Chapter XI: Part 11

Do you think it would make any difference if the contents were lost?--If there were no contents spread over the intestines, then that would make a difference. If they had been spilt and shaken, then it would make no difference.

But, supposing they were not there?--There would be the washings of the stomach. If the stomach was sent me with no contents, I would wash the stomach and proceed with that.

If you had tried on the tissues of the deceased’s body I suppose you would have been able to ascertain whether there had been any strychnia?--That is my opinion.

So that the time that has elapsed since Cook died would not matter. If you had an opportunity to operate on it, you would have found the strychnia?--If it had been there, I feel satisfied I should find it.

LORD CAMPBELL--Do you mean then or now?--I do not see that the time would prevent it.

* * * * *

[Sidenote: H. Letheby]

Dr. HENRY LETHEBY, examined by Mr. KENEALY--I am a Bachelor of Chemistry and Professor of Medicine in the London Hospital; also a medical officer of health to the city of London. I have for a considerable time studied poisons. I believe in every case of this kind tried in this Court during the last fourteen years I have been engaged on behalf of the Crown. I have been present during the examination of the medical witnesses at this trial and heard them describe certain symptoms attending the death of Mr. Cook. I have seen many deaths by strychnia in the lower animals. I have seen several cases of nux vomica in the human subject, one of which was fatal. The symptoms in the animals do not accord with the symptoms in this case. In the first place, I have never known such a long interval between the administration of the poison and the coming on of the symptoms. The longest interval has been three-quarters of an hour, and then the poison was given in a form not easy of solution, and when the stomach was full. I have seen the symptoms begin in five minutes after the poison was administered. A quarter of an hour would be the average. Another reason is that in all the animals I have seen, and the human subject also, when under strychnia, the system has been so irritable that the very slightest excitement, as an effort to move, a slight touch, a noise, or a breath of air, will set them off in convulsions. I do not think it at all probable that a person to whom a dose of strychnia had been given could rise out of bed and ring a bell violently. Any movement at all would excite the nervous system, and there would be spasms. It is not likely a person in that state of nervous irritation could bear to have his neck rubbed. Where poisoning by strychnia does not end fatally, the paroxysm is succeeded by other paroxysms, which gradually shade themselves off. They generally become less and less, over a period of some hours. My experience agrees with Dr. Christison, that it would last over a period of sixteen or eighteen hours before the man gets better. I do not hesitate to say that strychnia is of all poisons the most easy of detection. I have detected it in the stomach, in the blood, and in the tissues of animals in numerous instances. The longest period after death that I have examined a body has been one month. The animal was then in a state of decomposition, and I succeeded in detecting very minute portions of the strychnia. When the strychnia is pure it can be detected in a very small portion of a part, at least the twentieth part of a grain. When mixed up with other matter it is a little more difficult. I can detect the tenth part of a grain in a pint of any liquid that you put before me, whether the liquid was pure or putrefied.

You have succeeded in detecting it in animals which have been killed a month, and were in a state of decomposition. What is the dose you have given them?--I gave the animal, a rabbit, originally half a grain, which killed it, and I have the strychnia here within a fraction of what I gave. I lost about a tenth part of a grain in the course of the investigation.

[Sidenote: H. Letheby]

Supposing a person had taken strychnia eight or ten days before, and that he died of strychnia poison, should you be able positively to say that you could detect it?--I do say so positively. I have never failed. In the post-mortem examinations I have always found the right side of the heart full of blood. The reason for that is that the death takes place by the fixing of the muscles of the chest in spasm. In my opinion this is invariably so. At that time the blood is unable to pass through the lungs, and the heart cannot relieve itself of the blood that is flowing into it. It therefore becomes gorged. I have also observed that the lungs are congested, filled with blood.

Do you agree in the opinion of Dr. Taylor that where strychnia is administered as a sort of pill or bolus it kills from about six to eleven minutes?--It may do so. I do not say it would always. I agree with him that the jaws are spasmodically closed, and also that the slightest noise reproduces another convulsive paroxysm. I do not agree with Dr. Taylor that the colouring tests for the discovery of strychnia are fallacious. They always succeeded with me.

