Chapter VII: Extracts From Argumentation and Evidence of Prosecution and Defense (7)

Pros.
Doc. No. Ex. No. Description of Document Page
NO-234 83 Letter from Rascher to Himmler, 10 September 219
1942, transmitting intermediate report on
freezing experiments (1618-PS).
1618-PS 84 Intermediate report, 10 September 1942, on 220
intense chilling experiments in Dachau
concentration camp.
1611-PS 85 Letter from Himmler to Rascher and Sievers, 22 221
September 1942, ordering rewarming in
freezing experiments through physical
warmth.
NO-285 86 Letter from Rascher to Rudolf Brandt, 3 221
October 1942, stating that Sievers would
obtain four gypsy women for rewarming
through body warmth.
1619-PS 87 Teletype from commandant of Dachau 223
concentration camp to Rudolf Brandt, 7
October 1942, stating that four women would
be available from Ravensbrueck concentration
camp for Rascher’s experiments.
NO-286 88 Letter from Goering’s office to Himmler, 8 223
October 1942, with attached invitation to
the conference on “Medical Problems Arising
from Hardships of Sea and Winter.”
1613-PS 90 Letter from Rascher to Himmler, 16 October 225
1942, transmitting report on cooling
experiments on human beings (NO-428).
NO-428 91 Report of 10 October 1942, on cooling 226
experiments on human beings.
1609-PS 92 Letter from Himmler to Rascher, 24 October 244
1942, and note by Rudolf Brandt.
NO-323 94 Memorandum of Rascher on women used for 245
rewarming warming in freezing experiments, 5
November, 1942.
NO-320 103 Letter from Sievers to Brandt, 28 January 246
1943, and Rascher’s report on his
discussions with Grawitz and Poppendick.
1616-PS 105 Letter from Rascher to Himmler, 17 February 249
1943, and summary of experiments for
rewarming of chilled human beings by animal
warmth, 12 February 1943.
NO-268 106 Letter from Hippke to Himmler, 19 February 252
1943, on freezing experiments in Dachau.
1580-PS 107 Letter from Himmler to Rascher, 26 February 253
1943, on freezing experiments in the
concentration camps Auschwitz and Lublin.
NO-292 111 Letter from Rascher to Rudolf Brandt, 4 April 253
1943, reporting on dry-freezing experiments
in Dachau.
NO-322 114 Letter from Rascher to Keindl, 28 April 1943, 254
about previous freezing experiments
conducted at Sachsenhausen.
NO-231 116 Letter from Rascher to Sievers, 17 May 1943, 255
concerning a conference with Gebhardt on
freezing experiments.
NO-432 119 Letter from Rascher to Neff, 21 October 1943, 258
concerning dry-freezing experiments.
NO-690 120 List of research projects from the files of 259
the Reich Research Council.
_Testimony_

Extracts from the testimony of Tribunal witness Walter Neff 260 Extract from the testimony of defendant Handloser 265 Extract from the testimony of defendant Schroeder 269 Extracts from the testimony of defendant Sievers 274

TRANSLATION OF DOCUMENT NO-234
PROSECUTION EXHIBIT 83

LETTER FROM RASCHER TO HIMMLER, 10 SEPTEMBER 1942, TRANSMITTING
INTERMEDIATE REPORT ON FREEZING EXPERIMENTS (1618-PS)

Dr. med. Sigmund Rascher Munich, Trogerstr. 56 at present Berlin, 10 Sep 1942 My dear Reich Leader,

May I submit in the enclosure the first intermediary report about the freezing experiments?

In the beginning of October, a meeting on the subject of freezing experiments is to take place. Professor Dr. Holzloehner, participating in our Dachau experiments on behalf of the Luftwaffe, wants to give on this occasion an account of the results of our experiments. SS Obersturmbannfuehrer Sievers, who surveyed the experiments in Dachau last week, believes that if any report was to be made at a meeting, I should be called upon to submit the report. A discussion with other experts on freezing experiments would surely be very valuable. I therefore request your decision.

1. Can a report be made elsewhere before the oral report has been submitted to you, my Reich Leader?

2. Is my participation in the conference on the subject of the freezing experiments of the Luftwaffe ordered by you, my Reich Leader?

I will take care that the report is submitted in the manner appropriate for top secret matter.

Yours gratefully and respectfully
Heil Hitler!
[Signed] Yours very devotedly, S. RASCHER
1 enclosure

TRANSLATION OF DOCUMENT 1618-PS
PROSECUTION EXHIBIT 84

INTERMEDIATE REPORT, 10 SEPTEMBER 1942, ON INTENSE CHILLING EXPERIMENTS
IN DACHAU CONCENTRATION CAMP

S. Rascher Intermediate report on intense chilling experiments in the Dachau Camp, started on 15 August 1942 _Experimental procedure_

The experimental subjects (VP) were placed in the water, dressed in complete flying uniform, winter or summer combination, and with an aviator’s helmet. A life jacket made of rubber or kapok was to prevent submerging. The experiments were carried out at water temperatures varying from 2.5° to 12°. In one experimental series, the occiput (brain stem) protruded above the water, while in another series of experiments the occiput (brain stem) and back of the head were submerged in water.

Electrical measurements gave low temperature readings of 26.4° in the stomach and 26.5° in the rectum. Fatalities occurred only when the brain stem and the back of the head were also chilled. Autopsies of such fatal cases always revealed large amounts of free blood, up to one-half liter, in the cranial cavity. The heart invariably showed extreme dilation of the right chamber. As soon as the temperature in these experiments reached 28°, the experimental subjects died invariably, despite all attempts at resuscitation. The above discussed autopsy finding conclusively proved the importance of a warming protective device for head and occiput when designing the planned protective clothing of the foam type.

Other important findings, common in all experiments, should be mentioned, marked increase of the viscosity of the blood, marked increase of hemoglobin, an approximate five-fold increase of the leukocytes, invariable rise of blood sugar to twice its normal value. Auricular fibrillation made its appearance regularly at 30°.

