A Not with me here.
Q Well, now, you have, first of all, a basic requirement for experimentation on human beings, being: "1. the voluntary consent of the individual upon whom the experiment is to be performed must be obtained."
A Yes.
Q "2. The danger of each experiment must be previously investigated by animal experimentation," and "3. the experiment must be performed under proper medical protection and management."
Now, does that purport to be the principles upon which all physicians and scientists guide themselves before they resort to medical experimentation on human beings in the United States?
A Yes, they represent the basic principles approved by the American Medical Association for the use of human beings as subjects in medical experiments.
JUDGE SEBRING: How do the principles which you have just enunciated comport with the principles of the medical profession over the civilized world generally?
A They are identical, according to my information, and with that idea in mind I cited the principles which were mentioned in this circular letter from the Reich Minister of the Interior dated February 28, 1931 to indicate that the ethical principles for the use of human beings as subjects in medical experiments in Germany in 1931 were similar to those which I have enunciated and which have been approved by the House of Delegates of the American Medical Association.
BY MR. HARDY:
Q Is it possible that in some field of scientific research that investigation by animal experimentation would be inadequate?
A Will you repeat that question? I did not get it.
Q Is it possible in some fields of medical research that experimentation or investigation on animals would be inadequate?
A Yes. The experiment on Trench Fever is a very good example.
Q How would investigate the danger of the experiment prior to resorting to the use of human beings?
A. The hazard would have to be determined by a careful study of the natural history of the disease.
Q. Does malaria also fall into that category?
A. We can use animals to some extent in malarial studies, canaries and ducks, for example, develop malaria, and in research designed to discover a better drug for treatment of malaria we can use Avian Malaria as a sort of screen method to detect which compounds might be employed with some assurance that might be effective in human malaria. In that way we decrease the random and unnecessary experimentation on man.
Q. To your knowledge have any experiments been conducted in the United States wherein these requirements which you set forth were not met?
A. Not to my knowledge.
HR. HARDY: Your Honor, I have no further questions concerning medical ethics to put to Dr, Ivy; however, I do have one question concerning the high altitude experiments which I wish to go back to at the conclusion of that complex, in high altitude, I will have completed my direct examination.
THE PRESIDENT: The Tribunal has no questions of the witness. Do I understand that you have completed your examination of the witness?
MR. HARDY: No, I have not; I have a further question to put to him, but I was going to leave the case of medical ethics.
THE PRESIDENT: We have no questions on that subject; you may proceed.
Q. Dr. Ivy, in medical science and research is the use of human subjects necessary?
A. Yes, in a number of instances.
Q. Is it frequently necessary and does it perform great good to humanity?
A. Yes, that is right.
Q. Do you have an opinion that the state, for instance, the United States of America, could assume the responsibility of a physician to his patient or experimental subject or is that responsibility solely the moral responsibility of the physician or scientist?
A. I do not believe the state can assume the moral responsibility that a physician has for his patient or experimental subject.
DR. SEIDL: I object to this question in that it is a purely legal question that the Court has to answer.
DR. SAUTER (For the defendants Ruff and Romberg): If I am not mistaken, a document was read this morning in which it says that the state assumes the responsibility. I believe that I am not mistaken in that. I also want to point out something else, gentlemen, in order to supplement what Dr. Seidl just said.
Here the question is always asked what the opinion of medical profession in America is. For us in this trial, in the evaluation of German defendants, that is not decisive, but in my opinion the Question must be decisive what for example, in 1942, when the altitude experiments were undertaken at Dachau, the attitude of the medical profession in Germany was. From my point of view as a defense counsel I do not object if the prosecution should ask Professor Ivy what the attitude or opinion of the medical profession in Germany was in 1942. If he can answer that question, all right, let him answer it, but we are not interested in finding out what the ethical attitude of the medical profession in the United States was, because a German physician who in Germany undertook experiments on Germans cannot, in my opinion, be judged exclusively according to an American medical opinion, which moreover is from the year 1945 and was coded in the year 1945 and 1946, was coded for the future use; it can have no retroactive force either.
