1947-06-12, #5: Doctors' Trial (late afternoon)

THE MARSHAL: The Tribunal is again in session.

PROFESSOR IVY - Resumed
DIRECT EXAMINATION (Continued)

MR. HARDY: May it please the Tribunal, the interpreters have called to my attention that the word on page 12 of Document Book V, that is in Document NO-177 which is Prosecution Exhibit 133, in the last sentence from the bottom of the page the interpreters state that the German word which has been translated as "drainage" in English should be replaced by the word "dehydration". In as much as Dr. Ivy could not quite understand, the meaning of "drainage" the interpreters checked the German and the German is better translated as "dehydration ". In that connection. Dr. Ivy, dehydration, of course, is a symptom which would be found in experiments of this sort?

A: Yes, In all of the groups with the exception of the Schaefer water group.

Q: Now, how many of the 14 subjects were supposed to have received 300 cc of sea water daily for six days or more according to your study of the individual charts?

A: You mean of the 44?

Q: Of the 44, pardon me.

A: You say how many received 500 cc of sea water?

Q: Yes, daily for six days or more.

A: 14.

Q: Dr. Ivy, could you refer for a moment to some of the charts herein the person drank 500 cc of sea water and determine whether or not the experiments began on the 21st day of August or whether the experiments began on the 22nd day of August. You will note on any one of the charts that a mark has been inserted under the date 22 August which is an arrow — a red arrow — with a blue circle at the end thereof, indicating the date of the commencement of the experiment and in addition to that there is also a mark in red indicating the date of the commencement of the experiment on the 21st. Dr. Beiglboeck suggests that he placed the arrow with a blue circle at the end thereof under the date of 22 August at some later date when he was re-evaluating these charts.

Now, can you straighten out for us, in your opinion, just when those experiments began, whether they actually began on the 22nd or whether they began on the 21st. Do you understand the import of my question, doctor?

A: Yes, I understand. If we refer to subject 12 who was given 500 cc of sea water presumably. On the chart marked 12 under the space of the chart indicated for August 21st there is a square arrow and on the next chart 12 under the space of August 22 there is a circle in blue from which there extends a straight arrow upward. The experiment apparently started on August 21st where the first arrow is indicated and the first results on urinary output are indicated on August 22. That is a natural way to make a report and a study of this sort because if I start an experiment we shall say on May first we generally make a weighing before breakfast on May first and then on May 2nd we will make a weighing breakfast. That is the first day or the first 24 hours of the experiment and as a general rule we end the urine collections at a similar time and then the urinary output is indicated as the urine output for the first day of the experiment. So, on the basis of these records I should say that in the case of subject no. 12 the experiment actually started on the 21st and the urinary output is recorded for the 22nd. That however may differ from what actually occurred.

Q: Dr. Ivy, Prof. Beiglboeck points out that the reason why he put the arrow under the date of the 22nd was because of the fact that no discrepancy in weight appears from the date of 21 to the date of the 22nd, and hence he deduces that if no loss of weight occurred, that the experiment could not have begun on the 21st. Now is that a logical deduction on his part?

A: No. The first weight loss would occur on the first day of the actual experimental period. As I explained, you get your first weight loss by taking the weight before breakfast on the first day of the experiment and from that subtracting the weight obtained before breakfast on the second day.

Q: I see. If you started the experiment on the 21st day of August as indicated by the square arrow on those charts, would you necessarily record an intake of water on the 21st, or would the first recording of an intake of water be made on the 22nd?

A: Well, on the basis of the way I explained the keeping of the records, you would record it on the 22nd. But just exactly what Dr. Beiglboeck did I cannot state, and we can't state from his records, because the water intake and the urinary output for the days preceding the alleged starting of the experiment are not indicated. The water intake and the urine output is only indicated in these charts for the experimental period.

Q: How many of the 44 subjects were sick at the end of the sea water period, according to your interpretation of the charts, regardless of how much of the 500 cc, they actually consumed?

A: Well, if we take subject 3, which was on or supposed to be on thirsting and fasting, according to the medication the subject received, that patient was sick or disabled. If we refer to Subject 14, which was supposed to be receiving 500 cc. of sea water for, according to our calculations, 8½ days with 4½ days of hunger, there was an acute fever and temperature of 39 degrees Centigrade on the day of the conclusion of the experimental period. That patient was sick.

