1947-06-14, #1: Doctors' Trial (early Saturday morning)
Official transcript of the American Military Tribunal in the matter of the United States of America against Karl Brandt, et al, defendants, sitting at Nurnberg, Germany, on 14 June 1947, 0930, Justice Beals presiding.
THE MARSHAL: Persons in the court room will please find their seats.
The Honorable, the Judges of Military Tribunal I.
Military Tribunal I is now in session. God save the United States of America and this honorable Tribunal.
There will be order in the court room.
THE PRESIDENT: Mr. Marshal, will you ascertain if the defendants are all present in court.
THE MARSHAL: May it please your Honor, all the defendants are present in the Court.
THE PRESIDENT: The Secretary General will note for the record the presence of all defendants in court.
Counsel, how long do you anticipate that your further cross examination of this witness will take?
DR. SAUTER: Mr. President, I estimate that Dr. Ruff will require perhaps half an hour, if the Tribunal permits. Following Dr. Ruff, I myself, should like to ask two or three more questions, so that we will be finished in about three-quarters of an hour.
THE PRESIDENT: Very well, you may have that time allocated to you.
I would ask Dr. Steinbauer — you may remain at your seat, Doctor.
DR. STEINBAUER: I believe I need about an hour.
THE PRESIDENT: Very well, an hour will he allocated to Dr. Beiglboeck.
I understand that Dr. Servatius will conduct the cross examination of the witness on at least some of the general subjects. Will any other counsel cross examine the witness upon any general matter?
DR. FLEMMING: I will need about ten minutes.
THE PRESIDENT: That will be allocated to you.
DR. NELTE: I will need about a quarter of an hour.
THE PRESIDENT: Very well, that may be allocated.
Counsel may proceed.
DR. SAUTER: I should like to have Dr. Ruff ask a few more medical questions.
THE PRESIDENT: Dr. Ruff may propound the questions to the witness.
DR. ANDREW C. IVY — Resumed
CROSS EXAMINATION (Continued)
BY DR. RUFF (Defendant):
Q: Dr. Ivy, yesterday you explained to the Tribunal what conditions and practice explosive decompression comes about and you had said that if a plane is flying at high altitude and the pressure cabin is damaged, this explosive decompression occurs.
Now, what happens to the persons in the plane if they have survived this explosive decompression? What happens to them after that? To make the question more precise I might add the following: Let us assume that the plane is flying at 17,000 meters.
A: They can either take a dive to the ground or they can bail out. In the American Air Forces they bail out, they disconnect from the oxygen supply of the plane and plug in with the oxygen supply of the bail-out bottle before leaving the plane.
Q: Professor Ivy, if this explosive decompression occurs at 17,000 meters then the crew has only a very short period of time for bailing out, is that correct?
A: Yes, that is correct.
Q: Because even with oxygen the crew becomes unconscious very quickly at 17,000 meters, is that right?
A: Yes, that is correct.
Q: Could you perhaps indicate how much time passes from the moment of explosive decompression until unconsciousness sets in — still at 17,000 meters?
A: That will depend upon the size of the fracture or damage of the plane, the rate at which the explosive decompression occurs. If it occurs relatively slowly they will be able to connect with their oxygen supply and will be able to get out of the plane before they lose consciousness in the course of perhaps 30-35 seconds. That period of time will vary.
Q: Yes, I quite agree with you. Now, if we assume that a whole pane of glass is broken, if there is a comparatively large hole in the cabin, would you agree with me that this time which we in German aviation call time reserve at this altitude is about 10 or 20 seconds?
A: I agree with that under those conditions.
Q: Now, Professor Ivy, if for reasons of aviation medicine one makes experiments with explosive decompression is it not sensible to carry out experiments on the course of the parachute descent following explosive decompression?
A: Yes, I think up to a certain point.
Q: Do you agree with me if I say that only explosive decompression experiments for 17,000 meters again, are senseless in practice if one does not at the same time investigate the question of rescue after explosive decompression?
A: Yes, that is correct.
Q: Now, Professor Ivy, in America explosive decompression experiments were carried out through about 17,000 meters — 47,000 feet. Can you confirm this second part of the problem, experiments for parachute descent from such altitudes were also carried out?
A: Yes, up to a certain point they were carried out but were not carried out the way you carried out your slow descents from 15 kilometers or approximately 39,000 feet, which requires subjecting the subjects to a long period of oxygen lack.
