1947-02-10, #2: Doctors' Trial (late morning)
THE MARSHAL: The Tribunal is again in session.
THE PRESIDENT: Is there any further cross-examination of this witness by defense counsel?
CROSS EXAMINATION OF KURT GUTZEIT BY THE DEFENSE - Continued
BY DR. BOEHM (Counsel for defendant Poppendick)
Q: I'm going to submit to the witness a publication regarding the typhoid treatment with acridin by Dr. Ding. This is Document No. 582, Exhibit No. 286.
JUDGE SEBRING: What book, please?
DR. BOEHM: Exhibit No. 286. It was not in any document book. It was presented singly.
BY DR. BOEHM:
Q: Professor, did you have sufficient time to investigate the acridin work by Ding so that you can state your expert opinion before the Tribunal today?
A: I read it, yes.
Q: Among others, you particularly dealt with questions of infectious diseases?
A: Yes, that's right.
Q: Is it correct to say that you wrote a book regarding infectious diseases where in particular you worked on experiences made during the last war?
A: Yes.
Q: As a consulting physician in the Army Inspectorate you must have gained experience in the field of typhus research, in particular, regarding the circumstances which deal with the originating of epidemics.
A: Yes, I dealt with that question.
Q: The document which was submitted to you bears the stamp "No objection from a medical point of view". There is a signature, i.a. Poppendick — by order of Poppendick, is that correct?
A: Yes.
Q: Well, is that thesis a typical report as it is made to a superior agency or does it have the form of a publication in a professional periodical?
A: It has the form of a publication in a professional periodical.
Q: How do you see that?
A: I can see this by the letter head — by the head of this work. Furthermore, I can see it because of the scientific discussion which deals with use of other authors regarding the same field. That is at the end of this thesis.
Q: Was it customary with the army to approve scientific works in that form?
A: With the army it was customary to establish the medical harmlessness of the work.
Q: Now, as an expert in typhus research, if one looks through this work does one have to come to the conclusion that one is here concerned with intentional artificial infection of human beings as it is described in this work?
A: One does not have to come to that conclusion of necessity. The only passage which may perhaps indicate that is List No. 1 where the treatment there used is laid down in the case of two patients where it was started on the first and third days of the incubation period. That is only possible when one is concerned with a small epidemic which is carefully observed and where one can exercise the daily control regarding the lice with reference to all the affected persons and where a louse was still found in the person of some human being who appears to be healthy. If therapy is started on that day, then you can find out on the first or second incubation day and you can start treatment. For instance, in the case of transport where delousing has taken place — that is, carefully delousing — and where these people arrived at their destination with lice, you can, during a typhus period, assume that the infection took place on the day the journey took place. That is to say, in the case of well-observed epidemics it is possible that treatment starts on the first or second incubation day but there are only only very few such occasion
Q: Thank you, that is sufficient.
According to your knowledge is Poppendick an expert in the field of typhus research?
A: Poppendick is a physician dealing with internal diseases — internal medicine. I don't know that he specially dealt with typhus cases.
Q: Now, if you just examine this thesis as a non-expert and if you read it through could you come to a conclusion or suspicion that criminal experiments are being described in that thesis?
A: I don't think that is possible.
Q: Thank you, I have no further question.
A: Because in that thesis you can, at no passage, find that there is any artificial epidemic in question. It says here "typhus research with acridin" and then it further says "within the framework of an epidemic".
DR. BOEHM: Thank you, I have no farther question.
BY DR. STEINBAUEK (Counsel for the Defendant WILHELM BEIGLEBOCK):
Q: Witness, last week you shortly mentioned liver punctions. In a publication of the First University in Vienna, I read the following sentence: "The Liver punctions, when local anesthetic is used, is painless and hardly interferes with the patient's health." I ask you, do you share that opinion?
A: Yes, that is also my opinion.
Q: Do you know that especially at the Clinic Eppinger in Vienna this method was worked upon a great deal?
A: In the Clinic of Eppinger, as they became known, liver punctions were often used.
Q: Do you know from literature or personally, the Defendant Dr. Beiglbock?
A: I know him personally, and because of attending scientific meetings.
Q: Would you say that he scientifically exercised this method and that he is fully acquainted with it?
A: I think that everybody can learn that method who is skillful manually.
Q: Is is correct that the Danish scientists, Evensen and Roholm, performed this liver punction on even quite healthy human-beings?
A: I do not remember that exactly. I believe, however, that pictures o quite normal livers are contained in the monograph which has appeared on that subject. But I do not remember it quite well. I do not remember whether liver punctions were performed on perfectly healthy human-beings.
