Please tell me whether you think that in those cases where the subject's weight on his release from the experiment has returned to its previous statue or has even increased a bit - now, in such a case don't you feel that the experimental subjects will recover completely after the experiment? - I am referring, for instance, to case No. 21.
A.- I gave a rather long list of subjects in which I said an interpretation of the records would permit the deduction that they were quite sick at the termination of the experiments. However, the list that I gave for those who were quite sick and in whom death might have occurred was rather short. As I recall I gave a list of only three such cases. Now referring to case No. 21.
Q.- There you will find that on the 14 of August his weight was 54 kilograms - is that not so?
A.- Yes.
Q.- Now will you please look at his weight when he was released?
A.- When he was released the weight was 54.2. But one may wonder how much of that increase of weight is due to retention of water by the body. It is possible that the patient may have received so much water or fluids that was retained or a large amount of that was retained and accounts for the return of weight to the normal level of 54. I do not see any urinary outputs in this particular subject on August 29, August 30, 31st and September 1, 2 and 3.
Q.- Professor, two weeks after the end of the experiment, on 12 September, the weight is still set down there in the chart. In the upper right hand part of the table.
A.- Do you have reference to D 12/9/44 - 57.5 kilograms?
Q.- That's right, yes.
A.- The weight of 57.5 kilograms is indicated for the 12th September.
Q.- Professor, would you not construe this as an indication that the man has completely recovered since after more than two weeks after the conclusion of the experiments his weight stands so high?
A.- Yes, I accept that as an indication but I should like to know the urinary output on the days particularly immediately following the experiment so as to see this increase in weight was not due to oedema.
DR. STEINBAUER: I should like to ask that the two smaller booklets which the Secretary General his may be shown as well as the fever charts.
THE PRESIDENT: Are the booklets available in the Tribunal?
DR. BEIGLBOECK: The urinary output is certainly set down in the booklets, for that period 7 to 12 September.
MR. HARDY: We recall, your Honor, that during the course of cross examination we found, that some of the urinary outputs were not contained in the books either.
DR. STEINBAUER: The Secretary General has had these books in his possession all the time; we have not had them since the beginning of the cross-examination.
BY DR. BEIGLBOECK:
Q.- On the 26th, the urinary output is 1,080, which is a considerable amount of elimination for a person who has just been thirsting. Professor, in case 23, you concluded from the acute gain in weight after the experiment that injury had been done? Was it your opinion that this was a case of oedema? Case 23 from the 30 to the 31 August?
A.- It was difficult for me to understand how the body weight could increase from 53.8 to 62.8 from the 30 to the 31st.
Q.- Perhaps I have made a mistake here. I have 59.8 and 62.8 as the two weights in question.
A.- Under the date of 29th there are two weights, 60.3 and 59.8, the latter is in pencil. On August 30, according to the figure as I read it it is 53.8 and on August 31st it is 62.8 and on September 1 61, and on September 2 62, and on September 3 62.9.
Q.- That is probably not 53.8 but 59.8. These are pencil notations, is that not so? The increase from 59.8 to 62.8 led you to look upon this as something pathological. Now, will you please follow the course of the weight here and conclude that some error was made in the weighing, either the patient drank a lot of water just before the weighing or an error was made by the recorder?
A.- Yes, that is possible.
Q.- You don't consider it probable that a case of oedema existed here because excretion the next day would have been improbable?
A.- Well, it is true that the excretion the next day was larger than the input but that does not mean that some oedema may not have been present. How extensive the oedema is, is hard to say and I am willing to agree that the figure 53.8 is an error in copying down the weight because it is difficult to believe that the patient may have lost that many kilograms in 24 hours and then jumped up to 62.8 the following 24 hours.
Q Professor, if an X-ray photograph shows that the pieces of the lung show a shadow which is not relieved by coughing and that the hilus of the lungs is thickened on both sides and is fibrous, would you not concur in my opinion that this X-ray shows simply that there is a certain pleural thickening of the pieces of the lungs, that there is a scar on the pieces of the lungs?
A That is possible. As I explained in my direct testimony I should have to see the X-ray films myself before I could base an interpretation on them or answer that question with any degree of accuracy.
Q But you do agree with me that this X-ray does not necessarily show a new process taking place in the lungs?
A I agree with that.