Q: The experiments to this end were not carried out in America because the American Air Forces oxygen equipment is available for parachutes so that the person is equipped with oxygen after bailing out, is that correct?
A: Yes, that is correct.
Q: Now in order to avoid any misunderstanding which might arise on the basis of one question asked by the prosecutor, I ask you on the basis of theoretical calculations can binding finds be made as to the exact altitude from which oxygen equipment for a parachute is necessary?
A: An approximately correct answer can be obtained by calculations.
Q: By calculations. Would you please briefly explain to the Tribunal what physiological factors would have to be considered in such a calculation?
A: One has to consider the questions of partial pressure of oxygen in the inspired air at the various altitudes, when the subject is breathing 100% oxygen at high altitudes, you would have to consider the ambient pressure in making the calculations of the pressure of the 100 % oxygen as I have indicated previously in my testimony; in order to obtain a 100% saturation of the blood with oxygen above an approximate altitude of 12,000 meters it is necessary to breath the 100% oxygen under pressure, so that breathing 100% oxygen between an altitude of 12 kilometers and 15 kilometers there would be some under-saturation of the blood with oxygen, even though the subject were breathing 100% oxygen. That would have to be taken into consideration and the rate of fall with the parachute open would have to be taken into consideration. The only place that the blood would not be 100% saturated would be in the region above 12 kilometers. I believe that is as simple as I can make the matter.
Q: Now, Professor Ivy, you mentioned two factors which have to be considered in these calculations.
Do you agree with me if I say that in addition to these two factors, the carbon dioxide in the lungs has to be considered because this influences the amount of oxygen in the lungs?
A: That will influence. The percentage composition by the partial pressure oxygen when you breath 100% oxygen can be determined the carbon dioxide and water vapor content would have to be taken into consideration in the calculations.
Q: Yes, you mentioned a fourth factor. That is the water vapor which also has to be considered. Now the speed of occurrence of altitude sickness may be influenced by the circulation too.
A: By altitude sickness do you mean the symptoms due to lack of oxygen only?
Q: Yes, only the symptoms of lack of oxygen otherwise that becomes too complicated.
A: Yes, the circulation is a factor, but there is no reason why the circulations should be significantly disturbed due to these conditions which we are discussing.
Q: I believe you misunderstood me, Professor Ivy. I asked whether this circulation time, that is the time a particle of blood needs to go through the entire circulation once and back to the lungs, whether this time is not also a factor.
A: Yes, that's always a factor, whether we are up in the air or on the ground.
Q: Then that would be the fifth factor. Now would you agree with me again that the respiration of the aviator in question, that is, the frequency and depth of respiration is responsible, would also influence the results of the calculations?
A: Yes, that influences results of such calculations whether you are in the air or on the ground.
Q: Now, would one also not have to consider the so-called adaptation to altitude?
A: Yes, there is a variation in susceptibility to the oxygen lack in different individuals, but that can be determined at altitudes of 18,000 feet only.
Q: Professor Ivy, do you know the German term, "Vormobilisation?" premobilization? In Germany we mean the attitude of human organism that in ascent to altitude he reacts differently to the lack of oxygen than in descent from altitude. To give a practical example, in ascent to 7,000 or 8,000 meters a person becomes unconscious if he is then taken up to 12 or 13 kilometers and then down again he becomes conscious at 9,00 meters and is capable of acting. Do you find this fact in your work too?
A: I have not studied that, but I can understand its explanation physiologically.
Q: Do you agree with me that this premobilization must be included in the calculations if one wants to come to reasonably valid results?
A: Yes. I agree with that question the way you have worded it.
Q: Now, one more brief question about respiration. We just said that the character of the respiration of the aviator in question is a factor in this calculation. You no doubt know that the time, reserve, for example, at 15,000 meters can be increased two or three times by holding ones breath. You know that, don't you?
A: What do you mean by "holding ones breath?" You mean holding one's breath in exerting pressure?
Q: I mean by not breathing, if one has been breathing pure oxygen before.
A: Yes, to some extent, a very minor factor.
Q: Now, if an aviator breathes very quickly, because he is excited, then this time reserve can be reduced to a fraction of normal, is that true?
A: Yes, that's true.
Q: Very well. Now, if we consider the reaction of a person at 15,000 meters and want to calculate, we have about ten factors and these ten factors vary individually. Do you believe that in view of all these factors one can come to a reasonably reliable picture through calculation of what the conditions are?