During attempts to save severely chilled persons [Unterkuehlte], it was shown that rapid rewarming was in all cases preferable to slow rewarming, because after removal from the cold water, the body temperature continued to sink rapidly. I think that for this reason we can dispense with the attempt to save intensely chilled subjects by means of animal heat.

Rewarming by animal warmth—animal bodies or women’s bodies—would be too slow. As auxiliary measures for the prevention of intense chilling, improvements in the clothing of aviators come alone into consideration. The foam suit with suitable neck protector which is being prepared by the German Institute for the Textile Research, Munich-Gladbach, deserves first priority in this connection. The experiments have shown that pharmaceutical measures are probably unnecessary if the flier is still alive at the time of rescue.

[Signed] DR. S. RASCHER
Munich—Dachau, 10 September 1942.

TRANSLATION OF DOCUMENT 1611-PS
PROSECUTION EXHIBIT 85

LETTER FROM HIMMLER TO RASCHER AND SIEVERS, 22 SEPTEMBER 1942, ORDERING
REWARMING IN FREEZING EXPERIMENTS THROUGH PHYSICAL WARMTH

Secret
Reich Leader SS
Rf/Dr. AR/19/30/42
Personal Headquarters
Reich Leader SS
22 September 1942
1. Dr. Rascher
Munich—Dachau

I have received the intermediate report on the chilling experiments in Camp Dachau.

Despite everything, I would so arrange the experiments that all possibilities, prompt warming, medicine, body warming, will be executed in positive experiment orders.

[Signed] H. HIMMLER
2. SS—Lt. Col. Sievers
Berlin
A carbon copy with the request for acknowledgment.
SS Lt. Col.
25 Sep 42

PARTIAL TRANSLATION OF DOCUMENT NO-285
PROSECUTION EXHIBIT 86

LETTER FROM RASCHER TO RUDOLF BRANDT, 3 OCTOBER 1942, STATING THAT
SIEVERS WOULD OBTAIN FOUR GYPSY WOMEN FOR REWARMING THROUGH BODY WARMTH

Dr. med. Sigmund Rascher; Munich, Trogerstr. 56, 3 October 42

Most honored Obersturmbannfuehrer!

First of all I want to thank you very much for “Das glaeserne Meer” (“The Glass Ocean”). My wife and myself are very happy to possess now a complete set of these books. I have already read the book with great interest.

The Reich Leader SS wants to be informed of the state of the experiments. I can announce that the experiments have been concluded, with the exception of those on warming with body heat. The final report will be ready in about 5 days. Professor Holzloehner, for reasons that I cannot fathom, does not himself want to make the report to the Reich Leader Himmler and has asked me to attend to it. This report must be made before 20 October, because the great Luftwaffe conference on freezing takes place in Nuernberg on 25 October. The report on the results of our research _must_ be made there, to assure that they be used in time for the troops. May I ask you to arrange for a decision from the Reich Leader regarding the final report to him, and the submission to him of the relevant material?

Today I received your letter of 22 September 1942, in which the Reich Leader orders that the experiments on warming through body heat must absolutely be conducted. Because of incomplete address it was delayed. Today I asked Obersturmbannfuehrer Sievers to send a telegram to the camp commander immediately, to the effect that four gypsy women be procured at once from another camp. Moreover, I asked SS Obersturmbannfuehrer Sievers to take steps to have the low-pressure chamber made ready for use.

The report to Field Marshal Milch planned for 11 September could not be made, as you have discovered, because he was prevented from attending, and no representative was commissioned to receive it. As the Reich Leader had not empowered me to report to anyone in the Reich Air Ministry (RLM), I abstained from making the report, which rather nettled the gentlemen of the Medical Inspectorate [Sanitaetsinspektion]. I immediately informed Obersturmbannfuehrer Sievers. For the time being the report is being held as a military secret at the German Aviation Research Institute (DVL) together with a distribution list prepared by the Reich Air Ministry. The distribution of the copies, however, has not yet taken place, because, as I said, the report has not yet been made to Milch. I assume that you were informed of this whole business long ago. What shall we do now?

I wish to enclose a letter of thanks to the Reich Leader from the former prisoner Neff. At the same time I should like to thank you very much for your efforts; and let me beg you, should opportunity offer, to convey to the Reich Leader my most sincere thanks for his granting of this request. I did not write to the Reich Leader in person, in order not to make any further demands on his valuable time.

With best wishes and
Heil Hitler!
Yours most sincerely
[Signed] S. RASCHER.

PARTIAL TRANSLATION OF DOCUMENT 1619-PS
PROSECUTION EXHIBIT 87

TELETYPE FROM COMMANDANT OF DACHAU CONCENTRATION CAMP TO RUDOLF BRANDT,
7 OCTOBER 1942, STATING THAT FOUR WOMEN WOULD BE AVAILABLE FROM
RAVENSBRUECK CONCENTRATION CAMP FOR RASCHER’S EXPERIMENTS

Reich Security Main Office (RSHA) Message Center

* * * * *

CONCENTRATION CAMP DACHAU 9793 7 OCTOBER 1942 1630-FR-

TO SS OBERSTURMBANNFUEHRER DR. BRANDT BERLIN PRINZ ALBRECHT STR. 8. THE HEADQUARTERS CONCENTRATION CAMP DACHAU REQUESTS CHIEF OF THE AMTSGRUPPE SS BRIGADEFUEHRER GLUECKS TO HAVE THE FOUR WOMEN ORDERED BY THE REICH LEADER SS FOR STABSARZT DR. RASCHER FOR THE PURPOSE OF EXPERIMENTS SENT IMMEDIATELY FROM RAVENSBRUECK TO DACHAU.

SIGNED WEISS, SS STURMBANNFUEHRER AND COMMANDANT OF THE CAMP.

