Q. Was it necessary to test the Berka method upon human beings in order to determine its efficacy?
A. Not for practical reasons, no.
Q. Could you have determined whether or not the Berka method was of any value chemically?
A. In the same way Dr. Konrad Schaefer did it.
Q. How long would that take. Doctor?
A. If you had the apparatus set up, the solutions and the necessary arrangements made, you could determine that in the course of half an hour. In order to study water requirements and salt and water metabolism, the experiments as were performed by Dr. Beiglboeck could be justified, but they were only necessary to perform in order to determine whether or not Berka water was a potable water, and whether or not Schaefer water was a water which would be of benefit to human physiology.
Q. Dr. Ivy, do you have before you Document Book V? That is the document book of the prosecution which contains the documents concerning the sea water experiments.
A. Yes.
Q. Would you kindly turn to Document NO 177, which is Prosecution Exhibit 133? Have you had the opportunity to study that document?
A. Yes.
Q. Now, this document is the minutes of a conference which was called to devise an experiment to test whether the Berka method of treating sea water could be tolerated, and it is stated in this document that the chief of the medical Services of the Luftwaffe is convinced that if the Berka method is used damage to health is to be expected not later than six days, and will lead to death, according to Dr. Schaefer, not later than twelve days. Now, on the basis of your knowledge of the toxicity of sea water, is that statement essentially correct?
A. Yes.
Q. Why do you say that, Doctor?
A. Upon the basis of my knowledge of the effect of drinking sea water on a body metabolism, body chemistry.
Q. Would the application of sea water treated by the Berka method in quantities of 500 cc. cause death in twelve days, or would the application of sea water treated by the Berka method in quantities of 1,000 cc. cause death in the same time or a shorter period?
A. It would cause death in a shorter period, that is the larger amount, because it would dehydrate the body more rapidly.
Q. What do you estimate would be the length of time a person could drink sea water treated with the Berka method before death would be reached after they had been subjected to 500 cc. of sea water, or Berka water?
A. That would depend upon the environmental conditions and upon the strength or robustness of the individual who was drinking the sea water or Berka water. For example, if one drinks no water under desert conditions, death occurs in three or four days. The desert is hot and dry and this increases the rate at which the body loses water. If a person is on a raft at sea where the humidity of the atmosphere is high and the temperature we shall say is around 70, then death would occur in around 8 to 14 days. There is no report on the latter, because the survival of a person on a raft at sea without water is for 17 days, but there is reason to believe the authenticity of that report, but one can calculate that under ideal conditions that a robust person could live 14 days without any water at all.
BY JUDGE SEBRING:
Q. Dr. Ivy, excuse me please, you said that in going over that report concerning the person who lived 17 days that there was reason to believe the authenticity of the report?
A. Reason not to believe, reason to disbelieve the authenticity of that report. For example, it isn't certain but there is reason to believe this person had a small amount of water with him when he got into the life raft.
Now, if one were to take 500 cc. of Berka water or sea water in a desert where the temperature is high and the humidity is low, they would not survive the otherwise three or four days which they would if they drank whole water, and there are I might say deserts on the sea, so far as rain is concerned. There are areas in the ocean which have no more rain than the Sahara desert, for example. If one were to take 500 cc. sea water or Berka water under ideal conditions, they would not survive the 8 to 14 days, but would die sooner. If they were to take 1,000 cc. of sea water or Berka water, they would die sooner,for reasons which I have just tried to explain, than if they took 500 cc. Berka or sea water.
Q. Now, Doctor, this Document NO-177, on page 17 of the English Document Book B-7, we find under the Section 2 a heading "Duration of Experiments 12 days", which reads as follows: "Since in the opinion of the Chief of the Medical Service (Chef des Sanitaetswesens) permanent injuries to health, that is, the death of the experimental subjects has to be expected, as experimental subjects such persons should be used as well as will be put at the disposal by the Reichsfuehrer SS." Now, in order to determine whether the Berka treated sea water is less dehydrating to the body than untreated sea water is it necessary to be so atrocious as to conduct the experiments to a point where lives or health is endangered?
A. No, three or four days would be all that is necessary.
Q. So it was absolutely unnecessary to endanger life or to cause permanent damage to organs to determine whether the treatment of sea water with Berkatit made it better for the body than untreated sea water?
A. It was unnecessary unless one desires to determine survival time of human beings on 500 cc. or 1,000 cc. of Berka water or sea water.