Q Professor, when you looked through my experimental records, did you look at Case #7?
A Yes, I looked at the record on every subject.
Q This is a case that was treated with Schaefer water. This experimental subject was in the experiment for twelve days, fasting for eight, and lost 4.8 kilos throughout the experiments from the 22nd to the 2nd of September. Is that not so? From 61.5 on the 22nd to 57 on the 2nd of September.
A Yes, and then on the 3rd of September, the patient apparently still lost some more weight.
Q Is the final weight of this experimental subject - namely, 60.5 is it the same as the person's weight roughly when he entered the experiment?
A Yes.
Q Then you would say that the subject had recovered from this fasting cure?
A Yes, on the basis of the information available.
Q In Case 3. Professor, please look in this notebook for the blood pressure record at the conclusion of the experiment - namely, on the 29th - and tell me if these blood pressures are normal?
On 30 August the blood pressure is 114 over 70, in case 3.
A Yes, that is normal.
Q On the 1st of September, under the influence of strychinine which the man took, the blood pressure is somewhat higher, 136 over 90?
AAre you referring to Subject 3?
Q Yes.
A I am sorry, I don't find that.
Q It's not on the chart.
A On the pages that you had indicated with this white sheet of paper, after Subject 3. on the 30th, I find a blood pressure of 119 systolic and 80 diastolic, and then the next record, that is on the 31st, 136 over 90. The next record is.... Is that what you have reference to?
Q Yes, that's what I am referring to.
And on the 2nd of September is there a record of blood pressure?
A Yes, 120 over 76 - pardon me, it's 119 over 70, and then the space after that is blank and nothing is written in.
Q Are those normal blood pressures, Professor?
A Yes.
Q Is it not possible, Professor, that in this case the strychnine was really given as a tonic for the intestines because the man was constipated and was afraid that this would last, so the strychnine was here administered, not as a stimulant to the circulation, but as a tonic for the intestines?
A I have never heard of strychnine being so used.
Q I can only tell you that in our clinic strychnine was very often used as an intestinal tonic, but perhaps that isn't the general practice.
Now, Professor, I don't want to go through every case separately now, but I have one brief question.
Are you of the opinion that intensified vesicular respiration indicates bronchitis?
A Yes.
Q Must one not assume that a thirsting person would excrete roughly 400 cc of urine a day?
A Yes.
Q And if such a thirsting person can concentrate 2% salt solution do you not agree with me that you can give him as much as eight grams of salt?
A Yes, that is a reasonable assumption.
Q Now, Professor, if a person receives roughly 15 grams of salt, which would correspond to about half a liter of seawater, then he would eliminate roughly 800 cc a day of urine? Is that not so?
A Yes, that's approximately correct.
Q Thus, any one who received this amount of salt would be worse off than a person thirsting?
A Yes.
Q However, if he receives this in the form of 500 cc of sea water he would, nevertheless, save 100 cc as compared with the thirsting person.
A Yes, that's theoretically possible.
Q Professor, do you know that the experiments carried on by Ledell and Edington and Winkler led to the conclusion that small amounts of sea water, because of this slight saving of water, are better than complete thirst?
A Yes, with that idea in mind I have made a study of the question of the extent to which one may stretch fresh water by adding sea water to it, and a small quantity of sea water may be ingested with saving, according to theoretical considerations, and according to the observations of Ledell and ourselves. The extent of the ability of different individuals to tolerate the additional seawater to the fresh water varies.
Q Then, you remember, Professor, that Ledell observed that two experimental subjects were capable of a concentration of salt higher than 2%?
A Yes, and I recall in my direct testimony, I said that since I had not seen that myself in my own experiments, I have wondered whether or not there might not be an experimental error in the case of the figure 2.3%.
Q Professor, am I right in spying that between your experiments, so far as I know them, and Ledell's experiments this difference exists - namely, that Ledell first created a certain status of dehydration before he gave seawater to be drunk?
A Yes, that's correct.
Q Then, is it not possible that a dehydrated body is capable of a better kidney concentration than a body that has enough water available to be a little luxurious in its elimination of the salt concentration?
A Yes, that's possible. That's one of the items of information that we see in the literature which we believe requires further confirmation before it can be generally accepted.
Q Is the analysis of the salt concentration in urine a difficult chemical process?