PARTIAL TRANSLATION OF DOCUMENT NO-286
PROSECUTION EXHIBIT 88

LETTER FROM GOERING’S OFFICE TO HIMMLER, 8 OCTOBER 1942, WITH ATTACHED INVITATION TO THE CONFERENCE ON “MEDICAL PROBLEMS ARISING FROM HARDSHIPS OF SEA AND WINTER”

The Reich Air Minister and Commander in chief of the Luftwaffe Az: 55 No. 5 340/secret/42 (L. I. 14, 2IIB)

Berlin W 8, 8 October 1942
Leipziger Strasse 7
By Messenger!
Subject: Research order on Freezing [Abkuehlung].

Reference: 1. D. R. d. L. and Ob. d. L. Ch. d. Lw. L. In. 14 Az: 55
No. 20058/41 (2II B) dated: 24/2/42

2. D. R. d. L. and Ob. d. L. Ch. d. Lw. L. In. 14 Az: 21
o-r No. 10909/42 (1 II A) dated: 6/8/42

To the Reich Leader SS

The Inspectorate of the Medical Service of the Luftwaffe has given an order for research to the Stabsarzt Professor Dr. Holzloehner, reference above, dated 24 February 1942, for work on the following problem:

“The effect of freezing on warm-blooded subjects.”

At the proposal of Stabsarzt Dr. Rascher appropriate examinations were made of human beings, and in agreement with the Reich Leader SS suitable SS facilities were used for the examinations.

In order to carry out these examinations a research group “Hardships at Sea” (“Seenot”) was set up, consisting of Professor Dr. Holzloehner as leader and Stabsarzt Dr. Rascher and Dr. Finke.

The leader of this research group reported that the examinations have been concluded.

It is intended to dissolve the research group at the latest by 15 October 1942.

The research documents and an extensive report will be presented to the Reich Leader SS by Stabsarzt Dr. Rascher. It is requested that the originals or copies of the report and of the documents be put at the disposal of the Inspectorate of the Medical Service of the Luftwaffe.

It is intended to make the results, in the form of an extract, accessible to experts at a conference which will take place in Nuernberg on 26 and 27 October 1942. The agenda schedule of the conference is closed.

The SS Central Office, Medical Department [SS Hauptamt, Sanitaetsamt] has been invited to this discussion by letter, dated 30 September 1942.

It is further requested to abstain from forwarding the documents and the report to other nonmedical offices.

Draft signed [Im Entwurf gez.]
By order
WULLEN
True Copy
[Signature] ANTHONY
1 enclosure
[Enclosure]
The Inspector of the Medical Service of the Luftwaffe

Conference on “Medical Problems Arising from Hardships of Sea and Winter” on 26 and 27 October 1942 in Nuernberg, Hotel “Der Deutsche Hof,” 29-35 Frauentorgraben. Chairman of the conference: Stabsarzt Professor Dr. Anthony, L. In. 14.

_Tentative schedule_:

26 October 1942.

* * * * *

15.35 o’clock—Oberstabsarzt Dr. Weltz: “Warming Up after Freezing to the Danger Point”. 15.55 o’clock—Stabsarzt Professor Holzloehner: “Prevention and Treatment of Freezing.” 16.40 o’clock—Discussion.

TRANSLATION OF DOCUMENT 1613-PS
PROSECUTION EXHIBIT 90

LETTER FROM RASCHER TO HIMMLER, 16 OCTOBER 1942, TRANSMITTING REPORT ON
COOLING EXPERIMENTS ON HUMAN BEINGS (NO-428)

Dr. Sigmund Rascher
Munich 16 October 42
Troger Str. 56
Highly esteemed Reich Leader!

Permit me to submit the attached final report on the super-cooling experiments performed at Dachau. This report does not contain the course and results of a series of experiments with drugs as well as experiments with animal body heat [animalische Waerme] which are now being conducted. Likewise this report does not contain the microscopic pathological examinations of the brain tissues of the deceased. I was surprised at the extraordinary microscopic findings in this field. I will carry out experiments before the start of the conference in which the effect of cooling will be discussed and I hope to be able to present further results by that time. My two coworkers left Dachau about 8 days ago.

In the hope that you, highly esteemed Reich Leader, will be able to spare a quarter of an hour to listen to an oral report, I remain, with the most obedient regards and

Heil Hitler!
Yours respectfully.
[Signed] S. RASCHER.

PARTIAL TRANSLATION OF DOCUMENT NO-428
PROSECUTION EXHIBIT 91

REPORT OF 10 OCTOBER 1942, ON COOLING EXPERIMENTS ON HUMAN BEINGS

STABSARZT PROF. DR. E. HOLZLOEHNER
STABSARZT DR. S. RASCHER
STABSARZT DR. E. FINKE

_I. Problem of the Experiment_

Up to the present time there has been no basis for the treatment of shipwrecked persons who have been exposed for long periods of time to low-water temperatures. These uncertainties extended to the possible physical and pharmacological methods of attack. It was not clear, for example, whether those who had been rescued should be warmed quickly or slowly. According to the current instructions for treating frozen people, a slow warming up seemed to be indicated. Certain theoretical considerations could be adduced for a slow warming. Well-founded suggestions were missing for a promising medicinal therapy.

All these uncertainties rested in the last analysis upon the absence of well-founded concepts concerning the cause of death by cold in human beings. In the meantime, in order to clarify this question, a series of animal experiments were started. And, indeed, these officials who wished to make definite suggestions to the doctors in the sea-rescue service had to assume a great deal of responsibility if it came to a question of convincing and consistent results in these animal experiments. At this particular point it is especially difficult to carry the findings in animals over into the human field. In the warm-blooded, one finds a varied degree of development in the heat-regulating mechanism. Besides this, the processes in the skin of the pelted animals cannot be carried over to man.

_II. General Procedure of the Experiment_

The effect of _water temperatures_ of 2°, 3°, to 12° C. [34°, 37°, to 54° F.] were investigated. A tank 2×2×2 m. [6-2/3×6-2/3×6-2/3 ft.] served as an _experimental basin_. The water temperature was attained by addition of ice, and remained constant during the experiment. The experimental subjects were generally dressed in _equipment_ such as the flier wears, consisting of underclothing, uniform, a one piece summer or winter protective suit, helmet, and aviators fur-lined boots. In addition they wore a life preserver of rubber or kapok. The effect of _additional protective clothing_ against water-cold was tested in a special series of experiments, and in another series the _cooling of the unclothed person_ was studied.