A: Yes, I do, because many of the factors are very minor, not important, or significant. I had such small factors in mind when I explained my opinion in previous testimony that I believe that it was unnecessary to place subjects to the hazard of that part of your experimental program in which the subjects were exposed to slow descent. I also stated that I should be reluctant to perform such experiments on myself or other subjects.
Q: Can you understand that German aviation medicine men held a view very different from your opinion saying that these calculations are too unsatisfactory and we are not to take the responsibility for conclusions drawn from these calculations?
A: I can understand that and I can also understand the fact that some people might be as reluctant as I would be to perform those experiments.
Q: Now, Professor Ivy, another question — a question on animal experiments. From the record you have, no doubt, seen that before our experiments we carried out orientation experiments on animals. Yesterday you yourself mentioned the work of Lutz and Wendt and, if I understood you correctly, in answer to a question of Prosecution you came to the conclusion that the slight difference between results of animal experiments and human experiments does not completely justify experiments on human beings. Did I understand your correctly?
A: That was my opinion as applied to this particular instance.
Q: Now, Professor Ivy, do you consider the difference between 14,000 meters and 21,000 meters as a maximum altitude from which one can rescue aviators for sure? Do you consider that so slight?
A: Will you repeat those figures again?
Q: 14,000 meters which was the maximum height as the result of animal experiments, and 21,000 meters which was the result of our human experiments. Do you consider this difference between 14,000 meters and 21,000 meters really so slight?
A: Not when that applies to slow descent with an open parachute. That doesn't apply there. No one would recommend, for example, that an aviator bail out at 21 kilometers, open up his parachute and descend. The experiments which we have under discussion involve slow descent from 15 kilometers. That's what we are talking about.
Q: Professor Ivy, I quite agree with you that one cannot one should not — carry out slow sinking experiments from 21 kilometers without oxygen and that one should recommend this to pilots. You have read our document 402 very carefully that no slow experiments without oxygen were performed from 21,000 meters.
A: That's right — 15 was the height from which you performed such experiments.
Q: The altitude at which we stopped and at which we said in a reports:
slow sinking experiments without oxygen from high altitude.
I shall quote — this is on page 82 of the English Document Book, page 19 of the report, page 97. I quote:
Slow sinking from higher altitude were not carried out since in practice there is no necessity to descend from such altitude with an open parachute and expose oneself to the danger of severe freezing.
A: Yes, on page 88 of document 402 you say:
descending experiments were made in larger numbers from 15 kilometers altitude since it became evident that at this altitude the approximate limits for what was possible in emergencies had already been reached essentially surpassed.
Now, the only point that I am making is that when those experiments were being done you had reached the physiological limits and were working in a very dangerous and hazardous zone insofar as the welfare of your subjects was concerned. And I said that I should be reluctant to perform such experiments and that I should prefer to depend upon that degree of accuracy which I could obtain from calculations of the results of animal experiments.
Q: Professor Ivy, do you know the state of technical development of high altitude flying in Germany in 1941 and 1942. That is the time when these experiments were carried out.
A: Yes, I know something of that.
Q: Then you no doubt know that at this time we had a fighter plane, Messerschmitt 163 which had the quality of having a rocket drive.
A: That is correct and I know that you were ahead of us in our developments as far as the ejection seat is concerned.
Q: Do you also agree with me that with these rocket planes one can reach any altitude desired and that the altitude reached depends only on the amount of fuel?
A: Yes.
Q: Professor Ivy, you know, you surely know, of modern developments in America in this field.
Do you know the American plane type XS1?
A: Yes, I know something about it.
THE PRESIDENT: Can the translators get the question?
Q: Professor Ivy, do you know the American plane type XS1?
A: I do not know it by that number.
Q: It is a rocket plane with a pressure cabin which is built for a ceiling altitude of 80,000 feet.
A: I know something of that.
Q: Is this a plane which in principle has the same propulsion as the Messerschmitt 163 which we had in 1941 and 1942?
A: I can't say yes or no to that. You are just making a statement without asking me a question.
Q: I asked you, Professor Ivy, whether this XS1 in principle has the same propulsion, that is rocket drive, as the Messerschmitt 163 which we had in 1941 and 1942?
A: My knowledge of the engineering factors of the two planes does not permit me to say yes or no. I know that the problems of aviation medicine involved are essentially the same.