Dr. Taylor has given as a reason for the non-finding of the strychnia that it is absorbed into the blood and becomes changed?--I agree with its absorption, but I do not agree with its being changed.

Have you turned your attention to the theory that strychnia is decomposed after the poisoning?--I have examined the tissues of the body and I have found it; and my opinion is that it is not changed so as not to be discoverable.

Supposing the contents were put into a jar and jumbled up with the intestines and a portion of the stomach, would that prevent the discovery of strychnia?--It would not.

Supposing that all the contents of the stomach were lost, ought the mucous membrane, in the ordinary course of things, to exhibit traces of strychnia?--I think so.

I have also studied the poison of antimony.

Supposing a quantity of antimony were placed in some brandy and water, and it was drunk off at a sudden gulp, would the immediate effect of that be to burn the throat, or anything of that kind?--No. Not in the form of tartar emetic.

[Sidenote: H. Letheby]

Cross-examined by the ATTORNEY-GENERAL--I am neither a member of the College of Physicians nor of the College of Surgeons. I do not now carry on business in the medical line, but have done so in general practice for not more than two or three years. I have destroyed about fifty animals by strychnia, some within the last two months. I have never given more than a grain. In recent cases I have always administered the poison in a solid form--sometimes made into a pill with bread, and at other times put on the tongue of the animal. In one case I gave it under very disadvantageous circumstances; the dog had had a very hearty meal, and it was kneaded up into a hard mass with some bread, and it took three-quarters of an hour before the action came on. There was one other case which took about half an hour, but the poison, half a grain, was not given in sufficient quantity. We gave it another dose, which acted in about ten minutes.

Dr. Nunneley describes the symptoms--first, a desire to be still, then a difficulty in breathing, a slobbering of the mouth, twitching of the ears, trembling of the muscles, and, after that, convulsions; did you observe all these?--I cannot say all of them in that order. There is an excitement manifested in the animal, an indisposition to touch, and trembling on being touched.

I am speaking of the symptoms before the convulsions. The touching, did that occasion a tremulous action of the muscles?--Yes, I have noticed that.

Have they come on in regular order?--No, I think not. There are some little variations.

After the convulsions have once commenced, is there an interval?--Yes. A breath, a sound, or a touch will cause a recurrence of the convulsive symptoms after they have been seized. This does not apply where the animal dies in the first paroxysm, and I have known many cases where an animal has so died.

You mentioned a distinctive feature in this case of Cook. You were surprised at his manifesting so much power as to be able to sit up in bed and ring the bell. Are you aware that that was at the commencement, before any of the convulsive symptoms had set in?--Yes, I apprehend that was at the onset or beginning of the paroxysm.

Do you know that he sat up in bed and rang the bell, and it was not till Palmer had been and had gone back and brought the pills that the convulsions came on?--Yes, I do; and I have noticed in animals that the mere touch sends them into convulsions, and they show an indisposition to move.

In the case of the lady who died near Romsey, did you hear what the maid said, that she discovered, when her mistress’ bell rang violently, that she had got out of bed and was sitting on the floor?--It struck me as inconsistent with what I have seen. I have no doubt that was a death from strychnia.

If that evidence be true, and it is a fact that she got up and rang her bell, does not that shake your faith?--No, it does not. You must compare it with what I have seen. Both are irreconcilable with what I have seen.

[Sidenote: H. Letheby]

Speaking of the Tuesday night, with the exception of the ringing of the bell, and that in this case it was an hour or an hour and a half after the supposed administration of the poison, can you point to anything to distinguish the symptoms and death of Mr. Cook from death by tetanus of strychnia?--No, I cannot. It is inconsistent with what I have seen, but it is not inconsistent with what I have heard in the case of Mrs. Smyth.

Is not one of the symptoms hard breathing?--It is a panting respiration. It is excitement of the breathing rather than difficulty. It is in the convulsions that there is a difficulty of breathing. If a man were to breathe hardly it is a position naturally assumed for him to sit up. Until the convulsion of the muscles comes on there is nothing to prevent the patient sitting up.