THE PRESIDENT: The first objection imposed by Dr. Seidl might be pertinent if the question of legality was concerned, a legal responsibility; that would be a Question for a court. The question of moral responsibility is a proper subject to inquire of the witness.
As to Dr. Sauter's objection, the opinion of the witness as to medical sentiment in America may be received. The counsel objection goes to its weight rather than to admissibility.
The witness could be asked if he is aware of the sentiment in America in 1942 and whether it is different from this of the present day or whether it does not differ. The witness may also be asked whether he is aware of the opinion as to medical ethics in other countries or throughout the civilized world. But the objections are both overruled.
Q. It is your opinion, then, that the state cannot assume the moral responsibility of a physician to his patient or experimental subject?
A. That is my opinion.
Q. What do you base your opinion on? What is the reason for that opinion?
A. I base that opinion on the principles of ethics and morals that are contained in the oath of Hippocrates. I think it should be obvious that a state cannot follow a physician around in his daily administration to see that the moral responsibility inherent therein are properly carried out. This moral responsibility that controls or should control the conduct of a physician should be inculcated into the minds of physicians just as moral responsibility of other sorts, and those principles are clearly depicted or enunciated in the oath of Hippocrates which every physician should be acquainted with.
Q. Is the oath of Hippocrates the Golden Rule in the United States and to your knowledge throughout the world?
A. According to my knowledge it represents the Golden Rule of the medical profession. It states how one doctor would like to'be treated by another doctor in case he were ill. And in that way how a doctor should treat his patient or experimental subjects. He should treat them as though he were serving as a subject.
Q. Several of the defendants have pointed out in this case that the oath of Hippocrates is obsolete today. Do you follow that opinion?
A. I do not. The moral imperative of the oath of Hippocrates I believe is necessary for the survival of the scientific end technical philosophy of medicine.
Q. Going back to the high altitude experiments for the moment, Dr. Ivy, this morning I put the following question to you in that I asked you in view of the fact that Romberg says he reported the death of three aviation subjects to Ruff, in view of the findings of air embolism in some of the subjects killed in parachute descending tests in Rascher's report, and in view of the interest of Rascher in his report and of Ruff, Romberg, and Rancher in their report on the cause of mental disturbances, is it probably beyond a reasonable doubt, in your opinion, that Ruff, when he approved, read or wrote paragraph 2 on page 91 of the Document Book No. 2, which starts with the words "in spite of", did he have in mind Rascher's experiments air embolism? And you answered the question yes. Now, Justice Sebring asked you whether or not any conclusion could be drawn from the entire report written by Ruff, Romberg, and Rascher which indicates that the writers of the report had knowledge of experiments at Dachau to any extent, that is, the entire report. I believe that was the import of the question by Justice Sebring. In any event, is it possible to ascertain from the entire report written by Ruff, Romberg, and Rascher that they had knowledge of the work of Rascher as solicited in the other reports?
A. No, my testimony in answer to those two questions was not inconsistent. I said that in view of the circumstances and because of the similarity of the subject matter in paragraph 2--
Q. Page 91.
A Paragraph 2, page 91 - and the pertinent paragraphs in the Rascher report.
Q That is Document 220.
A It is impossible when Paragraph 2 on page 91 was written that the observations reported in the Rascher report were not in mind. But, at the same time I said there is nothing in this report by Ruff, Romberg, and Rascher which proves that they had in mind the observations in the Rascher report pertaining to the pressure drop sickness.
DR. SAUTER: Mr. President, I have to object to this question and I ask to have the question and the answer stricken from the record* The question was asked by the Prosecution regarding this document. I am of tho opinion that anybody who is able to read and who is able to think logically can read a document for himself and who is asked to make a judgment about a document does not need tho statement of anybody else in order to make a judgment about this document. Therefore, I am of the opinion that it is inadmissible that an export is asked to give an expert opinion about a document which everyone of us can read and judge and that he is to toll us what he, from his personal point of view, thinks about this document.
MR. HARDY: Then I assume that defense counsel is objecting to the entire examination of Dr. Ivy concerning high altitude and the questions to Dr* Ivy by the Tribunal.
