a. Introduction
The defendants, Karl Brandt, Handloser, Rostock, Schroeder, Genzken, Gebhardt, Blome, Rudolf Brandt, Mrugowsky, Poppendick, Becker-Freyseng, Oberheuser, and Fischer were charged with special responsibility for and participation in criminal conduct involving sulfanilamide experiments (par. 6 (E) of the indictment). During the trial the prosecution withdrew this charge in the cases of Schroeder, Blome, and Becker-Freyseng. On this charge the defendants Karl Brandt, Handloser, Gebhardt, Mrugowsky, Oberheuser, and Fischer were convicted and the defendants Rostock, Genzken, and Poppendick were acquitted. Regarding the defendant Rudolf Brandt, the judgment makes no reference to this charge.
The prosecution’s summation of the evidence on the sulfanilamide experiments is contained in its final brief against the defendant Gebhardt. An extract from that brief is set forth below on pages 355 to 364. A corresponding summation of the evidence by the defense on these experiments has been selected from the closing brief for the defendant Gebhardt. It appears below on pages 364 to 370. This argumentation is followed by selections from the evidence on pages 371 to 391.
b. Selection from the Argumentation of the Prosecution
EXTRACT FROM THE CLOSING BRIEF AGAINST
DEFENDANT GEBHARDT
A. SULFANILAMIDE EXPERIMENTS
Experiments to test the effectiveness of sulfanilamide on infections were conducted in the Ravensbrueck concentration camp from 20 July 1942 until August 1943. These experiments were performed by the defendants Gebhardt, Fischer, and Oberheuser. (NO-228, Pros. Ex. 206.)
Gebhardt personally requested Himmler’s permission to carry out the sulfanilamide experiments and their execution was his responsibility. (Tr. pp. 4024-5.) He himself carried out the initial operations. (Tr. p. 4032.)
The experimental subjects consisted of 15 male concentration camp inmates, who were used during the preliminary experiments in July 1942, and 60 Polish women who were experimented on in 5 groups of 12 subjects each.
The purpose of the experiments was stated in a preliminary report by Gebhardt dated 29 August 1942, in which he stated:
“By order of the Reich Leader SS, I started on 20 July 1942 at Ravensbrueck concentration camp for women on a series of clinical experiments with the aim of analyzing the sickness known as gas gangrene, which does not take a uniform course, and to test the efficacy of the known therapeutic medicaments.
“In addition, the simple infections of injuries which occur as symptoms in war surgery had also to be tested; and a new chemo-therapeutic treatment, apart from the known surgical measures, had to be tried out.” (NO-2734, Pros. Ex. 473.)
The sulfanilamide experiments, as substantially all of the experiments with which the case is concerned, were directly related to the German war effort. Allied propaganda about the “miracle drug” sulfanilamide was having considerable effect on the confidence of the German soldiers in their medical officers. Heavy casualties had been sustained from gas gangrene on the Russian front in the winter of 1941-42. The theoretical question to be answered by these experiments was whether the wounded should be treated surgically in the front line hospitals or should be treated by field medical officers with sulfanilamide and then sent down the long lines of communication to a base hospital for further treatment. (Tr. pp. 4010-14.)
The same report cited above states that the defendant Fischer was appointed by Gebhardt as his assistant; Dr. Blumenreuter, a subordinate of the defendant Genzken, made available the surgical instruments and medicines; the defendant Mrugowsky put his laboratory and co-workers at the disposal of Gebhardt; and Dr. Lolling, chief medical officer of all concentration camps, assigned Dr. Schiedlausky and the defendant Oberheuser as co-workers.
This preliminary report concerns itself with the early experiments on 15 male subjects to determine a mode of infection with gangrene. Gebhardt was assisted by the Hygiene Institute of the Waffen SS, which made available the bacteria and gave advice on the method of bringing about gangrene infection artificially. The experimental technique was described in the report as follows:
“The point was to implant the lymph cultures on the damaged muscle tissue, to isolate the latter from atmospheric and humoral oxygen supply, and to subject it to internal tissue pressure. The inoculation procedure was as follows: a longitudinal cut of 10 centimetres over the musculus peroneus longus; after incision into the fascia the muscle was tied up with forceps in an area the size of a five-Mark piece; an anaemic peripheral zone was created by injection of 3 cc. adrenalin and in the area of the damaged muscle the inoculation material (a gauze strip saturated with bacteria) was imbedded under the fascia, subcutaneous adipose tissue and skin sutured in layers.” (NO-2734, Pros. Ex. 473.)
In the first series of experiments the subjects were infected with staphylococci, streptococci, para oedema malignum, bacteria Fraenkel, and earth. The resulting infections were not considered serious enough, and a conference was held with the Hygiene Institute of the Waffen SS and the bacteria used in bringing about the infections were changed. Six additional male subjects were then infected, but again the results were not considered serious enough. After further consultation with the collaborators in the Hygiene Institute of the Waffen SS, the infectious material was changed by adding wood shavings. During the course of these experiments the subjects were treated with various types of sulfanilamides, including catoxyn and marfanil-prontalbin, the latter being strongly recommended by the Army Medical Inspectorate. Efforts continued to make the gangrene infection more serious, and the report concluded with the following paragraph:
“We are now investigating the problem as to why the gangrene in the present cases did not fully develop. Therefore, the injuring of the tissue and the exclusion of a muscle from the circulation of the blood were undertaken during a separate operating session, and the large-scale necrosis resulting therefrom, was to be inoculated with bacteria strain which had already had one human passage. For it is only when the really definite clinical picture of the gangrene has appeared that conclusions may be drawn on therapy with chemo-therapeutics in connection with surgical operations.” [Emphasis supplied.] (NO-2734, Pros. Ex. 473.)
This report was certified as a correct copy by the defendant Poppendick.
In his zealousness to protect his fellow defendants, Gebhardt testified that neither the Hygiene Institute of the Waffen SS nor the defendant Mrugowsky played any part in these experiments, and that the infectious material was sent to him by Grawitz. (Tr. p. 4179.) This is clearly contradicted by his own report cited above.
Following the conclusion of the preliminary experiments on the male prisoners, experiments were continued on female Polish inmates. The affidavit of the defendant Fischer states that three series of operations were performed, each involving 10 persons, one using the bacterial culture and fragments of wood, the second using bacterial culture and fragments of glass, and the third using culture plus glass and wood. (NO-228, Pros. Ex. 206.) These experiments were undertaken during the month of August 1942. While Fischer speaks of experimental groups of 10 persons each, the defendant Gebhardt testified that the groups were composed of 12 experimental subjects. (Tr. p. 4056.) On 3 September 1942, after 36 women had been experimented on, Reich Physician SS Grawitz visited Ravensbrueck and inspected the experimental subjects. He asked Gebhardt how many deaths had occurred, and when it was reported that there had been none, he stated that the experiments did not conform to battlefield conditions. (NO-228, Pros. Ex. 206; Tr. p. 4057.) In order to make the gangrene infections still more severe, a new series of experiments involving 24 Polish female inmates was carried out. In this series the circulation of blood through the muscles was interrupted in the area of infection by tying off the muscles on either end. This series of experiments resulted in very serious infections and a number of deaths occurred. (NO-228, Pros. Ex. 206.)
Gebhardt, Fischer, and Oberheuser all admit that three of the experimental subjects died as a result of the experiments. (NO-228, Pros. Ex. 206; Tr. pp. 4059, 5492.) Other evidence, however, proves that five died as a direct result of the experiments and six were executed by shooting at a later date. (Tr. pp. 1438, 1449, 797, 845, 863.)
Four of the Polish women who were subjected to these experiments testified before the Tribunal. Most of the women who were used as subjects had been active in a resistance movement. (Tr. pp. 787, 816, 840, 857.) Only healthy inmates were used. (Tr. pp. 786, 815, 836, 856, 860-1.) None of them volunteered for the experiments. (Tr. pp. 789, 819, 842, 844-5, 861.) On the contrary, they protested against the experiments both orally and in writing. (Tr. pp. 789, 794, 823-5.) They stated that they would have preferred death to continued experiments, since they were convinced that they were to die in any event. (Tr. pp. 795, 824, 863.) They testified that 74 Polish women, 1 German, and 1 Ukrainian woman were experimented upon. (Tr. pp. 1438, 796, 818, 862.) Since Gebhardt placed the total number of Polish female experimental subjects in the sulfanilamide experiments at 60, the additional 16 women mentioned by the witnesses may well have been subjects in the bone, muscle, and nerve regeneration experiments. (Tr. p. 1462.)
The witness Kusmierczuk was one of the subjects in the sulfanilamide experiments. She is a Polish national and arrived in the Ravensbrueck concentration camp in the fall of 1941. (Tr. p. 857.) She was operated on in October 1942 and a severe infection developed in her case. (Tr. p. 858.) She remained in the hospital from October 1942 until April 1943, but her wound was still not healed at the time she was discharged from the hospital. Her condition deteriorated and she was readmitted to the hospital on 1 September 1943. (Tr. p. 860.) She left the hospital the second time in February 1944, but her wound did not finally heal until June 1944. (Tr. p. 861.) She identified the defendants Gebhardt, Fischer, and Oberheuser as having participated in the experiment upon her. (Tr. p. 860.) Kusmierczuk suffered permanent injuries as a result of this experiment, and her condition was described by the expert witness Dr. Leo Alexander. (Tr. pp. 864-9.) The post-operational care of this woman was not handled by Gebhardt and Fischer, but by the camp doctors. On the occasion of her second admission to the hospital in September 1943, Kusmierczuk was operated on by Dr. Treite in an effort to cure the deep-seated infection. (Tr. p. 861.) [See photographs, pp. [898] to [908].]