The _bodily warmth_ was measured _thermoelectrically_. Following preliminary experiments in which gastric temperatures were measured by a thermic sound, we adopted the procedure of continuously registering _rectally_ the body temperature [Kerntemperatur]. Parallel with this, the recording of the _skin temperature_ was undertaken. The point of measurement was the skin of the back at the level of the fifth thoracic certebral process. The thermoelectrical measurements were controlled before, during, and after the experiments by thermometric tests of the cheek and rectal temperature.

In severe cooling, _checking of the pulse_ is difficult. The pulse becomes weaker, the musculature become stiff, and shivering sets in. Auscultation during the experiment by means of a tube stethoscope fastened over the tip of the heart proved effective. The tubes were led out of the uniform and made possible the continuous _listening to the heart during the stay in the water_.

_Electrocardiographic controls_ were not possible in the water. After removal from the water they were possible only in those cases in which, a too severe muscle shivering did not disturb the electrocardiograph records.

The following _chemical studies_ were carried out: following up of the _blood sugar picture_ (continuous); the _sodium chloride picture_ in the serum; the _nonprotein nitrogen_ (_Rest-N_); the _alkali reserve_; the alkali reserve of the venous and arterial blood and _sedimentation rate_ (before and after the experiment). Besides this the general _blood condition_ and _viscosity_ were followed during the experiment, and before and after the experiment the _resistance_ of the red blood cells and the protein content of the blood plasma (this refractometrically) were measured.

The following _urinalyses_ were made regularly: _sediment_, _albumen_, _sugar_, _sodium chloride_, _acetone_, _acetic acid_, as well as a qualitative _albumen_ determination.

In part of the experiment lumbar and suboccipital punctures were made as well as corresponding spinal fluid studies.

Among _physical_ and _therapeutic measures_ the following were tested:

_a._ Rapid warming by means of a _hot_ bath.

_b._ Warming by means of a _light cradle_.

_c._ Warming in a heated _sleeping bag_.

_d._ Vigorous _massage_ of the whole body.

_e._ _Wrapping in covers._

_f._ _Diathermy of the heart._

In addition the following drugs were given: _Strophanthin_ i. v.; _Cardiaz_ 1 i. v. and i. c.; _Lobelin and Coramin_ i. v. and i. c. In other experiments alcohol or grape sugar was given.

A part of the experiments was begun under _narcosis_ (8 cc. _Evipan_ i. v.).

_III. The Clinical Picture of Cooling_

The clinical picture as well as the behavior of the body temperature showed certain regularities in the general course; the time of appearance of certain phenomena was, however, subject to very great _individual variations_. As one might expect, a _good general physical condition_ delayed the cooling and the concomitant phenomena. Further differences were conditioned by the _position of the subject in the water_ and the _manner of clothing_. Furthermore, differences showed up between experiments in which the subject lay horizontally in the water so that the nape of the neck and the back of the head were splashed with water, and others in which neck and head protruded freely out of the water.

Peculiarly, the _actual water temperatures_ between 2° C. and 12° C. [35° and 54° F.] had no demonstrable effect upon the rate of the cooling. Naturally such an effect must exist. But since besides the already mentioned individual differences and those due to experimental conditions, the various subjects cooled on different days at different rates of speed, the effect of the actual water temperatures between 2° and 12° disappears behind such variations.

If the experimental subject was placed in the water under narcosis, one observed a certain arousing effect. The subject began to groan and made some defensive movements. In a few cases a state of excitation developed. This was especially severe in the cooling of head and neck. But never was a complete cessation of the narcosis observed. The defensive movements ceased after about 5 minutes. There followed a progressive rigor, which developed especially strongly in the arm musculature; the arms were strongly flexed and pressed to the body. The rigor increased with the continuation of the cooling, now and then interrupted by tonic-clonic twitchings. With still more marked sinking of the body temperature it suddenly ceased. These cases ended fatally, without any successful results from resuscitation efforts.

In the course of the narcosis experiments the evipan effects in a few cases went directly over into a cold narcosis; in other cases one could determine a transitory return of consciousness, immediately following the awakening effect already described; at any rate, the experimental subjects were dizzy. Cold pain was not expressed.

Experiments without narcosis showed no essential differences in the course of cooling. Upon entry into the water a severe cold shuddering appeared. The cooling of the neck and back of the head was felt as especially painful, but already after 5 to 10 minutes a significant weakening of the pain sensation was observable. Rigor developed after this time in the same manner as under narcosis, likewise the tonic-clonic twitchings. At this point speech became difficult because the rigor also affected the speech musculature.

Simultaneously with the rigor a severe _difficulty in breathing_ set in with or without narcosis. It was reported that, so to speak, an iron ring was placed about the chest. Objectively, already at the beginning of this breathing difficulty, a marked _dilatation of the nostrils_ occurred. The _expiration was prolonged and visibly difficult_. This difficulty passed over into a rattling and snoring breathing. However, the breathing at this point was not especially deep as in Kussmaul’s breathing nor were any Cheyne-Stokes breathing or Biot’s breathing to be observed. Not in all subjects, but in a great number, a simultaneous hindering during this breathing through very profuse _secretion of mucous_ could be established. Under these conditions sometimes a white, _fine-bubbled foam_ appeared at the mouth which reminded one of an incipient _lung oedema_, though it was not possible to determine this symptom with certainty by clinical auscultation; only a sharpened unclean breath sound was audible. This foam might occur early, that is, at rectal temperatures of 32° C. to 35° C.; [90°-95° F.]. No special significance was to be attributed to this regarding the outcome of the experiment which is the opposite of the described relaxation of rigor. The _rate of breathing increased_ at the beginning of the experiment, but after about 20 minutes it decreased to something like 24 per minute with slight variations.