JUDGE SEBRING: Mr. Hardy, in order to clear up this matter perhaps the Tribunal had better again attempt to frame its question that it framed this morning.
Dr. Ivy, you said this morning in answer to a question put by the Tribunal that you had given thorough study to Prosecution Document no. NO-402, beginning at page 82 in Prosecution Document Book II which purports to bo tho report made by Ruff and Romberg concerning "experiments on rescue from high altitude". The purport of the question put by tho Tribunal this morning was this: Can you state whether or not there is any scientific information contained in the Ruff-Romberg report which could not have been gained by Ruff and Romberg as the result of the experiments supposed to have been conducted by them on their own experimental subjects and within the framework of the experiments as outlined in the report?
A My answer was no, by which I mean that the Ruff, Romberg, Rascher report as it stands could have been written if Rascher had not done his autopsy work on the subject in question.
BY MR. HARDY:
Q In that connection, doctor, may I ask you to refer to page 91 of Document Book II. This paragraph reads "In spite of the relatively large number of experiments, tho actual cause of the severe mental disturbances and bodily failures attendant upon post-hypoxemic twilight state remains something of a riddle." What do you determine that sentence to mean scientifically?
A Well, in that connection I believe that since Dr. Ruff and Dr, Romberg knew that a subject had died at high altitude, that the subject had been autopsied, and bubbles found in the blood vessels, that they could not write this paragraph 2 on page 91 without that information coming to mind because the subject matter of this paragraph on 91 pertains to the same subject matter that is reported in the Rascher report.
Q Then it further states "It appeared often as though the phenomena of pressure drop sickness ha d combined with the results of severe oxygen lack." Well, now could that information have been written in this report without knowledge of the Rascher experiments?
A Yes, that could have been written in this report on the basis of knowledge of the previous literature.
Q Well, they state here - "It appeared often as though the phenomena of pressure drop sickness...." Well, now if it appeared often they must have been in a position to observe this pressure drop sickness, is that true?
sickness, is that true?
A Yes, and as a result of their experiences in aviation medicine, study of subjects at high altitude, they could have observed decompression sickness or pressure drop sickness.
Q Can you observe pressure drop sickness and determine that a person is suffering from pressure drop sickness without performing an autopsy or without seeing bubbles in the blood stream?
A Yes.
Q How can you do that, doctor?
A Well, you can determine whether they have the Bends of the system which is evidenced by pain in the joints and inability to walk or stand or to move the joints normally. They could determine whether or not the patient had chokes and fits of coughing: which is another symptom of pressure drop sickness. They could determine whether or not the patient had. a localized paralysis which is another symptom of pressure drop sickness and it is perfectly reasonable on the basis of the knowledge of the literature to assume that when a human being is subjected to the conditions that were used in this experiment that the symptoms manifested by the patient might be due to the combination of oxygen lack and of low pressure.
Q Then, in the first sentence of that paragraph - that sentence could have been written also without knowledge of the Rascher work? That is the sentence starting out with "In spite of......"
A Yes, because the expression" relatively large number of experiments" refers, I believe, to experiments performed by Ruff, Romberg, and Rascher.
Q I didn't understand your answer. I ask you, could that sentence have been written without knowledge of Rascher's work at Dachau?
A Yes.
Q Is it highly probable that the author of this report had knowledge of Rascher's work in writing that sentence?
A I don't see how since Romberg was present at the death of the subject and witnessed the autopsy in which the air bubbles in the blood vessels, and reported that to Dr. Ruff. How they could have prevented having knowledge of that when they wrote that paragraph - they had it on the basis of previous experience.
Q I have no further questions, your Honor.
DR. SAUDER: Mr. President, the last question and the last answer of the witness did not come through over the translation system. May I ask Mr. Hardy to repeat the last question and the witness should repeat the last answer he gave.
MR. HARDY: I asked, if there was a probability that the author of the report had the work of Rascher in mind when they wrote the paragraph on page 91 with starts out with words, "In spite of...."