If we refer to patient or subject 36, receiving allegedly or supposedly 500 cc of sea water, that patient was given strophanthin therapeutically, indicating that the patient was ill; otherwise why give such medication? If we refer to patient 37, we find that that patient had a fever during the course of the experimental period. If you refer to patient 39, who likewise was supposedly receiving 500 cc of sea water daily, sterosundin was given therapeutically. That would indicate that the patient was ill and needed intravenous or parenteral medication.

Q: Do you believe, Doctor —

A: Referring —

Q: Go ahead, continue.

A: Referring to Subject 21, that patient was supposed to have received 500 cc of Berka water each day, was given chloramine and was too weak to stand for blood pressure reading on two days. Subject 23 in the same group was apparently very sick and comatose, and according to the acute weight gains, 8 to 10 pounds after the experimental period, the patient was sick. Subject 25 in the same group had a fever and was given morphine. There was x-ray evidence of lung pathology, which causes me to believe that that patient was ill. Patient 28 was too weak to have the blood pressure taken. The same was true of patient 29. That completes the list of the patients who were ill during the experiment.

Q: Do you believe, Dr. Ivy, that any of these 44 subjects were permanently injured or died later?

A: One cannot answer that question yes or no. It is possible, but I should say not highly probably. There are three patients whose after records I should be particularly interested in knowing about. That is subjects No. 3, 23, and 25.

Q: Have you carefully observed case No. 30? Dr. Beiglboeck informed us that the shorthand notes which are contained on the back of sheet 23-C are shorthand notes concerning the condition of the patient in case No. 30.

Are you able to determine from these stenographic notes and study of case No. 23 and Case 30 whether or not the notes apply to Case 30 or to Case 23? I will pass up to you an English copy of the transcription of the stenographic notes on the back of case No. 23.

A: From my study of the charts for subject 23 and subject 30, since the stenographic pencil record on the back of the Chart C-23 is not dated, l can only answer your question by stating that the stenographic record on the back of Chart C-23 is just as likely to be true of subject 23 as of subject 30. There is nothing in the clinical record or data which would indicate that the implications of the symptoms and signs described in the stenographic record is more likely attributable to subject 23 than subject 30.

Q: While you have the copy of the stenographic notes before you, Doctor Ivy, could you analyze for the Tribunal just what state of health the subject referred to in the stenographic notes, contained on the back of Graph C-23, was in?

A: This patient was in a coma. He was quite sick. Does that take care of your question?

Q: Would there be a great deal of difference in your analysis if, in the sentence which reads "He asks for water only when he awakes from his somnolent condition," that the word "somnolent" was replaced by the word "semi-conscious"?

A: There's a definite difference in the medical implications of somnolence and semi-comatose.

Q: If you please those two words that I suggest in this paragraph, would you be under the impression that the patient was sicker than as indicated in the paragraph as now written on the mimeographed sheet you have before you?

A: By those changes you improve the clinical condition of the patient.

Q: Improve the clinical condition of the patient?

A: With the changes made.

Q: You mean, with the changes that will now appear on the mimeographed sheet I have given you, not by the words I have suggested to you to be replaced, to make the word "no" and the word "semi-conscious"?

A: The idea that I'm trying to convey is that after the changes have been made you get the idea that the patient was not as sick as is originally indicated before the changes were made.

Q: Perhaps I have created a difficulty. I have asked you to replace the word "little" with the word "no" and the word "somnulent" with the word "semi-conscious", but you mean now, that it is written on this mimeographed sheet and as the document now reads, after it has been changed, it would indicate that the patient is not as sick as it would indicate before the stenographic notes were altered?

A: Thats' correct. In other words, by asking these changes in the stenographic record, the clinical condition of the subject was improved.

Q: Now, in the sentence in the second paragraph which reads:

The general condition gives no cause for alarm

— if the stenographic symbol for "no" was added later would that make a considerable difference in your analysis of the patient?

A: Obviously.

Q: In the sentence in the third paragraph which reads now as follows:

Respiration some what flatter, moderately frequent

would there be a considerable difference if it was written as it appeared originally before an ensure, in that the word "is" was placed in he sentence instead of the word "somewhat"? In other words, the sentence would read: "Respiration is flatter", and then, later in the same sentence, after the word "flatter", in place of the word "moderately" we insert the word "hardly" so that the sentence as written originally would have read: "Respiration is flatter, hardly frequent."