If I understand you, if I except the delay and the fact of his sitting up in bed and crying for help on the Tuesday, is there anything to distinguish the convulsions under which this man suffered and died from the convulsions of tetanus of strychnia?--It is not perfectly consistent with strychnia, because I say that the account which is given of Mrs. Smyth is what I cannot reconcile with what I have before observed.

With regard to the abrupt termination instead of the gradual subsidence?--I have observed the gradual subsidence in man as well as in animals.

In the case of the man--what dose had he taken?--Nearly a grain and a half.

This is a strongish dose?--Yes.

You might expect a recurrence of the paroxysm?--Certainly. The subsidence will not depend on the strength of the dose; it will depend on whether the individual is to recover or not. I have seen four or five instances of recoveries.

Is it not generally known that the effect of strychnia is very varied in different individuals?--No, I do not think so. There would be a little variation in time, but in the main features of the case there is no variation.

Do not you find this difference, that from the same dose in the same species you get no paroxysm, or you get a series of paroxysms ending in death?--Yes, that is true; but the attacks are the same for all that. The symptoms are the same.

What do you say about the Sunday night fit?--I was disposed to think it was a fit. I cannot tell you what it was; I have formed no opinion.

What do you ascribe Mr. Cook’s death to?--It is irreconcilable with everything I am acquainted with.

By LORD CAMPBELL--Is it reconcilable with any known disease which you have ever seen or heard of?--No, my lord.

[Sidenote: H. Letheby]

Re-examined by Mr. SERJEANT SHEE--Do you mean to say it could not be the result of any variety of convulsions, however violent, though not classed under a particular description of convulsion?--We are learning new facts every day, and I do not conceive it to be impossible that some peculiarity of the spinal cord, unrecognisable except the examination be made immediately after death, may produce symptoms like these.

When you say it is irreconcilable with anything you have heard of, do you include anything you have heard of strychnia poison as well as anything else?--Certainly I do.

Is the vomiting of the pills just before death inconsistent with what you have known and observed of strychnia poison?--It is not consistent with anything I have observed.

Have you ascertained whether, if you touch an animal which is beginning those minor premonitory symptoms, but which as yet has had no paroxysms, this brings the paroxysms on?--Yes.

Was not the Romsey case exceptional from the manner in which the strychnia was administered and the quantity of the dose?--Yes, it was. It is quite consistent with all I am saying that the ringing of the bell by the lady the moment she felt anything of uneasiness would produce the paroxysm which ultimately was observed. In my judgment, it is not safe to argue from the symptoms of a case in which the paroxysm took place only a few moments after the ingestion of the poison, and it was in a fluid state, to what may be the probabilities in another case.

* * * * *

[Sidenote: R. E. Gay]

Mr. ROBERT EDWARD GAY, examined by Mr. SERJEANT SHEE--I am a member of the Royal College of Surgeons. In 1855 I attended a person named Foster suffering under tetanus. He had an inflammatory sore throat, muscular pains in the neck and the upper portion of the spinal vertebræ. He was feverish, and had the usual symptoms attending catarrh. On about the fourth day the muscular pains extended to the face. A difficulty of swallowing came on, the pains in the muscles covering the spinal vertebræ and in those of the lower jaw increased. In the evening of that day the jaw became completely locked; the pain came on in the muscles of the bowels, the same in the legs and the arms. He became very much convulsed throughout the entire muscular system. He had frequent and violent convulsions of the arms and hands, and afterwards of the legs. The difficulty of swallowing increased up to the ninth or tenth day. Not a particle of food, either solid or liquid, could be taken or introduced to the mouth. An attempt to swallow the smallest portion brought on the most violent convulsions. The convulsions were so strong throughout the whole system that I could compare him to nothing more than a piece of warped board in shape. The head was drawn back, the abdomen was forced forward, and the legs were frequently drawn upwards and backwards. The attempt of feeding with the spoon, the opening of the window, or placing the fingers on the pulse frequently brought on violent convulsions. He complained of great hunger. He was able to speak. He repeatedly cried out he was very hungry, what would he do if he could not eat? and he was kept alive till the fourteenth day by injections of a nutritive character. He screamed during these convulsions, and the noises he made were more like those of a dying man. About the twelfth day he became insensible. The convulsions, although very weak, continued till the fourteenth day, when he died. He was by business an omnibus conductor. He had been ill some few days--it might be a week. He had no other hurt or injury to his person of any kind which would account for these symptoms. His body was not examined after death.