Q: Was that perhaps the explanation why a ten day experimental plan was talked about here?
A: It is the only logical deduction that I can make from that statement.
Q: Then, in other words, from reading that Document NO. 177 and from your knowledge of sea-water research problems, you are certain that this committee's minutes or this report deliberately plans or expects death to occur?
A: I do not know what they had in mind when they wrote the statement of the report, but that is the only interpretation which I am able to give.
Q: In this report dad you run across the word "volunteers" at any time?
A: No.
Q: Are you familiar at all, now after your study, or are you familiar enough to testify regarding the experiments performed by Professor Beiglboeck on prisoners at Dachau?
A: Yes.
Q: Could you tell us the design of the sea-water experiments conducted on the experimental subjects by Dr. Beiglboeck at Dachau? I will pass up to you, Doctor, for reference if need be the records of the experimental subjects in the two books and if you wish to refer to them at any time, you may do so.
Dr. Ivy, to date just what records have you seen which outline the results of the experiments conducted at Dachau?
A: When I was in Nurnberg in January and I met with Dr. Leo Alexander, Dr. Beiglboeck and his attorney, at that time I saw records in two books, which contained data which came from these experiments and which I discussed with Dr. Beiglboeck. Since returning to Nurnberg, as of this time, I have seen these documents, which you just brought up; one data, book and another data book which is only part of the data books, which I saw in January and then these charts, giving the individual data or record on the 44 subjects of the experiments.
Q: Have you seen any further data on these experiments?
A: I have seen one summarizing table, which was submitted to the Tribunal as a Document. The number of that ....
Q. Was that one written by Professor Beiglboeck since has incarceration here in Nurnberg you mean?
A: That is the one I had in mind.
Q: Then you have seen no other documents concerning the results and records of the experiments at Dachau?
A: Not that I recall at the present.
Q: No that one note-book, which you say that there is only a part thereof in the folder at the present time; was that a note-book which had a black cover on it when you saw it in January?
A: I could not say what color the cover was. According to my recollection, it was a cover, it was a stiff cover and different from the note book which has been submitted in evidence with a cover. As I recall, it was a stiff cardboard cover.
Q: Were you able to ascertain or can you remember what was removed from that book?
A: I specifically recall that there is missing a summarizing table with the list of names of the various subjects. I recall this specifically because in discussing the data that has summarizing this table from day to day as the experiment progress, I could tell from the data that the subjects or at least some subjects, had gotten some water, some fresh water and at times urine was lost, at times part of the day's specimen were lost and apparently things of that sort.
I remember that specifically because after I looked over the data, the summarizing date, I said to Dr. Beiglboeck, "Would you publish this data, as a scientific report in a medical journal?" He said, "No". That was the answer that I expected to get from an honest conscientious scientist Then I said, "Why did you, a well trained clinical investigator, along with adequately trained chemists for assistants, consent to perform experiments requiring a great deal of effort on such unreliable and irresponsible subjects, particularly in an experiment of this sort where the cooperation and interest of the subjects in the out come of the experiments is essential for the success of the experiments?"
He told me that he did that because he was ordered to. He said that he had written to Professor Eppinger and had suggested that those experiments be performed on himself and his co-men, or some convalescent soldiers about to be returned to the front, but he had been told that these experiments were to be performed on prisoners at Dachau.
He also told me that he had written a letter to his relatives or home folks telling them he did not like to do this work. So, I remember specifically for that reason that particular table and I do not find it in these Documents.
Q: Is there anything else, which you think is missing from these document or do you think that those documents before you now show the complete records of one experiments at Dachau or is it customary in scientific research or this sort to keep more accurate records?
A: Well, I think these records are in as much detail as those which one generally makes chlorite readings and phyosphoria figures, from which these final results have been calculated are sometimes kept, but as a general rule are thrown way. There is one general defect in the records of the individual patients and that is it would some to me that when one is making a study of the effect of the deprivation of food and water on the human body for a period of iron four to eight days or when one is making a study of of 1,000 cc per day, there should be a longer follow-up period to determine whether or not there were delayed effects of these procedures on the patients open subject. So, I believe that it would have been highly desirable for Dr. Beiglboeck to have added a longer period of after observation. He did add a relatively long period, six to twelve days, in the group of study on Schaefer water. I believe his experiments would have been much better if he had at least a week after study on him subjects in the other groups.
Q: Then you are familiar, Dr. Ivy, with the design of his experiments; could you outline for the Tribunal that design he followed, chat as the various groups, etc.?