A Not to a well-trained chemist or to a well-trained chemical technician.
Q Don't you think that someone who was an assistant with Thomas for 6 years in Leipzig was capable of carrying out such an analysis.
A Yes.
Q I asked this question because that is the case with my associate in the experiments. Does not a slight elimination or urine lead to the concentration of residual nitrogen in the blood?
A That is correct.
Q Have you not ascertained, Professor, that the residual nitrogen quantities in the blood of my experimental subjects did not reach any alarming proportions?
A That is my recollection from seeing your figures last January. I have not looked them over or seen them recently.
Q Professor, please convince yourself of that again on the basis of this booklet which will be put to you; are you not of the opinion, as is generally held to be so in literature, that the juvenile organism contains more water than the adult organism?
A Yes. Will you please indicate in this booklet where I can find the figures on non-protein nitrogen?
Q The residual nitrogen values are carried continuously here with the various dates; every two days the residual nitrogen was measured and the word "Blut" (blood) is next to that figure? On the 28th and on the 30th, these are the points where the experiments reached their maximum, and here the residual nitrogen quantities are given, and you will find that in only a few cases is there any increase, but none reached the point of being dangerous. Perhaps you will also observe that only the thirsting group had a certain increase, whereas the seawater group kept normal residual nitrogen values.
A Yes, that is true, with the possible exception of Subject 32.
Q Yes. In a few cases it rises above 50, but particularly in the case of the series using 500 cc seawater everything is normal. Is it not true that seawater taken from near the seacoast contains less salt then water taken from the high seas?
A Yes.
Q Do you not then consider it possible that Mediterranean searwater taken near the coast might contain a salt concentration of 2.7 per cent?
A Yes.
PROFESSOR DR. BIEGELBOECK: No further questions.
DR. STEINBAUER: (Dr. Steinbauer for Biegelboeck) BY DR. STEINBAUER:
Q Now, Professor -----
THE PRESIDENT: The defendant Biegelboeck may continue to sit by his counsel, if he desires.
Q I should like to show to you, Dr. Ivy, the document that Dr. Servatius put to you day before yesterday, Karl Brandt, 104. This is a report by a prisoner regarding a hunger experiment. I shall not put this to you in order to show that these were similar experiments, but because I want to establish certain expressions that are used in it. Let me give this document to you in the English translation.
MR. HARDY: Will Dr. Steinbauer kindly refer to the page and number of the document, what Karl Brandt document book the exhibit is contained in, and the exhibit number.
DR. STEINBAUER: It is Karl Brandt Document Book 104, and on the copy I have I should like the witness to turn to the second page where the prisoner says the following: "We all had imaginary physical, ailments and hysteria." Then five lines further on "In the cases of many persons their knees and joints swelled up to as much as three times normal in half an hour. Some of the persons fainted."
Q Doctor Ivy, does this not indicate edema resulting from hunger, this swelling of the knees and joints?
A I don't know what that means. This is an article apparently taken from "Readers Digest", which is a fiction magazine. We can't depend on the authenticity of statements made in such a magazine or on their scientific accuracy. The writers for this magazine are frequently paid to write in a dramatic and sensational manner for the purpose of interesting only lay readers.
DR. STEINBAUER: In that case, Professor, in view of what you have just said we shall not pursue this document further, and I shall withdraw it. I do not wish unscientific matter to be confused with scientific matter.
I have no further questions.
THE PRESIDENT: Defendant Biegelboeck will resume his place in the box.
I understand Dr. Tipp desires to propound some questions to the witness.
Does Dr. Tipp desire his client to sit beside him during the crossexamination, or is it unnecessary.
DR. TIPP: It is not necessary, Your Honor.
BY DR. TIPP:
Q Professor Ivy, if I have understood you correctly you said in your direct examination that the consumption of large amounts of seawater for long periods of time can lead to serious injury and to death; did I understand you correctly?
A Yes.
Q You spoke also of Berkatit, that is, the drug to make seawater potable, and told the Tribunal that seawater treated with Berkatit was identical in its practical effects with pure seawater; did I understand you correctly in this?
A Yes.
Q Under these circumstances, Professor Ivy, could a person take the responsibility of giving Berkatit as the drug that makes seawater potable in practical sea emergency cases?
A I do not understand the first part of that question?
