Chapter IV (2)

_Examination continued._—“After this interruption the opening of the stomach was pursued. The stomach contained about three ounces of a brownish fluid. There was nothing particular in that. Palmer was looking on, and said, ‘They won’t hang us yet.’ He said that to Mr. Bamford in a loud whisper. That remark was made upon his own observation of the stomach. The stomach after being emptied, was put into the jar. The intestines were then examined, but nothing particular was found in them. They were contracted and very small. The viscera, with their contents, as taken from the body, were placed in the jar, which was then covered over with two bladders, which were tied and sealed. I tied and sealed them. After I had done so I placed the jar upon the table by the body. Palmer was then moving about the room. In a few minutes I missed the jar from where I had placed it. During that time my attention had been withdrawn by the examination. On missing the jar I called out, ‘Where’s the jar?’ and Palmer from the other end of the room, said, ‘It is here; I thought it would be more convenient for you to take away.’ There was a door at the end of the room where he was. He was within a yard or two of that door, and about twenty-four feet from the table on which the body was lying.” (Before making this last statement the witness referred to a plan of the room which was put in by the Attorney-General.) “The other door near which Palmer was standing was not the one by which he entered the room. I called to Palmer, ‘Will you bring it here?’ I went from the table and met Palmer half-way coming with the jar. _Since I last saw it it had been cut through both bladders. The cut was hardly an inch long, done with a sharp instrument._ I examined the jar. The edges were quite clean; no part of the contents could have passed through it. Finding this cut, I said, ‘Here is a cut! who has done it?’ Palmer, Devonshire, and Newton, all said they had not done it, and nothing more was said. When I was about to remove the jar from the room, the prisoner asked me what I was going to do with it. I said I should take it to Mr. Frere’s (a neighbouring surgeon). He said, ‘I would rather you would take it to Stafford than take it there.’ I made no answer that I remember. On finding the slit, I cut the strings, and altered the bladder, so that the slits were not over the top. I took it to Mr. Frere’s, and left it in his hall, tied and sealed. Afterwards when I went for my carriage, whilst waiting in the yard, the prisoner came and asked me what would be done with it, and I said, ‘Sent either to Birmingham or London for examination.’ When I recovered the jar, I tied each corner separately and resealed it with my own seal. During the first _post-mortem_ examination, there were several Rugeley persons present, but, I believe, no one on behalf of the prisoner. At the second examination there was some one on behalf of Palmer (_Mr. Pemberton_ and _Mr. Bolton_).”

On _cross-examination_, after stating that Palmer’s words, “they won’t hang us yet,” were addressed to Bamford in a loud whisper, and afterwards repeated to several persons, and that his original notes in pencil were destroyed, a more formal report being written by him on getting home, _Dr. Harland_ said—

“At the base of the tongue of the deceased I observed some enlarged mucous follicles; they were not pustules containing matter, but enlarged mucous follicles of long standing. There were a good many of them, but I do not suppose that they would occasion much inconvenience. They might cause some degree of pain, but it would be slight. I do not believe they were enlarged glands. I should not say that the deceased’s lungs were diseased, although they were not in their normal state. The lungs were full of blood and the heart empty. I had no lens at the _post-mortem_ examination, but I made an examination which was satisfactory without one. The brain was carefully taken out; the membranes and external parts were first examined, and thin slices about a quarter of an inch in thickness were taken off and subjected to separate examination. I think that by that means we should have discovered disease if any had existed; and if there had been any indication of disease I should have examined it more carefully. _I examined the spinal cord as far down as possible, and if there had been any appearance of disease, I should have opened the canal. There was no appearance of disease, however. We opened down to the first vertebra. If we had found a softening of the spinal cord, I do not think that it would have been sufficient to have caused Mr. Cook’s death; certainly not. A softening of the spinal cord would not produce tetanus; it might produce paralysis. I do not think, as a medical man investigating the cause of death, that it was necessary carefully to examine the spinal cord. I do not know who suggested that there should be an examination of the spinal cord two months after death. There were some appearances of decomposition when we examined the spinal cord, but I do not think that there was sufficient to interfere with our examination._[36] I examined the body to ascertain if there was any trace of venereal disease. I did find certain indications of that description, and the marks of an old excoriation, which was cicatrized over.”

_Re-examined by the Attorney-General._—“There were no indications of wounds or sores such as could by possibility produce tetanus. There was no disease of the lungs to account for death. The heart was healthy, and its emptiness I attribute to spasmodic action. The heart being empty, of course death ensued. The convulsive spasmodic action of the muscles of the body, which was deposed to yesterday by Mr. Jones, would, in my judgment occasion the emptiness of the heart. There was nothing whatever in the brain to indicate the presence of any disease of any sort; but if there had been, I never heard or read of any disease of the brain ever producing tetanus. _There was no relaxation of the spinal cord which would account for the symptoms accompanying Mr. Cook’s death as they have been described. In fact, there was no relaxation of the spinal cord at all, and there is no disease of the spinal cord with which I am acquainted which would produce tetanus._”

_Dr. Monckton_, a physician at Rugeley, made a separate examination of the spinal marrow of the deceased on the 28th of January, when he said that the body was in such a condition as to enable him to do so satisfactorily, and when had there been any disease of a normal character on the spine he should have had no difficulty in discovering it. All that he found were certain granules, the origin of which it was difficult to account for, though frequently found in persons of an advanced age, but which he never knew to occasion sudden death. He agreed entirely with the evidence of Dr. Harland.[37]

EVIDENCE OF MEDICAL EXPERTS.