By LORD CAMPBELL--What do you call the disease?--I call it inflammatory sore throat from cold and exposure to the weather. The symptoms became tetanic in consequence of an extremely nervous and anxious disposition. He had a very large family, and was a very hard-working man. I did not hear the evidence of the witnesses who described the symptoms of Mr. Cook.

Cross-examined by the ATTORNEY-GENERAL--That is what you call idiopathic tetanus?--Yes, decidedly so. I have had a vast number of cases of inflammatory sore throats and a great many anxious, nervous patients. That is the only case I have ever seen of idiopathic tetanus.

If I rightly apprehend your history of the symptoms, the disease was altogether progressive in its character, and, although there was an occasional cessation of the more painful symptoms, there never was a full cessation of the symptoms?--He was not suffering from tetanic affection. There was a twitching of the muscles going on, but there was not that violent convulsion. The lockjaw was the first of the more aggravated symptoms that presented itself, the muscular spasms about the trunk of the body progressing onwards to the extremities. He was conscious till the tenth day, when insensibility supervened while the convulsions were upon him. I consider the brain had been affected and congestion had taken place, and that produced insensibility.

After that was there some diminution in the severity of the convulsions?--Very great diminution, but they still continued.

Would that be likely to take place from the constant recurrence of the convulsions?--From the constant recurrence of the convulsions the brain would be congested.

You would expect to find a difference in that respect in a case where a man died very early in such a disease, and where it was spread over a longer period?--That would depend greatly on the violence of the convulsions.

By LORD CAMPBELL--And the repetition?--And the repetition.

The Court then adjourned.

Ninth Day, Friday, 23rd May, 1856.

The Court met at ten o’clock.

[Sidenote: J. B. Ross]

Mr. JOHN BROWN ROSS, examined by Mr. GROVE--I am house surgeon to the London Hospital. On 22nd March a labourer, aged thirty-seven, was brought to the hospital about half-past seven in the evening. He had had one paroxysm in the receiving room of our hospital before I saw him. He had a rapid but feeble pulse, breathing quickly though not laboriously. The jaws were closed and fixed, there was an expression of anxiety about the countenance, and the features were sunken. He was unable to swallow, the muscles of the abdomen and back were somewhat tense. After he had been in the ward about ten minutes he had another paroxysm and opisthotonos, which lasted about one minute. He was then quiet for a few minutes; he had then another, and died. He had only been in the hospital about half an hour. An inquest was held on the body, but no poison was found. I attribute the cause of death to tetanus. There were three wounds, two on the back of the right elbow, about the size of a shilling each, and one on the left elbow, about the size of a sixpence. The man told me he had had them about twelve or sixteen years. They were old, chronic, indurated ulcers, circular in outline, the edges thickened round, undermined, and covered with a dirty white coating without any granulations. I am unable to say what produced those ulcers. I have seen old, chronic syphilitic wounds in the legs similar to those in the elbow, but I cannot say that these were so. These wounds were the only things to account for tetanus. There was no other cause found.

Cross-examined by the ATTORNEY-GENERAL--I learned from the man’s wife that a linseed meal poultice had been applied to this ulcer a day or two before. The jaws were completely fixed when he came, so as to render him incapable of swallowing anything. He said he had just been taken with strange symptoms about the jaws at dinner that morning about eleven o’clock. He was able to speak, though he could not open his jaw. That is the case in tetanus.