Q: Tank you. I have no further questions.
THE PRESIDENT: Is there any further cross examination of this witness by any of the defense counsel?
(Pause)
There being none, the Prosecution may cross examine.
CROSS EXAMINATION OF KURT GUTZEIT BY MR. HARDY:
Q: Witness, you have stated in direct examination that you were consulting physician with the Medical Inspectorate of the Army and that Handloser held that position as Medical Inspector from January 1941 to September 1944. Now the Tribunal has asked you how many times did you consult with Handloser. I ask you again, how many times did you physically contact Handloser in the course of your duties as a consulting physician to him?
A: I have already said that I cannot say that I spoke to him once a week; sometimes it occurred once in 3 weeks, other times once in 4 weeks, and sometimes I saw him one week after the other. That is, a physical contact, as you said.
Q: Well, the, witness, would you say that you saw Handloser 10 times a year?
A: Yes, I could quite say that.
Q: More or less? Witness, I am simply asking you how many times do you estimate that you saw Handloser in the course of a year 5, 10, 15, or 30 times? That isn't too difficult to remember, is it?
A: I should say that I met him 10 times a year, but it may well have been 13 or 14 or 15 times; I am sure that it differed in the individual years.
Q: Thank you. You were also attached to the Military Medical Academy as I understand it?
A: Yes.
Q: You have stated that Generalarzt Dr. Schreiber was the commanding officer of the Military Medical Academy and that you were subordinate to him in that connection. Is that correct?
A: Yes. He was not the commander of the Military Medical Academy but the commander of the so-called Training Group C of the Military Medical Academy which is a part of it.
Q: Now the Military Medical Academy was under the control of the Medical Inspector of the Army, was it not?
A: The Training Group C was subordinated to the Military Medical Academy and its commander; and the Military Medical Academy and with it this Training Group C, was subordinated to the Army Medical Inspectorate. The head of the Army Medical Inspectorate was the Army Medical Inspector.
Q: Hence, Dr. Schreiber, as chief of this department in the Military Medical Academy, was, in fact, a subordinate of the Medical Inspector, Handloser, during the time Handloser held that position as Medical Inspector, is that correct?
A: Yes. In the final analysis, all medical officers were subordinates of the highest medical officer; that, of course, also includes Generalarzt Schreiber; as the commander of the so-called Training Group C he was the subordinate of the Army Medical Inspector.
Q: Now, witness, in addition to the duties you have outlined in the direct examination, did you ever receive questions in scientific research from the Reich Research Council?
A: Would you please repeat that question more precisely? I did not quite understand.
Q: Did you ever receive requests or questions from the Reich Research Council on matters of scientific research?
A: On occasions I was asked by the Reich Research Council on numerous medical matters; this was mostly done by writing and I then defined my position to the questions by writing. These questions concerned numerous fields. For instance, I remember one question about a proposed treatment of typhus. It was intended to treat it with certain bathing processes — warm bathing processes. There were also other questions I had to deal with — questions concerning certain treatment of diseases, whether a certain method of treatment proposed by some one had any value according to my opinion so that it could generally be exploited and used. The selection of certain drugs was dealt with by me by request of the Reich Research Council.
Q: Now these various research tasks that were assigned to you-were they assigned to you by Professor Dr. Rostock of the Reich Research Council?
A: Research assignments were not received by me from the Reich Research Council. These were merely inquiries about proposals which may have come from any side and on the basis of my experiences I had to state my opinion. I myself, however, did not receive any certain research assignments. However, this was not the case in the case of hepatitis. During the Hepatitis work, after having worked on that for a long time, 1943 or 1944, I don't remember exactly, the Reich Research Council gave me such an assignment. I did not ask for that assignment. It was merely handed to me.
Q: Just a moment, witness. I am not interested in the nature of your assignment at this point. My question is: were these inquiries or tasks assigned to you — did they originate from Professor Dr. Rostock?
A: These were inquiries. I said inquiries. I said nothing about any certain assignments. At least I do not remember anything about them. I just said they were inquiries about proposals which came from one side and it was my duty to make statements about their execution. I gave you an instance before. Any medical officer might have suggested a certain form of typhus treatment. I subsequently was asked whether it was also my opinion that this typhus treatment should be used generally; experiences were to be collected on that point. That is just an example. These also emanated from professor Rostock.
Q: Regarding yellow jaundice, what are the dangers and possible complications of Hepatitis?