The expert witness Maczka, who worked as an X-ray technician in the Ravensbrueck concentration camp during the course of the experiments, testified concerning deaths of the five Polish experimental subjects resulting from the sulfanilamide experiments. Weronica Kraska developed typical tetanus symptoms a few days after the experimental operation was performed on her. After a brief illness she died under cramps caused by tetanus. (Tr. p. 1438.) Kazimiera Kurowska was artificially infected with gangrene bacillus. She was a healthy Polish girl of 23 years. From day to day her leg became blacker and more swollen. She was given care for only the first few days. After that she was taken to Room 4 in the hospital where she lay for days in unbelievable pain and finally died. Maczka was able to observe this case personally and in her opinion immediate amputation would have saved her life. (Tr. pp. 1439-40.) It is quite clear that if a German soldier’s life had been endangered by gangrene infection, an amputation would have been undertaken immediately. In this experiment, where the very effort was to develop a serious gangrene infection and to test the effects of sulfanilamide preparations, it is equally clear why the leg of Kurowska was not amputated. Aniela Lefanowicz was infected with oedema malignum. Her leg kept swelling more and more, the blood vessels eroded, and she died from bleeding. Maczka testified that the blood vessels should have been tied off and an amputation carried out in order to save her life. She was completely neglected after the first 2 or 3 days. (Tr. pp. 1440-1.) Zofia Kiecol died under similar circumstances. (Tr. p. 1441.)
Alfreda Prus was infected with oedema malignum the same day as the witnesses Kusmierczuk, Kiecol, and Lefanowicz. She was a beautiful, young 21-year-old girl, and a university student. She proved to be stronger than Kiecol and Lefanowicz and for that reason she lived a few days longer. She suffered terrible pain and finally died of hemorrhage. (Tr. pp. 1142-3.) Kusmierczuk was the only subject to survive that series of experiments. (Tr. p. 1443.)
It is hardly necessary to point out that all of the experimental subjects suffered severe pain and torture. (Tr. pp. 790-1, 802, 820, 842, 859; NO-876, Pros. Ex. 225; NO-871, Pros. Ex. 227; NO-877, Pros. Ex. 228.) The Tribunal was able to observe for itself the mutilations to which the Polish witnesses were subjected, and pictures of their scars were introduced to form a permanent part of the record. (NO-1079a, b, and c, Pros. Ex. 209; NO-1081a, and b, Pros. Ex. 211; NO-1082a, b, and c, Pros. Ex. 214; NO-1080a-g, Pros. Ex. 219.)
The post-operational care of the experimental subjects was entirely inadequate. (NO-873, Pros. Ex. 226.) Many of the subjects were given neither medicine nor morphine by order of defendant Oberheuser. (NO-877, Pros. Ex. 228.) They were given bandages from time to time when the doctors felt like it. Sometimes they waited 3 days, sometimes 4 days. There was a terrible odor of pus in the rooms. The girls were forced to help each other. (Tr. p. 1444.) Post-operational care, such as it was, was administered by the camp doctors. The witness Broel-Plater testified that:
“My leg pained me; I felt severe pain, and blood flowed from my leg. At night we were all alone without any care. I heard only the screaming of my fellow prisoners, and I heard also that they asked for water. There was nobody to give us any water or bed pans.” (Tr. p. 790.)
The witness Karolewska testified that:
“I was in my room and I made the remark to fellow prisoners that we had been operated on under very bad conditions and were left here in this room, and that we were not given even the possibility to recover. This remark must have been heard by a German nurse who was sitting in the corridor because the door of our room leading to the corridor was open. The German nurse entered the room and told us to get up and dress. We answered that we could not follow her order because we had great pains in our legs and could not walk. Then the German nurse came into our room with Dr. Oberheuser. Dr. Oberheuser told us to dress and go to the dressing room. We put on our dresses; and, being unable to walk, we had to hop on one leg going to the operating room. After one hop we had to rest. Dr. Oberheuser did not allow anybody to help us. When we arrived at the operating room quite exhausted, Dr. Oberheuser appeared and told us to go back because a change of dressing would not take place that day. I could not walk, but somebody, a prisoner whose name I do not remember, helped me to get back to the room.” (Tr. p. 822.)
At least five human lives were sacrificed in the sulfanilamide experiments, while an additional six were shot after having survived the operations. All the surviving victims suffered terrible pains and were crippled for life. Nevertheless, the experiments were not even scientifically successful. The results, as reported by Gebhardt and Fischer at the Third Conference of the Consulting Physicians of the Wehrmacht at the Military Medical Academy in Berlin in May 1943, were not adopted, and medical directives were issued which required the continued use of sulfanilamide. (Gebhardt, Fischer, Oberheuser 3, Gebhardt, Fischer, Oberheuser Ex. 10.) The sulfanilamide experiments were entirely unnecessary, since similar results could have been achieved by the treatment of wound infections of German soldiers normally contracted during the course of the war. (Tr. pp. 3334, 3338.)
Gebhardt does not seriously contend that the experimental subjects were volunteers. He admitted that he did not know whether the women consented. He testified he was not interested in that. He left it to the “legal authorities.” He did not discuss this matter with Himmler. (Tr. p. 4214.) By legal authorities, Gebhardt meant Himmler who, as he said, “had the power to execute thousands of people by a stroke of his pen.” (Tr. p. 4025.) Gebhardt, however, showed no interest whatever in the moral or legal character of that power. At one point in his testimony, he stated that the subjects were nonvolunteers forced to submit to the experiments by the State. (Tr. p. 4064.) At still another point, they were “more or less volunteers, condemned persons.” (Tr. p. 4021.)
Gebhardt’s defense, if it can be dignified with that word, is rather that the Polish women had been condemned to death for participation in a resistance movement and that by undergoing the experiments, voluntarily or otherwise, they were to have their death sentences commuted to some lesser degree of punishment whereby they would at least not be executed. This was no bargain reached with the experimental subjects; their wishes were not consulted in the matter. It was, according to Gebhardt, left to the good faith of someone unnamed to see to it the death sentence was not carried out on the survivors of the experiments. Certainly Gebhardt assumed no responsibility, or even interest, in this matter.
The prosecution points out, in connection with this alleged defense, that the proof shows that the experimental subjects who testified before this Tribunal were never so much as accorded a trial; they had no opportunity to defend themselves against whatever crimes they were said to have committed. They were simply arrested and interrogated by the Gestapo in Poland and sent to a concentration camp. They had never so much as been informed that they had been marked for, not sentenced to, death. (Tr. p. 831.) Article 30 of the Regulations Respecting the Laws and Customs of War on Land annexed to the Hague Convention expressly provides that even a spy “shall not be punished without previous trial.” The alleged defense of Gebhardt is accordingly without merit.
Gebhardt would have the Tribunal believe that but for the experiments all these Polish girls would be dead; that he preserved the evidence now being used against him. Nothing could be further from the truth. There is no proof in the record that these women would have been executed if they had not undergone the experiments. The witness Maczka is living proof of the contrary. She was arrested for resistance activities on 11 September 1941, and shipped to Ravensbrueck on 13 September. (Tr. p. 1433.) She was not an experimental subject yet she lives today. Substantially all the Polish experimental subjects arrived in Ravensbrueck in September 1941. (Tr. pp. 788, 817, 840.) These girls had not been executed by August 1942 when the experiments began. Indeed, it was a surprise to Gebhardt, according to his testimony, that they were used at all since during July 1942 the experiments were conducted on men. There were some 700 Polish girls in that transport. (NO-877, Pros. Ex. 228; Tr. p. 4216.) There is no evidence that a substantial number were ever executed even though most of them were not experimented on.
No, the proof has shown beyond controversy that these Polish women could not have been legally executed. The right to grant pardons in cases of death sentences was exclusively vested in Hitler by a decree of 1 February 1935, Reich Law Gazette [RGBl], I, page 74. (NO-3070, Pros. Ex. 531.) On 2 May 1935, Hitler delegated the right to make negative decisions on pardon applications to the Reich Minister of Justice. (NO-3071, Pros. Ex. 532.) On 30 January 1940 (RGBl, I, p. 399), Hitler delegated to the Governor General for the occupied Polish territories the authority to grant pardons and to make denying decisions in pardon matters for the occupied Polish territories. (NO-3072, Pros. Ex. 533.) By edict, dated 8 March 1940, VOB1 GGP I p. 99, the Governor General of occupied Poland ordered with reference to the execution of the right to pardon in the case of death sentences that:
“The execution of a death sentence pronounced by a regular court, a special court or a police court martial shall take place only when my decision has been issued not to make use of my right to pardon.” [Emphasis supplied.] (NO-3073, Pros. Ex. 534.)
Assuming arguendo that the experimental subjects had all committed substantial crimes, that they were all properly tried by a duly constituted court of law, that they were legally sentenced to death, it is still clear from the decrees set forth above that these women could not have been legally executed until such time as the Governor General of occupied Poland had decided in each case not to make use of his pardon right. There has been no proof that the Governor General had ever acted with respect to pardoning the Polish women used in the experiments, or, for that matter, any substantial number of those not used in the experiments.
The only reason these 700 Polish women were transported from Warsaw and Lublin to Ravensbrueck was because the Governor General had not approved their execution. Otherwise they would have been immediately executed in Poland. At the very least, these women were entitled to remain unmolested so long as the Governor General took no action. He may never have acted or, when he did, he may have acted favorably on the pardon.
The affidavit of Schiedlausky, the camp doctor at Ravensbrueck, shows that the Governor General had not turned down a pardon when the experiments started. He said on page four of the original:
“Polish women who had been sentenced to death by court martial and who were awaiting execution, after their sentences had been approved by the Governor General, were chosen as subjects.” (NO-508, Pros. Ex. 224.)