Were there also symptoms of rigidity when he was brought in about the abdominal and lumbar muscles; did you learn from him how long this rigidity had been coming on?--Not further than that the first symptoms of the illness he had felt were that morning. He did not say how long he had felt this rigidity about the neck. He was seen by the parish surgeon in the afternoon before coming to the hospital. I have no doubt that the disease had been coming on from the morning.

[Sidenote: J. B. Ross]

Though you cannot speak as to the precise character of these sores, were they ugly sores?--Yes; sores of a chronic character--ulcers. The two on the right elbow were perfectly running into one another. A piece of integument connected the two, so that they would be likely to run into one another eventually. By saying that those sores were undermined I mean that the wounds continued under the skin. There were no signs of healing, and they had the appearance of old, neglected sores.

Were they near the site of any particular nerve?--They were near the ulnar nerve, a very sensitive nerve connected with what we call the “funny bone.”

How soon was he seized with the first paroxysm after he came in?--He had one directly he came into the hospital, but I did not see it. Half an hour from that time he died.

Had he had any paroxysms before he came to the hospital?--I believe he had, all the afternoon.

That was not one continuous paroxysm?--No; there was a twitching of the muscles of the legs and arms.

What are the particular symptoms of the case to which you refer as indicative of death from tetanus?--From the tetanic symptoms and from having wounds.

Put aside for the moment the fact of his having the wounds that would lead to that inference; what were the symptoms that manifested themselves previous to, or concomitantly with, death which you would call tetanic?--The tetanic symptoms there are the lockjaw and the muscles of the abdomen and the back also being rigid; and he complained of pain in his stomach, just over the stomach. I did not hear the account given of the symptoms of Mr. Cook’s death.

Re-examined by Mr. GROVE--Strychnia was suspected in this case before the body was examined. The nerves of the tongue are very delicate ones. There are very delicate nerves at the throat and fauces.

Were you here yesterday when a case was described of an injury in the throat--a sore throat that caused tetanus?--I was.

Are you of opinion that an irritation of the nerves of the throat would cause tetanus as well as the other nerves?--That was produced by exposure to cold; it was therefore idiopathic.

Would any injury to any delicate nerves be a cause of tetanus?--Decidedly.

* * * * *

[Sidenote: F. Wrightson]

Dr. FRANCIS WRIGHTSON, examined by Mr. KENEALY--I was a pupil of Liebig. I am an analytical chemist and teacher of chemistry at the School of Chemistry at Birmingham. I have studied and made experiments in various poisons, including strychnia. I have not found any extraordinary difficulties in the detection of strychnia. It is detected by the usual tests. I have detected strychnia pure, and I have also discovered it when mixed with impurity, such as bile, bilious matter from putrefying blood, after having separated it from the impurities. Strychnia can be discovered in the tissues. I have discovered it in the viscera of a cat poisoned by strychnia, also in the blood of a dog poisoned by strychnia, also in the urine of another dog poisoned by strychnia. I have heard the theory propounded by Dr. Taylor as to the decomposition of strychnia by the act of poisoning.

Are you of opinion strychnia undergoes decomposition in the act of poisoning?--I am of opinion that it does not. If it were decomposed in the act of poisoning I should say it would not be possible to discover it in the tissues. Portions of strychnia can be discovered in extremely minute quantities indeed. In the first case I mentioned of the detection of strychnia in the blood, 2 grains were given to the dog. One grain was given to the second dog, in which we detected it in the urine. Half a grain was attempted to be administered to the cat, but a considerable portion of it was spilt.

Assuming that a man was poisoned by strychnia, and that his stomach and a portion of his tissues were sent within eight, or nine, or ten days after death for analytical examination, do you say you could discover the poison of strychnia in his remains?--I should have no doubt whatever in saying so.

Cross-examined by the ATTORNEY-GENERAL--Suppose the whole of this poison to be absorbed, where would you expect to find it?--In the blood.

In its progress to its final destination, the destruction of life, does it pass from the blood, or is it left by the blood in the solid tissues of the body before it produces that effect?--I cannot tell.

If it has passed from the stomach by absorption in the blood, the whole dose, into the circulation, do you say you would still expect to find any of it?--Decidedly so, because I believe it exists as strychnia in the blood.

