He may begin to propound those questions now, if his counsel desires.
BY THE DEFENDANT DR. ROSE:
Q. How many members of the American armed forces were used in the yellow fever experiments of Reed? How many of them were there?
A. I do not know.
Q. Is it not correct that, outside of the two persons whom you mentioned, only coolies who had volunteered for payment were used?
A. According to my information, the two doctors whom I mentioned, Carroll and Lazar, and then American soldiers. I did not know that there were any natives used.
Q. Well, you do not know about it?
A. We do not have coolies in Cuba or in the West Indies.
Q. How large is the mortality in yellow fever?
A. How large? You mean--
Q. What is the mortality rate?
A. That is in epidemics or in the experiments of Walter Reed?
Q. Yellow fever in general.
A. I think it about fifty percent, if I recollect the figure correctly. It varies.
Q. Is it not correct that in the case of all races, with the exception of the Negro, the mortality rate is eighty to ninety percent?
A. I remember that it is quite high.
Q. Is it not correct that the number of experimental subjects in the Reed experiments was more than thirty?
A. I do not remember.
Q. Then there is no point in asking further questions about it if you are not informed about it.
You told the prosecution in regard to pages 187 and 188 from the Philippine Journal, regarding the plague experiments by Strong - you said that the experimental subjects had a temperature of one degree Fahrenheit, and that the harmlessness of the experiment was absolutely no surprise to the author because he could foretell the successful results.
Did I understand you correctly?
A. On the basis of his animal experiments.
Q. For what reason were criminals who had been condemned to death used for these experiments, in view of those facts?
A. I do not know.
Q. May I ask for Exhibit 513, please. The prosecutor, on Friday, read from this exhibit. I want to continue exactly at the same place where he stopped reading:
"Surprising as it may seem, the injection of these large amounts of the living plague organism have not given rise to any severe reactions. A few hours after the inoculation the temperature of the individual usually begins to rise. When the injection has been given in the morning, the fever may, on the evening of the first day, reach 38.9 to 39.4, but rarely has it touched 40 degrees Celsius."
Would you not like to change your testimony after hearing this, namely, that the temperatures were higher than one degree Fahrenheit? For 40 degrees Celsius is 104 degrees Fahrenheit.
A. As I recall, I did not specifically specify one degree. I believe I qualified by saying approximately one degree or so. If I specified only one degree, then I should change my testimony to say approximately one degree or so.
Q. And from this wording, "surprising as it may seem", does not one have to gain the impression that the assumption that the injection of living plague baccilli could not have any unfortunate consequences was not certain by any means at the beginning of the experiment?
A Well, I interpreted the expression "surprisingly as it may seem" as a rhethorical expression for the reader and not necessarily for Dr. Strong.
Q Do you know that the experiments conducted by Strong were criticized?
A I have never heard them criticized.
Q But that is mentioned in the further papers by Strong, in which he discusses these criticisms.
A No, I have not seen that.
Q The experiments by Strong were conducted in 1905, and they were published in 1906. This injection with living plague bacilli was one of the most important advances in the fighting of plague. Can you tell me the reason why it took twenty years before this discovery was introduced into practice?
A No, I cannot. That is true of a number of medical discoveries. For example, sulfanilamide had been made, before it was applied in practice, some ten to twenty years.
Q Yes, but that was for because the chemical-therapeutical qualities of sulfanilamide were not known. After these qualities were known, it did not take twenty years before it was used in practice. But these details about the development of plague vaccines are not known to you personally?
A Not that Colonel Strong was criticized for his work.
Q And also not the difficulties, why it took twenty years before plague vaccines were introduced into medical practice?
A The specific reasons in this case are not known to me, but I do know that in other cases there is quite a lage between the original discovery and its application in practice.
Q So it is not known to you that the criticism regarding the danger of this method and the possibility that the plague bacilli could become virulent again was the reason for waiting twenty years, for further scientific development?
A I am mot familiar with that.
Q Do you know that Strong himself, in further publications, reported about the application of this method with monkeys, which died of the consequences of this injection of the plague vaccine?
A I am familiar with the fact that he used other animals in his studies, but I do not recall the details.
Q Well, I shall go ever to another point.