We come next to a remarkable body of evidence given by men of such eminence in their profession as Mr. Curling, Dr. Todd, Sir Benjamin Brodie, and others of nearly equal mark, negativing the idea that had been suggested in the previous cross-examinations that the death was due to one of the two forms of true _tetanus_, and affirming that the symptoms which had been detailed were those of the action of strychnia. Not only were these opinions closely questioned in cross-examination, but as many medical men, several of them of not less eminence than these witnesses, were subsequently called for the defence to contradict them; and thus the most extraordinary conflict of scientific evidence raised that had hitherto been witnessed in a criminal court. Subsequently, as we shall see, a similar dispute between the medical giants of the day was roused in the case of Dr. Smethurst, but with, in the end, a very different result. In reading the following statements for the prosecution, it will help to make them more clear, if it is borne in mind that _tetanus_ is of two kinds—(1), _Idiopathic_, or self-generated, and the other (2), _Traumatic_, the result of a wound or a sore; that the former may arise from exposure to cold or damp, or even from the irritation of worms in the alimentary canal, but in temperate climates is by no means a frequent disease; whilst the latter, from the various accidents to which human beings are liable, is of more frequent occurrence. Another point to be remembered is, that it is a moot point in medical practice whether a syphilitic sore, unless of course of a most aggravated character, will produce _tetanus_, and that the difference between the symptoms and progress of _true tetanus_ and of that due to poison is, in the opinion of these experts, very marked. _Dr. James Blizard Curling_, surgeon to the London Hospital, was first called, and after describing the two kinds of _tetanus_ and their causes, and speaking of the very numerous cases of the “traumatic” kind which he had seen, he thus detailed the symptoms:—

“The disease first manifests itself about the jaws and neck. Rigidity of the muscles of the abdomen afterwards sets in. A dragging pain at the pit of the stomach is almost a constant attendant. In many instances the muscles of the back are extensively affected. These symptoms, though continuous, are liable to aggravations into paroxysms. As the disease goes on these paroxysms become more frequent and more severe. When they occur the body is drawn backwards; in some instances, though less frequent, it is bent forward. A difficulty in swallowing is a very common symptom, and also a difficulty of breathing during the paroxysms. The disease may, if fatal, end in two ways. The patient may die somewhat suddenly, from suffocation, owing to the closure of the opening of the windpipe; or he may be worn out by the severe and painful spasms, the muscles may relax, and the patient gradually sink. The disease is generally fatal. _The locking of the jaw is an almost constant symptom attending ‘traumatic tetanus;’ I may say a constant symptom. It is not always marked, but generally so. It is an early symptom._ Another symptom is a peculiar expression of countenance. I believe this is not peculiar to ‘_traumatic tetanus_,’ but my observation is from such cases. There is a contraction of the eyelids, a raising of the angles of the mouth, and contraction of the brow. In ‘_traumatic tetanus_’ the lower extremities are sometimes affected, and sometimes, but rarely, the upper ones. When the muscles of the extremities are affected, the time at which that occurs varies. If there is no wound in the arms or legs, the extremities are generally not affected until late in the progress of the disease. _I never knew of tetanus being produced by a sore throat or a chancre. In my opinion a syphilitic sore would not produce tetanus. I know of no instance in which one has led to tetanus. I think it a very unlikely cause._ The time within which ‘_traumatic tetanus_’ causes death varies from twenty-four hours to two or three days or longer. The shortest time to my knowledge was eight to ten hours. _When once commenced, the disease is continuous._”

_Question._—“Did you ever hear of a case in which a man was attacked one day, had twenty-four hours’ respite, and was then attacked the next day?”

_Witness._—“Never. Such a case could not occur.”

_Question._—“You have heard Mr. Jones’s account of the death of the deceased. _Were the symptoms there consistent with any forms of traumatic tetanus?_”

_Witness._—“_No._”

_Question._—“_What distinguishes it from such causes?_”

_Witness._—“_The sudden onset of the disease._ In all cases that have come under my observation the disease was preceded by the milder symptoms of _tetanus_, gradually proceeding to the complete development.”

_Question._—“_Were the symptoms described by Mills those of tetanus?_”

_Witness._—“_No. Not of tetanus of disease._”

_Question._—“Assuming tetanus to be synonymous with convulsive or spasmodic action of the muscles, was there, in that sense, _tetanus_ on Monday night?”

_Witness._—“No doubt there was spasmodic action of the muscles, but not _idiopathic_ or _traumatic tetanus_, because the sudden onset of the spasms, and their rapid subsidence, are consistent with neither of the two forms of _tetanus_.”

_Question._—“Is there not _hysteric tetanus_?”

_Witness._—“Yes: it is rather _hysteria_ combined with spasms, but it is sometimes called _hysteric tetanus_. I have known no instance of its proving fatal, or of it occurring to a man. Some poisons will produce _tetanus_. Nux vomica, acting through its poisons, strychnia and brucia, poisons of a cognate character, produce that effect. I never saw human or animal life destroyed by strychnia.”

In his _cross-examination_, Mr. Curling admitted that irritation of the spinal cord, or of the nerves proceeding to it, might produce _tetanus_, and the correctness of Dr. Watson’s statements in his Lectures, that, in four cases out of five, the disease begins with lockjaw, and that all the symptoms of tetanic convulsions may arise from very trivial blows; but he denied that there was any well authenticated instance of “_traumatic tetanus_” occurring within a quarter of an hour after the reception of the injury, or that it was very likely that the irritation of a syphilitic sore by wet, cold, drink, mercury, or mental excitement, might lead to _tetanic_ symptoms.