Would that convey an entirely different meaning to you than the sentence as it reads now: "Respiration somewhat flatter, moderately Frequent."?

A: Yes, the changes made indicate that the clinical condition of the patient is better.

Q: In the sentence in the 8th paragraph which reads:

Heart beats very low, poorly audible

— if the word poorly was replaced by the word "scarcely" would that tent to create a different meaning so that the sentence would read:

Heart beats very low, scarcely audible

rather than "poorly audible"?

A: I'm trying to make a difference between "poorly" and "scarcely".

Q: Would there be a difference?

A: So far as I am personally concerned, that would make no difference. Poorly and scarcely audible are almost the same thing.

Q: Doctor, are you familiar with the expression "Romberg plus plus" as indicated in the last paragraph?

A: I am, of course, familiar with the Romberg test or Romberg sign, but the use of plusses varies with different doctors, so just exactly what is meant by Romberg plus might mean something different for me from that it would mean to some one else.

Q: What is the purpose of a Romberg test, Doctor?

A: It is to determine one's ability to stand steadily without falling with their feet together and their eyes closed. A two plus would indicate that it would be difficult for this subject to stand without falling. That would be my interpretation.

Q: Could you explain to us what the remark in the last sentence in the last paragraph "bulbous reflex positive" means?

A: Well, that is the patient would respond when the eye ball was pressed upon.

Q: What is the purpose of such a test as that, Doctor Ivy?

A: That is generally used to determine the extent of unconsciousness or the degree of coma.

Q: The second sentence from the bottom, in the last paragraph, which reads:

Tonus of the bulb of the eye bad

— what does that indicate?

A: That again is a test used for the purpose of estimating the extent of unconsciousness or degree of disability of a person. If the tone of the eye ball is low, that indicates that the blood pressure is low or the state of the circulation is quite poor.

Q: Is that a bad prognostic sign, Doctor?

A: It is one among others that is bad.

Q: If such a condition exists in adults is it apparent to the attending physician that a serious condition is existent and that death may result?

A: Will you repeat that question?

Q: Is it apparent in the general condition of adults, in grown-ups, that death may be approaching if we find the tonus of the bulb of the eye is bad?

A: Yes, as you say "may be".

Q: Do you have any other analysis to make concerning any of the other notations on the back of this Chart #23 as set forth in the translation that you have before you?

A: No.

Q: Have I pointed out to you clearly the remarks which are indicative of illness on the part of the patient?

A: Yes, I think it is obvious that the patient was quite sick, and as a matter of fact, I should say in a dangerous condition and requires immediately remedial therapy.

Q: Well, then, you would state that a follow-up of this patient would have been necessary?

A: Yes.

Q: Can you tell as from observing Charts #23 and Charts #30, inasmuch as it is not certain whether or not these notes apply to case #23 or Case #30, just how long the follow-up was made on these two patients?

A: In case 23 temperature and pulse record was made for four days after the termination of the experimental period, and in the case of Subject 30, 5 days.

Q: Do you think that was a sufficient length of time to follow up those cases?

A: I do not think so. As I have already indicated, I believe that records should have been kept as in the case of Schaefer water experiments for approximately a week, and in a case where patients or subjects have become as ill as this subject apparently was, I should think should be followed for or three weeks after the termination of the experimental period.

Q: Would you say it was possible that this subject could have died if not properly taken care of?

A: On the basis of the symptoms and signs recorded I should answer that question, yes.

Q: Now, in the summation concerning these records, Doctor, let us consider the group of 8 subjects that were supposed to drink 500 ccs Berka water or seawater treated with Berkatit; now, of theses 8 subjects receiving 500 ccs Berka water daily do you state that three became definitely sick and one other subject, No. 24 doubtfully sick, according to the record?

A: That is correct.

Q: And Subject 21 had to be given coramine, a heart stimulant, as he was too weak to stand on two occasions?

A: Yes, he was too weak to have his blood pressure taken.

Q: And Subject 25 had a fever at the end of the Berka Water period and was too weak to stand up on two occasions, and he had to have morphine, and X-ray of tile chest disclosed pathology, perhaps pneumonia?

A: Perhaps pneumonia, yes. There a, as a shadow on each side of the bronchus.

Q: Doctor, you said this morning that condition was bronchitis, would you be able to determine from the charts whether that was pneumonia, on is that too difficult?