Moreover, from Volume VII of the Philippine Journal of Science, you submitted pages 290 and 291. That is the paper by Strong regarding beriberi. Did you read that paper yourself?
A Yes, I read the paper, and then I had photostats made of these two pages indicating that volunteers were used.
Q In addition, you also discussed the matter with one of the authors of this paper, did you not?
A That is correct; Dr. Crowell.
Q Did I understand you correctly, that you said in your testimony on Friday that none of the experimental subjects died?
A Yes, I said that to the best of my knowledge none of the experimental subjects died.
Q And since you read the paper yourself, as you just confirmed to me now, may I perhaps, in order to refresh your memory, ask you to turn to page 379 of this paper? I have put a white sheet of paper in that place. Moreover, the tables 4 to 7 of this paper. Perhaps for the benefit of the Tribunal I may read the important lines.
On page 379 it says:
"The patient gradually sank and died at 2 P.M. on the following day."
THE PRESIDENT: Dr. Rose, from what book are you reading? Will you please read into the record the title of the publication?
DEFENDANT DR. ROSE: The Philippine Journal of Science, Volume VII, Section B, page 379.
BY DEFENDANT DR. ROSE:
Q Further down it says: "Necropsy: One half hour after death."
The tables 4, 5, 6, and 7, which follow page 414, are anatomical presentations regarding this. Will you please convince yourself?
(Volume submitted to witness)
After having looked at this text, would you not like to correct the statement you made that there were no fatalities?
A Yes, there is a fatality. I do not know yet what it was due to, though.
Q I thought you read the paper.
A Yes.
Q Well, now, if you now want to read over all those pages which describe the case history of this man, unfortunately too much of the time that is made available to me for questioning you will be lost. Therefore, I shall now proceed.
Is beriberi a serious disease?
A It depends upon how far it advances.
Q Well, you have read the paper through and therefore you know that the case histories of the 29 patients are described exactly in this paper, and how serious degree of illness these patients had. Do you agree with me that beriberi is a disease which causes serious damage to the heart and to the nervous system?
A Yes, if it is permitted to go to a point where serious damage occurs.
Q Yes, if one lets it proceed to the extent that the patient dies of it, then, after all, it has proceeded pretty far.
The paper says that the experimental subjects could speak neither English nor Spanish, and apparently also not the native dialect which was spoken in Manila, but that one had to speak to them through interpreters in their native dialect. They were apparently illiterates.
Do you consider that persons of that kind are able to judge the significance beriberi experiment?
A I think so, when beriberi is endemic in the region from which they come.
Q Well, you know just as well as I do that beriberi does not occur in the mountain regions of the Philippines.
A No, I am not sure of that.
Q But in any case you agree with me, that beriberi is such an important problem that the experiments by Strong, from an ethical and scientific point of view, were justified to their entire extent?
A I have heard no criticism of those experiments.
Q And you yourself do not criticize them either? You know the paper after all, do you not?
A Yes. I read the paper the latter part of December, so all of the subject matter is not familiar to me now.
Q But in any case, at the time when you were reading it, you did not have any misgivings about it, did you?
A No; I was primarily interested in finding out whether the subjects were volunteers and whether they were offered a reward. That was the part of the paper which I had photostated.
Q Yes, but after all, in order to make a photostat one first has to have read the paper.
A Yes.
Q Now I want to go over to the malaria experiments in the American prisons. Exhibit 516 contains a written statement which was given to the experimental subjects regarding the danger involved in the experiment before they declared their willingness to participate in the experiment. We are apparently concerned with several different experiments. The experimental subjects had it pointed out to them that they would he infected with the Chesson strain of malaria. Can you tell the Court what kind of a malaria strain that is?
A No, I cannot.
Q But if I tell you that this is a very well-known strain of malaria tropiod, can you confirm that?
A I confirm that, but I don't want you to believe that I am an expert on malaria.
Q Will you please tell the Tribunal what the malaria which is caused by plasmodium vivax is called in English?
A Vivax.
Q Is it not called benign tertian?
A Yes, that is right, and it is subject to relapses.
Q That is the scientific name of the type of malaria that is caused by plasmodium falciparum?
