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.
A: The charts show a temperature up to 37.83 centigrade in thirsting.
Q: Professor, is it well-known that after the administration of a hypotonic table salt solution temperature rises occur?
A: Yes.
Q: Professor, would you, therefore, if such sub-febrile temperatures occ** in a condition of thirst, think that it was justifiable to consider such an experimental subject ill or seriously ill?
A: It means that they are considerably dehydrated.
Q: Professor, I believe that these records of Dennig's experiments show that temperatures were observed already on the first and second days.
A: In the experiments in this article?
Q: Yes.
A: According to my interpretation of the charts, on the 3rd and 4th days
Q: I think that I can remember that in one experiment on the first day there was already a temperature over 37 degrees centigrade.
A: Perhaps.
Q: Professor, is dehydration a condition of lack?
A: Yes.
Q: And does the administration of liquid do away with this lack?
A: The administration of water alone may not do away with the lack; it may require water plus a little salt.
Q: Thus you would consider it expedient in such a case to use salt solutions?
A: Yes, hypotonic.
Q: Professor Ivy, do you know a report in medical literature according to which lasting damage was observed with certainly after a thirst condition was removed?
A: Thirst alone; no.
Q: Do you know such a report as a result of the drinking of seawater?
A: No, except in those cases on a raft at sea, who drank seawater, developed hallucinations, and walked or jumped overboard or died.
Q: Professor, I believe that you have misunderstood me again. I asked you whether after the rescue, that is, after they had been given fresh water, an observation of permanent damage has so far been published in any world medical literature?
A; I know of no articles in which, after subjects have experimentally taken seawater in small amounts for short periods of time, have manifested any permanent damage.
Q: Professor, is it correct that during the condition of thirst, due to the thickening of the blood, that is, due to the fact that the blood loses water, the circulating amount of blood is reduced?
A: Yes, the blood volume is reduced.
Q: Yes. Professor, from the records of my experiments could you convince yourself that the pulse frequency during the experiment showed a tendency toward reduction?
A: Yes, as I recall, there was a tendency to a reduced rate.
Q: Professor, if the blood volume is reduced and the frequency of the pulse does not increase, is it correct that the minute volume of the heart is reduced?
A: Yes.
Q: Professor, after the heart has adjusted to this smaller minute volume, and after a sudden intravenous administration of liquid of about 1/3 of the volume, would you help that heart with a stimulant?
A: I should not.
Q: But can you imagine that a practicing physician would consider such a thing?
A: Well, perhaps, depending upon the general condition of the patient.
Q: Professor, from the fact alone that a stimulant is used, can one conclude with certainly that there was a weakness of the heart?
A: I do not believe that you can.
Q: Professor, is it correct that one of the symptoms of weakness of the heart is rather a faster pulse rate than a slower one?
A: Yes.
Q: Professor, I believe you have also carefully studied the values for blood pressures which I recorded. Could you convince yourself that in all cases the blood pressure was normal after the experiment?
A: Do you mean after the experimental period?
Q: Yes, that is what I mean.
A: As I recall, there was a tendency for the blood pressure to be normal, although in some cases it was somewhat below what it was before, but not strikingly so.
Q: Did you compare the blood pressure before the experiment with the blood pressure after the experimental period?
A: Yes, that is what I had in mind.
Q: And in doing so you found that the blood pressure at the end of the experimental period was the same as that before the experiment?
A: Essentially so, on the average.
Q: Later I shall come back to those cases which were described as seriously ill here, and I shall discuss the blood pressures in those cases. Professor Ivy, if I tell you that Sterofundin is nothing but Ringer solution, do you still consider it justified, if Sterofundin is used than a thirst experiment is interrupted, to conclude that it was a serious illness?
A: No, I should not conclude that it was, because ...
Q: Professor, ...
THE PRESIDENT: The witness may complete his answer to the question. It was interrupted.
A: No, I should not conclude that because Sterofundin is used the patient, after a thirst experiment, necessarily was in a serious condition; but one wonders why, in such experiments, the material was given intravenously rather than orally.
Q: That was administered because an intravenous administration of salt solution, in accordance with all of the statements in medical literature known to me, influences the liquid content of the body more permanently.