WITNESS: My answer was Yes and I answered it yes because Romberg saw the patient die, attended the autopsy, saw the gas bubbles in the blood vessels and reported that to Dr. Ruff and when they wrote this paragraph in the Ruff, Romberg, Rascher report they couldn't have done that, in my opinion, without recalling this dramatic incident that happened under Rascher's experimentation at Dachau. I think that should be obvious.
MR. HARDY: No further questions, your Honor.
THE PRESIDENT: I understand counsel for Prosecution has concluded his examination in chief.
MR. HARDY: Yes, your Honor.
THE PRESIDENT: Any questions to the witness by defense counsel?
MR. HARDY: May it please your Honor, in the cross examination of this witness would it be possible for the defense counsel to keep the cross examination in sequence, that is, the subject matter in sequence. For instance, sea water, high altitude, etc., so that it may be followed easier in the record.
THE PRESIDENT: That would be helpful. Does counsel desire to cross examine the witness on the sea water experiments?
DR. SAUTER: President, may I ask that the brief afternoon recess should be taken now so that the cross examination should begin only after the recess. I have a few questions to discuss with my colleagues about the form that the cross examination shall assume.
THE PRESIDENT: Very well, counsel. I would suggest that the Prosecution identification documents be gathered up and returned to the counsel for Prosecution.
The Tribunal will now be in recess.
THE MARSHAL: Persons in the courtroom will please find their seats. The Tribunal is again in session.
MR. HARDY: May it please the Tribunal, I request that the Tribunal ascertain how many defense counsel intend to cross examine Dr. Ivy so that the prosecution can, in turn, ascertain how long Dr. Ivy will remain on the stand. I have many other duties to take care of in the course of the next two or three days and I want to sort of gauge my work and if it will be possible to ascertain how long Dr. Ivy will be under cross examination it will be helpful to the prosecution.
THE PRESIDENT: Will defense counsel who desire to cross examine the witness, Dr. Ivy, please signify so by rising.
MR. HARDY: Thank you, Your Honor.
CROSS EXAMINATION BY DR. SAUTER (Counsel for the defendants Ruff and Romberg):
Q. Witness, you are an expert in the field of aviation medicine?
A. Yes.
Q. May I ask you what fields within aviation medicine you have worked on specifically, because my clients, who are recognized specialists in this field, attach importance to ascertaining precisely what fields you have worked in particularly?
A. I have worked particularly in the field of decompression or pressure drop sickness, and I have also worked in the field of anoxia or exposure to altitude repeatedly at a level of 18,000 feet to ascertain if that has any effect in the causation of pilots' fatigue.
Q. At what time did you specifically concern yourself with the fields you have just named? Was that before the Second World War, during the Second World War, or was it earlier than that?
A. My interest in these fields of aviation medicine, including free fall which I did not mention, started in 1939.
Q. Regarding your specific work in this field, witness, you have also made publications. I believe you spoke of two publications. Did I understand you correctly, or were there more?
A. There were two in the field of decompression sickness. There was one publication in the field of the effects of repeated exposure to mild degrees of oxygen lack. My other work has not yet been published, but was submitted in the form of reports to the Committee on Aviation Medicine of the Rational Research Council of the United States.
Q. When were these two papers published of which you just told us that they were published; when, and where they printed by a publishing house. Did they appear in a journal or a periodical?
A. One appears in the Journal of Aviation Medicine either in September or October of 1946. The other appears in the Journal of the American Medical Association in either December or January of 1946 or 1947. The publication on the effect of repeated exposure to mild degrees of oxygen, lack oat altitude appears in the quarterly bulletin of Northwestern University Medical School and part of the work, insofar as its effect on the elimination of the basis in the urine is concerned, appeared in the Journal of Biological Chemistry around 1944 or 1945, I am not sure of that date.
Q. Theretofore, witness, you had thus made no publication in the field of aviation medicine before the papers of which you just gave the dates of publication?
A. The question is not clear.
Q. You just gave us the titles of the publications you have published and whn; now I asked whether before the dates you just gave you did not have any publications in the field of aviation medicine?