In general a definite _dulling of consciousness_ occurred at the dropping of the body temperature of 31° C. [88° F.] rectal temperature. Next, the subjects still responded to speech but finally answered very sleepily. The _pupils_ dilated markedly. The contraction under light became increasingly weaker. The gaze was directed overhead with a compulsive fixation. After withdrawal from the water _an increase in the reflexes_ was evident in spite of the rigor, and regularly a very marked drawing up of the testicles occurred which practically disappeared into the abdomen. Early in the experiment the _face_ was pale. After 40 to 50 minutes _cyanosis_ appeared. With this the face appeared redder, the mucous membrane bluish-red. The skin veins were not maximally collapsed and were virtually always penetrable.

The _heart activity_ showed a constant change independent of all other individual variations, which was noticeable in all subjects. Upon introduction into the water with narcotized subjects as well as nonnarcotized subjects, the heart rate went suddenly to about 120 per minute. At a rectal body temperature of about 34° C. [93° F.] it then began to become increasingly slower and to sink continuously to about 50 per minute.

The bradycardia at a body temperature of about 29° to 30° C. [84° to 86° F.] changed suddenly to an _arrythmia perpetua_ or, as the case may be, to a _total irregularity_ and this began with a slow form of about 50 beats per minute; this slow form of irregularity could be transformed into a faster one. The transformation to the faster form was not an unfavorable sign regarding life.

When an electrocardiographic control after the experiment was possible, it regularly showed a Vorhof flutter. Let it be anticipated _that this irregularity could continue to exist after the cessation of the cooling and a recovery of the body temperature to 33° or 34° C. [91° or 93° F.] 1½ to 2 hours after removal from the water_, but then customarily changed of itself and without therapeutic aids into a coordinated heart activity. In the same way let it be anticipated that in all cases with a lethal termination, a sudden cessation of the heartbeat ensued upon an irregularity of the slow type.

A check of the _blood pressure_ was attempted, but was in no case satisfactory since an exact measurement was not possible in the decisive stage of the experiment because of the severe rigor and muscle fibrillation.

Reference has already been made to _individual differences in the behavior of the rectal temperatures_. Figure 4 gives an example which includes four experiments, in which four different experimental subjects were cooled at identical water temperatures and with identical clothing. It was shown that in water at 4.5° C. [40° F.] temperature the time required for reaching a rectal temperature of about 29.5° C. [85° F.] varies between 70 and 90 minutes. But nevertheless the diagram shows that in spite of these individual differences, it is observable that the progress of the rectal temperature proceeds according to rule. The body temperature begins to sink rapidly from about 35° C. [95°-97° F.].

_It is of very great practical significance at this point that the body temperature continues to sink virtually lineally for a considerable time after removal from the water._ This continued drop can last 20 minutes or more. During this drop an after-drop of 4° C. [7° F.] could be observed, and indeed not only at temperatures under 30° C. [86° F.]. In one case it was observed that an interruption of the experiment at 35° C. [95° F.] after a further lapse of 20 minutes the rectal temperature had fallen 4° to 5° C. [8° F.] more. We will later discuss the “arresting” of this after-drop by physical measures.

In our experimental series, the lowest rectal temperatures which could be survived varied individually just as did the progress of the temperature drop. In general (in six cases) death occurred with a drop in temperature to values between 24.2° and 25.7° C. [75.6° and 77.6° F.]. In one case, however, a drop to 25.2° C. was survived. This experiment fell outside the typical picture insofar as after 90 minutes at 26.6° C. [79.9° F.] a virtually stationary condition of the rectal temperature had become established for 85 minutes. We will come back again to this special experiment.

The _skin temperature_ sinks or drops much more rapidly than the rectal temperature. Within a minute there occurs a thorough saturation of the articles of clothing. Correspondingly the skin temperature falls already within 5 minutes to values between 24° and 19° C. [75° and 66° F.]. After 10 minutes it may have already dropped to 12° C. [54° F.]. Within 10 to 20 minutes more after the beginning of the experiment the steepness of the drop changes considerably. The curve of the skin temperature runs for some time, that is, for 15 to 30 minutes virtually horizontal. After this time there follows a further but now slower drop to the lowest figures, which may lie below 15° C. [59° F.] at the close of the experiment.

Parallel experiments which compare the _course of the rectal temperatures_ and the cooling of the body with and _without submersion of neck and back of head_ showed great difference in temperature drop. The curves pertain to the same experimental subject. The one with the deep fall to 26° C. [79° F.] in 70 minutes was obtained with a water temperature of 12° C. [54° F.] the other with a drop to 32.5° C. [90.4° F.] in the same time resulted from a water temperature of 5.5° C. [41.9° F.]. The very marked difference cannot be explained by a variation in resistance of the particular person, but is to be attributed to the position of the subject in the water and his head covering. In the experiment with the water at 12° C. [54° F.] the subject, in a kapok life preserver, lay flat in the water so that his neck and the back of his head were well submerged; beyond this he did not wear a flier’s helmet. In the other experiment with water at 5.5° C. [41.9° F.] the head was covered with an aviator’s summer helmet without headphones. The subject wore a rubber life preserver open at the back; with this, the head is somewhat out of the water.

In order to follow up the effect of _isolated cooling of the neck and the back of the head_ on consciousness, body temperature, and circulation, this was undertaken in three special experiments. The experimental subject lay horizontal; the back of the head and the neck were dipped into a receptacle through which water of corresponding temperature was continuously run. In an experiment of 3 hours duration there occurred small temperature drops of not more than 0.8° C. [1.4° F.]. The water temperature was 1° to 2° C. [34° to 35° F.]. In one case after 50 minutes a marked sleepiness occurred which changed over into a deep narcosis. The heart activity was variable, and obvious bradycardia could not be observed. Irregularity never developed. Changes were not seen in the electrocardiograph. On the other hand in all three subjects the spinal fluid pressure was markedly increased after the ending of the experiment to maximal values of 300 mm. After the experiment, ataxia and definite Romberg phenomena were observed, as well as exaggeration of the normal reflexes; pathological reflexes were absent.