MR. Mc HANEY: I ask that the remark of Dr. Beiglboeck be stricken. He is going on direct examination. He can testify at that time.
THE PRESIDENT: The remarks of the witness were in the nature of testimony on his part rather than a question to the witness. His remarks will be stricken from the record. He will be permitted to take the stand again and make what statements concerning his own actions he desires.
Q: Professor Ivy, would you say that after an intravenous injection of Ringer or table salt solution, chills with sharp rises of temperature are sometimes observed?
A: Not when the technique is good. I have never seen chills and temperature after an intravenous injection of Ringer Solution or sodium chloride solution if the tubing is free and if the solution is free of pyrogenic substance, that is, triple redistilled water is used to be sure that there is no temperature - inducing substance in the water.
THE PRESIDENT: The Tribunal will now recess until 1:30 o'clock.
(A recess was taken until 1330 hours).
AFTERNOON SESSION (The hearing reconvened at 1330 hours, 16 June 1947)
THE MARSHAL: The Tribunal is again in session.
THE PRESIDENT: The Secretary General will file for the record the certificate as to the illness of defendant Oberheuser signed by the prison physician which has been received. The examination of the witness may proceed.
DR. ANDREW IVY - Resumed CROSS EXAMINATION (Continued) BY DEFENDANT BEIGLEBOECK:
Q. Professor, is it true that on the first day of a hunger-thirst experiment there is a considerable loss of weight?
A. Yes.
Q. Professor, I ask you to take a lock at the case records of cases 1 to 32 and to assure yourself that the weights between the 20th and 22nd of August either remain the same or increase somewhat and that from the 22nd to the 23rd of August in all of these cases there is a palpable loss of weight.
A. I looked at the first three charts and I fail to find a weight recorded on the 21st. I find a weight on the 20th, the next weight on the 22nd.
Q. Professor, wouldn't it be nonsensical to begin such an experiment without taking the weight on the first day?
A. Yes, I should say so.
Q. Professor, let me ask you to take a look at Case 1; on the 20th, 64.5; on the 22nd, 64.7, and on the 23rd, 62.2 are the respective weights. Is that correct?
A. Yes.
Q. If the experiment had begun on the 21st should one not assume that from the 20th to the 21st a gain in weight of about two kilograms would have taken place?
A. Did you say a gain of two kilograms?
Q. Presupposing that the experiment began on the 21st; so that the weight on the 22nd is determined already twenty-four hours after the hunger and thirst began, then from the 20th to the 21st the man myst have gained about 2 kilograms.
A. Yes, I understand. Yes, because the weight on the 20th is 64.5 kilograms and on the 22nd, 64.2, is the same; hence, there has been apparently no loss of weight between August 20th and August 22nd.
Q. Then, Professor, should you not assume that the experiment begain the 22nd if from the 22nd to the 23rd in this case more than 4 points are lost?
A. Yes.
Q. All the cases from 1 to 32 show the same phenomenon as regards the weight, I ask you, please, to look through the charts and assure yourself of that fact briefly.
A: There are some sheets missing.
Q: Professor, so far as I know the file is complete. They were all discussed here before the Tribunal.
A: I cannot find all of the sheets. For example under subject No. 32, the preperiod data are missing. I can answer your question, yes, up to subject No. 32.
MR. HARDY: I do not believe that the charts and subjects, that then No. 32 contained the first weight, I do not recall when I was questioning Beiglboeck that the chart then contained that and that they started out the first day of the experiment. Maybe that may be helpful.
BY DEFENDANT BEIGLBOECK:
Q: From the 32nd to the 44th, the experiments began on the 1st of September, and the other experiments began on the 22nd of August. I am asking you now whether the experiments began on the 21st or 22nd, and for that reason I shall ask you to look at the individual case records and to compare the weights and to tell us whether the experiments began on the 21st or the 22nd.
A: According to the weight records up to subject No. 32, which is as far as I have been able to follow the cases, indicates that the experiments started on the 22nd. For example on subject No. 32, on page 32, the first date apparently is August 22nd and the weight was 67.1 kilos, and on the 23rd it was 65.4, indicating that the experiment may have started on August 22nd.
Q: Professor, is it so that you can only test the Romberg reflex on someone who is able to stand?