A: The general plan of the experiments I think is adequate for a study of water and salt metabolism in the human body. He had one group who received no food or water, I believe there were six subjects in this group. He had mother group which received Schaefer water, which essentially is fresh at or and they received 1,600 to 1,500 cc a day. That is adequate to keep them in water balance unless the weather happens to be warm, because 800 to 1,000 cc of water is all that is required to keep the body in water balance.
Now it would have been better in all of these experiments if he had taken into consideration the loss of water by the lungs and by the skin, because when we say that from 800 to 1,000 cc of water digested per day is enough to keep an ordinary adult in mater balance. That is enough to make up for the loss of water loss through exhaling of air in the lungs through sensible or insensible perspiration and by way of the urine. I believe there were six subjects in the second group. He had a third group, which received 500 cc of sea water and a fourth group which received 500 cc of Berka water and then a group which received 1,000 cc of Berka water; five subjects in that group. I remember five subjects, which received 1,800 cc of sea water.
Q. In general would you say from your observation from the records that the various tests were performed adequately?
A. Yes, I should say so.
Q. By and large -
A. There is one exception. That is, I think some of his chloride determinations were inadequate, too high, so as to give him a concentration of table salt in the urine of greater than 2% approximating 3%.
Q. Have you been able to ascertain from the study of the records what was the purpose of this experimental plan?
A. As I said, it was adequate to make a good study with reliable subjects on water and salt metabolism -- that is, under various conditions or under the conditions that scientists working in this field would like to have.
Q. By and large, the experimental plan was technically to determine whether or not Berka water and Schaefer water differed from sea water, was it not?
A. Well, this elaborate setup wasn't necessary in order to determine whether or not Berka Water was different from sea water. I thought I had already made that point. You could determine that in the chemical laboratory and if you had to do some experiment on human beings you could determine the answer to that question in three or four days.
Q. Were the results of these experiments of any scientific value? Dr. Beiglboeck states he would not publish them in a medical journal. Have you anything further to ado to that?
A. I don't believe they were of scientific value.
Q. Is it probable, Professor Ivy, that one might expect acute, chronic bodily injury to occur as a result of these experiments?
A. If dehydration of the body is carried too far, acute injury and permanent injury may occur, even in the robust, healthy individual.
If individuals have some chronic disease such as tuberculosis, a period of fasting and marked dehydration may cause an exacerbation or a lightning up of the chronic disease or process.
Q. The only group actually in those experiments in which acute symptoms would not be anticipated is the group which were receiving the Schaefer water. Is that correct?
A. That is correct.
Q. Would a period of fasting for one week weaken a person?
A. Yes, obviously.
Q. Would they be liable to faint?
A. On standing, yes. Some people would be likely to faint. I fasted two weeks. I tolerate fasting quite well. I have had other subjects, however, when fasting only three days, faint on suddenly arising from a cot.
Q. Would an undernourished or underweight person be more inclined to weaken quicker than a normal person?
A. Yes.
Q. Could injury have occurred in the group in those experiments which received no water and no food?
A. That is possible.
Q. Now, some of these people went on the hunger and thirst from, oh, anywhere from five to eight days. Did you notice that in the records, doctor?
A. Yes, that is correct.
Q. Could you turn to subject No. 3 in the records there? Is there any indication in subject No. 3's records to the effect that he may have suffered as a result of this hunger and thirst period?
A. Well, I notice on studying the record that on several occasions the patient or subject was too weak to stand, apparently, to have his blood pressure taken.
Q. Doctor, on those records before you I believe on Case No. 3 you will find on the top of each graph a number "A3", on the second page "B3", and on the third page "C3". Do you find those numbers?
A. That is correct.
Q. Would you kindly refer to the entries on those charts by the chart number and the date where you find these entries you are referring to?
A. On the chart labeled "B3" I note that the subject was too weak to have his blood pressure taken on August 27th and 28th, and in the after-period, on August 31st and September 1st and September 2nd I notice on chart labeled "B3" that the patient was given an injection of Coronine which is a heart stimulant. That was on august 28, the day before the cessation of the supposed period of deprivation of food and water. On august 20th he was given some strychnine. On Chart "C3" I find that on august 30th and 31st he was given some Strychnine. Strychnine is given as a general stimulant and also as a cardiac stimulant. One wonders why these stimulating drugs were given and why the patient was too weak to stand or too weak to have his blood pressure taken unless ho was an ill patient or markedly disabled by the experimental procedure.