“The irritation,” said Mr. Curling, “which is likely to produce _tetanus_ is the sore being exposed to friction, to which syphilitic sores in the throat are not exposed. I should class _tetanus_ arising from the irritation of a sore as _traumatic_. Cases very rarely occur which it is difficult to class as either _traumatic_ or _idiopathic_. I should class _tetanus_ arising from irritation of the intestines as _idiopathic_. The character of the spasms of epilepsy are not tetanic.”

_Serjeant Shee._—“Not of the spasms; but are not the contractions of epilepsy sometimes continuous, so that the body may be twisted into various forms, and remain rigidly in them?”

_Answer._—“Not continuously.”

_Question._—“For five or ten minutes together?”

_Answer._—“I think not.”

_Question._—“Does it not frequently happen that general convulsions, no cause or trace of which in the form of disease or lesion is to be found in the body after death, occur in the most violent and spastic way so as to exhibit appearances of tetanic convulsions?”

_Answer._—“No instance of the kind has come under my observation.”[38]

_Question._—“Do you agree with this opinion of Dr. Copland, expressed in his _Dictionary of Practical Medicine_, under the head of ‘General Convulsions,’ ‘The abnormal contraction of the muscles is in some cases of the most violent and spastic nature, and frequently of some continuance, the relaxations being of brief duration or scarcely observable, and in others nearly or altogether approaching to tetanic?’”

_Answer._—“I would rather speak from my own observation. I have not observed anything of the kind.”

_Question._—“Does it not happen that a patient dies of convulsions, spasmodic in the sense of their being tumultuous and alternating, and chronic in the sense of exhibiting continuous rigidity, yet after death no disease is found?”

_Answer._—“It does not often happen to adults.”

_Question._—“Does it sometimes?”

_Answer._—“I do not know, nor have I read of such a case. I have no hesitation in saying that people may die from _tetanus_ and other diseases without the appearance of morbid symptoms after death.”

_Question._—“Are not convulsions, not, strictly speaking, tetanic, constantly preceded by retching, distention of the stomach, flatulence of the stomach and bowels, and other dyspeptic symptoms?”

_Answer._—“Such cases do not come under my observation as a hospital surgeon. I think it is very probable that general convulsions are accompanied by yelling. I don’t know that they frequently terminate fatally, and that the proximate cause of death is spasm of the respiratory muscles, inducing asphyxia.”

_Re-examined by the Attorney-General._—“These convulsions are easily distinguished from tetanus, because in them there is an entire loss of consciousness.”

_Question._—“Is it one of the characteristic features of _tetanus_ that the consciousness is not affected?”

_Answer._—“It is.”

_Dr. Todd_, for twenty-one years physician to King’s College Hospital, well known for his lectures on _Tetanus_ and the diseases of the Nervous System, and who had seen only two cases of what appeared to him to be _idiopathic tetanus_, so rare are they in this country, gave the following evidence:[39]—

“In my opinion the term _tetanus_ ought not to be applied to disease produced by poisons, but I should call the symptoms tetanic in order to distinguish the character of the convulsions. I have observed cases of _traumatic tetanus_. Except that in all such cases there is some lesion the symptoms are precisely the same as those of _idiopathic tetanus_. The disease begins with stiffness about the jaw. The symptoms gradually develope themselves and extend to the muscles of the trunk.”

_Question._—“When the disease has begun is there any intermission?”

_Answer._—“There are remissions, but they are not complete; only diminutions of the severity of the symptoms, not a total subsidence. The patient does not express himself as completely well, quite comfortable. I speak from my own experience.”

_Question._—“What is the usual period that elapses between the commencement and the termination of the disease?”

_Answer._—“The cases may be divided into two classes. Acute cases will terminate in three or four days, chronic cases will go on as long as from nineteen to twenty-two or twenty-three days, and perhaps longer. I do not think that I have known a case in which death occurred within four days. Cases are reported in which it occurred in a shorter period. In _tetanus_ the extremities are affected, but not so much as the trunk. Their affection is a late symptom. _The locking of the jaw is an early one._ Sometimes the convulsions of epilepsy assume somewhat of a tetanic character, but they are essentially distinct from tetanus. _In epilepsy the patient always loses consciousness._ Apoplexy never produces tetanic convulsions. Perhaps I may be allowed to say that when there is an effusion of blood upon the brain, and a particular portion of the brain is involved, the muscles may be thrown into short tetanic convulsions. In such a case the consciousness would be destroyed. Having heard described the symptoms attending the death of the deceased, and the _post-mortem_ examination, _I am of opinion that in this case there was neither apoplexy nor epilepsy_.”

The deposition of Dr. Bamford, before reported, was here read, his inability to attend from illness having been proved.