Do you say you would still expect to find any of it in the stomach?--In order to be absorbed it must be dissolved, and in that portion of the fluid which surrounds the coats of the stomach I should expect to find it.

Suppose the whole to be absorbed?--Then I should not detect it.

Suppose the whole of it has been eliminated from the blood and passed from the system?--Certainly not.

LORD CAMPBELL--You would expect to find it elsewhere, not in the stomach?--Yes. I would expect to find it in the blood and in the tissues.

[Sidenote: F. Wrightson]

Cross-examination resumed--My question only supposes the minimum of the dose that will destroy life to have been given; and, supposing that to have been absorbed into the circulation, and there deposited in the tissues, or part of it eliminated by the action of the kidneys, would you know where to search for it?--I should search for it both in the blood and in the tissues, and in the ejecta of the kidneys; and from my experiments I should expect to find it in each of them, in case the urine was not ejected during the time of poisoning.

Re-examined by Mr. SERJEANT SHEE--If a man had been killed by strychnia, administered an hour and a half before he died, the poison would certainly be detected in the stomach in the first instance.

Supposing it to have been administered in the shape of pills, would it by that time have been all absorbed and circulated in the system so as to get out of the stomach?--I cannot tell. If it were so I would find it in the blood, the liver, and the spleen.

Could you form an opinion whether it could be detected under these circumstances on the coats of the stomach?--Not knowing the dose administered and the powers of absorption, I cannot say with absolute certainty it would be detected, but I should think it in the highest degree probable if a moderate dose had been administered.

Could you form any opinion from the fact that death had taken place after one paroxysm, and in an hour and a half after the ingestion of the poison, whether it was a considerable or an inconsiderable dose?--I cannot give a decided opinion.

LORD CAMPBELL--I cannot allow this gentleman to leave the box without expressing my high approbation of the manner in which he has given his evidence.

* * * * *

[Sidenote: R. Partridge]

Mr. RICHARD PARTRIDGE, examined by Mr. GROVE--I have been for many years in practice as a surgeon, and am Professor of Anatomy at King’s College. I have heard the evidence as to the symptoms of Mr. Cook and as to the post-mortem examination. In my opinion it is most important in a case of convulsion that the spinal cord should be examined after death. The gritty granules that were found would be likely to cause inflammation of the arachnoid membrane, which would be discoverable if the spinal cord had been examined shortly after death. If examined nine weeks after it is not likely it would be discovered. Although I have not seen such a case, there are cases on record that such inflammation, if it existed, would be capable of producing tetaniform convulsions. The medical term for such inflammation of the arachnoid is arachnitis, or inflammation of the membrane. That disorder produces convulsions and death. I should not say universally; sometimes it does not result in death. I could not form any positive judgment as to the cause of death in Mr. Cook’s case. I have heard the evidence as to the state of contraction after death. No inference at all can be formed of the degree of contraction, or the kind of contraction, that I heard described. If I find the back curved and the body resting on its back and feet after death, I should infer that he died of that form of tetanus which convulses the muscles of the back. Various degrees and varieties of rigidity occur after a natural death. The clenching of the hands or the semi-bending of the feet are not uncommon in cases of ordinary death.

Cross-examined by the ATTORNEY-GENERAL--The granules from which arachnitis might have proceeded were, I understand, situated in the inner surface of the fibrous investment of the cord. They are occasionally found in these parts; not commonly. They are signs. Arachnitis, producing convulsions, has never come under my personal observation, nor has it satisfactorily come under my observation without producing convulsions. It is a very rare disease.

Are you enabled to state from the recorded cases the course of the symptoms of the disease?--No.

Do not you know it to be a disease of considerable duration?--The cases have varied in duration; commonly days at the shortest. Arachnitis is accompanied with paralysis if they live.

Would it, considering the connection that there is between the spinal cord and the brain, affect the brain by sympathy, or otherwise, prior to death?--No.

In these cases, where granules have produced arachnitis, do you happen to know whether the granules have been considerable in point of size?--It has varied in different cases.