Q: Very well. Your Honors, perhaps I may refer to Document 5 in the Romberg Document Book, Exhibit 3 in respect to this type XS1. For the state of German technological development in the year 1942 I should like to refer to affidavit in Ruff Document Book No. 20, Exhibit 8, it is an affidavit of the technical officer, the General of the Fighters at the time. I may also refer to the affidavit of the Chief of the German Fighters Major General who speaks of the development at that time. This document has not been submitted yet. It will be offered to the Tribunal later.
Now, Professor Ivy, I should like to read you a few sentences from the German expert who commented on these experiments described in document 402 and I should like to ask you whether you agree with the statements of the German expert. This expert is the lecturer, Dr. Gauer whom we unfortunately are unable to hear since at this time he is in the United States as a scientist.
The statement of this expert is on page 43 of the Ruff Document Book, Document 10, that is Exhibit 14. The expert comes to the following summary of his opinion on these experiments:
1) The question of rescue from extremely high altitudes constituted a problem of the utmost importance for aviation medicine. The experiments yielded unexpected results which were of importance for technical development.
2) Experiments with animals yield no quantitative, binding values.
3) The experiments were carried out on a scientific basis. The experiments were discontinued after a certain practical aim had been attained. No casualties ensued.
4) The subjective troubles during experiments with low pressure chambers in high altitudes without oxygen are slight.
Do you agree with this opinion of the German expert?
A: I agree with the opinion of the German expert that you just read with the exception of the experiments of slow descent from altitude of 15 kilometers.
Q: Very well. We have already discussed that. Now, Professor Ivy, I have a few brief questions on car document 402 in another connection. You said day before yesterday that the sinking experiments were more dangerous than the free falling experiments from 21,000 meters. You said that in the sinking experiments as in all other experiments, there was no damage to the heart but that there was the possibility of damage to the brain cells. Did I understand you correctly?
A: Yes.
Q: You also said that the possible damage to the brain cells could have been checked.
MR. HARDY: We are not getting Dr. Ivy's answers, Your Honor.
THE PRESIDENT: Will the interpreters check the system?
BY DR. RUFF:
Q: Professor Ivy, would you please repeat your answers to the previous question? I asked you whether in the examination by Mr. Hardy you said that there was the possibility of damage to brain cells. Is it true that you said that?
A: Yes.
Q: Professor Ivy, you also said that possible damage to the brain cells by lack of oxygen could have been tested by asking intelligence questions before and after the experiments. Did I understand you correctly?
A: By making the appropriate tests for ability, capacity to learn.
Q: Can you cite any work where the possibility of testing brain cell damage through lack of oxygen by an intelligence test is reported on?
A: That has been reported on only insofar as animals are concerned. I know of no one who has performed learning ability tests on human subjects and then have exposed them to prolonged periods of oxygen lack, such as your subjects in slow descent from high altitudes were exposed, and then follow it through with intelligence tests. But learning ability tests in animals before and after exposure to oxygen lack have been done, and it has been found that their learning ability is damaged.
Q: Then I misunderstood you the day before yesterday. It was not an intelligence test, it was a limited field of learning ability which to a certain extent can be tested on animals too?
A: Yes, because an intelligence test as applied by psychologists is nothing more than a test of ability to learn.
Q: Professor Ivy, I do not know whether the psychologists would quite agree with your opinion, but we will leave that aside.
A: You have quite a number of them to agree with that statement when I made it.
Q: Professor Ivy, did you know of any case in literature where after a brief lack of oxygen, ten minutes at the most, any provable organic damage to the brain was observed?
A: No. You know as well as I do that that depends upon the extent of oxygen lack and its duration. Permanent damage of the human cerebrum will occur if it is completely deprived of oxygen from five to seven minutes. That is lethal as far as the human, and I might also say the dog cerebrum is concerned. It is not necessarily lethal insofar as the vital medullary centers are concerned.
Q: Professor Ivy, do you know the work of Buechner and his school on this subject?
A: No.
Q: Professor Buechner found, and I am certain that similar work was carried out in America too, that if one leaves animals for days and hours in such a strong lack of oxygen that they are just barely kept alive, that even after these days one can find no damage to the cerebral cortex with these animals.
A: Well, that may depend upon the extent of anoxia to which they have been exposed. He probably determined just the threshold at which no damage occurred, and I have in mind, for example, experiments of Professor Wendell at North Western University where the extent of oxygen saturation of the blood for a period of several minutes was only 20 — 15, 20 or 30 percent.