Q If the consumption of seawater leads to severe injury in the long run and if Berkatit water is for all practical purposes identical with seawater, then also the consumption of Berka water must lead to serious injuries. Therefore I ask you, could a person take the responsibility under these circumstances for introducing Berkatit as the drug to be used in practical cases of sea emergency as the drug to render seawater potable for a flier who finds himself in a state of sea emergency?
A No.
Q Now, as we know, Professor, you have just studied the documentation for this trial most carefully, particularly the Document Book V, which deals with seawater. You will agree with me when I say the Technical Office in the RLM was determined, despite the medical misgivings, to introduce Berkatit as the drug to be used to make seawater potable; do you remember the documentation well enough to be able to corroborate this, Professor?
A That is an impression which may be gained from reading the documents.
Q. Let me say in addition, Professor, that the Technical Office of the R L M was the agency which could make the decision on what drug was to be used; now in this case was it not the duty of the medical officer in the Medical Service who was in charge of the troops to do everything he could to prevent the production of Berkatit for at least long enough to determine its usefulness or uselessness?
A. Yes.
Q. Then let me put the following to you in this manner: The experiments that were carried out in Dachau for the purpose of investigating seawater you regarded as useless because from a chemical point of view it was perfectly apparent that Berkatit was useless; was that not the point you expressed in direct examination to Mr. Hardy?
A. Yes.
Q. Let me put two matters to you; you said that during the war you were consulting medical officer in American offices both in the Air Force and the Navy; therefore I may here suppose your understanding for the fact that a responsibile medical officer when considering the introduction of a new drug, would have to consider not only the chemical aspects but also the clinical aspects and particularly in war, also the raw material or technical side; is that not so?
A. Yes.
Q. Schroeder and Becker-Freyseng, my two clients, are also of your opinion and were of that opinion in 1944, so far as the chemical side of it is concerned, but from the documents you have seen you know that to manufacture Wofatit, namely the Schaefer drug, silver in large amounst was necessary. In 1944 when Germany was so poor in raw materials, this silver could only have been obtained by taking it away from other agencies where silver was also a necessary vital war material. On the other hand, Berkatit was made of raw materials that were easy to obtain. Do you not agree with me, Professor, that this technical aspect should not be left out of consideration in this ques tion when a medical officer is called upon to make a responsible decision?
A. One must consider the availability of the raw material involved in any process.
Q. Yes. That is, the technical aspect speaks in favor of Berkatit. Now, do you know the name of Professor Eppinger from Vienna?
A. Yes.
Q. You also know of Professor Heubner from Berlin?
A. Yes.
Q. Then you will agree with me, Professor, when I say that these two men are a world famous clinician and a world famous pharmacologist.
A. Yes, they are well known.
Q. Now, as actually was the case, both Professor Huebner and Professor Eppinger said that they could not decide without experiments whether Berkatit was perhaps something that should be introduced in the sea rescue service for a short time; now, in view of that fact would you not give the responsible Luftwaffe medical officer at that time the right to clarify this problem in an experiment, taking into consideration the three aspects, the military, the chemical, and the clinical?
A. I do not think so.
Q. May I ask your reasons for that?
A. The reasons are as I have already indicated. There is no reason to believe there is anything in Berkatit which would in any way effect the salt in the seawater or alter its absorption, retention or secretion from the body.
Q. Quite so, Professor, that I readily admit and my two clients were also of that opinion, but my question is a different one. Perhaps I could precede it with another question. Why does a doctor carry out an experiment? Perhaps, I can give you my opinion on this and it will help to shorten things a bit; either he does this in order to confirm the correctness of his own idea or if there are two points of view, he wishes to confirm the correctness of one of them?
A. He also demonstrates if there is room or reason for two points of view.
Q. Quite so, but you admitted before that both Professor Huebner and Professor Eppinger are recognized authorities; you said that yourself?
A. Yes, but I should not consider them competent in this particular field.
Q. May I ask why not? The clinical aspect of this is a metabolic question, namely to what extent the kidneys are able to concentrate salt; you must admit that at that time there was no one in Europe better qualified to evaluate that problem than Professor Eppinger; or do you feel differently about that?
A. I don't believe that Professor Eppinger had any experience-
Q. Perhaps the interpretor could speak louder. I am not hearing the answers that you present. Professor, will you kindly repeat the last answer?