At still a later point, on page 15 of the original, he said:
“During my tour of duty at Ravensbrueck, I estimate that about 25 women were executed by shooting. They were exclusively Polish women, who were already prisoners, whose sentences were only approved after a long time by the Governor General.” [Emphasis added.]
Schiedlausky was in Ravensbrueck from December 1941 until the middle of August 1943. During that long period of time only 25 of over 700 Polish inmates were made eligible for execution by action of the Governor General. Who is to say that the majority of these 700 Polish women did not live through the war even though they did not undergo the experiments? Certainly it was incumbent on the defense to prove the contrary by a preponderance of the evidence. This it did not do by any evidence.
The defendants Gebhardt, Fischer, and Oberheuser cannot claim that they believed in good faith that the Polish women could have been legally executed. Even the camp doctor Schiedlausky knew that the Governor General had to approve the execution. Moreover, the large number of 700 women being sentenced to death at this early stage of the war was enough to put any reasonable person on notice that something was wrong.
Additionally, the uncontradicted evidence proves that survival of the experiments was no guarantee whatever of avoiding execution in any event. At least six of the experimental subjects were executed after having survived the experiments. (Tr. pp. 1449, 797, 845, 863.) The names of the Polish girls who were shot were Pajaczkowska, Gans, Zielonka, Rakowska, Sobolewska, and Gutek. (NO-873, Pros. Ex. 226; NO-861, Pros. Ex. 232.) It was not a question of experimentation or execution but experimentation and execution.
Indeed, in February 1945, an effort was made to execute all the experimental subjects. They were ordered to report to one block and remain there. They were informed that they would be transferred to the Gross-Rosen concentration camp, but it was common knowledge that Gross-Rosen was already in the hands of the Allies. They, therefore, knew that they were going to be executed and so took different identification numbers and hid themselves. This was possible because of disorganization in the camp. (Tr. pp. 1450-1, 862-3; NO-876, Pros. Ex. 225; NO-877, Pros. Ex. 228.)
If one takes the case of the defense at its face value, the Tribunal is in effect asked to rule that it is legal for military doctors of a nation at war to experiment on political prisoners of an occupied country who are condemned to death, to experiment on them in such a way that they may suffer death, excruciating pain, mutilation, and permanent disability—all this without their consent and in direct aid of the military potential of their enemy. There is no valid reason for limiting such a decision to civilian prisoners; the experiment would certainly have been no worse had it been performed on Polish or American prisoners of war. It is impossible to consider seriously the ruling being sought for by the defense.
c. Selection from the Argumentation of the Defense
EXTRACT FROM THE CLOSING BRIEF FOR
DEFENDANT GEBHARDT
The Sulfanilamide Experiments
Of all medical experiments forming the subjects of the indictment, the experiments for testing sulfanilamides were undoubtedly the most directly connected with the war. The problem of wound infection is one with which every nation at war must concern itself especially in modern warfare. This problem is not only one of great importance to the life and health of the individual wounded soldier, but it may have a decisive effect on the strategical position and on the outcome of the war itself through the resultant gaps in the ranks. Already the First World War showed that the majority of soldiers do not die on the battlefield itself and that in most cases death is not the direct result of a wound, but that the heavy losses must be attributed to infection of wounds received. These experiences have been confirmed in the Second World War and the special conditions prevailing in Russia and the climatic conditions due to the winter there have shown even more than in the First World War that wound infection was a medical and tactical problem of the highest importance for the troops and their health. As regards details, I refer to statements made in this connection on the witness stand by several defendants in these proceedings.
Consequently, it could not come as a surprise that in this war, too, efforts were made to deal with wound infection not only by using surgical measures, but that a way was sought to prevent the formation and spreading of bacterial infections or at least to confine them within reasonable limits by using chemical preparations.
Such efforts seemed the more called for as the war in the East not only meant an immense strain on the resources in material and personnel in general, but also in view of the fact that especially the supply of the army troops and the Waffen SS with medical officers and, above all, with trained field surgeons became more and more difficult. Had it been possible to assist the field medical officers at the front and at the main dressing stations with a reliable and effective chemo-therapeutic preparation against bacterial wound infection, progress of vast importance would have been achieved.
On the other hand, however, it was impossible to overlook the fact that the introduction of a chemo-therapeutic preparation which did not operate safely involved a certain amount of danger to an effective medical care of the wounded and consequently to the war potential of the wounded and consequently to the war potential of the German Wehrmacht and its striking power. In his lecture on the chemo-therapy of wound infection as delivered before the First Conference East of the Consulting Specialists on 18 May 1943, which I submitted as part of the report dealing with this conference, (Gebhardt, Fischer, Oberheuser 1, Gebhardt, Fischer, Oberheuser Ex. 6.) Professor Dr. Rostock referred to the great danger of chemo-therapy, i. e., the possibility “of making negligent physicians careless in the surgical aspect of wound dressing, since they may place a certain trust in chemo-therapy.”
This warning was all the more in order since, at that time there was not only complete uncertainty as regards the effects of sulfanilamides, but also because there was a divergence in opinions as to the efficacy of this preparation. It has been clearly shown by the evidence that, in spite of close observation of the effects of sulfanilamides in peace time and in war, it was impossible to answer this question. Opinions were very much divided. While some were convinced of the efficacy of these preparations in connection with wound infections, and ascribed extraordinarily good results to them, others were of the opinion that these chemical preparations could at the best be used as a supplement and that if used by themselves, they did not have the properties to prevent bacterial infection resulting from combat wounds. With regard to the details I refer to the statements of the defendants Karl Brandt, Handloser, Rostock, Gebhardt, and Fischer and to Gebhardt Exhibits 6, 7, and 10 as submitted by me during the hearing of the evidence.
In this respect, it is highly interesting to review the scientific discussions of the consulting specialists as contained in the report on the First Conference East on 18 and 19 May 1942. (Gebhardt, Fischer, Oberheuser 1, Gebhardt, Fischer, Oberheuser Ex. 6.) These discussions which took place prior to the sulfanilamide experiments comprising the subject of the indictment give a true picture of the situation as it was at that time with regard to the efficacy of sulfanilamides.
In this respect we are able to distinguish three sharply defined groups. In the group which rejected the chemo-therapeutic treatment of wound infection, Geheimrat Professor Sauerbruch was the leader. He emphatically voiced the opinion that these chemical preparations tend to obscure surgical work and to lead to perfunctory treatment. He requested that the preparations should be critically tested, that is to say, the test should be made by surgeons experienced in general surgery.
In the other camp there were surgeons who claimed to have obtained extraordinarily favorable results in the chemo-therapeutical treatment of bacterially infected wounds. Among them was Dr. Krueger, the Berlin professor of surgery, who claimed to have observed a favorable effect of sulfanilamide in as many as 5,000 cases.
To the third group belonged the surgeons, bacteriologists, and pathologists who took the view that nothing definite could be said as yet as to the effects and the efficacy of sulfanilamides as agents in the fight against bacterially infected wounds and that further tests along these lines would have to be made.
Thus it can be said that after the experiences of the Russian winter campaign of 1941-1942, the fight against bacterial wound infections, and the question of the efficacy of the sulfanilamides had become a military-medical and medical-tactical problem of the first importance, about which opinions differed widely. A solution of this problem was the more urgent as an answer had to be found quickly, and on the other hand the fact was not to be disregarded that the experiences gained during nearly 10 years of peace and war in clinics as well as in laboratories were insufficient to answer this question.
The Order for the Execution of these Experiments
The evidence has shown that the order to ascertain the effectiveness of the sulfanilamides by experiments on human beings was given directly by the Head of State and Supreme Commander of the Wehrmacht. Hitler’s order was not at first submitted by Himmler to the defendant Gebhardt, but to Dr. Grawitz, Reich Physician of the SS and police.
However, the evidence showed further that another circumstance arose which from the point of view of time at least caused the order for these experiments to be given, viz, the death of the Chief of the Reich Security Main Office, General of the Waffen SS Reinhardt Heydrich, who in May 1942 was assassinated in Prague. For the details I refer to the testimony of Gebhardt in the witness box on this matter. Heydrich’s death is connected with the experiments themselves only insofar as, at that time, the charge was leveled that Heydrich’s life could have been saved if sulfanilamides, and especially a certain sulfanilamide preparation, had been administered to the wounded man in sufficient quantities. The whole problem of sulfanilamide therapy came to the fore once more in this one case, and then in such an obvious manner that the Head of State himself gave the order to clarify by way of all-out experiments the question which for a long time had been of general importance for the fighting troops at the front.
Within the scope of this evaluation of evidence, it is irrelevant to enter into the details which resulted in the experiments being carried out by the defendant Gebhardt himself. Against the strict order of the Reich Physician SS Grawitz, Gebhardt carried out the experiments not by deliberately inflicting bullet wounds but by causing an infection while observing all possible precautionary measures.
It was further shown by the evidence that the experiments were started with 15 habitual criminals who had been sentenced to death and who had been transferred from the concentration camp Sachsenhausen to Ravensbrueck. In view of the fact that this part of the experiment is not a subject of the indictment, it seems to be unnecessary to enter into this matter. It should, however, be kept in mind that at the conference on 1 June 1942, at which the conditions for the experiments were determined in detail—the defendant Gebhardt has described this conference in detail and I am referring to this—it was understood that the experiments should be carried out with the male habitual criminals who had been sentenced to death and who were to be pardoned in case of survival.
The Experimental Arrangements for the Sulfanilamide Experiments
It was shown by the evidence that the experiments for testing the effectiveness of the sulfanilamides were carried out in three groups. The first group included 15 men (habitual criminals). This group has nothing to do with the charges of the indictment and it is therefore superfluous to enter into this matter more closely.