Suppose them to be very small and minute?--I should think there would be less likelihood of their producing inflammation.

Suppose an examination at a longer interval than nine days after death failed to detect the inflammation of the arachnoid, that the spinal cord and its integuments had not undergone any decomposition, and that the appearance was perfectly healthy, should you be warranted in inferring there was inflammation?--I should not conclude there was inflammation. Prior to decomposition I should not.

The examination was made by four medical men; are you of opinion that they would be competent judges as to decomposition?--[The question was objected to.]

Does arachnitis not sometimes extend to a matter of months, even where it extends to death?--It might go on for months.

Does it not affect the patient by a series of convulsions at recurring intervals?--That varies.

Did you ever know, or hear of, or read of a case in which the patient died after a single convulsion of arachnitis?--Not a single one.

What would be the concomitant symptoms; would it affect the rest of the patient or affect the general health?--I cannot say.

[Sidenote: R. Partridge]

Do you believe that a man could have twenty-four hours of complete repose?--No.

In the interval between the convulsions could he be quite well?--No; he would have pain and uneasiness according to the situation of the muscles convulsed, the back usually.

You have heard the symptoms, and I presume you have heard from the midnight of Monday till Tuesday Mr. Cook had complete repose. I now ask you if, in the face of the Court and of the profession, you will undertake to say that Mr. Cook’s death proceeded from arachnitis?--I should think not. The majority of the symptoms do not show arachnitis.

You have mentioned that there were one or two of the appearances after death in Cook’s case which would be common to other cases, the semi-closing of the hand. Did you ever know, except in a case of tetanus, the hand so completely clenched as to require force to take the fingers away from the hand?--No, I do not.

Have you ever known the feet to be so distorted as to be described by a medical man as assuming the form of a club foot?--Never.

Did you hear the description given by Mr. Jones that when this man died the body was bowed so that, if he had turned it from its side upon its back, it would have rested on its head and on its heels?--I did.

Have you any doubt that that indicates death from tetanus?--Not from some form of tetanic symptoms. I am only acquainted by reading and hearsay with the symptoms that accompany death from tetanus resulting from the administration of strychnia.

From your knowledge of the subject, having attended to the symptoms described by Mr. Jones from the moment the paroxysm set in of which Mr. Cook died, and the symptoms and appearances attending his death, does it appear that these symptoms are consistent with death by strychnia?--Some are consistent and some are inconsistent. The long interval which occurred after the taking of the poison is inconsistent.

What I am asking you is, whether these symptoms on the Tuesday night, from the time the man was taken with the paroxysms of convulsions of the muscles of the trunk, of the legs, of the arms--the bending of the body into a bow--the difficulty of respiration--are consistent with what you know of death by strychnia?--Quite.

Do you agree that the symptoms in tetanus come on gradually and progressive; that, although they are intermitted, the disease is never wholly remitted?--I do.

What is the shortest period in which you have ever known the disease of traumatic tetanus run its course to death?--Never under three or four days.

[Sidenote: R. Partridge]

Suppose a case could be described as of shorter duration, such as a day or a few hours, would your medical experience lead you to infer that the premonitory symptoms had very likely been neglected?--I should consider that probable.

Bearing in mind the distinction between traumatic and idiopathic tetanus and a case such as has been here described, have you ever seen such a death as this was with the symptoms mentioned proceed from natural causes?--No.

Re-examined by Mr. GROVE--What are the other symptoms which you consider inconsistent with strychnia?--The sickness manifested before the attack came on; the beating of the bed clothes with the arms, want of sensitiveness to external impression, and the sudden cessation of the convulsions, and apparent complete recovery.

You mentioned previously the time that occurred between the ingestion of the poison and the paroxysm coming on. What inference do you deduce from that?--That it is inconsistent with strychnia.

As to the mode in which it came on without premonitory symptoms, do you consider that is inconsistent with strychnia?--There was apparently an absence of the usual condition that is described.

You stated that the bent form indicated some tetaniform symptom. Did that answer apply to natural tetaniform as well as to tetaniform convulsions caused by strychnia?--Yes. The bent form of the feet indicated tetanic spasm. That would be the case whether it was a tetaniform spasm with poison or without poison.