A. No, my first research started in 1939.
Q. You yourself have carried out experiments too; is that not so?
A. Yes.
Q. With human experimental subjects, of course?
A. Yes and on myself.
Q. And with a low pressure chamber?
A. Yes.
Q. Were these frequent experiments or were they experiments in which you yourself took part only infrequent in number?
A. The experiments in which I took part were infrequent in number compared to the total number of experiments which I performed.
Q. Did you take part in these experiments as the director of the experiments, as the person responsible or were you usually the experimental subject yourself?
A. I served in both capacities. For example, I have frequently gone to the altitude of 40,000 ft. to study the symptoms of dens with an intermediate pressure device, which we produced in our laboratory. I have been to 47,500 ft. on three or four occasions, on one occasion at 52,000 ft. for half an hour. I have frequently been to 18,000 ft. without supplemental oxygen in order to study the effect of the degree of oxygen lack present there for my ability to perform psycho-motor tests.
Q. Can you tell us approximately during what year you began these experiments of your own?
A. In 1939.
Q. 1939; did you at this time carry out explosive decompression experiments too? Witness, one moment please, the English for that is "explosive decompression." That is thus the experiment in which one ascends slowly to a certain height, let us say 8,000 meters and then all at once suddenly one is brought up to a height of 15,000 meters; that is, first slowly up to 8,000 and then suddenly to, let us say, 15,000 -- that is what I understand under the term "explosive decompression" experiment, and my question is: whether you also carried out such experiments and if so when and to what extent?
A. I carried out over one hundred experiments on explosive decompresion in various laboratories on animals, the rabbit, the dog, the pig and the monkey. I did not serve as a subject myself in experiments on explosive decompression, but a student who was trained with me in physiology, Dr. J. J. Smith did the first experiments on explosive decompression in which human being subjects were used at Wright Field. I am familiar with the work which Dr. Hitchcock did on this subject at Ohio State University in which he studied some one hundred students under conditions of explosive decompression.
To what altitude, witness; to what maximum altitude did you carry your own explosive decompression experiments?
A. In animals it was up to 50,000 ft., in the case of human subjects the maximum was 47,500 with pressure breathing equipment.
This altitude you reached in your own experiments. Now, Doctor, it would in rest me to know to what maximum altitude have any experiments in explosive decompression been carried in America; what do you know about this maximum altitude?
A. I believe that 47,500 or slightly above is the maximum.
Q. Witness, do you know the German Physiologist Dr. Rein; Professor Rein, do you know his name; R-e-i-n from Goettingen?
A. Yes.
Q. At the moment he is the ordinarius for Physiology at Goettingen, he is a rector at the University and a member of the Scientific Advisory Committee for the British zone. On the basis of your own knowledge do you consider Professor Rein an authorative scientist in the field of physiology and aviation medicine?
A. I consider him an authorative physiologist, I am not acquainted with his work in the field of aviation medicine.
Q. Mr. President, I previously put in evidence -- I want to recall that now -- n expert opinion from this Dr. Rein regarding Dr. Ruff in Document Book Ruff Document No. 5, Exhibit 3. This expert testi-money is from Professor Rein.
In your own experiments, witness, you also used conscientious objectors, is that not so? Did I understand you correctly?
A. Yes, in some of the experiments.
G. Rill you tell us why you, specifically happened to use conscientious objectors, were they particularly adapted for these experiments; or what was the reason for you some conducting experiments to use especially conscientious objectors?
A. Yes; it was their duty, their volunteer duty to render public service. They had nothing else to do but to render public service, In the experiments in which we used the conscientious objectors, they could devote their full attention to the experiments. Many of the subjects, which I have used, have been medical students or dental students, who besides serving as subjects had to attend their studies in schools.
In the experiments we did on the conscientious objectors, they could not attend school at the same tame and carry on or perform all the tests they were supposed to perform. For example, we used a group of conscientious objectors for repeated exposure to an altitude of 18,000 feet without the administration of supplemental oxygen. These tests involved the following of a strict diet, they involved the performance of work tests and psycho-motor tests, which required several hours every day to perform. Another group of conscientious objectors that I used were used for vitamin studies in relation to fatigue.
These conscientious objectors had to do, a great deal of carefully measured work during the day as well as to perform psycho-motor tests; so, medical students or dental students could not be used. we had to have subjects who could spend their full time in the experiments.