The second group included 36 female prisoners who had been members of the Polish Resistance Movement and who, for this reason, had been sentenced to death by the German court martial in the General Government. This second group was divided into 3 subgroups of 12 experimental persons each. As to the particulars of the provisions for the experiments, I refer to the testimony of the defendants Gebhardt and Fischer in the witness box. Contrary to the first group, contact substances were used in this second group to accelerate the process of infection. The contact substances were inserted into the open wound together with the germs. Sterile and pulverized glass and sterile wood particles were used as contact substances. These contact substances took the place of earth and uniform particles and were to produce war-like conditions for the wounds, without, however, producing at the same time the general dangers created by infection of the wound by earth and parts of clothing.
As in the case of the first group, staphylococci, streptococci, and gas gangrene bacilli were used as agents. But the contention of the indictment that tetanus germs were also used is incorrect. On the contrary, the evidence has proved that the treatment of tetanus did not come within the scope of these experiments. There was all the less reason for this as it was realized long ago by German military surgery that the sulfanilamide preparations are not suitable for the effective prevention of traumatic tetanus. Here I refer to the directives for the chemo-therapeutical treatment of wound infection which were issued at the First Working Conference East of the Consulting Specialists in May 1943 (Gebhardt, Fischer, Oberheuser 1, Gebhardt, Fischer, Oberheuser Ex. 6)—that is prior to the performance of the sulfanilamide experiments charged in the indictment. In these directives it is expressly pointed out that the outbreak of traumatic tetanus cannot be prevented by means of the sulfanilamides and that tetanus anti-toxin has to be administered as usual.
During the presentation of evidence, only the witness Dr. Maczka maintained that tetanus was actually used in one individual case. This witness did not make her own observations of the case but drew conclusions based exclusively on the pathological picture presented by one of the experimental subjects according to her statements. In view of the fact that even according to the testimony of this witness tetanus bacilli were employed only in one individual case, the assertion of this witness can hardly be taken as a true representation of the facts, for if it had really been the intention of the defendant Gebhardt to determine the effect of sulfanilamides on tetanus too, one experimental subject would certainly not have been sufficient, and more experiments would have been necessary before a final decision regarding this question could possibly have been made.
The third group consisted of 24 experimental subjects who were not treated with any sort of contagion—unlike the procedure applied to the second group—but only had part of the muscle ligatured. The defendants Gebhardt and Fischer have given detailed evidence regarding these new experimental arrangements, how they originated, what considerations had to be regarded, and what part was played by SS Reich Physician Dr. Grawitz. With regard to these details I refer to the testimony of the defendants in the witness box.
The experimental subjects were treated with sulfanilamides as described by the defendants in the witness box. A few persons were not treated with sulfanilamides but were used as control subjects. But that did not mean that these persons were not treated at all. As the evidence has proved, all experimental subjects were treated, namely by surgical measures if the sulfanilamides did not prove effective against the inflammation. For this reason too the experimental subjects to whom sulfanilamides were applied, and where the inflammation did not pass away by itself, were given direct surgical treatment under observance of the generally recognized principles of surgery, particularly as developed in Germany by Gebhardt’s teacher Professor Dr. Lexer. This direct surgical treatment resulted in the scars which the court has seen on the experimental subjects questioned as witnesses. As explained by Professor Dr. Alexander, the expert produced by the prosecution, these scars are the result not of the bacteriological infection but of the operations performed in order to eliminate this infection. In the prosecution case, four experimental subjects were called to give evidence. In addition, the prosecution submitted a series of affidavits given by other persons used as experimental subjects. The statements of the four witnesses questioned in court coincide largely with the testimony given by the defendants Gebhardt, Oberheuser, and Fischer themselves in the witness box. For this reason alone it appears expedient and sufficient for the pronouncement of a just sentence and for the establishment of the true facts to base the sentence exclusively on the testimony of these four witnesses together with the statements of the defendants themselves. This is not only in accordance with the principle of direct and oral proceedings in court prevailing in any modern criminal procedure and which should not be departed from without urgent reason, but also such handling of the case seems suitable because the statements of the four witnesses are identical essentially so that they themselves, together with the statements given by the defendants, can be regarded as a safe basis for a finding—apart from one point which I shall go into later. In addition, the affidavits submitted by the prosecution not only differ in essential points from the statements made by the witnesses in court, but are inconsistent and contradictory in themselves as well. This is shown, above all, by the fact that in several of these affidavits contentions are quite obviously made which are not based on personal and factual observation, but have become known to these witnesses by hearsay. The affidavits, moreover, fail to represent the circumstances in clear chronological order, which makes the whole matter all the more doubtful, as it was proved by the evidence that in the Ravensbrueck camp experiments were obviously also performed by other physicians with whom the defendant in this case had no connection.
Considerable doubts also exist regarding the statements made by the witness Dr. Maczka. The prosecution has submitted two affidavits given by this witness as part of its evidence. When questioned in court, this witness could not maintain the most incriminating contentions which appeared in the two affidavits. Under these circumstances, the court has to consider whether it regards the statements of this witness as sufficiently reliable to enter into the judgment. I would answer this question in the negative, not only because she had to revoke the most essential points of her previous affidavits, but because a large part of her testimony was based not on her own observations, but either on information obtained from other prisoners or on conclusions drawn by her.
d. Evidence
| Prosecution Documents | |||
| Doc. No. | Pros. Ex. No. | Description of Document | Page |
| NO-228 | 206 | Affidavit of defendant Fischer, 19 November 1946, concerning sulfanilamide experiments conducted in the concentration camp Ravensbrueck. | [371] |
| NO-472 | 234 | Affidavit of the defendant Fischer, 21 October 1946, supplementing his affidavit concerning sulfanilamide experiments. | [376] |
| NO-1080 A, E, F | 219 A, E, F | Exposures of the witness Maria Kusmierczuk who underwent sulfanilamide and bone experiments while an inmate of the Ravensbrueck concentration camp. (See Selections from Photographic Evidence of the Prosecution.) | [901] |
| NO-1082 A, C | 214 A, C | Exposures of the witness Jadwiga Dzido who underwent sulfanilamide and bone experiments while an inmate of the Ravensbrueck concentration camp. (See Selections from Photographic Evidence of the Prosecution.) | [903] |
| Defense Documents | |||
| Doc. No. | Def. Ex. No. | Description of Document | |
| Gebhardt, Fischer, Oberheuser 21 | Gebhardt, Fischer, Oberheuser Ex. 20 | Extract from affidavit of Dr. Karl Friedrich Brunner, 14 March 1947. | [377] |
| Gebhardt, Fischer, Oberheuser 1 | Gebhardt, Fischer, Oberheuser Ex. 6 | Extract from report on the First Conference East of Consulting Specialists on 18 and 19 May 1942 at the Military Medical Academy, Berlin. | [377] |
| Gebhardt, Fischer, Oberheuser 3 | Gebhardt, Fischer, Oberheuser Ex. 10 | Extracts from report on the Third Conference East of Consulting Specialists on 24 to 26 May 1943 at the Military Medical Academy, Berlin. | [378] |
| Testimony | |||
| Extracts from the testimony of prosecution witness Jadwiga Dzido | [381] | ||
| Extracts from the testimony of the prosecution expert witness Dr. Leo Alexander | [386] | ||
| Extracts from the testimony of defendant Gebhardt | [388] | ||
PARTIAL TRANSLATION OF DOCUMENT NO-228
PROSECUTION EXHIBIT 206
AFFIDAVIT OF DEFENDANT FISCHER, 19 NOVEMBER 1946, CONCERNING SULFANILAMIDE EXPERIMENTS CONDUCTED IN THE CONCENTRATION CAMP RAVENSBRUECK
AFFIDAVIT
I, Fritz Ernst Fischer, having been duly sworn, depose and state under oath:
I am a doctor of medicine, having been graduated from the University of Hamburg. I passed my state examination in 1936. On 13 November 1939 I was inducted into the Waffen SS and after having served with a combat division as medical officer, I was hospitalized and then assigned to the SS hospital at Hohenlychen, as assistant surgeon.
In addition to my normal duties as surgeon at the SS hospital at Hohenlychen, I was ordered by Professor Gebhardt to begin medical experiments in my capacity as assistant surgeon to Professor Gebhardt on or about 12 July 1942. The purpose of the proposed experiments was to determine the effectiveness of sulfanilamide, which I was informed at that time was a matter of considerable importance to military medical circles.
According to the information which I received from Professor Gebhardt, these experiments were directed initially by the Reich Leader SS and the Reich Physician Dr. Grawitz.
Professor Gebhardt instructed me, before the operations were undertaken, on the techniques to be followed and the procedure to be employed. The persons who were to be the subjects of these experiments were inmates of the concentration camp at Ravensbrueck who had been condemned to death.
The administrative procedure which was followed in obtaining the subjects for the experiments was established by Professor Gebhardt with the camp commandant at Ravensbrueck. After the initial arrangements had been made, it was the general practice to inform the medical officer at Ravensbrueck as to the date on which a series of experiments was to be begun and the number of patients who would be required, and then he took the matter up with the commandant of the camp, by whom the selections of subjects were made. Before an operation was undertaken, the persons who had been selected in accordance with this procedure were given a medical examination by the camp physician to determine their suitability for the experiments from a medical standpoint.
The first of the series of experiments involved five persons. The gangrenous bacterial cultures for use in the experiments were obtained from the Hygiene Institute of the Waffen SS. The procedure followed in the operations was as follows: The subject received the conventional anesthetic of morphine-atropine, then evipan ether. An incision was made 5 to 8 centimeters in length and 1 to 1½ centimeters in depth, on the outside of the lower leg in the area of the peronaeus longus.
The bacterial cultures were put in dextrose, and the resulting mixture was spread into the wound. The wound was then closed and the limb encased in a cast, which had been prepared, which was lined on the inside with cotton so that in the event of swelling of the affected member the result of the experiment would not be influenced by any factor other than the infection itself.