_IV. Blood, Spinal Fluid, and Urine During Freezing_

The _differential blood smears_ showed no special features during cooling. On the other hand the number of white and red blood corpuscles shows a regular change. The _number of leukocytes_ rapidly increases, roughly with the beginning of the steeper temperature drop at about 35° C. [95° F.] rectal temperature to values of from 25,000 to 27,000 per cu. mm. After one hour a maximum may be reached and a falling-off begins in the number of leukocytes, while the body temperature falls still further. The number of red corpuscles undergoes an increase, though to a relatively small degree, which in its course resembles the change in the _number of leukocytes_. We saw increases up to 20 percent. This increase is interrupted even earlier than the increase in the number of leukocytes, so that both curves give no reflection of the temperature curve. The increase of the erythrocytes corresponded to the increase of the hemoglobin of from 10 to 20 percent. A reduction of the fragility of the red corpuscles could not be demonstrated with certainty, on the other hand, although in three experiments a definite hemolysis occurred.

The viscosity regularly increases with the beginning of the fall in temperature. The rise can reach values up to 7.8. This rise occurs very early, indeed, already at body temperatures of 35° C. [95° F.]. After that the values remain relatively constant with further temperature falls. The _albumen content of the plasma_ was likewise increased after the experiment, on the average by 1 percent of the absolute value. Since these measurements could not be made as often as those of viscosity for technical reasons, the connection with the progress of the viscosity remained unclear. Such a connection could not be recognized from the absolute values obtained.

With the acceleration of the temperature drop, there always occurs a more marked increase of the blood sugar to maximal values which may attain an average _increase of 80 percent_ and in a few cases may reach an _increase of over 100 percent_. According to that, the maximal value of about 27.5° C. [81.5° F.] is reached and is maintained for some time. It is to be observed that _as long as the temperature drop continues, in no experiment was it possible to observe a decrease in these high blood sugar values_. It is usually to be observed that a relatively rapid drop of the blood sugar values sets in when, after removal from the water, the temperature drop ceases and goes over into a temperature rise. We consider these findings to be of theoretical significance. During the isolated cooling of the neck and back of the head which was described in section III the blood sugar remained constant.

In striking contrast to the increase of the blood sugar, there was never established a _corresponding glycosuria_ in the urine collected immediately after the experiment or withdrawn through a catheter, although considerable quantities of urine averaging 500 cc. were found in the bladder; in only two cases could traces of sugar (0.5 percent) be demonstrated. This paradoxical behavior can, perhaps, be explained in this manner: during the time of great blood sugar increase, a blocking of the kidneys had occurred, and that the associated urine quantities were formed before or after this blocking under reflex polyuria. Acetone and acetic acid, likewise, could not be demonstrated in the urine.

The _alkali reserve_ in the arterial and venous blood was regularly very much reduced at the end of the experiments. Experiments concerning _oxygen saturation_ could not be carried out. According to the color of the venous blood withdrawn from the arm veins, the saturation of this blood must have been very greatly reduced; the blood was virtually black as it came into the syringe. Noteworthy in this connection are the autopsy findings which were undertaken directly after death. In these, the blood in the right heart appeared very dark, and in the left heart very bright red. According to this, one must calculate upon an _increase in the saturation differential between the arteries and veins_.

_Sodium chloride_ and _nonprotein nitrogen_ in the blood were not clear in the blood at the end of the experiments or increased within the limit of error. _Sodium chloride in the urine_ was generally less, corresponding to a reduction of the specific gravity. On the other hand at the end of the experiments _traces of albumin_ could regularly be demonstrated _in the urine_ and moderately increased leukocytes, occasional erythrocytes, and epithelial cells in the sediments. In particular cases, _albumin casts_ were also observed. The reaction of the urine remained identical before and after the experiments virtually without exception. The studies of the bile yielded no results.

_Lumbar and suboccipital_ punctures immediately after the experiments showed a considerable _increase in fluid pressure_. On the average it amounted to between 50 and 60 mm. In one case, an _increase to 420 mm._ was seen. The protein values were always normal. Cell increases did not appear, likewise no abnormal deviation of the colloidal gold curve was observed. The meaning of these findings for therapy is still to be discussed later.

_V. Recovery After Cooling and Its Dependence Upon Physiotherapeutic
Measures_

The important fact has already been referred to that after rescue from the cold water, the body temperature sinks further and so a further temperature reduction of 4° C. [7° F.] may take place. As was likewise emphasized, this may occur as a postphenomenon not only when low temperatures have been obtained already during the experiments, but it can be noted also at final temperatures of 35° C. [95° F.]. A dependence of this after-drop on the duration of the experiment could not be established; as a result it is difficult to calculate in advance. This fact becomes of great importance for practical measures; on the other hand it makes it difficult to gain an insight into the manner in which various physiotherapeutic measures affect the arresting of this after-drop and the recovery of the body temperature. Only because of the large number of the experiments was it possible to obtain well-founded concepts of this.

The _flattest rise of the body temperature_ was to be observed when the subject was merely dried off, wrapped in warm cover, and left to himself after removal from the water. The recovery is greatly accelerated if the subject is placed in a hot bath as soon as possible after the removal of the wet articles of clothing. Warming under a light cradle assisted the temperature rise. Vigorous massage had a favorable effect, however, only if it was preceded by treatment in a hot bath or light cradle. _In no case was it established that there was any indication of bad effects from the hot water or the light cradle, or that the subject had been harmed in any way._ On the other hand, it was observed in three cases that a hot bath had doubtless a life saving effect. In two of these cases there had been complete cessation of heart and breathing action, and in one case the heart had stopped for several seconds after a markedly slackened irregularity before the subject was placed into water of not more than 50° C. [122° F.]. _As a result of this we can discard all traditional objections to a sudden rewarming._

The favorable effect of a hot bath is still clearer in the observation of the general condition of the subject than in the temperature curves, although it cannot be presented objectively. The breathing very often becomes “freer” immediately upon introduction into the hot water. The hot water releases a strong stimulus; the unconscious subject often reacts with an outcry. Soon thereafter there occurs a distinct lessening of the severe rigor. The return of consciousness occurs sooner, and indeed at temperatures at which it did not usually happen under other methods of treatment.