A: I already stated the danger of Hepatitis during my previous examination. With reference to the life of the patient, the danger is very small. The figures shown in literature about so-called mortality in the case of jaundice is loss than one thousand, Jaundice, in itself, with reference to the mortality figure is a harmless disease. Jaundice, on the other hand, cannot be avoided through any safeguard whatever its nature may be. There is no possibility of preventing the infection and extension of that disease. The average length of illness is usually four to eight weeks. There are very easy cases where patients are restored to health within a few days and there arc more severe cases where patients arc yellow for weeks and sometimes months. During the war we learned aftereffects and complications of this disease are very very rare. Patients usually become ill, they feel badly. Generally, they have no pain, but after a certain period of time, as I said, six to eight weeks, they are completely restored to health.
Q: Does it not often cause severe damage to the liver?
A: That was a belief which was held before the war. Such cases occurred before the war sporadically, that is singly. In the case of these single diseases, there are certainly a number of cases of infectious jaundice. In the same way, however, there are quite a number of cases which have nothing whatsoever to do with the infectious jaundice.
These are liver inflictions of another kind which have existed from the very beginning and which may have been caused by food poisoning or other poisons. During the war we learned that the infectious disease leaves no damage to the liver. That is the result of a number of liver punctures as they were performed in a number of cases. They were performed in order to be able to tell the patient concerned, with certainty, that the liver damage during the jaundice, is completely over.
We physicians and also pathologists were very surprised at the changes of the liver as they occured during the jaundice period. They completely disappear within a relatively short period time. Pictures of the liver after jaundice has disappeared do not at all differ from the pictures of a normal liver.
Q: What are the causes and conditions of death in Hepatitis?
A: In most cases, death during jaundice is not caused by jaundice itself, but by other diseases. For instance, if a person is heavily wounded, and then a so-called sepsis develops, and then he becomes infected with jaundice; the person concerned will die because of sepsis. In these cases where jaundice is added to another severe illness, one can always judge them as jaundice death cases. That is how it is done in literature. In reality, they are not dead because of jaundice unless one wants to put it that way. It is merely an optical science. A death case merely from jaundice is something which has never been observed with certainty.
Q: Doctor, is there any difference between Hepatitis as it occurs in epidemics and sporadically and that produced by inoculation?
A: May I repeat once more, did you ask me whether there was a difference between spontaneous disease and a disease caused by inoculation?
Q: That is correct.
A: Is that correct?
Q: Yes. Is there any difference?
A: According to my opinion, there can be no difference. A difference cannot be expected.
If the cause of jaundice against which I am inoculating is that very cause, the disease must be the same as the spontaneous disease. However, I have to add that there is a difference between an infection and an inoculation. You inoculate by means of a vaccine, that is to say, a dead excitor, a dead infector. During these inoculations, diseases of jaundice are not to be expected at all. If, however, the virulent cause is being treated as in the case of animals and if it then infected into a human being, then the well-known jaundice comes about as it is known in its spontaneous cause.
Q: Now witness, you have told me that during the course of the war, you did not know of a single case where a patient died from jaundice. How do you justify the fact from the document Dr. Nelte exhibited to you this morning? That is the letter from Grawitz to Himmler requesting permission to conduct these hepatitis experiments on human beings. These inoculations were to be made from virus cultures, and death cases were to be anticipated?
A: I can only explain it by thinking that Grawitz, himself, was not sufficiently informed about jaundice, its cause and its danger. Grawitz was not a specialist in jaundice matters because Reichsarzt-AA, he was not in touch with practical medicine.
Q: Now, witness, is there any difference between hepatitis of man and that of experimental animals?
A: The differences are great. The animal, for instance— well, let me start again, The animal experiments, the animal does not receive jaundice at all, does not contract it at all. The yellow coloring never appears in the case of the animal. However, changes of the liver are noticeable in the case of the animal which was infected, and they arc very similar as in tie c so of a man who is infected with the same virus. Then there are further differences, I already said that yellow fever never has a fatal result, whereas in the case of animals, at any rate a part of them, die as a result of this disease. That is true as in the case of other comparisons between animal experiments and human experiments, namely that the external appearance of the disease in the case of man or animal by using the same virus can be completely different and in addition the danger of the animal disease and the human disease can differ completely, although one is concerned with the very same virus.
Q: Is hepatitis more dangerous in overworked or undernourished people?
A: Speaking on the whole the figures of the disease and its danger in the case of well nourished or undernourished people contracting jaundice are the same. When jaundice occurs as a complication of another severe infectious disease the cause of the original disease by virtue of the added jaundice is not influenced whatsoever. That is contrary, for instance, to other infectious diseases. I shall give you one example, typhus has a very definite course and we know mortality figures in the case of typhus. Now, if within such a typhus epidemic, and that is something that was frequently observed during the War, a jaundice epidemic comes into appearance in addition, so that people inflicted with typhus at the same time they are inflicted with jaundice then the typical cause of the typhus illness is not at all changed by this addition of jaundice and no larger amount of mortality figures can be observed during this typhus epidemic.