The bacterial cultures used on each of the five persons varied both as to the type of bacteria used and the amount of culture used.
After the initial operations had been performed, I returned to Ravensbrueck each afternoon to observe the progress of the persons who had been operated on. No serious illnesses resulted from these initial operations. I reported the progress of the patients to Professor Gebhardt each night.
When the five persons first operated on were cured, another series of five was begun. The surgical procedure and the post-operative procedure was the same as in the initial experiments, but the bacterial cultures were more virulent. The results from this series were substantially the same as in the first and no serious illnesses resulted.
Since no inflammation resulted from the bacterial cultures used in the first two series of operations, it was determined, as a result of correspondence with Dr. Mrugowsky, the Chief of the Hygiene Institute of the Waffen SS, and conversations with his assistant, to change the type of bacterial culture in the subsequent operations. Using the new culture, two more series of operations were performed, each involving five persons.
The difference between the third and fourth series was in the bacterial cultures used. The Hygiene Institute of the Waffen SS prepared them from separate combinations of the three or four gangrene cultures which were available. In the third and fourth series, more pronounced infection and inflammation were discernible at the place of incision. Their characteristics were similar to a normal, local infection, with redness, swelling, and pain. The circumference of the infection was comparable in size to a chestnut. Upon the completion of the fourth series, the camp physician informed me that the camp commandant had instructed him that male patients would no longer be available for further experiments, but that it would be necessary to use female inmates.
Accordingly, five women were prepared for the operation, but I did not operate on them. I reported the change of situation to Professor Gebhardt and suggested that in view of these circumstances, it would be desirable to stop the experiments. He did not adopt this suggestion, however, and pointed out that it was necessary for me as an officer to carry out the duties which had been assigned to me.
The experiments, however, were interrupted for a period of 2 weeks, during which Professor Gebhardt told me he had discussed the matter in Berlin and had been instructed to carry on the experiments, using Polish female prisoners who had been sentenced to death. In addition, he instructed me to speed up the experiments since the Reich Physician, Dr. Grawitz, intended to go to Ravensbrueck soon to test the results of the experiments. Accordingly, I went to Ravensbrueck and operated on the female prisoners.
Since the infections which resulted from the first four series of experiments were not typical of gangrenous battlefield infections, we communicated with the Hygiene Institute of the Waffen SS to determine what steps could be taken more nearly to simulate infections caused by battle. As a result of this correspondence and a conference at Hohenlychen presided over by Professor Gebhardt, it was decided to add tiny fragments of wood shavings to the bacterial cultures, which would simulate the crust of dirt customarily found in battlefield wounds.
As a result of this conference, three series of operations were performed, each involving 10 persons, one using the bacterial culture and fragments of wood, the second using bacterial culture and fragments of glass, and the third using the culture plus glass and wood.
About two weeks after these new series were begun, Dr. Grawitz visited Ravensbrueck. Professor Gebhardt introduced him to me and explained to him the general nature of the work. Professor Gebhardt then left, and I explained to Dr. Grawitz the details of the operations and their results. Dr. Grawitz, before I could complete my report on the procedures used and the results obtained, brusquely interrupted me and observed that the conditions under which the experiments were performed did not sufficiently resemble conditions prevailing at the front. He asked me literally, “How many deaths have there been?” and when I reported that there had not been any, he stated that that confirmed his assumption that the experiments had not been carried out in accordance with his directions.
He said that the operations were mere flea bites and that since the purpose of the work was to determine the effectiveness of sulfanilamide on bullet wounds it would be necessary to inflict actual bullet wounds on the patients. He ordered that the next series of experiments to be undertaken should be in accordance with these directions. That same evening, I discussed these orders of Dr. Grawitz with Professor Gebhardt and we both agreed that it was impossible to carry them out, but that a procedure would be adopted which would more nearly simulate battlefield conditions without actually shooting the patients.
The normal result of all bullet wounds was a shattering of tissue, which did not exist in the initial experiments. As a result of the injury, the normal flow of blood through the muscle is cut off. The muscle is nourished by the flow of blood from either end. When this circulation is interrupted, the affected area becomes a fertile field for the growth of bacteria; the normal reaction of the tissue against the bacteria is not possible without circulation.
This interruption of circulation usual in battle casualties could be simulated by tying off the blood vessels at either end of the muscle.
Two series of operations, each involving 10 persons, were begun following this procedure. In the first of these, the same bacterial cultures were used as were developed in the third and fourth series, but the glass and wood were omitted. In the other series, streptococci and staphylococci cultures were used. In the series using the gangrenous culture a severe infection in the area of the incision resulted within 24 hours.
Eight patients out of ten became sick from the gangrenous infection. Cases which showed symptoms of an unspecific or specific inflammation were operated on in accordance with the doctrine and manner of septic surgery. The Lexer doctrine formed the basis of the procedure. The technique is that an incision in the area of the gangrene is made, from healthy tissue to healthy tissue on either side. The wound and fascian corners were laid open, the gangrenous blisters swabbed, and a solution of H2O2 (hydrogen peroxide) was poured over them. The inflamed extremity was immobilized in a cast. With most patients it was possible to improve the gangrenous condition of the entire infected area in this manner.
In the series in which banal cultures of streptococci and staphylococci were used, the severe resultant infection with accompanying increase in temperature and swelling did not occur until 72 hours later. Four patients showed a more serious picture of the disease. In the case of these patients, the normal professional technique of orthodox medicine was followed as outlined above, and the inflamed swelling split. Due to the slight virulence of the bacteria it was possible in the case of all patients except one to prevent the threatened deadly development of the disease.
The incisions were made on the lower part of the leg only in all series to make an amputation possible. It was not made on the upper thigh because then no area for amputation would remain. However, in this series the inflammation was so rapid that there was no remedy and no amputations were made.
Since after the tying up of the circulation of the muscles, a very severe course of infection was to be expected, 5 grams of sulfanilamide were given intravenously in the amount of 1 gram each, beginning 1 hour after the operation. After the wound was laid open to expose all its corners, sulfanilamide was shaken into the entire area and the area was drained by thick rubber tubes.
The infection normally reached an acute stage over a period of 3 weeks, during which time I changed the bandages daily. After the period of 3 weeks the condition was normally that of a simple wound which was dressed by the camp physicians rather than by me.
The procedure prescribed for the post-operative treatment of the patients was to give them three times each day 1 cc. of morphine, and when the dressings were changed, to induce an esthesia by the use of evipan.
In all the series of experiments, except the first, sulfanilamide was used after the gangrenous infection appeared. In each series two persons were not given sulfanilamide as a control to determine its effectiveness. When sulfanilamide and the bacteria cultures together were introduced into the incision no inflammation resulted.
My behavior towards all patients was very considerate, and I was very careful in the operations to follow standard professional procedure.
In May 1943, on the occasion of the Fourth Conference of the Consulting Physicians of the Wehrmacht, a report was made by Professor Gebhardt and myself as to these operations. This medical congress was called by Professor Handloser, who occupied the position of Surgeon General of the Armed Forces, and was attended by a large number of physicians, both military and civilian.
In my lecture to the meeting I reported on the operations frankly, using charts which demonstrated the technique used, the amount of sulfanilamide administered, and the condition of the patients. This lecture was the focal point of the conference. Professor Gebhardt spoke about the fundamentals of the experiments, their performance and their results, and then asked me to describe the technique. He began his lecture with the following words: “I bear the full human, surgical, and political responsibility for these experiments.”
This lecture was followed by a discussion. No criticism was raised. I am convinced that all the physicians present would have acted in the same manner as I.
Subsequent to my repeated urgent requests, I went to the front as surgeon immediately after this conference. Only after I was wounded did I return as a patient to Hohenlychen. I never entered the Ravensbrueck camp again. I protested vigorously against these experiments on human beings, endeavored to prevent them, and to limit their extension after they had been ordered. In order not to be forced to participate in these experiments, I repeatedly volunteered for front-line service. Insofar as it was in my power, I tried to dissuade Doctor Koller and Doctor Reissmayer from performing these experiments. I declined habilitation at the University of Berlin because I felt that it might result in my being obliged to carry on additional experiments at Ravensbrueck. After I succeeded in scientific discoveries of the highest practical importance, that is, the solution of the cancer problem and its therapy, I did not communicate this fact to Professor Gebhardt and did not publish this work in order not to be ordered again to carry out experiments.
Fritz Ernst Fischer
TRANSLATION OF DOCUMENT NO-472
PROSECUTION EXHIBIT 234
AFFIDAVIT OF THE DEFENDANT FISCHER, 21 OCTOBER 1946, SUPPLEMENTING HIS AFFIDAVIT CONCERNING SULFANILAMIDE EXPERIMENTS
3. At the conference of May 1943, which I described on page 12 of my affidavit (last paragraph) the following officials were present to the best of my recollection: Dr. Paul Rostock as chairman of the conference; Dr. Siegfried Handloser, who was then the Chief of the Medical Service of the German Armed Forces, who had sent out the invitations to the meeting; Professor Karl Brandt, who sat in the center of the front row; Dr. Leonardo D. Conti, the Reich Health Leader; Professor Dr. Sauerbruch; Dr. Frey; and Professor Heubner. The Medical Service of the Luftwaffe was represented by Dr. Hippke, who was the Chief of the Medical Service of the Luftwaffe; and by Dr. Oskar Schroeder. The Medical Service of the Waffen SS was represented by its chief, Dr. Karl Genzken. Dr. Helmut Poppendick, who was the Chief of Staff of the Reich Physician SS and Police, and Dr. Grawitz were also present.
5. It was made perfectly clear during the speeches made by Dr. Gebhardt and myself that the experiments were conducted on inmates of a concentration camp.