The _examination_ of Dr. Todd by the _Attorney-General_ was then proceeded with as follows:—

“Having heard the deposition of Dr. Bamford read, _I do not believe that the deceased died from apoplexy or from epilepsy. I never knew tetanus arise either from syphilitic sores or from sore throat._ There are poisons which will produce tetanic convulsions. The principal of these poisons are nux vomica and those which contain as their active ingredients strychnia and brucia. I have never seen human life destroyed by strychnia, but I have seen animals destroyed by it frequently. The poison is usually given in a largish dose in those cases, so as to put an end to the sufferings and destroy life as soon as possible. I should not like to give a human subject a quarter of a grain. I think that it is not unlikely that half a grain might destroy life; and I believe that a grain certainly would. I think that half a grain would kill a cat. The symptoms which would ensue upon the administration of strychnine when given in solution—and I believe that poisons of that nature act more rapidly in a state of solution than in any other form—would develope themselves in ten minutes after it was taken, if the dose was a large one; if not so large, they might be half an hour or an hour before they appeared. _Those symptoms would be tetanic convulsions of the muscles—more especially those of the spine and neck; the head and back would be bent back, and the trunk would be bowed in a marked manner; the extremities also would be stiffened and jerked out. The stiffness, once set in, would never entirely disappear; but fresh paroxysms would set in, and the jerking would reappear, and death would probably ensue in a quarter of an hour or so. The difference between tetanus produced by strychnia and other tetanus is very marked. In the former case the duration of the symptoms is very short, and instead of being continuous in their development, they will subside if the dose has not been strong enough to produce death, and will be renewed in fresh paroxysms: whereas in other descriptions of tetanus the symptoms commence in a mild form, and become stronger and more violent as the disease progresses._ The difficulty experienced in breathing is common alike to _tetanus_ properly so called, and to tetanic convulsions occasioned by strychnia, arising from the pressure on the respiratory muscles. I think it is remarkable that the deceased was able to swallow, and that there was no fixing of the jaw, which would have been the case with _tetanus_ proper, resulting either from a wound or from disease. _From all the evidence that I have heard, I think that the symptoms which presented themselves in the case of Mr. Cook arose from tetanus produced by strychnia._”

_Cross-examined by Mr. Grove, Q.C._—“There are cases sloping into each other, as it were, of every grade and degree, from mild convulsions to tetanic spasms. I have published some lectures upon diseases of the brain, and I adhere to the opinion there expressed, that the state of a person suffering from _tetanus_ is identical with that which strychnia is capable of producing. _In a pathological point of view, an examination of the spinal cord shortly after death, in investigating supposed deaths from strychnia, is important. The signs of decomposition, however, could be easily distinguished from the evidence of disease which existed previously to death, but it would be difficult to distinguish in such a case whether mere softening resulted from decomposition or from pre-existing disease._ There is nothing in the _post-mortem_ examination that leads me to think that the deceased died from _tetanus_ proper. _I think that granules upon the spinal cord, such as I have heard described, would not be likely to cause tetanus._ In animals to which strychnia has been administered I cannot say that I have observed what you call an intolerance of touch, but by touching them spasms are apt to be excited. That sensibility to touch continues as long as the operation of the poison continues. I have examined the interior of animals that have been killed by strychnia, but I have not observed in such cases that the right side of the heart was usually full of blood. It is some years since I made such an examination, but I am able, nevertheless, to speak positively as to the state of the heart. _It is usually empty on both sides._ I do not agree with Dr. Taylor, or other authorities, that, in cases of _tetanus_, animals died asphyxiated. If they did, we should invariably have the right side of the heart full of blood, which is not the case. I think the term asphyxiated is sometimes very loosely used. I know, from my reading, _that morphia sometimes produces convulsions, but believe they would be of an epileptic character. I think that the symptoms of morphia would be longer deferred in making their appearance than from strychnia_, but cannot speak positively on the point. Morphia, like strychnia, is a vegetable poison. I have not observed in animals the jaw fixed after the administration of strychnia.”

_Re-examined by the Attorney-General._—“Whatever may be the true theory as to the emptiness of the heart after strychnia, I should say that the heart is more ordinarily empty than filled after _tetanus_, and more contracted after strychnia, than in ordinary _tetanus_. I do not believe that a medical practitioner would have any difficulty in distinguishing between ordinary convulsions and tetanic convulsions. I have heard the evidence of the gentlemen who made the _post-mortem_ examination, and I apprehend that there was nothing to prevent the discovery of disease in the spinal cord had any existed previously to death.”

_Sir Benjamin Brodie’s_ evidence, which follows, was given “with great clearness, slowly, audibly, and distinctly,” and produced a marked effect.

_Sir Benjamin Brodie, examined by Mr. James, Q.C._—“I have been for many years senior surgeon to St. George’s Hospital, and have had considerable experience as a surgeon. In the course of my practice I have had under my care many cases of death from _tetanus_. Death from _idiopathic tetanus_ is, according to my experience, very rare in this country. The ordinary _tetanus_ in this country is _traumatic tetanus_. I have heard the symptoms which accompanied the death of Mr. Cook, and I am of opinion that so far as there was a general contraction of the muscles they resembled those of _traumatic tetanus_; but, as to the course those symptoms took, they were entirely different. I have attended to the detailed description of the attack suffered by Mr. Cook on the Monday night, its ceasing on Tuesday, and its renewal on the Tuesday night. The symptoms of _traumatic tetanus_ always begin, so far as I have seen, very gradually, the stiffness of the lower jaw being, I believe, invariably, the symptom first complained of—at least, so it has been in my experience. The contraction of the muscles of the back is always a later symptom—generally much later. The muscles of the extremities are affected in a much less degree than those of the neck and trunk, except in some cases where the injury has been in a limb, and an early symptom has been spasmodic contraction of the muscles of that limb. I do not myself recollect a case of ordinary _tetanus_ in which occurred that contraction in the muscles of the hand which I understand was stated to have taken place in this instance. Again, ordinary _tetanus_ rarely runs its course in less than two or three days, and often is protracted to a much longer period. I knew one case only in which the disease was said to have terminated in so short a time as twelve hours; but probably in that case the early symptoms had been overlooked. Again, I never knew the symptoms of ordinary _tetanus_ to last for a few minutes, then subside, and then come on again after twenty-four hours. I think that these are the principal points of difference which I perceived between the symptoms of ordinary _tetanus_ and those which I have heard described in this case. I have not witnessed tetanic convulsions from strychnia on animal life. I do not believe that death in the case of Mr. Cook arose from what we ordinarily call _tetanus—either idiopathic or traumatic. I never knew tetanus result from sore throat or from a chancre, or from any other form of syphilitic disease. The symptoms were not the result either of apoplexy or of epilepsy. Perhaps I had better say at once that I never saw a case in which the symptoms that I have heard described here rose from any disease._ (Sensation.) _When I say that, of course I refer not to particular symptoms, but to the general course which the symptoms took._”