JUDGE SEBRING: Dr. Sauter, at this point I should like to ask a question, if I may.
BY JUDGE SEBRING:
Q. Dr. Ivy, do you know whether or not American citizens who were conscientious objectors were drafted into the American military service during World War II.
A. No. They were drafted into this Civilian Public Service Corps and, as I indicated, there were two types of conscientious objectors: one type that did not cooperate in any way - they were imprisoned - and there was another type that were willing to perform public service as long as it was not in the nature of military duty.
Q. And what group is it that you say you used for your experiments?
A. The latter group.
Q. Do you know the nature of the oath, if any, that they took when they were inducted into this special service?
A. No, I do not.
Q. Do you know what their general physical qualifications were as compared to the physical Qualifications of the man who was inducted into the military service of the United States?
A. Well, some of them were excellent physical specimens.
Q. What I mean to say is this. Was there a physical Qualification scale set up for them in regard to age brackets and physical qualifications just as there was for the men who were inducted into military service?
A. I presume so because they would be drafted, and they would have to report that they were conscientious objectors.
Q. Then, so far as you knew, they were drafted; they had to register their names, numbers, residence, and so forth and were drafted just as all other American citizens within certain age brackets were drafted?
A. Yes.
Q. And then when it came time for selections for induction into the service they registered the fact that they were conscientious objectors and then were placed in a special organization for public service if they would agree to do public service or, if they would agree to do nothing, were placed in prison.
A. That is according to my information.
JUDGE SEBRING: Thank you.
BY DR. SAUTER:
Q. Witness, from the answers that you have given so far, I am still not clear in my mind precisely why you hit upon conscientious objectors in particular as the experimental subjects. You said there were two groups of them: some were in prison and some had to perform public service. From the latter group you took your experimental subjects, but please give me a clear answer to the question: Why did you specifically use such conscientious objectors for your altitude experiments?
A. They could devote full time to the experimental requirements. They did not have to do any other work as was the case of medical students or dental students, the only other type of subjects that I had available to me.
Q. Doctor, these persons were obliged to perform public service. If these conscientious objectors had not been there or if they had been used for public service, then you wouldn't have had any experimental subjects either. There must be a specific reason why you specifically used conscientious objectors and I ask you, please, to tell me that reason.
A. Well, we couldn't have done the experiments unless the conscientious objectors had been available. That is the answer to your question.
Q. Could you not have used any prisoners, even conscientious objectors who refused to do public service and, therefore, were in prison without doing any work? Could you not have used them?
A. Well, that would have meant that I and my assistants would have to go to the prison which was quite a distance away. The conscientious objectors could come to us at the university where they could live in the university dormitory or in the university hospital.
Q. Doctor, if your experiments were really important - perhaps important in view of the state Of war - then it is difficult to understand why the experiments could not have been carried out in a prison, let us say. Other experiments have been carried out in prisons to a large extent and in another context, Doctor, you told us that you simply had to get in touch with the prisoners; you simply wrote them a letter or you put up a notice on the bulletin board and then, to a certain extent, you have prisoners available. Can you give me no other information as to why you used specifically and only conscientious objectors?
A. No, if it had been convenient and necessary for me to use prisoners, I believe that we could have gotten prisoner volunteers for this work.
Q. Witness, were you ever in a penitentiary as a visitor?
A. Yes.
Q. Did you see there how the criminals condemned to death were housed?
A. Yes.
Q. Are they completely at liberty there or are the criminals condemned to death locked up in their cells?
A. They were locked up in their cells.
Q. Now, can you please tell us how a criminal condemned to death is to see the notice that you would put on the bulletin board? You told us today that it was very simple - you simply put a notice on the bulletin board - and for hours I have now been trying to figure out how a criminal condemned to death, who is locked up in his cell, is going to see that notice on the bulletin board.
A. While these prisoners are taken out for their meals, they can pass by a bulletin board or a piece of paper with the statement on it which I read can be placed in their cells for reading or, as a large group in the dining room, the statement can be read to them.
Q. Are criminals condemned to death together at meals in America?