A. I do not offhand know.
Q Can you confirm to me that the scientific name is malaria tropica, or malaria perniciosa?
A I do not know.
Q Is malaria tropica considered more dangerous than benign tertian?
A Yes, I am sure of that.
Q The judgment of a Dachau court has been submitted to the Tribunal here. This judgment concerns itself with the malaria experiment of Prof. Schilling. In this judgment it is laid down that 300 to 400 persons during the course of the malaria experiments conducted by Dr. Schilling died or are supposed to have died of the consequences of malaria infection. The prosecution witness Vieweg stated here that Schilling worked only with plasmodium vivax, benign tertian. On the other hand, it is well-known, and you have confirmed that in the American malaria experiments they worked malaria tropica, and we are both in agreement that malaria tropica is considerably more dangerous than malaria tertiana. May I now ask you whether fatalities occurred in the malaria experiments in American penitentiaries?
A If fatalities have occurred, I have not heard of them
Q Did you see the reports about these malaria experiments?
A No, I have not read the reports on the malaria experiments. I just simply know Dr. Arvin, who is supervising the experiments at Stateville.
Q Mr. McHaney, the prosecutor, informed us here that in the American malaria experiment no fatalities occurred. Of course, he did not state where he got this information, and of course he was not under oath either when he made that statement here. But I have to tell you that Prof. Schilling is supposed to have experimented on almost 1,000 experimental subjects. Now does it not even though you are not an expert on malaria, on the basis of your general medical knowledge not appear somewhat peculiar to you that in an experiment with the benign malaria there is supposed to the a fatality rate of 30 to 40% and in experiments with the dangerous form of malaria no fatalities occur?
MR. MC HANEY: I object to the question being put. It necessarily must be a hypothetical question. I don't think it contains all of the necessary hypotheses to give us any probative value from an answer to the question that has been put. If we do not know the condition of the experimental subjects who are used in the two experiments, if we do not know the methods of treatment given to the two different groups of experimental subjects, and I have particular reference to the proof on the use of pyramidon in Schilling's experiments, if we don't know certain other factors concerning the treatment and the care given the patients, I do not see that an answer from the witness to the question put can have any probative value.
THE PRESIDENT: The objection is sustained.
BY DR. ROSE:
Q Were the natives in the Philippines during the years 1905 to 1912 that is, during the time when Strong was carrying on his experiments there with human subjects American citizens, or from the racial point of view and according to their nationality were they regarded as non-American?
A I do not know. My recollection of political history in the Philippines Islands is not certain.
Q But in any case you personally are convinced, are you not, that Prof. Strong conducted his experiments with natives, not because he considered them racially inferior, but that he used them as experimental subjects because the government of the Philippines did not make any other subjects available to him, and he personally in the knowledge that his experiments would serve medical research and thus all of humanity, was not very much interested in the nationality of the experimental subjects.
AAll I know is that they were prisoners condemned to death, and, according to Dr. Crowell, volunteers.
Q You submitted a document to the Tribunal which was given the Exhibit No. 518, regarding Veintimillas typhus investigations. You said that the experimental subjects were volunteers. May I ask you how you know that? I know the paper very well, and in the paper itself it is not stated.
A I am not sure that I said they were volunteers. It states that for this purpose we selected 48 persons from 30 to 40 years of age and on whom no previous typhus infection was suspected, according to anamnesic or historical analysis.
Q But do you have any other sources or information than the paper itself? Did you speak with Veintimillas himself?
A I fell quite sure that I did not testify that volunteers were used in this article.
Q Then I must have misunderstood you. At least over the microphone that is what I heard, and I made a note of it.
A That may have been implied, the way they were being submitted, and the questions came in, but I know that volunteers were not specifically states in this particular article, and in the same way they were not specifically stated in the plague experiments of Col. Strong.
And when I found the word "volunteer" was not specifically included in the experiment of Col Strong I called up Dr. Crowell and discussed the matter with him. I could not do that in the case of this article. And I wanted to point out that on page 343 it is stated: "It was obvious that typhus fever in men could be produced by such inoculum, and as we considered it unnecessary to expose human beings to the risk of a certain infection, we therefore relied on guinea pigs for control cases.
Q I am familiar with that. Are you a expert in the field of testing typhus vaccines?