_Cross-examined by Mr. Serjeant Shee._—“I believe I remember one case in the physician’s ward of St. George’s Hospital, which was shown to me as a case of _idiopathic tetanus_, but I doubted whether it was _tetanus_ at all. It was a slight case, and I do not remember the particulars.”

_Question._—“Considering how rare cases of _tetanus_ are, do you think that the description given by a chambermaid and a provincial medical man, who had never seen but one case, is sufficient to enable you to form an opinion as to the nature of the case?”

_Answer._—“I must say I thought that the description was very clearly given.”

_Question._—“Supposing that they differed in their description, which would you rely upon—the medical man or the chambermaid?”

_Lord Campbell._—“That is hardly a proper question.”

_Baron Alderson._—“It may be a very proper observation for you to make.”

_Cross-examination continued._—“I never knew syphilitic poison produce tetanic convulsions, except in cases where there was disease of the bones of the head.”

Two other surgeons, _Dr. Daniell_, late surgeon to the British Hospital, and _Mr. Samuel Solly_, of St. Thomas’s Hospital, confirmed in every respect the views of the previous medical witnesses, that the circumstances attending Cook’s death were clearly distinguishable from those attendant on ordinary _tetanus_. They relied on the fact that ordinary _tetanus_ was always progressive, and that it is never intermittent to the extent witnessed in Cook’s case, and seldom endured less than from thirty to forty hours. Mr. Solly alluded to the peculiar grin—“the _risus Sardonicus_, as the first symptom of _true tetanus_, which is not common to all convulsions, and which having once seen,” he said, “you cannot forget.” He distinguished between _tetanus_ with convulsions and death from epileptic convulsions by the fact that “the first seldom leaves any trace behind it, whilst the latter does leave its trace in the shape of a slight effusion of blood on the brain, and a congestion of the vessels.” The syphilitic theory was finally overthrown by the testimony of _Mr. Henry Lee_, surgeon to the Lock Hospital, which is exclusively devoted to syphilitic cases. Though he saw there nearly 3000 cases a year, he had never known one resulting in _tetanus_, or read of a case of primary or secondary symptoms having that result.

In addition to these experts, on the sixth day important evidence was given by _Dr. Jackson_, who had had twenty-five years’ experience of _tetanus_ in India, on the difference of the symptoms observed in the _idiopathic_ and _traumatic_ kinds; the former being much more frequent in India than in other climates, affording him in his practice as many as forty cases.

“It is as equally fatal,” said Dr. Jackson, “according to my experience, as _traumatic_. It is frequently found, in India, in children, both natives and Europeans, and generally takes place the third day after birth. It will also be occasioned by cold in that climate. In infants there is a more marked symptom of lockjaw in _idiopathic tetanus_. In adults there is no difference in the symptoms from _traumatic_. I have always seen the _idiopathic_ form preceded by premonitory symptoms, such as a peculiar expression of the countenance, stiffness of the muscles of the throat and of the jaw. The usual period from the attack to death in infants is forty-eight hours; in adults, when arising from cold, it is of longer duration, and may continue for many days, going through the same grades as the _traumatic_ forms.”

_Cross-examined by Mr. Serjeant Shee._—“The patient always appears to be very uncomfortable shortly before an attack of _idiopathic tetanus_. His appetite would not be affected, but he would chiefly complain of the muscles of the neck. He might entertain a desire for food, and take it as usual within twelve hours of the attack. I never heard a patient complain of want of appetite. Within the twelve hours I should say that the patient’s attention would be more directed to the stiffness of his mouth and neck. I have known cases of _idiopathic tetanus_, where the first paroxysm was in bed. Difficulty of swallowing is another premonitory symptom.”

_Re-examined by the Attorney-General._—“In the case of a child not more than six hours would elapse between the premonitory symptoms and the tetanic convulsions; in an adult the period would not be greater than twenty-four hours. The duration of the disease generally varies from three to ten days, but death has occurred as early as two days. The _traumatic_ and _idiopathic_ cases are alike in these respects. Both forms of the disorder are much more common in India than they are in this country. The symptoms are not more severe. _In all my experience I never saw a case in which the disease ran its course in twenty minutes._”

LATE EXAMPLES OF DEATH BY STRYCHNIA.