A: No, I would have to see the actual film.

Q: Now, you state that one should have certainly followed up the subjects 21, 23, and 30, and number 25?

A: Yes, and number 3.

Q: And number 3. Now, the subjects that supposedly received 1,000 cc. of Berkatit treated seawater daily from about 7 to 10 days, how many of those became sick again, Doctor?

A: Two.

Q: That was subjects —

A: 28 and 29.

Q: Now, I note that Subject 27 is supposed to have gone 10 days, Subject 28 supposed to have gone 29-1/2 days, and Subject 21, 8 days on 1,000 cc Berka water, is that possible?

A: Not that is not possible. According to the urinal output in relation to the 1,000 cc of intake Patient 27, for example, supposedly did not take all the 1,000 cc of Berka water.

Q: Well, now, how did the five subjects supposed to have taken 1,000 cc of seawater daily from 4-1/2 to 8 days fare?

A: Subject 32 and Subject 40, among the five who were supposed to have taken 1,000 cc of seawater, were quite ill. Subject 32 was too weak on two occasions to have the blood pressure taken, and Subject 40 was given some sterofundin perenially.

Q: Now, Doctor, it is obvious that all of these patients did not drink the seawater, but that some of them cheated, isn't that true?

A: Yes, that is true.

Q: So it us apparent that these experiments turned out to be a farce scientifically?

A: Scientifically speaking, yes.

Q: Now, out of the total of 44 subjects is it true 12 were too weak to stand up on one or more occasions, and who had a fever and who required cardiac medication or were unconscious, those subjects being 4,3,14,21,23, 25, 28, 29, 32, 36, 37, 39 and 40?

A: Yes, according to the data recorded on the charts those patients either required some sort of X-ray or unusual therapy, or were too weak to have their blood pressure taken, or had a fever or had difficulty with the X-ray, for example?

Q: Dr. Ivy, several witnesses have testified here that one or three of the 44 subjects died during the course of these experiments or later, now, in your opinion after studying these records which of these 12 subjects who manifested observed signs of abnormality during the period of observation recorded on the charts were sick enough to cause concern regarding whether they might have died?

A: Well, subject 25, the subject to whom the stenographic notes on the back of page C-23 apply, and Subject 3. Those are the subjects in this group which concern me in relation to your question. Now, that statement is simply an opinion based on the data that are available.

Q: On page 8762 of the official transcript of this trial, Doctor, the testimony of the defendant Beiglboeck, which will be found in the afternoon session of 9 June 1947 —

A: What was the page, please?

Q: That is page 8762. A question put to Dr. Beiglboeck reads as follows, and this is found in the second paragraph of the official transcript for 9 June 1947, on page 8762 of the English. When the interpreters have that will they tell me. I will wait for you.

THE INTERPRETER: We don't have the English text at all yet. We don't Have the 9 June, but if you continue we can translate.

Q: (continuing) The question:

The witness Bauer, who is a business man, in a civilian profession, says further that he saw symptoms of heart weakness; what do you say about that?

Dr. Beiglboeck answered as follows:

The witness Bauer developed the electro-cardiograms which I took. He developed the film. I suppose that on that opportunity he also examined them like an expert. What occurred in the case of the experimental subjects was a slowing down of the pulse.

This is called in German medical literature Schon Stellung. It is a protective position of the blood circulation. This is supposed to express that through the slowing up of the heart beat, as in the case of any case of deficiency, as in the case of hunger, a certain economic using up, that is a quieting down of the circulation develops. This theory, I believe, is the correct one, but not the one that Herr Bauer accepted.

Now, Dr. Ivy, do you recall that several of the subjects were given coramine or strychnine at the end of the experimental period?

A: Yes.

Q: What are the drugs commonly used in treating patients, what are these drugs commonly used for in treating patients?

A: As a cardiac stimulant?

Q: Does not the use of heart stimulants by Dr. Beiglboeck on a few of these subjects confirm the reports of Herr Bauer?

A: Yes, I would say so, toward the theories, the opinion expressed by Bauer?

MR. HARDY: At this point I have no questions to put to Dr. Bauer concerning seawater experiments, and if the Tribunal has any I will not proceed to another portion of the examination.

BY JUDGE SEBRING:

Q: Doctor, do you have before you Document NO 177, which has been introduced as Prosecution Exhibit 133, and appears in Prosecution Document book V, at pages 11 to 17, inclusive?