A. I do not believe that Professor Eppinger had performed experiments on the elimination of salt in the urine and the ability of the kidneys to concentrate salt.
Q. That is a question, which I, as a lawyer, am not competent to decide. I can only base my statements on what has been told me and I believe Professor Eppinger has done a great deal of work in this field, but that does not strike me as being the fundamental question. The basic question is this; if a world renouned clinician, of whose competence there can be no doubt, states: "I, Professor Eppinger, am not in a position to state definitely whether Berkatit should be introduced into practice or not, that must be decided by an experiment"--if such an authority makes such a statement.....
MR. HARDY: Your Honor, I believe the witness has answered the question. This is merely an argument persuing between defense counsel and the witness.
THE PRESIDENT: Objection overruled, the Witness may answer the question.
THE WITTNESS: In a situation of that sort, I don't believe the world renowned clinician is entirely competent to answer the question. I would prefer to take the opinion of a physiologist or biochemist on an opinion of that sort in preference to his opinion.
BY DR. TIPP:
Q. Pardon me for saying so, Professor, but you are evading the question. I will ask you this question; could a responsible medical officer in this situation ignore Professor Eppinger and Professor Huebner's views, two recognized authorities, when they say that from their point of view experiments are necessary; could he do that or should he rather say, I am of a different opinion from that of these two authorities, however, whether I am right or these two authorities are right must be decided by an experiment. I believe you can give a perfectly clear answer to that question?
A. It is not necessary to ignore such an opinion, but one should not necessarily base their acts on that opinion without seekin the opinions I have already mentioned, such as a biochemist and a physiologist, who have worked on the subject of salt metabolism.
Q Well, Professor Schroeder is very sorry that you were not his advisor at that time; but, I can only repeat that if the world renowned clinician, who is regarded as an authority and whose opinion is not to be disregarded, if such a man says it is possible that Berkatit contains substances that permit a higher concentration in the kidney, at least for a certain length of time, in my opinion a medical officer is not to disregard such an attitude on the part of this well known authority, but must do what this authority suggests, namely, carry out an experiment, particularly if the other side, namely a Pharmacologist expresses a different attitude.
A It still does not mean that the experiment was necessary.
Q I am afraid we are not understanding one another. I am not trying to hear from you whether the experiment is necessary. That the experiment was not necessary, that Berkatit was not suitable, that was decided in the experiment. I want to hear from you whether or not it was not right to carry out experiments for this reason: first, the raw materials problem played a role; and, secondly, two scientific authorities spoke in favor of having the experiments carried out. These questions were under debate, and I do not believe that you can assert that all these reasons should simply be disregarded, and that a person should say: I will not carry out any experiments. These two factors, the scientific opinions of the scientists and the raw materials question must be taken into consideration by the medical officer in question.
MR. HARDY: Your Honor, I object to this. This is purely argument. The witness has answered this question for him on two occasions. And he is trying to put words in the mouth of the witness, and get the witness to say things which the witness does not believe. I must object and request that the question be stricken from the record.
JUDGE SEBRING: The Tribunal will propound the question to the witness.
BY JUDGE SEBRING:
Q Doctor Ivy, I am not sure I understand the nature of your statement, but is this what it amounts to? It is your view that it can be ascertained chemically and with absolute certainty that the Schaefer Wofatit would precipitate salt from seawater; is that correct?
A Yes.
Q And, it could be ascertained chemically with absolute certainty that Berka's Berkatit would not precipitate salt from seawater?
A That is my opinion.
Q And, that consequently any experiment carried on with Berkatit would be in essence nothing more or loss than an experiment carried on with seawater. Is that the point?
A That is correct.
Q And, it is your view that when those situations exist, and you have on the one hand Schaefer's Wofatit that can be proven chemically as being able to precipitate salt from sea water; and on the other hand, you have Berka's Berkatit which will not precipitate the salt; that you do not have two preparations or substances so closely akin or in common as to warrant an experiment with Berkatit when you note that the effect, that the prime result or effect is a testing of a product on the one hand that will precipitate salt from seawater, and a product on the other hand that will not precipitate salt from seawater, where the prime objective is to determine a method to make sea water potable; is that your point?
A Yes.
THE PRESIDENT: It seems to me the question propounded to the witness was purely argumentative. Does the Counsel desire to propound any other questions to the witness?