Four cases of undoubted poisoning by strychnia were brought forward by the prosecution, in each of which the symptoms had been observed by medical men, as well as by the attendants on the several patients. In the _first_ case, that of Agnes Sennett, or French, a patient in the Glasgow Infirmary, in September, 1845, for a sore skin, from thoughtlessness apparently, she took one of two strychnia pills prepared for a paralytic patient, and then went and sat by the ward fire. “In three quarters of an hour,” said _Kelly_, another patient, “she was taken ill and fell back on the floor. I went for the nurse; we took her to bed, and sent for the doctor; we were obliged to cut her clothes off first because she never moved. She was like a poker. She never spoke till she died.” Each pill, according to the prescription, contained a quarter of a grain of strychnia. When the medical clerk of the hospital saw her in bed, the symptoms were—

“_A strong retraction of the mouth; the face much suffused and red; the pupils of the eyes dilated; the head bent back; the spine curved, and the muscles rigid and hard as a board; the arms stretched out; the hands clinched; and there were severe paroxysms occurring in about a quarter of an hour. She died in about an hour and a quarter._ When I was called the paroxysms did not last so long; but they increased in severity.” “_The retraction of the mouth was continuous, but worse at times._ I do not think I observed it after death. _The hands were not clinched after death; they were semi-bent._ The symptoms appeared about thirty minutes after taking the pills. I tried to make her vomit with a feather. She only vomited partially after I had given her an emetic. _There was spasmodic action and grinding of the teeth. She could open her mouth and swallow. There was no lockjaw or ordinary tetanus._”[40]

_Dr. Watson_, the surgeon to the infirmary, who was called in within a quarter of an hour of the patient being taken ill, said, “_She was in violent convulsions, and her arms stretched out and rigid; they were kept quiet by rigidity. She did not breathe, the muscles being kept still by tetanic rigidity._ That paroxysm subsided, and fresh ones came on after a short interval. She died in about half an hour. She was perfectly conscious. Her body was opened. _The heart was found distended and stiff. The cavities of it were empty._ The spinal cord was healthy.”

The _second_ case, also of accidental poisoning, by the error of a local chemist, who substituted strychnia for salicine (willow bark), of which there ought to have been nine grains in the bottle of medicine, was that of a Mrs. Sergeantson Smyth, residing near Romsey. On the 30th of October, 1848, she took half a wine-glass of the mixture, equal to a third of the whole, containing three grains of strychnia. The effect was of course immediate. The symptoms were identical with Cook’s.

“I left the room,” said _Hickson_, the lady’s maid, “when I had given it her. Five or ten minutes afterwards I was alarmed by the ringing of her bell. I went into her room and found her out of bed leaning upon a chair in her night-dress. I thought she had fainted. She appeared to suffer from what I thought were spasms. I ran and sent the coachman for Dr. Taylor, and returned to her. Some of the other servants were there assisting her. _She was lying on the floor. She screamed loudly, and her teeth were clinched. She asked to have her arms and legs held straight. I took hold of them; they were very much drawn up. She still screamed and was in great agony. She requested that water should be thrown over her, and I threw some. I put a bottle of hot water to her feet, but it did not relax them. Shortly before she died she said she felt easier. The last words she uttered were, ‘Turn me over.’ She died very quietly. She was quite conscious, and knew me during the whole time. About an hour and a quarter after I gave her the medicine she died._”

_Cross-examined by Mr. Grove, Q.C._—“She could not sit up from the time I went to her till she died. It was when she was in a paroxysm that I tried to straighten her limbs. The effect of the cold water was to throw her into a paroxysm. It was a continually recurring attack, lasting about an hour and a quarter. Her teeth were clinched the whole time.”

_Re-examined._—“She was stiff all the time till within a few minutes of her death. She was conscious all the time.”

_Mr. Francis Taylor_, of Romsey, found her dead on his arrival. “Her body was on the floor by the bed; _the hands very much bent; the feet contracted and turned inwards; the soles of the feet hollowed up and the toes contracted, apparently from recent spasmodic action; the inner edge of each foot was turned; there was a remarkable rigidity about the limbs; the body was warm, and the eyelids almost adherent to the eyeballs._” Three days afterwards the witness made a _post-mortem_ examination, with the following results:—

“The contraction of the feet continued, but it had gone off somewhat from the rest of the body. I found no disease in the body. _The heart was contracted, and perfectly empty_, as were all the large arteries leading from it. I analysed the medicine she had taken with another medical man. It contained a large quantity of strychnia. It had originally contained nine grains; she had taken a third—three grains. I made a very casual examination of the stomach and bowels, as we had plenty of proof that poison had been taken, without the use of tests.”

_Cross-examined by Mr. Serjeant Shee._—“In cases of death from ordinary causes the body is much distorted. It does not generally remain in the same position. If the body is not laid out immediately, probably it is stiffened by the _rigor mortis_. The ankles were tied by a bandage to keep them together. I commenced to open the body by the thorax and abdomen. The head also was opened.”

The _third_ case was that of a Mr. Clutterbuck, a gentleman suffering from paralysis, on whom, with _Dr. Chambers_, _Mr. E. D. Moore_, who detailed the case, had attended some fifteen years before.

“We had been giving him,” said the witness, “small doses of strychnia, when he went to Brighton. On his return he told us he had taken larger doses of it, and we in consequence gave him a stronger dose. I made up three draughts of a quarter of a grain each. He took one in my presence. I remained with him a little time, and he said he felt quite comfortable. About three quarters of an hour afterwards I was summoned to him. _I found him stiffened in every limb, and the head drawn back. He was desirous we should move him, and turn him and rub him._ We tried to give him ammonia in a spoon, _and he snapped at it_. He was suffering, I should say, more than three hours. Sedatives were given to him. He survived the attack. _He was conscious all the time._”

_Cross-examined by Mr. Serjeant Shee._—“The spasms ceased in about three hours, but the rigidity of the muscles remained till the next day. His hands were at first drawn back, and he was much easier when we got them round clinched together. His paralysis was better after the attack.”

_Re-examined by the Attorney-General._—“Strychnia stimulates the nerves which act upon the voluntary muscles, and therefore acts beneficially in cases of paralysis.”