Q. Do you have any further comments to make concerning Case No. 3, doctor?
A. No.
Q. What is the range of survival, Dr. Ivy, of strong men without food and water?
A. As I have indicated, that depends upon the environmental conditions; under certain conditions around three or four days, under ideal environmental conditions eight to fourteen days.
Q. How do you happen to specifically know that so well? Did you over publish any works in that regard?
A. Yes, I have reviewed the entire literature on that subject. I have published those reviews of tho literature in two places, one in a couple of articles on desalination of sea water, the minimal water and food requirements in the U.S. Naval Medical Bulletin, and another in the proceedings in the Chicago Institute of Medicine.
Q. Dr. Ivy, when you state that it is possible for a person to reach at sea a maximum of fourteen or fifteen days before death, how do you account for the fact that in America in 1943 we can recall having seen articles and headlines about a seaman in the United States Navy named "Icjy" who survived on a raft on the Atlantic Ocean 83 or 84 days?
A. No, that seaman was Icci, I c c i, I recall. I interrogated him when he returned to Washington. I was interested particularly in the details of his adventure. I found that the longest that he had been deprived of sea water was seven days. Now, I can recall that figure for this reason.
Q. Pardon me, Doctor, you mean deprived of sea water or deprived of natural water?
A. I mean deprived of water. Did I say "sea-water"?
Q. Yes, doctor.
A. I mean he was deprived of water for seven days. When he boarded the raft he had some water with him. That was used up and then he collected rain water which he would collect and hold. I remember the seven days because at that time I was in the process of making rain charts for the oceans and he had passed through an area of ocean in the South Atlantic where the longest period of freedom from rain was eight days and, when he was in that particular region of the ocean he had been without water for seven days. That was the longest period that he was without water to drink.
Q. That death may have occurred in fasting and thirsting subjects is not probable, is it?
A. Will you ask that question again?
Q. Is it probable that death might occur in fasting and thirsting subjects used in experiments like this?
A. Yes, after a period of days, 6 or 3 to 14, depending upon the environmental conditions and the original health of the subject.
Q. Then it is possible that death might occur?
A. Yes.
Q. Is it probable that drinking 500 cc of sea water daily from four to ten and a half days and taking no food for from two to six days will cause injury?
A. Well, it might cause acute injury and embarrassment such as fainting.
Q. In the drinking of sea water -
A. Or collapse.
Q. On page 12 of Document No. 177, in Document Book No. 5, Doctor, this is the report on the committee meeting held in Berlin. On page 12 of the document book, the last two sentences from the bottom, you see the following language:
"External symptoms are to be expected such as drainage, diarrhea, convulsions, Hallucinations and, finally, death." Is that an accurate statement?
A. I have not found that.
Q. That is on page 12 of Document Book No. 5. That is Document NO. 177.
A. I have it now.
Q. That last sentence on that page 12.
A. I do not know what is meant by the word "drainage" but it is true that diarrhea, convulsions, hallucinations and, finally, death, may occur when one takes 500 to 1,000 cc of sea water every day. Diarrhea would not occur in the case of fasting and thirsting hallucinations, finally death, muscular twitchings, perhaps convulsions, might occur in similar thirsting and fasting conditions.
MR. HARDY: This is a good breaking point for recess, your Honor.
THE PRESIDENT: The Tribunal will be in recess.
(A recess was taken)
THE MARSHAL: The Tribunal is again in session.
MR. HARDY: May it please the Tribunal, the interpreters have called to my attention that the word on page 12 of Document Book V, that is in Document NO-177 which is Prosecution Exhibit 133, in the last sentence from the bottom of the page the interpreters state that the German word which has been translated as "drainage" in English should be replaced by the word "dehydration". In as much as Dr. Ivy could not quite understand, the meaning of "drainage" the interpreters checked the German and the German is better translated as "dehydration ". In that connection. Dr. Ivy, dehydration, of course, is a symptom which would be found in experiments of this sort?
A. Yes, In all of the groups with the exception of the Schaefer water group.
Q. Now, how many of the 14 subjects were supposed to have received 300 cc of sea water daily for six days or more according to your study of the individual charts?