6. Six months after this, the 10th anniversary of the hospital at Hohenlychen was celebrated. Dr. Karl Brandt, Dr. Siegfried Handloser, Dr. Leonardo D. Conti, and Professor Dr. Sauerbruch were invited to the celebrations.
7. When the sulfanilamide experiments started, I was told by Professor Gebhardt, my military and medical superior, that these experiments were being carried out by order of the Chief of the Medical Office of the Wehrmacht and the Chief of the State Medical Office, with the initial order from Hitler, and I must therefore carry out these orders.
8. Dr. Herta Oberheuser and Dr. Schiedlausky assisted me in the sulfanilamide experiments.
9. As a result of these experiments, three people died.
[Signed] Fritz Ernst Fischer
TRANSLATION OF GEBHARDT, FISCHER, OBERHEUSER
DOCUMENT 21
GEBHARDT, FISCHER, OBERHEUSER DEFENSE EXHIBIT 20
EXTRACT FROM AFFIDAVIT OF DR. KARL FRIEDRICH BRUNNER, 14 MARCH 1947
I only heard of the sulfanilamide experiments on human beings at Ravensbrueck after their conclusion through the public report made by Professor Gebhardt and Dr. Fischer before the Third Conference East of Consultant Specialists of 24 and 26 May 1943 at the Military Medical Academy, Berlin. I attended this conference as Stabsarzt in the army from a military reserve hospital in Berlin. Later on I read a report in the directives. Professor Dr. Gebhardt did not speak to us about this point subsequently. On the other hand, the existence of this sulfanilamide experiment was known and was not kept secret, although even foreigners were continuously to be found among the assistants, as, for instance, the Swiss surgeon, Dr. Meyer, during my time.
TRANSLATION OF GEBHARDT, FISCHER, OBERHEUSER
DOCUMENT 1
GEBHARDT, FISCHER, OBERHEUSER DEFENSE EXHIBIT 6
EXTRACT FROM REPORT ON THE FIRST CONFERENCE EAST OF CONSULTING SPECIALISTS ON 18 AND 19 MAY 1942 AT THE MILITARY MEDICAL ACADEMY, BERLIN
Directives for the chemo-therapy of wound infections
The treatment of war wounds with sulfanilamide preparations in order to combat wound infections seems to have prospects. In stock now in the medical stores are: prontalbin-marfanil powder, prontosil, neo-uleron-albucid, eubasinum, sulfapyridine-cibazol, and eleudron pills.
Traumatic tetanus cannot be prevented by these preparations; tetanus antitoxin must therefore be given as usual.
Chemotherapeutics are not a safe precaution against gas oedemata. The collection of further experiences in this field is especially desirable.
When treating war wounds, an operative arrangement of the wound must first be made by removing the dead tissue and opening all cavities of the wound. Then the remedy is applied with a powder distributor or with dredging boxes, in dosages of from 5-20 grams according to the size of the wound. This is repeated whenever a change of dressing is necessary. Independently of the change of dressing, and spread evenly over the day, the patient is given 8 grams on the first day, 6 grams on the second day, 5 grams on the third day and on each of the fourth, fifth, and sixth days, 4 grams of sulfanilamide preparations per os (if necessary, rectal or intravenous injections). Then the drug treatment is discontinued and started again if necessary. The earlier this treatment is begun the better are its chances.
Local treatment with the available sulfanilamide powders together with an internal treatment with albucid, cibazol, eleudron, eubasinum, globucid (particularly for gas oedema), marfanil-prontalbin, protosil is suggested.
If, in rare cases, secondary reactions occur such as nausea, vomiting, diarrhea, buzzing in the ears, headaches, skin rashes, or icterus, these remedies must be discontinued at once. A blood transfusion may be useful.
PARTIAL TRANSLATION OF GEBHARDT, FISCHER,
OBERHEUSER DOCUMENT 3
GEBHARDT, FISCHER, OBERHEUSER DEFENSE EXHIBIT 10
EXTRACTS FROM REPORT ON THE THIRD CONFERENCE EAST OF CONSULTING SPECIALISTS ON 24 TO 26 MAY 1943 AT THE MILITARY MEDICAL ACADEMY, BERLIN
5. SS Gruppenfuehrer and Major General, Professor Gebhardt, and F. Fischer.
Special Experiments on Sulfanilamide Treatment
CONCLUSIONS
“1. The development of suppuration on the soft parts caused by bacteriae cannot be prevented, even if sulfanilamides are applied immediately, locally, or internally.
“2. It could not be proved that the course of an inflammatory illness caused by aerobic organisms on abscesses and phlegmons of the limbs was influenced by sulfanilamides. We were of the impression that combined gas gangrene therapy took a milder course under the influence of sulfanilamides.
“3. Surgical measures are indispensable for a successful treatment of inflammations.”
Additional Remarks
The sprinkling of sulfanilamide powder on wounds can be injurious, if, by so doing, the fundamentals of surgery are infringed, if, for instance, the powder basis is not dissolved by the tissue fluids, and if the discharge of secretions is hampered by coagulation. The wounds treated with sulfanilamide powder show a slight tendency to exudation.
Hypothesis of Functions
The inflammation on the mesodermal soft parts shows a tendency towards necrosis at an early stage. The necrosis is the seat of the bacterial culture. Its surroundings show thrombosed vessels. Access to it by chemo-therapeutic reagents is very difficult.
Directives for the Application of Sulfanilamides
Experiments (Gebhardt-Fischer) showed the following results: Even the immediate internal and external application of sulfanilamide preparations cannot prevent a suppuration of the soft parts due to ordinary suppurative organisms. It could not be proved that the course of the inflammatory disease caused by anaerobions is influenced by sulfanilamides. The sulfanilamides seemed to have an easing effect on the course of combined gangrene therapy.
Disorders caused by sulfanilamides (Randerath) are relatively rare. They occur directly as liver disorders including acute yellow liver atrophy, as kidney disorders, and as agranulocytosis. Therefore, as far as is possible under front-line conditions, the white and red blood count should be controlled. The decrease of the body temperature caused by an infection of the central regulatory system may be looked upon as an indirect disorder, so that the temperature curve permits no conclusions as to the development of the wound infection. Furthermore, local powder treatment may lead to an occasional increase in the depth of the wound infection. Direct injury to the tissue at the spot where the preparations were applied was not observed.
The endolumbal application of the sulfanilamides (Mueller) must also be rejected for the treatment of meningitis, since it leads to serious disturbances in the region of the spinal cord and may result in paralysis.
The clinical discourse (Frey) emphasized the decrease of optimistic and the increase of critical opinions. The clinical doctor considers the principal disorders to be anorexia, nausea, and increasing exhaustion. Early application in the wound itself is essential for the efficacy. The enteral or parenteral inducing of sulfanilamide drugs cannot prevent wound infections, but can favorably influence its course.
The following rules for practice therefore result: All surface wounds, that is, grazing shot wounds, sulcus-shaped wounds and large gaping wounds of the soft parts should be sprinkled as soon as possible with sulfanilamide powder. The powder treatment is of no use if the depths of the wound are not reached. It is ineffective to powder the small wounds caused by the penetration and exit of the bullet. The powdering of the skin is senseless and may cause eczema. Deeper wounds must be treated in the quickest and most thorough manner. After this, the wound can be additionally treated with sulfanilamide powder which must reach the deepest cavities. It is not advisable to powder granulating wounds.
If the powder treatment cannot be applied during the first hours or does not seem to suffice, a pororal application of sulfanilamides should take its place or be performed supplementarily. Front-line conditions will not always allow intravenous injections. According to the danger of a wound infection, the wound should be treated for a short time with large doses of sulfanilamides (6-10 grams during 3-4 days, not more than a total of 50 grams). On the whole, small doses are insufficient and therefore have no influence on the course of an infection, but if applied too long they may be injurious. Suitable preparations are preferably eleudron, cibazol, and globucide. If possible, the treatment should be applied by a medical officer.
Wounds endangered by gas oedema—and this means all large and deep muscle wounds—should, in addition to the local and oral treatment with sulfanilamide, also be treated with gangrene serum. At subsequent operations, for example resection of the ribs, empyema of the chest, secondary sutures, and late amputations, the new wound caused by the operation may be powdered adequately with sulfanilamides when bleeding has stopped.
The thoroughness of the surgical wound treatment should in no way be lessened even by the additional application of sulfanilamides.
Abdominal gunshot wounds can also be treated with sulfanilamide powder (about one tablespoon) or the sulfanilamide may be induced into the abdominal cavity in the form of an emulsion.
EXTRACTS FROM THE TESTIMONY OF PROSECUTION WITNESS JADWIGA DZIDO[[40]]
DIRECT EXAMINATION
Mr. Hardy: Witness, what is your full name?
Witness Dzido: Jadwiga Dzido.
Q. Do you spell that J-a-d-w-i-g-a, last name spelled D-z-i-d-o?
A. Yes.
Q. Witness, you were born on 26 January 1918?
A. Yes.
Q. You are a citizen of Poland?
A. Yes.
Q. Have you come here to Nuernberg voluntarily to testify?
A. Yes.
Q. Would you kindly tell the Tribunal your present home address?
A. Warsaw, Garnoslonska 14.
Q. Witness, are you married?
A. No.
Q. Are your parents living?
A. No.
Q. What education have you received?
A. I finished elementary school and high school at Warsaw. In 1937 I started to study pharmacology at the University of Warsaw.