The _fourth_ case of poisoning by strychnia, though at this time given anonymously, as it had not as yet been brought to a public trial, was that of Mrs. Dove, of Leeds, more fully related in the next report. In this case, _Mrs. Witham_, who had been in attendance on the deceased, described how, after taking the medicine given to her, “_She complained first of her back; her head was thrown back; her body stretched out; that she twitched, her eyes were drawn aside, staring, and that when the witness put her hands on the patient’s limbs they did not relax._” In this case the illness commenced on the 25th of February; attacks came on the 27th, 28th, and 29th (the last a very slight one), and then again, about a quarter past eight, on the 1st of March, and the person died about twenty minutes to eleven on that night. “She principally complained of prickings in the legs, twitchings in the muscles and in the hands, which she said she could compare to nothing else than a galvanic shock. Between the attacks, she was composed. _She wished her husband to rub her legs and arms._ She was dead when the doctor came.”

On _cross-examination_, the witness said that the sufferer “_could not bear to have her legs touched when the spasms were strong upon her. Her limbs were rigidly extended when she asked to be rubbed between the intervals of the spasms. Touching her then brought on the spasms. Her body was stiff immediately after death_,” but how long it continued so the witness could not say, as she did not stay long. _She was sensible from half an hour to an hour_, from a quarter past eight till after nine, and the witness _supposed she was insensible the remainder of the time; she did not speak_. On the Saturday before she died the symptoms were the same as on the other days—not more violent.”

_Mr. Morley_, the surgeon who had attended this case, and whose opinion as to the symptoms being identical with those in the present inquiry, was directly opposed by _Mr. Nunneley_, of Leeds, who had then assisted him in the _post-mortem_ examination, not only detailed the symptoms he then saw, but also the method and results of his subsequent examination of the body.

“I had attended,” said Mr. Morley, “on the lady to whom the last witness has alluded for about two months before her death. On the Monday before she died she was in her bed, apparently comfortable, when I observed (as I stood by her side) _several slight convulsive twitchings of her arms_. I supposed they arose from hysteria, and ordered medicine in consequence. _The same symptoms appeared on the following Wednesday and Thursday._ I saw her on Saturday, the day she died. She was apparently better and quite composed in the middle of the day. She complained of an attack she had had at night. She spoke of pain and spasms in her back and neck, and of shocks. I and another medical man were sent for hastily on Saturday night. We were met by an announcement that the lady was dead. On the Monday I accompanied another medical gentleman (Nunneley) to the _post-mortem_ examination. We found no disease in any part of the body which would account for death. There was no emaciation, wound, or sore. _There was a peculiar expression of anxiety in the countenance. The hands were bent and the fingers curved. The feet were strongly arched._ We carefully examined the stomach and its contents for poison. We applied several tests—nitric acid, followed by protochloride of tin,[41] sulphuric acid, followed by bichromate of potash in a liquid and also in a solid state. They are the best tests to detect strychnia. In each case we found appearances characteristic of strychnia. We administered the strychnia taken from the stomach to animals by inoculation—to two mice, two rabbits, and a guinea-pig, having first separated it by chemical analysis. We observed in each of the animals more or less of the effects produced by strychnia, namely—_general uneasiness, difficult breathing, convulsions of a tetanic kind, muscular rigidity, arching backwards of the head and neck, violent stretching out of the legs._ These symptoms appeared in some of the animals in four or five minutes, in others in less than an hour. The guinea-pig suffered but slightly at first, and was left, and was dead next day. The symptoms were strongly marked in the rabbits. After death there was an interval of flaccidity, after which rigidity commenced, more than if it had been occasioned by the _rigor mortis_. I afterwards made numerous experiments on animals with exactly similar results, the poison being administered in a fluid form.”

_Cross-examined by Mr. Grove._—“I did not see the patient during a severe attack. I have observed in animals that spasms are brought on by touch. That is a very marked symptom. The spasm is like a galvanic shock. The patient was not at all insensible during the time I saw her, and she was able to swallow, but I did not see her during a severe attack. After death we found the lungs very much congested. There was a small quantity of bloody serum found in the pericardium. The muscles of the whole body were dark and soft. There was a decided quantity of effusion in the brain. There was also a quantity of serum tinged with blood in the membranes of the spinal cord. The membranes of the spinal marrow were congested to a considerable extent. We opened the head first, and there was a good deal of blood flowing out. _Part of the blood may have flowed from the heart. That might partially empty the heart, and would make it uncertain whether the heart was full or empty at the time of death. I have often examined the hearts of animals poisoned by strychnia. The right side of the heart is generally full._ In some cases I think that the symptoms did not appear for an hour after the administration of the poison. I have made the experiments in conjunction with Mr. Nunneley. We have made experiments upon frogs, but they are different in many respects from warm-blooded animals. I have in almost all cases found the strychnia where it was known to have been administered. In one case it was doubtful. We were sure the strychnia had been administered in that case, but we doubted whether it had reached the stomach. There were appearances which might lead one to infer the presence of strychnia, but they were not satisfactory. I have detected strychnia in the stomach nearly two months after death, when decomposition has proceeded to a considerable extent.”

_Re-examined by the Attorney-General._—“From half a grain to a grain has been administered to cats, rabbits, and dogs. From one to two grains is quite sufficient to kill a dog.”

_Question._—“How does the strychnia act? Is it taken up by the absorbents, and carried into the system?”

