, New York: Harcourt Brace Jovanovich, 1980, pp. 234-236.)