A: Yes, I have it.

Q: Will you please turn to page 13 in Document Book V?

A: Yes, I have it.

Q: And I direct you attention in particular to that paragraph which be with the Arabic numeral 2. Prior to that paragraph these words appear:

duration of experiments maximum 6 days. In addition to these experiments a further experiment should be conducted as follows:

2. Persons given seawater and as a diet also the emergency sea rations. Duration of experiments 12 days.

Can you tell by an inspection and analysis of the graph papers and the data books which you now have before you whether there were any experiments set up to last a period of 12 days nourished with sea water and emergency sea rations?

A: Except for the subjects in the group receiving Schaefer water, which is essentially fresh water, none of the experiments extended longer than 10½ days, according to my way of interpreting the extent of the experimental period. According to Dr. Beiglboeck's way of interpreting the extent of the experimental period, the longest period would be 9½ days.

Q: Will you please explain what is comprehended within the period of 10½ days as you estimate it and 9½ days, as the defendant Beiglboeck estimated; maybe perhaps I can make myself more explicit; in estimating that period of time are you taking into account the preliminary observation period of seven days?

A: No, when I used the expression experimental period, I meant the period of time that the subject was thirsted and fasted or the period of time the subject received Schaefer water or the period of time the subject received either Berka water or sea water. The period before the experimental period was referred to as the control period or pre-experimental period and and the period after the experimental period may be referred to as the post control period.

Q: Let us assume that your interpretation of the records are complete and that some of the experimental subjects participated in the experiments for a period of as long as 10½ days; can you say from examining the report whether that was an unbroken experimental period?

A: In every case, I should first say that I have studied the records with that idea or point in mind and in every case, according to the urine output, I should say that the experimental period was broken. That is, if you refer to the chart of patient No. 27, you will find that patient was supposed to take 1,000 cc of Berka water for ten days, the last six of which were hunger.

If you look at his record of urine output, you find it was impossible for him to follow that strict routine.

Q: In regard to the experimental subject you have just been referring to, can you state from looking at the chart and records what his physical condition was at the time he broke into the experiment by gaining access to water or to fresh water as the case may be?

A: The record will show that I did not include subject No. 27 in my list of the subjects who appeared to be sick on the basis of the study of these records.

Q: The defendant has made the statement, if I understand his testimony correctly that he found of the entire group of experimental subject that twenty of them gained access to water during the course of the experiment and he listed them, if I understood his testimony correctly. Perhaps you have a pencil and pad there, do you, Doctor?

He listed them as the experimental subjects Nos. 2, 5, 12, 15, 16, 19, 20, 24, 27, 28, 29, 31, 33, 35, 37, 38, 40, 41, 42, and 43. Can you examine the grafts or records of those experimental subjects, or any or either of them and give the court your medical view as to the condition, physical or mental, that those subjects were in at the time they broke off the experiment; by that I mean at the time they discontinued the strict routine under which they were placed as experimental subjects?

A: First, I should like to give an answer to that question insofar as Subject No. 27 is concerned. I just referred to that subject as having been supposed to receive 1,000 cc of Berka water. According to my interpretation of his urinary output, that subject received sea-water to any significant extent only on the first four days of the ten day experimental period.

Q: Here is the thing, Doctor. Perhaps I may aid you in getting the information, if you can get it, that the Tribunal is interested in. Here is an experiment, which as you say, according to your interpretation of the charts, was conducted for a period of at least 10½ days with some of the subjects. I think that the Tribunal is interested in knowing —

A: I think we should correct that figure to ten days.

Q: Ten days — I think the Tribunal is interested in knowing what the condition of those subjects was when they broke off their experiments, because as I remember the Defendant Beiglboeck said that when he discovered that fact, he placed some of them again back on the routine as volunteers. As he puts it, if he found them and continued them in that status; we are interested in knowing whether or not at the time they broke off the experiment by gaining access to fresh water, they were in physical fit condition or, if they were not, whether during the interim that they gained access to fresh water they again became fit enough so that they could safely be put on a second routine of salt water, or hunger and thirst; do I make myself clear, Sir?

A: Yes, in the case of Subject No. 27, and we are talking about that subject, the chart indicates that the pulse was quite slow and unstable and that is the only indication on this chart.

Q: When?