A No, I am not an expert in the field of typhus.
Q But perhaps you know just because of this fact which you just pointed out, namely, on the basis of the fact that no human controls are available, the entire experiment conducted by Veintimmilas and of the typhus experts is not considered to have any probative value?
A No, I do not know that.
Q But you do know, don't you, that the reaction of an animal to an infection does not prove anything in regard to what the same infectious material would cause in human beings?
A I do not know that to be true.
Q But you submitted this paper, this article by Veintimillas and in this paper the experiment by Franciscassa is mentioned. He conducted a similar experiment and he used human controls, that is, infected and non-immunized persons. Are you familiar with that experiment?
A I am not familiar with that experiment.
Q But it is mentioned in this papers? Did you overlook it?
A I did not look up the references cited in this paper.
Q But this fact, that he used controls who had not been vaccinated, is mentioned in this paper by Veintimillas, over and above that, do you know that Blanc and Baltazzard conducted a number of vaccine tests of that type, in which the persons who were vaccinated were infected with virulent bacilli, as well as other control subjects?
Do you know of these experiments?
A. I do not.
Q. Do you know the experiment by Otere, who infected unvaccinated persons with typhus?
A. No.
Q. Do you know the experiment by Yersin and Laval, who infected two coolies successfully with typhus?
A. No.
Q. Do you know the similar experiments by Sergent and his collaborators?
A. No.
Q. Do you know similar experiments by Reitano, Mitchell and Richardson, Sparrow and Lumbroso?
A. No.
Q. Perhaps at least you know the experiment of the Americans, McCalla and Brereton, who infected two persons with Rocky Mountain spotted fever, and in particular do you know why as their experimental subject they took a patient who had had both legs amputated?
A. No, I do not.
Q. Did you ever, at least in American medical journals, read a criticism of these experiments or protests against these experiments?
A. No.
Q. Even not, although now you are concerning yourself with the question of human experiments?
A. Yes.
Q. To return to malaria once more, may I ask you whether you consider it adequate information regarding the danger of an experiment with tropical malaria to say, "While the danger to life from this strain of malaria is small, there is a strong probability of relapses or recurrent malaria fever for a period up to several years after the infection?
A. I know that that is true, yes.
Q. Yes, and do you consider this information adequate in order to inform an applicant for a malaria experiment who is a layman about the dangers and risks of such an experiment?
A. Yes, I believe that is adequate.
Q. In any case, you are of the same opinion as I am, namely, that malaria experiments on human subjects, in view of the importance of this problem, are absolutely justified, scientifically as well as ethically, even if they bring with them danger for human life.
A. Provided the subjects are volunteers and the hazards of the experiment have been explained to the extent that they are explained in the malarial experiments we have conducted in the United States.
Q. Well, this principle, that you keep constantly to the voluntary nature of the experimental subjects, you have already explained sufficiently.
Now, I want to ask you only briefly about two other experiments, whether you know them, because in the history of experiments on human subjects they have been widely discussed; first, the experiment by Adler, who infected five cancer subjects with kala-azar, with the result that all five died. Do you consider that experiment ethically justified?
A. I did not follow the first part of that.
Q. Do you know the experiment by Adler, who infected five cancer patients with kala-azar, with the result that all five died?
A. I am not familiar with that experiment, but I should like to know whether or not the cancer patients agreed to this therapy. Generally, when a therapy of this sort is tried, the doctor asks the patient to sign a release. That is customary in performing surgical operations in our country, because there is always a certain amount of danger associated with an anesthetic and an operative procedure, and this was an untried therapy, and I presume the patients were of the nature of volunteers and agreed to have this new treatment applied or tried on them.
Q. Did you ever hear of the treatment of cancer by infection with kala-azar?
A. Yes.
Q. Well, I never heard of it.
Do you consider it in accordance with medical ethics if criminals who are condemned to death are administered a dangerous dosage of medicines so that, in case they should not die of this poisoning, the changes in their liver can be studied after their execution?
A. It did not all come through to me.
Q. Do you consider it to be in accordance with medical ethics if criminals who are condemned to death are administered dangerous doses of medicines so that, if they should not die of this poisoning, the changes in their liver can be studied after their execution?