Q: But as far as I remember this work in a short lack of oxygen, by this I mean a maximum of ten minutes such as occurred in our experiments in such short experiments no damage to the brain was observed, is that correct?
A: No, I am not familiar with that. There are two factors concerned. One is the degree of oxygen lack, and the time. Those two factors have to be considered, and as you stated in your own report, you were working at the upper limits of what you considered to be safety.
Q: Now, Professor Ivy, I am sure you know that the first damage to the brain from anoxia and usually after a long interruption of the oxygen supply is damage to the ganglia, and especially the corpus striatum.
These things are known to a far extent from chronic carbon monoxide poisoning and from literature.
A: Yes, that is morphologically speaking. In such experiments learning ability tests, to my knowledge, have not been applied. There is particular reference to carbon monoxide poisoning.
Q: Professor Ivy, you will no doubt agree with me that in these cases of brain damage in the area of the corpus striatum there are so-called Parkinsonianisms, Parkinsonianisms's.
A: That is correct. I happen to be very familiar with that subject. For example, this week at the meeting of the American Medical Association in Atlantic City, I have an exhibit on the subject of resuscitation from carbon monoxide poisoning. I happen to be the expert consultant on that subject for the Council on Physical Therapy of the American Medical Association.
Q: Now, Professor Ivy, since you are especially well informed in this field, do you agree with me that this damage which appears after a long period of anoxia, these Parkinsonianisms, that they can be found in neurological tests and in the clinical aspect of the person much better than in an intelligence test?
A: All patients do not manifest the symptoms of Parkinsoniansm or paralysis agitans. I should like to also indicate that some of the human beings and animals who have been subjected to carbon monoxide poisoning, human beings, of course, accidentally, will show a blear period after they recover consciousness of from five to ten days in which they are apparently normal. Then they will develop various manifestations of damage to the nervous system or neurological sequela which may take the form of tremors in Parkinson's disease, may take the form of amnesia, loss of consciousness, and may be followed by death. So one might reasonably ask whether or not any of these subjects that were exposed to this anoxia as a result of slow descent showed any symptoms after a period of from five to ten days had passed.
Q: I absolutely agree with you on this point, Professor Ivy. I can tell you as far as I recall, that was not mentioned exactly in the report, that the experimental subjects who went through these sinking experiments were under observation for about six weeks afterwards, and that after six weeks the nervous system and the clinical aspect of these experimental subjects showed nothing whatever, and I believe you will agree with me if I say that with the probability bordering on certainty, that is probability which is the most which we as doctors can give, it can not be expected that these people suffered damage at any other point in the brain.
MR. McHANEY: I object to the remarks of Dr. Ruff. He is not now testifying. He is engaged in the examination of Dr. Ivy, and I submit that he should restrict his remarks to direct questions to the witness.
THE PRESIDENT: The objection is well taken. That was purely an argumentative statement in testimony.
I would also call Dr. Ruff's attention to the fact that he has already exceeded the time which he stated he desired to be allocated to him for this examination.
Counsel.
DR. SAUTER: Mr. President, I should like to ask you to admit this last question. It is a point which was not brought out expressly in the Ruff-Romberg-Rascher report, which was brought up only during the trial. Now, Dr. Ruff must have an opportunity to inform the expert — to question the expert on this point. If I have understood this question correctly, the point was what the expert has to say about the statement of my client that these patients were under observation for six weeks and that there was not the slightest change in their psychical condition. This question has acquired a certain importance in the course of this trial.
THE PRESIDENT: I do not think there is anything in the record on that question. The witness may be asked a hypothetical question, but Dr. Ruff was himself making a statement as a witness. He is not now on the stand. He may ask a hypothetical question of the witness.
DR. SAUTER: I beg your pardon, Mr. President, I did not realize that.
BY DR. RUFF:
Q: Professor Ivy, I have only a few very brief questions.
I believe you said yesterday that, according to present day opinion, bends is a result of air bubbles in the blood. Do you agree with me — or rather I would ask a question. Are there not air bubbles in the blood vessels which do not cause any disturbances to the system and do not cause any pain?
A: Yes, and there are probably air bubbles which do.
Q: On the other hand, is there pain in bends or symptoms with the bubbles in the blood vessels or the tissue which can be found — when bubbles which cannot be found?