A: This was on August 30th, which is the ninth day, and the patient was taken off of the experimental period the following day, so that would indicate that either because of the other evidence indicated that the patient was quite dehydrated or because of the condition of the pulse, that Dr. Beiglboeck decided to break the experiment.

On the other hand, he may have decided to break the experiment because the patient was not taking all the sea-water, I mean all the Berka water.

Q: I think the defendant made the explicit statement that in regard to some of the subjects, he came to the conclusion that they were gaining access to water and he confronted them with that fact and then threatened them with the fact that he was not going to give them the cigarettes he had promised them because they were not engaging in the experiment fairly and then they entreated him to be allowed to again embark upon the experiment, whereupon he started a new period. And I am interested, the Tribunal is interested in whether or not, at the time they started the new period, they were physically in condition that they should have been allowed to do so.

A: Subject No, 11 is supposed to have received 500 cc of sea-water; his experimental period was seven days and then he was taken off the experiment and then a few days later started on a second period for five days. If you will refer to the list of numbers that you gave me, you will not find Subject 11 there. He was supposedly on the 500 cc of sea water for two different periods.

Q: Well, in fairness to the defendant, I believe I should say, that is as I understood his testimony this morning, he called attention to those subjects by number who had not already been dealt with by the Prosecution. I believe in fairness to the defendant that ought to be stated.

Doctor, perhaps that will take some time and perhaps you would like to go back over those records with our question in mind and perhaps be in a position in the morning, after you have had an opportunity to analyze all of those sheets. —

A: I have already done that.

Q: I see.

A: I thought maybe you wanted me to take them up one at a time on the basis of my study of these records of the group of subjects who were exposed to two experimental regimes without more than four or five days between. All of them were in good condition at the time the second period was carried out. Now they had not all gained as much weight, by that I mean they had not returned to their original body weight, all of them.

A: On the basis of their pulse, on the basis of their temperature and other data available, I couldn't say that they were debilitated to such an extent that they could not tolerate of renewal of the regime for the period on which they were placed.

Q: May I ask you now this, Sir? In your opinion, under what circumstances should a volunteer for a sea water experiment such as we are considering here be allowed to drop out of an experiment before its conclusion. I mean be allowed to drop out of his responsibility on his own request?

A: That isn't an easy question to answer. In the experiments which I have performed involving, the aggravation of sea water with and without dilution or in which I have restricted the water intake to determinate minimal water requirements, I have permitted the volunteer subjects to withdraw from the experiment whenever they expressed the desire to do so, regardless on the fact that they agreed at the start to continue until they were released.

Q: Then let me ask you, should the factor whether the experimental subjects feel that he is unable to continue with the experiment be a matter to be determined by him or should it be determined solely by the man conducting an experiment?

A: I do not believe that it should be solely determined by the man conducting the experiment.

Q: If it should appear from the evidence that the person conducting the experiment reserved for himself the decision as to whether or not the experimental subject should be allowed to drop out because of physical or mental distress or discomfort and did not allow the experimental subject to make that decision or choice for himself, would you consider that experimental subject, who desired to drop out of an experiment during its course but who was not allowed to do so by the man conducting the experiment, was thereafter a volunteer?

A: I do not believe that he would be a volunteer and the reason why I have always permitted subjects to withdraw from the experiment when they expressed the desire was from one, a humanitarian standpoint; number two, from a pragmatic standpoint from which I mean that if I forced him to continue he would not be reliable and cooperative and I could not expect to obtain reliable data from him; so I permit them to drop out as soon as they express their desire — the reason of humanitarian and pragmatic ethical philosophy.

Q: Let us assume that at the outset and prior to the beginning of the experiment the person who is going to conduct the experiment advised the potential experimental subjects that he himself was going to reserve for himself the decision, the sole decision, whether am experimental subject would be allowed to drop out during the course of the experiment and let us assume that the experiment started and that, because of extreme physical or mental distress or discomfort, one of the experimental subjects expressed a desire to drop out and let us assume that the man conducting the experiment determined that they should not drop out because prior to the beginning of the experiment he had warned them that he would reserve that decision for himself, would you think that after that time that experimental subject would be in the sense of a volunteer?

A: No. My answer is the same as before because when you coerce or cause a volunteer subject to continue as a subject you can expect cheating and unreliable cooperation and, hence, that challenges the scientific nature of the complete experimental design and at the same time you are exercising coercion.