In the first experiments with hot water treatment, this was continued only for 10 minutes; after that the subjects were removed and vigorously massaged. Under these circumstances it could be established that the temperature rise continued during the rubbing, indeed in one experiment the rise became steeper. As already indicated, this favorable effect of dry rubbing was not so pronounced without preliminary treatment by heat. It is important, too, that the rubbing be done when the severe spasm of the peripheral vessels has already passed.

_In view of this, the hot hath is the best method of treatment of the severely cooled person._ However, in the practice of sea rescue service it will not be possible to carry out this method, since the necessary means are not available in aircraft and boats. Under these circumstances we must consider next only the rapid rewarming with light cradle or electrically _heated sleeping bag_. Therefore a sleeping bag as now used in the sea rescue service was also tested. It was evident that the temperatures which can be developed by this means are not sufficient for heat therapy. With those it was possible to reach a temperature of only 32° C. [90° F.] over the skin, with the heat turned on fully. Besides this, the wall of the foot-section of the sleeping bag is only partly heated; on the outer sides it remains completely cold. As long as no improvement and strengthening of the heating equipment of the sack is carried out, the sleeping bag can be considered only as a substitute for wrapping in warm covers.

The warming by means of the _light cradle_ is more uneven than with a hot bath. With warming by light one might expect severe local vessel expansion with _danger of collapse_. Actually the subjects often complained of dizziness and nausea after reaching consciousness if the treatment lasted longer than 15 minutes. Occasionally vomiting occurred. In these cases it is indicated to switch off the light cradle and to pack the subject with covers. Apart from this it must be remembered that during unconsciousness the subject should be protected against direct contact with the lamps by means of covers, otherwise burns could occur during clonic-tonic convulsions.

This suggests that “_short waves_” be employed to supply heat, since it was shown in animal experimentation that by this means it is possible to bring about a thorough warming of the whole animal, which leads to a recovery of the animal with puzzling rapidity. We did not have the proper equipment for a thorough warming of a human being by this means. For this reason the _short wave therapy of the heart_ was tried. This did not have any demonstrable effect. Above all, it is necessary to advise against a practical application of this method, since there exists the danger of prolonged burning even in full consciousness, as the result of cold anaesthesia, even if the treating physician carefully tries to avoid this.

The severe difficulty in breathing as well as the formation of foam before the mouth, which reminded one of incipient lung oedema, seemed to indicate oxygen therapy. Therefore this therapy was tried in four experiments. It showed no effect on either the breathing or the heart action. It has been pointed out that the arterial blood appears especially light red.

_VI. Death After Cooling in Water_
_Practical and Theoretical Considerations_

Reports to the effect that those who have been rescued at sea are imperilled for a considerable time after rescue has aroused special attention. It has been reported especially that sudden cases of death occurred as much as 20 minutes to 90 minutes after rescue, and that in mass catastrophes these sudden deaths could amount to mass-dying (rescue collapse). These observations have set off far-reaching discussions. Bleeding in the rewarming periphery, break-downs of neural and humoral correlations and similar ideas have been brought up.

In contrast to this our experiments give a relatively simple explanation of cold-death under these conditions. With the exception of a single case, a total irregularity of the heart chamber could be definitely demonstrated in all cases of cooling under 30° C. [86° F.], (50 experiments), when the rectal temperature reached 29° C. [84° F.] and usually already at a cooling of 31° C. [88° F.]. The exception was an experiment on an intoxicated subject, which is to be gone into more fully below (_see sec. VII_).

_Furthermore heart-death was established clinically in all cases of death observed by us._ In two cases breathing ceased simultaneously with the heart activity. These were cases in which it was specially noted that the neck and the back of the head lay deep in the water. In all remaining cases breathing outlasted the clinical chamber cessation by as much as 20 minutes. In part this was “normal, much decelerated breathing,” in part an angonal form of gasping. As already referred to, an auricular flutter could be demonstrated cardiographically during the irregularity.

In cases in which a special _cooling of neck and back of head_ had existed before death, the _autopsy_ showed _a marked brain oedema_, a tight filling of the general brain cavity [Hirngefaesse] blood in the spinal fluid as well as blood in the Michaelisrhomboid.

The heart findings warrant our taking a certain attitude toward _the question of rescue collapse_. Death occurred relatively quickly after removal from the water, which may be compared with rescue. The longest interval involved was 14 minutes. It is to be noted, however, in the first place, that almost certainly a much larger number of deaths would have been observed if an active heat therapy had not almost regularly been coupled directly with the completion of the experiment; in the second place, that in such cases there would have been very much longer intervals. We have already called attention repeatedly to the after-cooling following the experiment. In every case where this had proceeded to a certain point, countermeasures were taken, since the experiments were never planned to end in death. One may well imagine, however, that in mass catastrophes, in which almost exclusively rescue collapse has heretofore been described, the therapeutic measures were confined to an undressing and drying off of the rescued together with a subsequent wrapping in covers. Under these conditions after-drops of great magnitude and long duration were to be expected. In the course of this delayed fall in temperature, a heart-death might occur as in our experiments.

_We should like to emphasize that the irregularity per se is not to be regarded in our experiments as a symptom of danger to life any more than in the clinic, but rather as a sign of direct heart damage, which increases continuously with further falling off of temperature, until finally the heart fails. If the temperature drop is arrested, the slow form of irregularity passes over into a rapid form._ This transition is a favorable sign for survival; for this irregularity virtually always passes over of itself after a time averaging 90 minutes into normal heart activity. It continues therefore for a long time after the body temperature has already risen markedly. A danger to the circulatory system could not be demonstrated at this stage. In three cases the return of the heart action to normal occurred in spite of simultaneous energetic physical work.