A. If those prisoners condemned to death have volunteered and if there is good reason to believe that such tests are necessary, in my opinion it is ethical to do that.
Q. All right. Well, you do not object to the experiments themselves, even if they are so dangerous, but all your objections concern merely the one point, namely, whether the patient himself, that is the experimental subject himself, gives his consent.
A. That is the first principle of medical ethics which I explained yesterday in my testimony. There are two other principles that always have to be kept in mind. One is to be sure that the experiment is necessary on the basis of previous animal experimentation and a knowledge of the natural history of the disease, and in this latter case I presume that adequate animal experimentation had preceded the injection of the volunteer prisoner condemned to die in order to indicate that such an experiment was necessary and worthwhile to perform. The third principle of medical ethics was that the experiment must be done carefully, so as not to cause any unnecessary pain and suffering, by adequately qualified scientists, and when there is any prior reason indicating that permanent disability or death might occur then the scientists themselves should be willing to serve as a subject in the experiments.
Q. I have no further questions.
DR. FRITZ: I also have no further questions, Your Honor.
THE PRESIDENT: Dr. Kaufmann, you may cross-examine the witness.
CROSS-EXAMINATION BY DR. KAUFMANN (For the defendant Rudolf Brandt):
Q. Professor, I will probably have to ask you only one single question. So far we have discussed only the question of ethics as far as physicians are concerned. Now, I should like to ask you to what extent a layman, who is not a physician, who is not a specialist, can recognize from reports, for example, reports by Rascher, what the borderline is between what is admissible and what is not admissible; in other words, I should like to ask you, can a layman recognize whether the professional ethical principles, the three which you mentioned, Professor, were violated when he reads such reports, for example, a report by Rascher?
A. Did you say a report by Rascher?
Q. Yes, a report by Rascher.
A. Well, I believe they can, and I believe that a lay person reading a report of that sort would be stirred to indignation.
Q. All right, but in order to do so, it is probably necessary that he study the report thoroughly, is it not?
A. I do not think so. I think reading the portion of the report where he stated that he held people under water until they died would stir a layman to indignation, should he read that.
Q. I have no further questions, Your Honor.
THE PRESIDENT: How many other Defense Counsel, if any desire to cross-examine this witness, of course with the exception of Dr. Steinbauer on behalf of Beiglboeck. Dr. Tipp, have you any questions?
DR. TIPP: Yes, Your Honor. The questions which I should like to put are only in respect to the sea water experiments, and, therefore, it would be more appropriate if I put them after Dr. Steinbauer has completed his examination.
THE PRESIDENT: Yes, Dr. Steinbauer, you may proceed to cross examine the witness. The defendant Beiglboeck may leave the dock and take his position beside his counsel. You may proceed, Counsel.
CROSS-EXAMINATION.
BY DR. STEINBAUER: (Attorney for Defendant Prof. Dr. Beiglboeck):
Q. Professor Ivy, I want to address two brief questions to you myself. Was the problem of making sea water potable, in which you yourself collaborated very well, was it a contribution to humanity in regard to rescue in sea distress?
A. Yes.
Q. Do you agree with the Englishman Dr. Baker, who wrote a paper about this problem, that every means to be applied to making sea water ptoable has to be examined in advance very carefully in order to avoid groat danger?
A. Yes.
DR. STEINBAUER: Then, I have no further questions for the moment. With the permission of the Tribunal, I now ask to have Dr. Beiglboeck cross-examine the witness.
THE PRESIDENT: Just a moment, is the transmission system functioning satisfactorily?
INTERPRETER: Yes, Your Honor.
THE PRESIDENT: In cross examining the witness, Dr. Beiglboeck, avoid arguing with the witness; propound your questions to him in as simple, scientific language as possible, and make your questions not too long. Instead of asking one very long question, it would be more profitable if several shorter questions may be propounded. You may proceed.
CROSS EXAMINATION BY THE DEFENDANT DR. BEIGLBOECK:
Q. Professor Ivy, how old were you when you conducted the sea water experiment on yourself?
A. Forty-nine.
Q. How much weight did you lose during the experiment?
A. As I recall, in three days it was almost two kilos somewhere between four and five pounds. I did these experiments late in 1942, and I can't be particularly accurate.