THE PRESIDENT: There will be no further questions from the Tribunal.

BY MR. HARDY:

Q: Professor Ivy, in connection with the sea water records, did you note thereon any indications that Professor Beiglboeck had performed liver punctures on the experimental subjects?

A: Yes.

Q: Could you explain to us whether or not in these experiments, these liver punctures were necessary, whether if necessary they would be harmful, and whether or not a person suffers as a result of a liver puncture?

A: A liver puncture is a diagnostic procedure which has been used considerably in the last five or six years. When the procedure is carried out by a skilled and experienced operator, the danger of the procedure is minimal, very small. In itself it cannot be said to be a dangerous diagnostic procedure.

Q: Do these records indicate that Dr. Beiglboeck performed lumbar punctures on any of the experimental subjects?

A: Well, when the first looked over the subjects we did not know exactly what the abbreviation "LP" meant. We thought that that might mean a lumbar puncture, or a liver puncture. We also were not certain regarding the meaning of the abbreviation "HP". "H" could stand for liver, "hepatic," or "H" could stand for the German word "hind-brain", but we thought that "HP" stood for cisternal puncture and "LP" for lumbar puncture. I don't understand that "LP" refers to liver puncture and "HP" to intravenous medication.

Q: Would where be any purpose whatsoever in performing a lumbar puncture in these experiments?

A: Well, I do not think so. From a scientific standpoint one could say that it would be wort while knowing whether or not the cerebral spinal fluid pressure was changed by dehydration, whether or not the concentration of cerebral spinal fluid was changed.

Q: Would there be any purpose in the course of sea water experiments as performed at Dachau and performed by Professor Beiglboeck to perform a cisternal puncture?

A: No more than the reasons I gave you for a lumbar puncture. The lumbar puncture is a much safer procedure than a cisternal puncture.

MR. HARDY: Your Honor, at this time I would like to proceed to the examination of Professor Ivy concerning the high altitude pressure. Dr. Sauter is now here in the courtroom and he informs me he can represent defense counsel for Weltz and defense counsel for Romberg as well as for himself for Ruff.

THE PRESIDENT: Very well, proceed.

BY MR. HARDY:

Q: In order to bring Dr. Sauter up to the points that we reached this afternoon in connection with the high altitude research, Dr. Ivy, I am going to request that we go back over the questions concerning the report, Document NO 402, now if you will turn to page 88 of Document Book, No. 2 which is the data given concerning an experiment performed at Dachau, the protocol of which appears in Document NO 402, I wish to ask you the following question: Was it necessary to perform such a hazardous experiment as elicited here on page 88 in Document Book No. 2 in the report of Ruff, Romberg and Rascher?

A: In my opinion no.

Q: Do you consider on the whole the experiments set forth in Document NO-402 to have been particularly dangerous?

A: Only those experiments involving slow descent or descent with the parachute opened from the higher altitude do I consider dangerous.

Q: That is those experiments which were concerned with slow descent from an altitude exceeding 15000 meters or 47200 feet?

A: Yes. All those in which the period of unconsciousness or oxygen lack were prolonged I indicated that that might cause injury of the cells of the brain in a permanent way which would be indicated by a test of the learning mechanism.

Q: Well, in a slow descent experiment of this sort how long would the brain and the heart be deprived of adequate oxygen?

A: As I indicated the experiments, the results of the experiments, show that the subjects were unconscious for fifteen or, I believe, up to thirty minutes because of lack of oxygen and they were disoriented for a period of from thirty up to ninety minutes.

Q: Well, now the extremeness of these conditions are recorded by the authors on page 97 of Document Book II. Therein they report that no lasting injury due to oxygen lack occurred. Is that statement uncritical?

A: I believe it is in so far as the brain or cerebrum is concerned. But I believe it is a correct statement so far as the heart is concerned.

Q: But in these experiments they did not study the learning mechanism of the brain, did they?

A: No.

Q: Would you explain to the Tribunal just what you mean by the study of the learning mechanism of the brain?

A: Well, in order to learn the cells of the cerebral cortex must be normal. The cells in our body which are most sensitive to lack of oxygen are the cells of the cerebrum.

Hence, in determining whether or not a period of oxygen lack had caused any injury to the body test should be applied to that bodily mechanism which is most susceptible or sensitive to oxygen lack. It is for that reason, I believe, these experiments were incomplete and it could not be stated categorically the body of these subjects resulted in damage from oxygen lack.