A: Pain occurs and paralysis occurs in areas where gas bubbles cannot be visualized by the X-ray apparatus, but that does not mean that there are no gas bubbles present. The only conclusion permitted is that the X-ray technique does not reveal them. That is as far as we can go with these facts.
Q: Professor Ivy, what I was interested in was the following. Is there pain or are there symptoms occurring without gas bubbles in the blood vessels?
A: No, so far as I know. It is a question that, at the present time, we cannot categorically answer "yes" or "no".
Q: Very well.
Then, you agree with me that the question of bends is not yet clear in certain points?
A: Yes, in that the bubble theory theory has not been absolutely established, but it is the theory that has the most evidence in its support and it is the only way, in my opinion, that we can explain the prevention of pressure drop sickness by the pre-breathing of oxygen for the purpose of washing out the nitrogen from the body.
Q: In the final question I shall come to this point, but first I should like to ask another question.
Dr. Ivy, is it customary in medical science, in working on such problem to set up theories and working hypotheses and first to work with these hypotheses as long as there is no obvious objection to them?
A: Yes.
Q: Now, Professor Ivy, you just said that one of the greatest reasons in favor of the bubble theory is the previous breathing of oxygen, and you said yesterday that previous breathing of pure oxygen for two to three hours is a sure method to avoid the formation of bubbles in the blood or in the tissue. Did I understand you correctly?
A: Yes.
Q: Now, Professor Ivy, in connection with your examination Mr. Hardy showed you Document NO-220 of the prosecution on page 82 of the German Document Book 2. Document NO 220, Page 74 in the English Document Book.
The last page of the document. It is a secret report from Rascher to Himmler of the 11th of May. When Mr. Hardy read this last page of the document to you yesterday, an experiment of Rascher was reported on where, after 2½ hours of breathing oxygen, an experimental subject died at 20 kilometers within six minutes and the autopsy showed that there were air embolisms in the vessels. Does this statement of Rascher's, which you did not object to yesterday when the document was read, does this not contradict your testimony just now and does it now show the great amount of confusion in the field of decompression sickness?
A: No, that observation doesn't confuse me because obviously you know as well as I do that if the experiment was actually conducted as stated there would be no appreciable amount of nitrogen in the gas and hence those gas bubbles would consist primarily of carbon monoxide. You can take a cat, for example, clear it of nitrogen by prolonged breathing of 100% oxygen, take the cat to an altitude of 15 kilometers, stimulate the muscles and gas bubbles will appear in the veins, and it obviously must be carbon monoxide.
Q: Professor Ivy, I am quite well informed in this field too. I don't know whether you know that in 1945 and 1946, together with my co-defendant Becker-Freyseng, I worked for one year on this decompression sickness. Now, Professor, we have examined these reports of Rascher carefully, not only for this trial but also we worked on them from the scientific point of view as far as possible on the basis of the records rather inadequate for a scientist, and it seemed to us that in this experiment which I have just mentioned to you Rascher perhaps made a discovery, the significance of which he did not realize, but it seems to me to be quite important and now we have a request to you. When you go back to the United States, test this thing again in an animal experiment and see to it that the superstition of breathing of pure oxygen is removed if Rascher's findings are justified.
In the German Luftwaffe, by a fortunate coincidence, from the beginning of our investigations on decompression sickness for fighter planes, from the time when these mobile low pressure chambers were put into use an 1941, we set the time for the stay at 12 kilometers at 10 minutes. If you in the United States make the time 10 to 20 minutes, I believe you will not have any more deaths which, as you said yesterday and the day before, you considered a matter of fate.
I have no further questions.
BY DR. SAUTER:
Q: Mr. President, I have only two very brief questions.
Witness, you spoke yesterday of a number of experiments carried out in the United States and in other countries outside of Germany. For example, pellagra, swamp fever, Beri-beri, plague, etc. Now, I should like to have a very clear answer from you to the following question.
In these experiment which you heard of partly from persons involved in them and partly from in the international literature, did deaths occur during the experiments and as a result of the experiments or not? Professor, I ask you this question because you said yesterday that because of this question you examined all international literature and therefore have a certain specialized knowledge on this question.
A: I also said that when one reviews the literature he cannot be sure that he had done a complete or perfect job.