_Answer._—“I think it acts upon the nerves, but a part may be taken into the blood and act through the blood. We generally examined the stomach of the animals when the poison had been administered internally. Sometimes we examined the skin. The poison found in the stomach would be in excess of that absorbed into the system.”

_Question._—“Are you then of opinion that, a portion of the poison being taken into the system and a portion being left in the stomach, the portion taken into the system would produce tetanic symptoms and death?”

_Mr. Serjeant Shee_ objected to a question which suggested a theory.

_The Attorney-General._—“What would be the operation of that portion of the poison which is taken into the system?”

_Answer._—“It would destroy life.”

_Mr. Baron Alderson._—“And yet leave an excess in the stomach?”

_Answer._—“That is my opinion.”

_The Attorney-General._—“Would the excess remaining in the stomach produce no effect?”

_Answer._—“I am not sure that strychnia could lie in the stomach without acting prejudicially.”

_Question._—“Suppose that a minimum quantity is administered, which, being absorbed into the system, destroys life, should you expect to find any in the stomach?”

_Answer._—“I should expect sometimes to fail in discovering it.”

_Question._—“If death resulted from a series of minimum doses spread over several days, would the appearance of the body be different from that of one whose death had been caused by one dose?”

_Answer._—“I should connect the appearance of the body with the final struggle of the last day.”

_Question._—“Would you expect a different set of phenomena in cases where death had taken place after a brief struggle, and in cases where the struggle had been protracted?”

_Answer._—“Certainly. At the _post-mortem_ examination of which I have spoken we found fluid blood in the veins.”

_Mr. Serjeant Shee._—“Is it your theory that in the action of poisoning the poison becomes absorbed and ceases to exist as poison?”

Answer.—“I have thought much upon that question, and have not formed a decided opinion, but I am inclined to think that it is so. A part may be absorbed and a part remain in the stomach unchanged.”

_Mr. Serjeant Shee._—“What chymical reason can you give for your opinion that strychnia, after having effected the operation of poisoning, ceases to be strychnia in the blood?”

_Answer._—“My opinion rests upon the general principle that, in acting upon living bodies, organic substances—such as food and medicine—are generally changed in their composition.”

_Mr. Serjeant Shee._—“What are the component parts of strychnia?”

_Mr. Baron Alderson._—“You will find that in any cyclopædia, brother Shee.”

_Mr. Serjeant Shee._—“Have you any reason to believe that strychnia can be decomposed by any sort of putrefying or fermenting process?”

_Witness._—“I doubt whether it can.”[42]

ANALYTICAL EVIDENCE.

On the fifth day, the late _Doctor Alfred Swaine Taylor_, the well-known Analytical Chemist and Author of “Medical Jurisprudence” (the text-book of the legal profession in all criminal investigations), _Doctor Owen Rees_, now one of the physicians extraordinary to her Majesty, and the late _Professor Brande_, of the Royal Institution, were called as witnesses. By the two first, the analytical examination of the various parts of Mr. Cook’s body had been conducted, and they had made a joint report of the results. By the last, that report had been carefully examined, and he had also heard all the evidence as to symptoms previously given in the case. No inconsiderable portion of the _cross-examination_ of Dr. Taylor was occupied by questions connected with the publication, in the _Illustrated Times_, by Mr. Augustus Mayhew, of what professed to be statements as to the details of their analysis by Dr. Taylor and Dr. Rees, in which, if correctly reported, the former had committed himself somewhat prematurely to opinions on the case, and had used expressions towards the prisoner which, to say the least, were not discreet. Dr. Taylor, however, stoutly maintained that he had not used many of the expressions objected to; that the opportunity of interviewing him, after the American fashion, had been unfairly obtained, and the pretended report published not only without, but contrary to, his expressed wish. Except, however, as throwing a shade of partisanship over his conduct, and so far lessening the value of his evidence, the whole episode was useless to the defence—perhaps, to a certain extent, injurious. Dr. Taylor had been hasty and injudicious, and undoubtedly taken at an advantage by the energetic reporter, who certainly obtained his interview with him by pretences not strictly true.[43] With these remarks, due to Dr. Taylor’s reputation and abilities, we proceed to give his evidence.

_Dr. Alfred Swaine Taylor, examined by the Attorney-General._—“I am a fellow of the College of Physicians, lecturer on medical jurisprudence at Guy’s Hospital, and the author of the well-known treatise on poisons and on medical jurisprudence. I have made the poison called strychnia the subject of my attention. It is the produce of the nux vomica, which also contains brucia, a poison of an analogous character. Brucia is variously estimated at from one-sixth to one-twelfth the strength of strychnia. Most varieties of impure strychnia that are sold contain more or less brucia. Unless, therefore, you are certain as to the purity of the article, you may be misled as to its strength. I have performed a variety of experiments with strychnia on animal life. I have never witnessed its action on a human subject. I have tried its effects upon animal life—upon rabbits—in ten or twelve instances. The symptoms are, on the whole, very uniform. The quantity I have given has varied from half a grain to two grains. Half a grain is sufficient to destroy a rabbit. I have given it both in a solid and liquid state. When given in a fluid state it produces its effects in a very few minutes; when in a solid state, as a sort of pill or bolus, in about six to eleven minutes. The time varies according to the strength of the dose, and also to the strength of the animal.”

_Question._—“In what way does it operate, in your opinion?”

_Answer._—“It is first absorbed into the blood, then circulated through the body, and especially acts on the spinal cord, from which proceed the nerves acting on the voluntary muscles.”

_Question._—“Supposing the poison has been absorbed, what time would you give for the circulating process?”