DR. TIPP: I have a number of question, which perhaps it will be better to put after the recess.
THE MARSHAL: The Tribunal is again in session.
THE PRESIDENT: Counsel may proceed.
BY DR. TIPP:
Q. Professor, if I understood your attitude to Berkatit correctly-namely, as you stated it in the direct examination, you expressed the view at the time that due to the pleasant taste which Berkatit lends to sea water, it would lead the shipwrecked to drink large amounts of sea water, as, for example, occurred with experimental subject number 2. Did I understand you correctly in that respect?
A. Yes, I believe there is a tendency in that direction.
Q. And is this correct too, Professor? Did I understand your statement correctly that your experimental subject number 3-- a physician who, during three days, drank only about 800 CC of sea water--did not have any complaints due to that?
A. Yes, that is correct.
Q. Now you certainly know, Professor, you have already mentioned this with Bieglock, that not only the excessive loss of water but also the loss of salt, that is, of sodium chloride, can bring with it damaging results. Did I understand you correctly in that respect too? I mean, that the loss of sodium chloride occasioned by thirsting is damaging?
A. No, I think that you must have misunderstood some statement that I made.
Q. Professor-
A. If one loses salt as the result of perspiration, then that loss of salt is deleterious.
Q. I thought, Professor, it was pointed out that through the loss in the blood, the so-called hypochlorenia -- that is, the sodium choloride loss in the blood is important, and that therefore there can be some damaging results.
A. That only occurs with excessive sweating.
Q. But one thing must be correct, Professor. You have already stated today that a number of scientists, among them Ledell, were of the opinion that the administration of small amounts of sea water is better than pure thirsting.
A. Yes, because they would gain a little water, perhaps 100 CC, and still would be able to excrete that salt in the urine that would otherwise be formed and excreted.
Q. Now, Professor Ivy, I want to speak with you about the testimony of the expert, Professor Vollhardt. You have read his testimony, and therefore you will admit that he too stated that the drinking of small amounts of sea water is to be preferred to absolute thirsting; is that correct?
A. Yes, that is my recollection.
Q. Therefore, Professor, it is correct that the drinking of large amounts of sea water is harmful. On the contrary, however, the drinking of small amounts is not harmful; yes, according to the opinion of some scientists, is even to be preferred to thirsting. Now, in your statements you thought that you saw a contradiction in the statements made by Professor Vollhardt. I don't quite understand what this contradiction was supposed to be; perhaps you would be so kind as to clarify this contradiction somewhat further.
A I should have to refer to the record.
MR. HARDY: The two points that defense counsel referred to, Your Honor, I have typewritten here, but I don't have the record. If he wants me to read the two points to him to aid in examining Dr. Ivy, I will point out the page numbers. Dr. Ivy has the record before him and he can refer to it if necessary. The first one is on page 8483, the language is the middle of the page in the Vollhardt testimony, beginning with the word "however". The next is at the bottom of the next page, page 8484, wherein Vollhardt testifies that drinking sea water with Berkatit would have serious consequences after six days. I believe those were the two pages you referred to.
BY DR. TIPP:
Q On those two places I could find no contradiction, Professor. Perhaps you could clarify the contradiction which you think you find in these two pages.
A On Page 8384 the sentence reads: "However the experiments did not give a definite supportive evidence of that but they did have an important result, not only the obvious result, namely that the Schaefer water was superior to anything else, but also the observation that the kidneys can nevertheless concentrate so astonishly well up to the concentration of sea water that in the future one could give the advice that in cases of sea distress instead of being completely thirsty, one could rather drink 500cc. of sea water and in that manner increase the salt contents of the blood but would not have to be afraid of dedydradion quite so quickly." On Page 8484 the answer at the bottom of the page. First the question: "And you went on to say, Professor, that the "admonition" of water with Berkatit which is equal to sea water would have done serious injury in practice, and provided it went on over six days would lead to death?" And the answer is: "It would have serious consequences after going on for over six days and would most certainly lead to death after --" which was the end of the sentence. Now on page 8484, it is indicated that the consumption of sea water could, on going over six days, lead certainly to death, whereas on Page 8483 it states that one could give the advice that in cases of sea distress, instead of being completely thirsty, one could rather drink 500cc.