A. You mean of the 44?
Q. Of the 44, pardon me.
A. You say how many received 500 cc of sea water?
Q. Yes, daily for six days or more.
A. 14.
Q. Dr. Ivy, could you refer for a moment to some of the charts herein the person drank 500 cc of sea water and determine whether or not the experiments began on the 21st day of August or whether the experiments began on the 22nd day of August. You will note on any one of the charts that a mark has been inserted under the date 22 August which is an arrow - a red arrow - with a blue circle at the end thereof, indicating the date of the commencement of the experiment and in addition to that there is also a mark in red indicating the date of the commencement of the experiment on the 21st. Dr. Beiglboeck suggests that he placed the arrow with a blue circle at the end thereof under the date of 22 August at some later date when he was re-evaluating these charts.
Now, can you straighten out for us, in your opinion, just when those experiments began, whether they actually began on the 22nd or whether they began on the 21st. Do you understand the import of my question, doctor?
A. Yes, I understand. If we refer to subject 12 who was given 500 cc of sea water presumably. On the chart marked 12 under the space of the chart indicated for August 21st there is a square arrow and on the next chart 12 under the space of August 22 there is a circle in blue from which there extends a straight arrow upward. The experiment apparently started on August 21st where the first arrow is indicated and the first results on urinary output are indicated on August 22. That is a natural way to make a report and a study of this sort because if I start an experiment we shall say on May first we generally make a wieghing before breakfast on May first and then on May 2nd we will make a weighing breakfast. That is the first day or the first 24 hours of the experiment and as a general rule we end the urine collections at a similar time and then the urinary output is indicated as the urine output for the first day of the experiment. So, on the basis of these records I should say that in the case of subject no. 12 the experiment actually started on the 21st and the urinary output is recorded for the 22nd. That however may differ from what actually occurred.
Q. Dr. Ivy, Prof. Boiglboeck points out that the reason why he put the arrow under the date of the 22nd was because of the fact that no discrepancy in weight appears from the date of 21 to the date of the 22nd, and hence he deduces that if no loss of weight occurred, that the experiment could not have begun on the 21st. Now is that a logical deduction on his part?
A. No. The first weight loss would occur on the first day of the actual experimental period. As I explained, you get your first weight loss by taking the weight before breakfast on the first day of the experiment and from that subtracting the weight obtained before breakfast on the second day.
Q. I see. If you started the experiment on the 21st day of August as indicated by the square arrow on those charts, would you necessarily record an intake of water on the 21st, or would the first recording of an intake of water be made on the 22nd?
A. Well, on the basis of the way I explained the keeping of the records, you would record it on the 22nd. But just exactly what Dr. Beiglboeck did I cannot state, and we can't state from his records, because the water intake and the urinary output for the days preceding the alleged starting of the experiment are not indicated. The water intake and the urine output is only indicated in these charts for the experimental period.
Q. How many of the 44 subjects were sick at the end of the sea water period, according to your interpretation of the charts, regardless of how much of the 500 cc, they actually consumed?
A. Well, if we take subject 3, which was on or supposed to be on thirsting and fasting, according to the medication the subject received, that patient was sick or disabled. If we refer to Subject 14, which was supposed to be receiving 500 cc. of sea water for, according to our calculations, 8½ days with 4½ days of hunger, there was an acute fever and temperature of 39 degrees Centigrade on the day of the conclusion of the experimental period. That patient was sick.
If we refer to patient or subject 36, receiving allegedly or supposedly 500 cc of sea water, that patient was given strophanthin therapeutically, indicating that the patient was ill; otherwise why give such medication? If we refer to patient 37, we find that that patient had a fever during the course of the experimental period. If you refer to pationt 39, who likewise was supposedly receiving 500 cc of sea water daily, sterosundin was given therapeutically. That would indicate that the patient was ill and needed intravenous or parenteral medication.
Q. Do you believe, Doctor -
A. Referring -
Q. Go ahead, continue.
A. Referring to Subject 21, that patient was supposed to have received 500 cc of Berka water each day, was given chloramine and was too weak to stand for blood pressure reading on two days. Subject 23 in the same group was apparently very sick and comatose, and according to the acute weight gains, 8 to 10 pounds after the experimental period, the patient was sick. Subject 25 in the same group had a fever and was given morphine. There was x-ray evidence of lung pathology, which causes me to believe that that patient was ill. Patient 28 was too weak to have the blood pressure taken. The same was true of pationt 29. That completes tho list of the patients who were ill during the experiment.
Q. Do you believe, Dr. Ivy, that any of these 44 subjocts were permanently injured or died later?
A. One cannot answer that question yes or no. It is possible, but I should say not highly probably. There are three patients whose after records I should be particularly interested in knowing about. That is subjocts No. 3, 23, and 25.