A: According to my knowledge of that test, the way I perform it, it is necessary for the subject to stand.
Q: Then in a deeply unconscious state a subject could not be given the Romberg test?
A: That is correct.
Q: Professor, do you think a person who is deeply unconscious can ask for water.
A: That depends upon whether they are so unconscious that they cannot speak. An unconscious person can ask for water.
Q: Professor, in the usual linguistic usage in German medicine the word "coma" means a total unconsciousness, such as in a come diabeticum. I don't know whether the word "coma" in English usage has a wider meaning. Could you please tell us whether you understand the words "Comatose" and "unconscious" to be synonomous?
A: No, unconscious and comatose are not synonomous according to the way I use the terms.
Q: Then you think that the condition here described is not one of deep unconsciousness?
A: What words do you have reference to?
Q: I am referring to the case in which it is said that the Romberg test is positive and that the man is in a semi-conscious state. I want to ask if you agree with me that according to medical linguistic usage the state being referred to here is one of somnolence?
A: That depends upon the meaning of a two plus Romberg. I believe that was your question. I am not accustomed to saying that a Romberg sign is two plus so it may be that the two-plus Romberg could mean that the individual could not stand but when attempting to stand would fall over to the ground so I don't know the meaning of the two plus Romberg.
Q: Professor, let me tell you that the two-plus sign is used when the reflexes can be tested and are strongly positive. Can the Eschner eyeball reflex be tested on a healthy person?
A: Will you repeat the question?
Q: Can you use the eyeball pressure reflex according to Eschner on health persons?
A: I don't know what a reflex is according to Eschner.
Q: This is a reflex that affects the rate of the pulse when pressure is exercised on the eyeball.
A: Yes, you can try that test both on conscious and unconscious persons.
That was ay understanding of the meaning of the eyeball reflex, but I had not heard the expression "according to Eschner".
Q: It is usually so designated in Germany Professor. You still have the charts before you. Please let us go through a few of these cases together and I want to ask you whether it is your opinion that in these cases water, to wit, fresh water, as drunk. Please turn to case No. 3. Do you think that this patient from the 26th to the 27th and from the 28th to the 29th drank some fresh water, if from the 28th to the 29th he loses only 300 grams weight?
A: That is a small loss of weight which is consistent with taking in some water. The small urinary output, however, is hardly consistent with taking in some water, and when one is quite thin to begun with the loss of weight becomes relatively small after four or five days of fasting.
Q: Professor, where the amount of urine is 250 cc and the total loss of weight is 300 cc, one is forced to a conclusion that the man would have lost only 30 grams through perspiration and through respiration, now that is not very probable, is it?
A: No, it is not very probable and my interpretation was that he probably got some water.
Q. Do you agree with me, professor, when I say that the first reaction of a thirsting person when drinking water is retention?
A.- Yes, that is true.
Q.- Would this explain the slight amount of urine?
A.- This is consistent, yes, with that explanation.
Q.- In order not to take up too much time I should like to ask you to tell me in the other cases I am going to put to you whether you agree with me that when the person is receiving 500 cc of sea-water a day and is fasting as well, is it not so that one must count a minimum loss of weight of 500 cc a day?
A.- Yes, I agree with that generalization. I might say for the sake of the record in making these predictions whether the subject did or did not gain access to water that I should prefer to see the blood chemistry.
Q.- The blood analyses are available. But I just wanted to ask this - take a look at case 18 - for three successive days weights vary from 51.6, 51.5 and then again 51.5. Now in this case cannot sno say with absolute certainty that the person has been drinking considerable amounts of fresh water?
A.- I should agree.
Q.- Is the dullness heard when tapping the liver a pathological symptom in and of itself? Or, let me put it this way, if in a case history you find a notation that states the liver is the way it was before, would you regard that as a pathological pehnomena on?
A.- That question is not clear to me.
Q.- In one of these charts I noted "Liver not enlarged, liver dullness as before" and the Prosecution construed this to be a pathological symptom.
A.- That would indicate to me that the liver was the same as it was before.
Q.- Professor, you have brought up a large number of cases here in which you have been of the opinion that it could be deduced that severe injury had been done, and possibly permanent injury resulted there from.