Q. Do you mean that you lost this much weight per day or during the entire course of the experiment?
A. During three days.
Q. Only two kilograms, without taking in fresh water?
A. Yes, I took nothing but 240 cc of sea water and 180 calories of food a day.
Q. I must have misunderstood the translation at the time. It was my understanding that during those three days you drank 2,400 cc of sea water.
A. That is correct.
Q. In other words, you only suffered a maximum loss of liquid of 2000 cc; is that correct?
A. As I said, I can't be absolutely accurate regarding the amount of weight I lost.
Q. Professor Ivy, is it correct that the speed of dehydration is very important?
A. Yes, that is correct.
Q. If during the condition of thirst one consumes small amounts of liquids, would the speed of dehydration then be delayed or in part equalized or balanced?
A. Yes.
Q. Professor, in the condition of thirst, the body, from its water stores, supplies some water, is that correct?
A. Yes.
Q. Is it also correct that the liver, the skin and the muscle are the stores of water which would cover this water loss first?
A. Yes, during the first day or two.
Q. Professor, is it correct, and do you agree with the opinion of Marx, that the muscles are able to give up to three liters, that is three quarts of water ---
THE PRESIDENT: The translation is not coming through.
Q. Do you agree with the opinion of Marx, that the muscles are able to give up two to three liters, or quarts, of water?
A. In, toto, yes.
Q. Do you know that in the case of people who have cholera, it has been observed that the muscle have lost up to twenty per cent of water?
A. I recall that figure from the literature.
Q. That would be more than four liters, or four quarts.
A. Yes, that checks with my calculations.
Q. Professor, is it therefore correct that when water is lacking, first of all the muscles are affected?
A. I am not sure they are the first to be affected. They do lose water beginning early, but whether they are the first to be affected, I do not know.
Q. From clinical experience with dysentery and cholera, we know quite well that it is predominantly the muscles that give up the water. Do you have any experience in this field?
A. No, but I would agree with your qualification "predominantly."
Q. Professor, if it is correct that the muscle first of all is affected in the condition of thirst, is it correct then too, that the damage caused by thirst, that can be expected first, are the protein deterioration of the muscles?
A. I think that will depend a great deal on whether or not the individual is starving -- how much protein they are obtaining in their ration.
Q. Professor, if a muscle that has lost water is supposed to perform some work, would it work under worse conditions than a muscle that contains a lot of water?
A. It would work under worse conditions that a muscle containing a normal amount of water.
Q. Would it, therefore, be expedient from the medical point of view to expect a muscle that has lost water to work?
A. It could perform work, but not as much as in the normal condition.
Q. Professor, I believe you didn't quite understand my question. My question is -- whether from the medical point of view it would be expedient to expect this muscle to preform some work that it does not absolutely have to perform?
A. The translation is not clear to me.
Q. I did not ask you Professor Ivy, whether a muscle that has lost water can work less well, but I asked you whether it would not be expedient that a muscle that has been dehydrated should be spared any unnecessary work.
A. I agree.
Q. Professor, if the blood pressure is measured after a strain, then the experimental subject has to do some work beforehand; is that correct?
A. That is, to do the amount of work it requires standing.
Q. Yes. Did you convince yourself, Professor Ivy, that in my record of the experiments the blood pressure at rest of all experimental subjects was taken daily?
A. Yes.
Q. Do you leave the possibility open that the blood pressure at strain was not taken in order to spare the experimental subject?
A. That is possible, but I wondered why the blood pressure wasn't taken with the subject prone -- lying down.
Q. The blood pressure was measured on the experimental subject in a prone position; during the first period of the experiment also after a strain; and in individual cases toward the end of the experiments we did not take the blood pressure any more under strain because of the existing weakness of the muscle.
A. I understand.
Q. Professor, is it known that in an adult, too, the temperature can rise when he is in a condition of thirst?
A. Yes.
Q. Perhaps I may show you here a paper by Denning from the last century, and I should like to ask you to look at pages 293, 298, and 304, and convince yourself by means of the temperature curves that during the thirst experiment, which lasted for six to seven days, temperatures up to about thirty-eight centigrade occurred.