With the demonstration that cold-death of man is primarily a heart-death, the essential points for therapy are also cleared up. The _cause of the severe heart_ damage is another question. Since our studies were primarily aimed at the development of practical methods of treatment, we will not go very far into the theoretical concepts which may be developed in this connection. Still, several hints may be drawn from the blood studies:

1. The great increase of the _viscosity_ causes an _increased loading_ upon the heart.

2. The _choking of peripheral vessel_ areas by the severe vessel contraction leads to an over-filling of the central areas. This appears not only from our autopsies. In all available records of autopsies which pertain to cases of death from cold in the water after sea disaster, we find uniformly a severe over-filling of the right heart.

3. It is to be calculated that, under the effect of the low blood temperature, the _heart_ itself becomes severely _hypodynamic_. It has been proved long ago in animal experimentation that a Vorhof flutter can be developed by the overloading and cooling of the isolated heart.

Besides a physical damaging of the heart musculature by the cold, we must also keep in mind the _damaging by pathological products of metabolism_. Next, the sharp increase in blood sugar may be connected with the increased outpouring of adrenalin. The constancy of this increase of blood sugar during the temperature drop is, however, remarkable. One may well assume that this flow of adrenalin exhausts itself with the continuance of the temperature drop. With this there would have to be a rapid decrease in the blood sugar if the oxidation processes were to continue undisturbed. The decrease in the alkali reserve or the development of an acidosis argues strongly for an injury.

Animal experiments, with general cooling, give grounds for believing that the intermediary metabolism is disturbed during drops in temperature; but this change is also discussed in connection with local freezing of the human being and has been proved to a certain extent. Furthermore, not only this disturbance shows a transition between general and local damage by cold. In both cases there occurs an increase in viscosity, which points to a change in the capillary walls and indicates the conclusion that there is a change in the permeability of those walls for protein and water.

The heart-death remains prominent, the regular increase of spinal fluid pressure with severe cooling of the neck and back of the head leaves it unsettled whether, in addition, this has pathognomonic significance for the outcome. With a fluid pressure of 420 mm. it must in fact be assumed that this participates in the development of bradycardia.

The detection of an increase in fluid pressure is also not without significance for therapy. One may think of a lumbar or suboccipital puncture as a measure to be prescribed. After a lumbar puncture there occurs a transformation of the slow form of arrhythmia into the rapid form. It must remain undecided whether such measures, which delay a rapid, active rewarming, are to be recommended for practical application in the sea-rescue service.

The idea that cold-death in water depends upon failure of the heart, accompanied or unaccompanied by breathing, is subject to limitation. One experiment among fifty-seven was typical. This involved survival of a cooling to 25.2° C. [77.4° F.] during a stay of 3 hours in water of 5.5° C. [41.4° F.]. The rectal temperature under these conditions remained constant within slight variations between 27° and 25° C. [81° and 77° F.] for the last hour and a half. Likewise, quite irregularly, no increase in blood sugar occurred. But most striking was the fact that until the end of the experiment and after its termination consciousness was undisturbed. The course of the experiment reminded one of the behavior of certain experimental animals which can withstand extremely low body temperatures for long periods of time. Lower, warm-blooded animals (for example, rats) can endure rectal temperatures of 20° C. [68° F.] for several hours. It is conceivable that this atypical experiment, had it been continued, would have shown also an atypical cause of death. Against this we have the fact that an irregularity had already set in but not before a temperature of 30.1° C. [86.2° F.] had been reached.

Also, aside from the fluid pressure increase, the part which the _central nervous system_ plays in the outcome of the experiment seems to us to be _secondary_. The experiments with simultaneous cooling of the neck of course showed how the cooling of the neck and back of the head speeds up the lowering of temperature. This is to be explained by the fact that the counter-controls which are relayed from the temperature center to the periphery, either cannot exist further because of hypofunction of the centers (effect of oedema and cooling), or are no longer transmitted because of cold-blocking of the pathways. But likewise central counter-controls for the areas of the peripheral capillaries may fall; thus delaying the overloading of the heart by extended periphera vasco friction.

_VII. The Influence of Pharmacology and the Question of Alcohol_

Now experiments by _Jarisch_ have shown that heart drugs like _strophanthin_ and stimulants like _cardiazol_ and _coramine_ in therapeutic doses may react _toxically_ upon cooled animals. These findings are a warning to be most careful in the medicinal treatment of severely cooled persons, though strophanthin and cardiazol have heretofore been expressly recommended in such cases.

In experiments with fatal outcome, the stopping of the heart occurred either in the water or after an interval of not more than 14 minutes after removal from the water. With such a rapid course of events it is unlikely that one can favorably influence the heart action by intravenous injections of strophanthin, especially because the circulation is at a very low ebb before the heart-death. For this reason, in a case whose condition was already very dangerous, _strophanthin was given intracardially_ in a dose of 0.25 mg. Thereupon the heart condition grew still worse and after 5 minutes the heart stopped. One had the impression that the heart action was made worse by the intracardial injection of strophanthin. This is, however, the only case which left the possibility of damage by strophanthin in doubt. No such damage could ever be established in the intravenous injection of strophanthin. On the other hand no therapeutic effect, even with maximal doses of 0.5 mg., could be detected. Figure 11 [not reproduced], last section, shows the total duration in 10 cases of the irregularity observed without strophanthin dosage. This varies between 25 and 200 minutes. On the other hand in Figure 13 in the last section, first five cross-rows there are corresponding time values of 175 to 360 minutes. At various experimental time points during these experiments 0.25 to 0.5 of strophanthin were given. Accordingly, a shortening of the duration of the irregularity cannot be established. Furthermore no improvement of the pulse or general condition was ever noted. Obviously these experiments are too few to rule out a possible favorable effect in all cases. Several hundred experiments would be necessary to obtain statistically reliable data on this point. And so, since contrary to animal experimentation, we could not unquestionably establish damage following intravenous strophanthin dosage, we may leave it to the treating physician whether or not he may still want to make an _experiment with strophanthin_. To be sure, such an employment of it must be advised against in case of a very much decelerated form of irregularity. This will be observed when there is the greatest danger; under such circumstances time should never be lost by experimenting with drugs, but every effort should be made in the direction of intensive heat therapy.