Q. Did you graduate from the University in Warsaw?
A. No.
Q. What did you do after you had finished school in the University of Warsaw?
A. I started studying pharmacology at the University, and then when I was studying the second year, the war broke out.
Q. What did you do after the war broke out?
A. In 1939 I was working in a pharmacy during the holidays.
Q. Were you a member of the Resistance Movement?
A. In the autumn of 1940 I entered the Resistance Underground.
Q. What did you do in the Resistance Movement?
A. I was a messenger.
Q. Then were you later captured by the Gestapo and placed under arrest?
A. I was arrested by the Gestapo on 28 March 1941.
Q. What happened to you after your arrest by the Gestapo?
A. I was interrogated by the Gestapo in Lublin, Lukow, and Radzin.
Q. And what happened after that?
A. In Lublin, I was beaten while naked.
Q. Did you then receive any further treatment from the Gestapo, or were you released?
A. I stayed in Lublin 6 weeks in the cellar of the Gestapo building.
Q. Then were you sent to the Ravensbrueck concentration camp?
A. On 23 September 1941, I was transported to the Ravensbrueck concentration camp.
Q. Were you told why you were sent to the concentration camp in Ravensbrueck?
A. No, I was not told.
Q. Were you ever given a trial in any German court?
A. Never.
Q. Who sent you to Ravensbrueck concentration camp?
A. All the prisoners in the prison at Lublin were sent there, and I went with them.
Q. Now will you tell the Court, Miss Dzido, in your own words what happened to you after you arrived at Ravensbrueck?
A. When I arrived in the Ravensbrueck concentration camp, I thought that I would stay there till the end of the war. The living conditions in the prison were such that we could not live there any longer. In the camp we had to work, but in the camp it was not so dirty, and there were not so many lice as used to be in the prison.
Q. What work did you do in the camp, Witness?
A. I did physical work inside or outside the camp.
Q. Were you ever operated on in the Ravensbrueck concentration camp?
A. I was operated on in November 1942.
Q. Will you kindly explain the circumstances of this operation to the Tribunal?
A. In 1942 great hunger and terror reigned in the camp. The Germans were at the zenith of their power. You could see haughtiness and pride on the face of every SS woman. We were told every day that we were nothing but numbers, that we had to forget that we were human beings, that we had nobody to think of us, that we would never return to our country, that we were slaves, and that we had only to work. We were not allowed to smile, to cry, or to pray. We were not allowed to defend ourselves when we were beaten. There was no hope of going back to my country.
Q. Now, Witness, did you say that you were operated on in the Ravensbrueck concentration camp on 22 November 1942? [See photographs, pp. 898-908.]
A. Yes.
Q. Now, on 22 November 1942, the day of this operation, will you kindly tell the Tribunal all that happened during that time?
A. That day the policewoman, camp policewoman, came with a piece of paper where my name was written down. The policewoman told us to follow her. When I asked her where we were going, she told me that she didn’t know. She took us to the hospital. I didn’t know what was going to happen to me. It might have been an execution, transport for work, or operation.
Dr. Oberheuser appeared and told me to undress and examined me. Then I was X-rayed. I stayed in the hospital. My dress was taken away from me. I was operated on 22 November 1942 in the morning. A German nurse came, shaved my legs, and gave me something to drink. When I asked her what she was going to do with me she did not give me any answer. In the afternoon I was taken to the operating room on a small hospital trolley. I must have been very exhausted and tired and that is why I don’t remember whether I got an injection or whether a mask was put on my face. I didn’t see the operating room.
When I came back I remember that I had no wound on my leg, but a trace of a sting. From that time I don’t remember anything till January. I learned from my comrades who lived in the same room that my leg had been operated on. I remember what was going on in January, and I know that the dressings had been changed several times.
Q. Witness, do you know who performed the operation upon your leg?
A. I don’t know.
Q. Now, you say that you had dressings changed. Who changed the dressings on your leg?
A. The dressings were changed by Drs. Oberheuser, Rosenthal, and Schiedlausky.
Q. Did you suffer a great deal while these dressings were being changed?
A. Yes, very much.
Q. Witness, will you step down from the witness box and walk over to the defendants’ dock and see if you can recognize anyone in that dock as being at Ravensbrueck concentration camp during the period and during the time that you were operated on?
A. (Witness points.)
Q. Will you point to the person again that you recognized, Witness?
A. (Witness points.)
Q. And who is that, Witness?
A. Dr. Oberheuser.
Mr. Hardy: May we request that the record so show that the witness has identified the defendant Oberheuser?
Presiding Judge Beals: The record will so show.
Mr. Hardy: Do you recognize anyone else in that dock, Witness?
Witness Dzido: Yes.
Q. Point out who else you recognize, Witness?
A. (Witness points.)
Q. Who is that, Witness?
A. This man I saw only once in the camp.
Q. Do you know who that man is, Witness?
A. I know.
Q. Who is that man, Witness?
A. Dr. Fischer.
Mr. Hardy: Will the record so show that the witness has properly identified the defendant Fischer as being at the Ravensbrueck concentration camp?
Presiding Judge Beals: The record will so show.
Mr. Hardy: Witness, do you have any other details to tell the Tribunal about your operation?
Witness Dzido: (No answer.)
Q. Witness, how many times were you operated on?
A. Once.
Q. When Dr. Oberheuser attended you, was she gentle in her treatment toward you?
A. She was not bad.
Q. Witness, have you ever heard of a person named Binz in the Ravensbrueck concentration camp?
A. I know her very well.
Q. Do you remember what time your friends were called to be operated on in August of 1943?
A. Yes.
Q. Will you kindly tell the Tribunal some of the details there and the names of the persons who were to be operated on?
A. In the spring of 1943 the operations were stopped. We thought that we could live like that till the end of the war. On the 15th of August a policewoman came and called ten girls. When she was asked what for, she answered that we were going to be sent to work. We knew very well that all prisoners belonging to our transport were not allowed to work outside the camp. The chief of the block where we were living was forbidden under capital punishment to let us outside the camp. That’s why we know that it was not true. We didn’t want to let our comrades out of the block. The policewoman came, and the assistants, the overseers, and with them Binz. We were driven out of the block into the street. We stood there in line 10 at a time and Binz herself read off the names of 10 girls. When they refused to go because they were afraid of a new operation and were not willing to undergo a new operation, she herself gave her word of honor that it was not going to be an operation and she told them to follow her.
We remained standing before the block. Then several minutes later our comrades ran to us and told us that SS men have been called for in order to surround them. The camp police arrived and drove our comrades out of the line. We were locked in the block. The shutters were closed. We were 3 days without any food and without any fresh air. We were not given parcels that arrived in the camp at that time. The first day the camp commandant and Binz came and made a speech. The camp commandant said that there had never been a revolt in the camp and that this revolt must be punished. She believed that we would reform and that we would never repeat it. If it were to happen again, she had SS people with weapons. My comrade, who knew German, answered that we were not revolting, that we didn’t want to be operated on because five of us died after the operation and because six had been shot down after having suffered so much. Then Binz replied: “Death is victory. You must suffer for it and you will never get out of the camp.” Three days later, we learned that our comrades had been operated on in the bunker.
Q. Now, Witness, how many women, approximately, were operated on at Ravensbrueck?
A. At Ravensbrueck 74 women were operated on. Many of them underwent many operations.
Q. Now, you have told us that five died as a result of the operations, is that correct?
A. Yes.
Q. And another six were shot down after the operation, is that correct?
A. Yes.
Q. Do you know why those other six were shot, Witness?
A. I don’t know.
Q. Witness, were any of these victims asked to volunteer for these operations?
A. No.
Q. Were any of them promised freedom if they would submit to operations?
A. No.
Q. When you were operated on, did you object?
A. I could not.
Q. Why?
A. I was not allowed to talk and our questions were not answered.
Q. Do you still suffer any effects as a result of the operation, Witness?
A. Yes.
Q. Were you ever asked to sign any papers with respect to the operation?
A. Never.
Q. When did you finally leave Ravensbrueck?
A. On 27 April 1945.
Q. Have you ever received any treatment since you have left Ravensbrueck in the last year?
A. Yes.
Q. Tell us what treatment you have received.
A. Dr. Gruzan in Warsaw transplanted tendons on my leg.
Q. When did he do that?
A. On 25 September 1945.
Q. Do you have to wear any special shoes, now, Witness?
A. Yes, I should wear them, but I can’t afford to buy them.
Q. What are you doing now, Witness? Are you working now, or what is your occupation?
A. I am now continuing my studies which I started before the war.
Q. I see. I will ask the witness to identify these pictures.
Mr. Hardy: This is Document NO-1082a, b, and c. I will pass these up to the Tribunal for your perusal. Were these photographs taken of you in Nuernberg in the last day or two, Witness?
Witness Dzido: Yes.
Q. Witness, would you kindly take your stocking and shoe off your right leg, please, and will you step out to the side and show the Tribunal the results of the operations at Ravensbrueck? (Witness complies.) That’s all, Witness, you may sit down.
Mr. Hardy: I have no further question on direct examination, your Honor.
Presiding Judge Beals: Is there any defense counsel who desires to cross-examine this witness?
Dr. Seidl (counsel for defendants Gebhardt, Oberheuser, and Fischer): I do not want to cross-examine the witness; however, I do not wish the conclusion to be drawn that my clients admit all the statements made by the witness.
EXTRACTS FROM THE TESTIMONY OF THE PROSECUTION EXPERT WITNESS DR. LEO ALEXANDER[[41]]
DIRECT EXAMINATION
Mr. Hardy: Dr. Alexander, have you examined Miss Dzido before today?
Witness Dr. Alexander: Yes, sir, I did, on several occasions during the last 3 days.
Q. During your examination, did you have X-rays made of the patient’s legs?
A. I did, sir.
Mr. Hardy: At this time I will introduce Document NO-1091 which is the X-ray of the witness, Miss Dzido. We will pass two copies to the Tribunal and one copy to the Secretary General. Dr. Alexander, in the course of your diagnosis of these X-rays, will you kindly diagnose this X-ray in English and then repeat in German for the benefit of the defendants?