So far as the reports I have read and presented yesterday there were no deaths in trench fever. There were no deaths mentioned, to my knowledge in the article on pellagra. There were no deaths mentioned, to knowledge in the article on Beriberi, and there were no deaths in the article, according to my knowledge, in Colonel Strong's article on plague. I could not testify that I have read all the articles in the medical literature involving the us of human beings as subjects in medical experiments.
Q: And, in the literature which you have read, witness, there was not a single case where deaths occurred? Did I understand you correctly?
A: Yes. In the yellow fever experiments I indicated that Dr. Carroll and Dr. Lazare died.
Q: That is the only case you know of?
A: That's all that I know of.
Q: And a second question, Professor.
You said yesterday that you yourself had carried out experiments in the field in question. I should like to know who supplied the experimental subjects for your experiments?
A: That has varied considerably. When I used human subjects for experiments in my younger days when I was an assistant or an instructor, I would invite the students to serve as subjects myself. Later, I did not think it proper for me to ask the students to serve as subjects so the laboratory assistants did this. I did not ask them because in my position, I believed they might be swayed if under duress or under undue influence. I testified yesterday that we used some conscientious objectors. We applied to the Civilian Public Service Agency in Washington for these subjects, through the National Research Council.
Q: The first agency — did I understand you correctly, was a policy agency?
A: No, the Civilian Public Service Agency. I never myself used prisoners.
Q: Then, it was the labor office. It must have been the labor office.
A: The Civilian Public Service Agency was a division of Selective Service which supervised the conscientious objectors and their activities.
Q: Witness, how did you go the people from this agency? Did you make an application? Were the people offered to you spontaneously? How did it happen?
A: A written application was made to the colonel in charge, stating the subject of the experiment to be performed, its objective, its background, the duration of the experiment, exactly how the experiment was to be performed, and it's possible hazards. We stated the number of subjects desired.
Q: And this number of subjects was made available to you by this agency then?
A: Yes.
Q: Witness, you said yesterday that the prisoners who ordinarily had to sign a waiver according to which, if I understood you correctly, that they gave up any claim if it proved a fatality, did I understand you correctly?
A: Yes, they signed an agreement, if I recall it correctly they would make plans for themselves in case of accidents.
Q: Not only if they were injured, but if the patient should be a fatality?
A: I believe the expression "heirs and assigns" was included, yes.
Q: Then the people gave up all claims for their heirs, too. Now, witness, in your experiments did you have such waivers signed by the subjects?
A: No. Our subjects, conscientious objectors, were given insurance against possible damage or injury.
Q: Insurance. Why did your subjects get this insurance, and why did the prisoners have to give up all claims? Why this distinction?
A: I do not know.
Q: Witness, on the basis of your great experience, don't you have any idea why there was this distinction? You are an expert in all those fields.
A: Well, I presume that it was out of a sympathy for the conscientious objectors. The soldiers in the Army were insured by the Government, and I thought — I should believe that might have been thought to be a good idea to insure the conscientious objectors for the same reason that they were taking experiments that had a small amount of hazard in them.
Q: Was this sympathy not felt in the case of the prisoners who volunteered for experiments on behalf of the general public?
MR. HARDY: May it please the Tribunal. Dr. Sauter discussed this point for better than an hour yesterday. I think he has covered the subject enough so that we can proceed to another point.
BY DR. SAUTER:
Q: Doctor, you can answer this question very briefly. Was this sympathy not felt with the prisoners, too, who volunteered for experiments in the interest of the general public? Something could have happened to them, too, and they could have poor heirs, too. Why did no one think of them?
A: I had nothing to do with that or determining the conditions. Thus, I can't answer the question "yes" or "no".
Q: My final question, Professor. From the point of view of medical ethics do you believe whether in America or in any other civilized nation that it is in accord with medical ethics to cary out experiments with a certain degree of danger on prisoners who are first asked to sign a waiver giving up all claims, even for their heirs?
In you opinion, can that be reconciled with medical ethics?
A: Yes, I believe it can be reconciled with the basic medical ethics.
DR. SAUTER: Then I have no further questions. Thank you very much, and thank you in the name of Dr. Ruff that you gave him an opportunity to ask specialized medical questions from the expert witness.
MR. HARDY: Your Honor, I request that if Dr. Ivy wishes to finish his answer, he may be allowed to do so.
THE PRESIDENT: Yes, if the witness did not complete his answer, he may complete it.
THE WITNESS: I said enough.
THE PRESIDENT: The Tribunal will be in recess for a few minutes.
(A recess was taken.)