In the case of other infectious disease this is basically different, for instance if typhus diseased persons contract diphtheria, which happens on numerous occasions, then this additional contraction of diphtheria, this additional infection practically means a death sentence for the person concerned, whereas in the case of jaundice it is entirely different.
Q: What special facilities are necessary to treat hepatitis adequately?
A: The methods of the treatment of hepatitis can only be done on the basis of symptoms. I already mentioned earlier that there is a specific kind of therapy, — that there is no specific kind of therapy, such as serum therapy. Many persons inflicted with hepatitis who are not severely ill received no treatment whatsoever, and in parts continued their civilian and military duties. In other cases they were told to go to bed and received a light diet. Sometimes there was some warm treatment. On the whole treatment of drugs showed no particular success in the case of jaundice.
Q: Considering the physical conditions of concentration camp inmates, and the hygienic conditions of concentration camp hospitals, wouldn't it have been more dangerous to perform hepatitis experiments on concentration camp inmates than on well nourished volunteers?
A: In all the camps, and that included concentration camps, jaundice illnesses, spontaneous illnesses occurred to a large extent. I mentioned the jaundice epidemic, for instance, in prisoner of war camps. These were persons with a very much deteriorated constitution. They had endured hard a battles and they had a very bad nourishment, and even in the case of these spontaneous epidemics within the camps a higher mortality figure than the one already mentioned, or after effects which had complications of jaundice did not become known.
In the case of an entire division in Russia, which was sent from the Crimea to Northern Russia, I personally saw high disease rates of human beings who had deteriorated in health, who were undernourished, overworked and exhausted, and where the cause of jaundice was secondly the same as in the case of other human beings with good conditions of nourishment and who lived under good conditions.
Q: Are states of mental confusion or delirium ever associated with hepatitis?
A: I personally didn't see it.
Q: Are any lasting or disappearing neurological changes ever associated with liver disease, and if so are they also associated with cases of hepatitis, especially in individuals who are undernourished or deficient in vitamins?
A: May I ask once more, what kind of a condition are you suggesting?
Q: I will repeat my question. Are any lasting or disappearing neurological changes ever associated with a liver disease, and if so are they also associated with cases of hepatitis, but especially in individuals who are undernourished and deficient in vitamins?
A: I know of no disease or nerve degenerations, and that is probably something that you mean by the neurological conditions, rather I didn't know of any such cases in dealing with hepatitis, and they are never described in literature. No matter whether the people concerned are healthy or strong, or whether in any way undernourished, and whether there is a deficiency in vitamins, we only know one disease that is a liver disease during the course of which at the same time neurological symptoms appear. This disease firstly is very rare, and secondly has nothing at all to do with hepatitis epidemica. We are not concerned with an infectious disease, but we are concerned with a primary simultaneous degeneration of liver tissues, and brain nerve tissues. For the most part these diseases are mostly hereditary.
Q: You have compared the liver punctures with the lumbar spinal and the sub-occipital puncture; isn't it true that with the various kinds of spinal puncture you only remove the fluid which surrounds the spinal cord or brain, while with the liver puncture you actually enter the organ itself; isn't that dangerous?
A: There are two cases here. In one case you take away some juice where tissues are available at the same time. That is in the so-called spine puncture. In the other case you only take tissues away. Now, you could compare the liver puncture with the so-called gland puncture. In that case organs are being punctured in order to take out certain small parts of tissue. Both kinds of punctures are considered harmless, as the gland puncture is today used in hospitals and clinics for diagnostic reasons.
Q: Didn't you, yourself, once describe jaundice as a serious sickness owing to the damage done to the liver?
A: As long as jaundice exists there certainly is a damage of the liver to be noted. But, as I said, that these damages necessarily are restored to the proper order. During the first period when we saw jaundice epidemic appear to a greater extent we occasionally received reports about patients who showed changes in their liver for a longer period than was customary. In the case of those patients, however, we were net concerned with damages which resulted from jaundice but there are certain jaundice cases, as I stated before, which have nothing at all to do with infectious jaundice. Jaundice is an optical symptom which is valid for quite a number of jaundice illnesses and only a part of the jaundice illnesses are in compliance with the so-called infectious diseases.