Witness Dr. Alexander: Yes, sir.
Q. Doctor, will you identify that X-ray which carried Document NO-1091?
A. Yes. This is the X-ray which included the lower two-thirds of the thigh bone, the femur, and the knee joint, and—
Mr. Hardy: I offer this X-ray as Prosecution Exhibit 215.
Q. Doctor, this X-ray you are referring to now is Document NO-1092?
A. This is Document NO-1091. The arrow points to the osteoporotic atrophy of the tibia. Document NO-1092 is the X-ray of the leg. It shows the fibula which is the smaller of the two larger bones of the leg, about in the middle between the area just mentioned under the bracket called “B”. On the side, looking toward the tibia is the osteoperiostitis of the periosteum. This group of marks is particularly severe in the smaller area which I have marked with the bracket “A”, which indicates a smaller area of the shaft of the tibia within the larger area of the disturbance marked as “B”. This alteration is indicative and consists of an ordinary inactive Coxa, which in view of the osteoperiostitis of the periosteum was probably an osteomyelitis process. However, there is no active osteomyelitis at the present examination of the right foot. In pictures 1093 and 1094, it shows arthritic changes of the cuniform navicula joints with narrowing of the joint spaces and increased marginal sclerosis. This has been marked in the X-ray with an arrow pointing to the joint. The other prints are the same. The prints have come out too dark, but it shows the condition clearly in the film.
This arthritis is due to the immobilization of the right foot. Secondary to the muscles and especially the paralysis of the perineal nerve. It is evidently arthritis of an immobilization nature which one sees also by inspection of the patient’s foot.
Q. Doctor, can you determine from your examination——
A. (Interposing) 1094—have I mentioned it?—shows the same as 1093 in a slightly different exposure. The marks are the same pointing to the most marked arthritis between the cuniform navicular joints.
Q. Doctor, in your opinion, from your examination of this patient can you determine what was the purpose of the experiment?
A. It appears that in this experiment a highly infectious agent was implanted, probably without the addition of a bacteria static agent such as sulfanilamide, and for that reason the infection got out of hand and became very extensive.
EXTRACTS FROM THE TESTIMONY OF DEFENDANT GEBHARDT[[42]]
DIRECT EXAMINATION
Dr. Seidl: The experiments on Polish internees were carried out in such a way that, first of all, three series of experiments were performed on three groups of 12 persons each. Is that correct?
Defendant Gebhardt: Yes. What I wanted to solve by means of this second experimental group was the task given me in my orders, namely, the testing of the drugs prescribed. I definitely hoped in these experiments, which produced gangrene, that if there was anything in the sulfanilamide drugs, which I had reason to hope, then the advantages connected with one or the other drug would become apparent, and I would be able to discontinue the experiments. Of course, I could not stop at the initial instructions. I really had to go on to a localized and definite infection, and for that there is an internationally known precept, not discovered by us, which is to produce a locus minoris resistentia—that is to say, the place of least resistance—where germs combine with contact substances. So we did not insert dirt, glass, or earth, cruelly; the dirt in the wound was represented by sterile glass silicate; soil and textiles which would enter a wound were replaced by us through sterile cellulose, finely ground. You all know that if you cut yourself and a nonsterile piece of glass remains in the wound, if you do not move the spot, it will heal with the glass inside without any aggravated symptoms. The only effect it has is to produce a catalysis for the germs and a local obstruction to the flow of blood, and possibly to damage a few cells slightly. In other words, we produced inflammation in the safest way possible for such an experiment. That is an unquestionable scientific train of thought in this sphere. We proceeded in just that manner and in addition, we gave our sulfanilamide, or zeibazol 1., eleutron, and nitron. Two control persons, however, were not without protection, because they were taken care of in the old established way.
Now, don’t suggest that I should know the schedule or that there was some schedule regarding the supply of sulfanilamide used. A schedule is always bad in medicine because it is no longer original. One thing is characteristic, however, with sulfanilamides and that is that you give a big dose at the beginning, and here there is a question of whether it is correct to introduce it locally or to leave it open. Someone might mix it, somebody else might have a different combination and that is how we did it. I would be a bad scientist if I were to write down for you now that I knew exactly that they were all given in a certain manner on the third day, or that they are all like this and this now. It states expressly in Thomas’ statement, of course, that any prearranged table for the administration is wrong, and that we also cannot prescribe the correct way to apply these drugs. It was obviously clear that there was a strong impression made by sulfanilamides and, even in the first group, we were astonished to find a certain result, which is useful for the idea as such, but not for practical purposes. Among other things we immediately and simultaneously sprinkled a mixture of germs together with sulfanilamide powder into the wound. That was the only exception made in the first group and it didn’t produce any results at all. Now, if I were a bad scientist then I would have assumed that that, in itself, was a success. No matter whether it was the ultrasepsis or the powder we had used, I would have been satisfied, and I would have said, “Everybody now has to take a little bag of sulfanilamide along with him and powder the wounds with it immediately because we know that if they are inserted simultaneously into the wound—the germ and the drug—then there will be no inflammation.” Only in complete ignorance of wound conditions and war conditions could one adopt that point of view. The disadvantage of the sulfanilamide bag is that a man who is badly shot isn’t in a position to act; he would be lying somewhere badly wounded and not be able to do anything. On the other hand, of course, the position is that the surface of the wound can easily be powdered, but of course not right down to the very bottom of the wound, and we know particularly well that sulfanilamides when applied wrongly in this way have caused injury.
Q. The second group consisted of the 36 women, 3 times 12 women?
A. Yes. Infection, plus contact materials.
Q. Is it true that the Reich Physician SS, Dr. Grawitz, on 3 September 1942, when inspecting Ravensbrueck, demanded that the experimental conditions had to be made more severe in order to create conditions similar to wartime conditions?
A. At the beginning of September, on the basis of my report, I was called to Grawitz to report on the results which might be expected. Grawitz, and as I shall explain later, Stumpfegger, came to me at the beginning of September. Since Grawitz was coming to Ravensbrueck I turned up on the same day, so that Fischer could demonstrate the patients under my protection. That is the impression probably created repeatedly by the testimony of witnesses; they have to wait for a time, and then I say “These are the patients whom I operated on.” I assume the same description was given each time. Grawitz was able to prove to me that the effects were circumscribed and not of a war nature. And he was able to prove to me that I had obtained no clear medical information, only assumptions, and the clinical conditions resulting might perhaps be expected after surgery at home. For another reason, which can be seen from the documents, the argument became rather violent. Grawitz turned to Fischer, who presented the cases to him. At any rate he then said, unfortunately, that a speedy clarification had to be reached and that wounds similar to combat wounds had to be created, that is, a gunshot wound infected by earth and matter. Of course, I did not accept these conditions and I looked for some way to get the experiment into my own hands so that, using all safeguards, a higher degree of infection might be brought about, and the cases might still remain under my control. I did not want to give up and say, “I have not reached any conclusion,” thereby impliedly giving permission for wounds similar to combat wounds to be inflicted elsewhere. And so we arrived at the idea of tying off the arteries of the third group, which is also a customary means of bringing about a locus minoris resistentiae in international experimental technique.
Q. You did not carry out the order then?
A. No.
Q. Then how were the experiments continued in order to create severe local inflammation in warlike wounds?
A. We kept to our old technique, the infusion, that is an incision on the outer side of the calf far from the joint, where it is not under pressure, and where the cast does not hurt it. In other words, we chose the most suitable place according to all medical considerations. Then we administered the infection in a place where the circulation of the blood had been reduced.
Q. What do you know about the deaths, and why was there no amputation in these cases?
A. I believe that I can remember the three deaths very well. But I only remember three—I have always testified that—with all the things that have happened in the meantime and all the patients I have taken care of. It was not that Fischer or I overlooked an amputation, and it is certainly not true that an amputation can save the life of the patient in all cases of gangrene. As I remember the case histories, the most serious patient had a large abscess on the hip. Probably the corresponding glands had been affected. The infection on the calf and the abscess on the hip—what can I amputate? One can amputate when the infection is limited to the calf. We did not have such cases because we forced the infection to the place where we wanted it, but we were not able to prevent the infection spreading to a different area and running into the blood vessel as does happen occasionally. There are infections of the veins, and then the patient dies suddenly, and it is a definite risk to perform an operation because the power of resistance is on the borderline, hanging by a hair. If we perform such major operations to save the patient’s life, then you may assume that we would have undertaken an amputation, or would you assume that a surgeon of my experience does not know when he has to amputate? Unfortunately that is the first thing that an operative surgeon like Fischer learns in wartime, to amputate in time.
As far as I remember, the deaths were from an abscess of the glands, an inflammation of the veins, an inflammation of the blood vessels, and one died from general sickness, in spite of all transfusions. This happens in cases of infection when there is no possibility of stopping the infection by local surgery. But one cannot conclude that any medical measures which should have been taken were overlooked, because just by seeing a case history from a distance one cannot decide that at such and such a moment the patient should have been operated on. I am convinced that in these three cases which Fischer reported to me exactly, which I saw, and in which the therapy was discussed, that we certainly did not overlook anything. As far as one can humanly say, we did what we considered necessary.
I wanted to publish this result or to report it to the public from the beginning. Therefore, it was obvious from the very beginning, if you did not assume that I had any humane or surgical motives, that I did everything in order to be able to publish the results.
[40] Complete testimony is recorded in mimeographed transcript, 20 December 1947, pp. 838-847.
[41] Complete testimony is recorded in mimeographed transcript, 20 Dec. 1946, pp. 848-855.
[42] Complete testimony is recorded in mimeographed transcript, 4, 5, 6, 7, 10 Mar. 47, pp. 3931-4256.