Q. Have you carefully observed case No. 30? Dr. Beiglboeck informed us that the shorthand notes which are contained on the back of sheet 23-C are shorthand notes concerning the condition of the patient in case No. 30.
Are you able to determine from these stenographic notes and study of case No. 23 and Case 30 whether or not the notes apply to Case 30 or to Case 23? I will pass up to you an English copy of the transcription of the stenographic notes on the back of case No. 23.
A. From my study of the charts for subject 23 and subject 30, since the stenographic pencil record on the back of the Chart C-23 is not dated, l can only answer your question by stating that the stenographic record on the back of Chart C-23 is just as likely to be true of subject 23 as of subject 30. There is nothing in the clinical record or data which would indicate that the implications of the symptoms and signs described in the stenographic record is more likely attributable to subject 23 than subject 30.
Q. While you have the copy of the stenographic notes before you, Doctor Ivy, could you analyze for the Tribunal just what state of health the subject referred to in the stenographic notes, contained on the back of Graph C-23, was in?
A. This patient was in a coma. He was quite sick. Does that take care of your question?
Q. Would there be a great deal of difference in your analysis if, in the sentence which reads "He asks for water only when he awakes from his somnulent condition," that the word "somnulent" was replaced by the word "semi-conscious"?
A. There's a definite difference in the medical implications of somnulence and semi-comatose.
Q. If you please those two words that I suggest in this paragraph, would you be under the impression that the patient was sicker than as indicated in the paragraph as now written on the mimeographed sheet you have before you?
A. By those changes you improve the clinical condition of the patient.
Q. Improve the clinical condition of the patient?
A. With the changes made.
Q. You mean, with the changes that will now appear on the mimeographed sheet I have given you, not by the words I have suggested to you to be replaced, to make the word "no" and the word "semi-conscious"?
A. The idea that I'm trying to convey is that after the changes have been made you get the idea that the patient was not as sick as is originally indicated before the changes were made.
Q. Perhaps I have created a difficulty. I have asked you to replace the word "little" with the word "no" and the word "somnulent" with the word "semi-conscious", but you mean now, that it is written on this mimeographed sheet and as the document now reads, after it has been changed, it would indicate that the patient is not as sick as it would indicate before the stenographic notes were altered?
A. Thats' correct. In other words, by asking these changes in the stenographic record, the clinical condition of the subject was improved.
Q. Now, in the sentence in the second paragraph which reads: "The general condition gives no cause for alarm", if the stenographic symbol for "no" was added later would that make a considerable difference in your analysis of the patient?
A. Obviously.
Q. In the sentence in the third paragraph which reads now as follows: "Respiration some what flatter, moderately frequent" would there be a considerable difference if it was written as it appeared originally before an ensure, in that the word "is" was placed in he sentence instead of the word "somewhat"? In other words, the sentence would read: "Respiration is flatter", and then, later in the same sentence, after the word "flatter", in place of the word "moderately" we insert the word "hardly" so that the sentence as written originally would nave read: "Respiration is flatter, hardly frequent."
Would that convey an entirely different meaning to you than the sentence as it reads now: "Respiration somewhat flatter, moderately Frequent."?
A. Yes, the changes made indicate that the clinical condition of the patient is better.
Q. In the sentence in the 8th paragraph which reads: "Heart beats very low, poorly audible", if the word poorly was replaced by the word "scarcely" would that tent to create a different meaning so that the sentence would read:
"Heart beats very low, scarcely audible" rather than "poorly audible"?
A. I'm trying to make a difference between "poorly" and "scarcely".
Q. Would there be a difference?
A. So far as I am personally concerned, that would make no difference. Poorly and scarcely audible are almost the same thing.
Q. Doctor, are you familiar with the expression "Romberg plus plus" as indicated in the last paragraph?
A. I am, of course, familiar with the Rombarg test or Romberg sign, but the use of plusses varies with different doctors, so just exactly what is meant by Romberg plus might mean something different for me from that it would mean to some one else.
Q. What is the purpose of a Romberg test, Doctor?
A. It is to determine one's ability to stand steadily without falling with their feet together and their eyes closed. A two plus would indicate that it would be difficult for this subject to stand without falling. That would be my interpretation.
Q. Could you explain to us what the remark in the last sentence in the last paragraph "bulbous reflex positive" means?