Q: An experiment of this type, would you be reluctant to do such an experiment on yourself?

A: Yes, I should unless it were absolutely necessary to provide some information that could not be obtained by some other method.

Q: Do you mean by experimentation on animals, monkeys or other animals?

A: Yes, and even perhaps myself.

Q: Well, would the difference between the result on animals and the result obtained on men be striking?

A: In some instances Yes but not in this particular instance, I should say that the difference between the results obtained by Lutz and Wendt and the results on animals obtained by Ruff, Romberg, and Rascher on these human subjects was not enough to indicate that these experiments were necessary. And that is what I should anticipate on the best of my knowledge.

BY JUDGE SEBRING:

Q: Doctor, that was the question I was going to ask. Could that have been anticipated with your knowledge prior to the time you had it and the reports of Ruff, Romberg and Rascher.

A: Yes that is correct because we know the particular pressure of oxygen at these various altitudes and we know how long there will be an adequate amount of oxygen in the blood to maintain physiological function. And we know at what altitude there is sufficient amount of oxygen in the air to oxygenate the blood in order to bring about consciousness. With that knowledge one can determine the amount of oxygen that has to be put in a bale out bottle in order to preserve consciousness from one high altitude to a lower safe altitude.

Q: Was that knowledge known, were those facts known generally in the medical world in the year 1942, doctor?

A: Yes, in 1942.

BY MR. HARDY:

Q: Professor Ivy, in your opinion is it possible for a physician, that is a senior physician or a medical scientist, to be attached to a distant laboratory by having his assistant working in that distant laboratory?

A: Yes. I have done that. I have had my assistants or men working under me in my laboratory to other laboratories and work there on problems under my supervision.

Q: Is that a common practice in the scientific field?

A: Relatively so, yes.

Q: Assume, doctor, that you were offered an assignment to work for instance in the University of California laboratory. Now you are situated in the University of Illinois and you sent an assistant to work in the University of California laboratory. Would you feel that you were responsible for the scientific activity of your assistant?

A: Yes, as long as he is under my jurisdiction I am responsible for his scientific activities.

Q: If in the course of his work a death occurred in his laboratory and the assistant reported the death to you, that is, assuming that he is experimenting on human beings. Would you then be impressed or unimpressed by the report given to you that a death occurred in his work?

A: Well, I should be very much impressed and I should either go myself to investigate the circumstances surrounding the death or I should have some one locally in whom I had a great deal of confidence make the investigation and give their report to me.

Q: Then it is the senior investigator's responsibility to care fully check the cause of any irregularities in the course of any assistant's research program?

A: Yes.

Q: Is it a common occurrence for a person to die or to be killed in the course of experiments in aviation medicine or clinical investigations of any sort?

A: Yes, it is relatively rare. As a matter of fact I only know of one death which has occurred in all of the experimentation which has gone on in the United States in the field of Aviation Medicine and that is the case of Major Boynton who in the study of free fall bailed out of an airplane I recall at something like 40,000 feet. All of the other experiments worked. I know of no death having occurred.

Q: Well when a death does occur, for example a case like Major Boynton, did the deceased become a so-called medical hero a martyr to medical science?

A: Yes, we consider Major Boynton a hero, a medical hero, in the field of aviation medicine and I might say that on the occasion of his death the causes were investigated very carefully by the Air Surgeon.

Q: Dr. Ivy, because of the fact that you are so familiar with laboratory and aviation research I should like to have you read several documents keeping the contest in mind that after which I desire to obtain your opinion as an expert. First I should like to have you read on page 76 of Document Book II. That is—

THE PRESIDENT: Counsel, how long will it take to read and discuss these documents?

MR. HARDY: It might be advisable to adjourn at this time. We could discuss this the first thing in the morning. This will be a rather extensive question.

THE PRESIDENT: Are you going to read these documents into the record?

MR. HARDY: I want to read the particular sections into the record so that it will appear in the record just what Dr. Ivy's opinion will be based on as to the particular section I referred to.

THE PRESIDENT: You might read these sections into the record and then in the morning direct Professor Ivy's attention to those documents.

MR. HARDY: If your Honor pleases, I would just as soon wait until tomorrow morning.

THE PRESIDENT: The Tribunal will now be in recess until 0930 o'clock tomorrow morning.