Q: You have stated, doctor, that the disease lasted from four to eight weeks. Now, is salvarsan used for the treatment of jaundice?
A: Salvarsan was not used for infectious jaundice but there is a kind of jaundice which is a symptom of the so-called syphilis and furthermore there is a jaundice which originates as a result of the salvarsan treatment of syphilis. All of these are various jaundice diseases. Salvarsan itself, when dealing with infectious jaundice is net used unless, of course, syphilis exists simultaneously. Then syphilis, although jaundice is there, has to be treated with salvarsan.
Q: You said this morning on direct examination that one could treat hepatitis, if I understood you correctly, on the same day of the incubation period. How is that possible? An incubation period is known as the period preceding the actual manifestation of the disease.
A: I didn't speak about jaundice in that connection but I spoke about typhus. I was asked about the foetus which dealt with the treatment of typhus with acridene. I was asked that question by the defense counsel of Poppendick and in connection with that work in the case of two types of illnesses, the treatment was started on the first and third day of incubation. This, however, is impossible in the case of jaundice because one never knows when the patient concerned was infected.
In the case of typhus it is sometimes possible since we know that typhus is usually only transferred by lice. Now, if I, for instance, deloused the human being today I know that he has no more lice and if on the next day I found a louse on his body I can assume that this very day was the very first incubation day. Whereby, of course, it remains unclear whether this louse really transferred typhus rikettsia that is something that one doesn't know but this holds not true in the case of jaundice.
Q: Doctor, you have conveyed the thought to me that liver puncture is not considered to be dangerous. If so, why is it necessary to obtain an operative permit in writing from the patient or next of kin for the purpose of all kinds of puncture? Spinal, liver or glandular in all German hospitals by those physicians who carried out such puncture?
A: In the case of punctures which are used for diagnostic and prognostic purposes it is customary that one tell the patient that I am going to perform this or that puncture and that really settles the matter.
If one wants to be particularly careful but that isn't customary at all, then you can ask him to give you a written certification as is the case in a real large scale operation. In most cases, however, one just tells the patient. "I intend to do this or the other", and under the circumstance you give him the reason for your doing these things in order to help the patient but a written confirmation of the patient is usually not applied for.
Q: Now, witness, this morning you mentioned at great length Dr. Dohman Like yourself, Dohman was attached to the Military Medical Academy, wasn't he.
A: Yes.
Q: And Schreiber was also his superior?
A: Yes.
Q: Now, you have stated that Haagen reproached Dohman after one of these scientific meetings at which Dohman had, as I understand, said how far he had advanced in his research work. Now, were you in the presence of Haagen and Dohman when this discussion took place?
A: During these Breslau hepatitis conversations Haagen, Dohman and all those who were concerned in Germany with hepatitis research were present.
Q: I am referring, doctor, to the episode where Haagen reproached Dohman and if I am correct it took place after the actual meeting had convened. That is, I mean they were, so to speak, on their way home. They talked to one another and you were in the circle of Haagen, Dohman and yourself. Is that correct?
A: Whatever was discussed there was actually discussed during the congress. Schreiber ordered this so-called division of work during that congress or rather proposed it.
Q: Schreiber proposed this collaboration on the part of Haagen and Dohman?
A: Yes, Schreiber proposed it.
Q: Now, you have stated that Dohman did actually go to Strassbourg to work on this hepatitis with Haagen. Is that correct?
A: Dohman went to Strassbourg and he was ordered to do that by Schreiber.
He had to go to Haagen there and a comparison between the viruses as were bred by Dohman was to be carried out with the ones that were bred by Haagen.
Q: How do you explain the fact, doctor, that Schreiber sufficiently arranged the collaboration of Haagen and Dohman when in Exhibit 193, presented to you this morning by Dr. Nelte, the second sentence states: "I" — meaning yourself — "have requested General Schreiber to assign Mr. Dohman to me as of 15 July for a limited period of time to begin with." Who arranged this assignment of Dohman to work with Haagen?
A: Haagen and Schreiber arranged the collaboration of Dohman and Haagen add I belonged to that group too and in addition to the formation of this collaboration of work Dohman had to, of necessity, get into contact with Haagen. Such a meeting had to be arranged by Schreiber and he had to detail Dohman for that purpose. I spoke to Schreiber after the Congress. I told him that these two people would have to get together. Then Haagen invited Dohman in a letter to come to Strasbourg. I had arranged with Schreiber that this channel was to be in accordance with what had already been established during the Breslau meeting; namely, that Dohman went to Haagen.
THE PRESIDENT: The Tribunal will now be in recess until 1:30.
(A recess was taken until 1330 hours.)