By LORD CAMPBELL--And the other symptoms of rigidity?--It is rather a question of degree.

They would be more violent if from poison?--No doubt.

You have stated in the cases of tetanus you have seen there was no intermission. Do you know, from your reading, that the intermission of the disease is a frequent thing?--I know it occurs, but it is not frequent.

As to decomposition of the spine. Do you think it could remain for nine weeks undecomposed?--I do not.

The ATTORNEY-GENERAL--I have one question which I would put (this gentleman spoke as to vomiting), whether, if the stomach had been brought by any other cause into a state of irritation, would he think those causes inconsistent?

LORD CAMPBELL--I intended to put the question myself.

WITNESS--I should think it not inconsistent.

* * * * *

[Sidenote: John Gay]

Mr. JOHN GAY, examined by Mr. GRAY--I am a Fellow of the Royal College of Surgeons, and have been for eighteen years a surgeon of the Royal Free Hospital. In the year 1843 I had under my care in the hospital a case of tetanus in a boy eight years old. He was brought in on the 28th of July. The accident occurred a week before. I saw him on the 28th of July. He could not open his mouth at that time. He complained of great pain and stiffness about the neck. During the first three days I saw him he had unusually severe paroxysms.

By LORD CAMPBELL--During the first night of his admission he started up convulsed, and spasmodically closed his jaw. During the following night he was a good deal convulsed at times. The abdominal muscles, as well as the muscles of the neck and back, had become rigid during the night. The muscles of the face were also in a state of great contraction. On the following day I found the muscles remained in the same state. In the morning of that day, at two o’clock, on visiting him I found there was much rigidity of the muscles, especially those of the abdomen and back. The following morning the muscular rigidity had gone. He opened his mouth as usual, and was able to talk. The lad appeared to be thoroughly relieved. He had no return of the spasms till the following day. At that time he asked the nurse to change his linen, and she was lifting him up in bed to do so when violent convulsions of the arms and face came on, and he died in a few minutes.

Examination resumed--About thirty hours elapsed from the time the convulsions of which he died came on and the last preceding convulsions. The last paroxysm before he died lasted a few minutes. Before it came on the rigidity which I have described had been completely relieved. At the time he was convulsed the nurse was lifting him up to put on his linen.

By LORD CAMPBELL--The second day I gave him small doses of tartar emetic to produce vomiting, but without effect. I repeated them in larger doses of 2 grains, but without effect. I did not repeat the dose after the third day.

Cross-examined by the ATTORNEY-GENERAL--What was the accident?--A large stone had fallen on the middle of the left foot and had completely smashed it. The wound had become very unhealthy. When I first saw it it had portions of bone and cartilage adhering to the surface. I amputated the toe. When the boy was brought in his mother said he could not open his mouth so wide as usual. When I saw him his mouth was almost closed up.

On 29th July he slept but little during the night, and during sleep started up convulsed and spasmodically closed the jaw. The jaw remained closed until the 1st of August. It was closed when I administered tartar emetic to him. In all these cases so trifling a remedy as the tarter emetic is easily given.

[Sidenote: John Gay]

By LORD CAMPBELL--The tongue seems to retain its powers?--Yes. The case is recorded in the _Lancet_.

Cross-examination resumed--After the 29th of July did the convulsions continue throughout the 30th and part of the 31st?--The convulsions came on during the night, and they appear to have remitted during the day, except a muscular rigidity. The tetanus did remain.

But were there no spasms during the daytime?--I believe not.

In the daytime, although there were no convulsions, were the muscles of the body, of the chest, and of the abdominal back and neck all rigid?--Yes. That continued throughout the two days I administered tartar emetic. The rigidity of the muscles and of the stomach would go far to prevent sickness.

You have no doubt that your tartar emetic would have produced its effect but for the rigidity of the muscles?--I suppose it would have done so.

When did the symptoms begin to abate?--On the 1st of August, on the fourth day, and they gradually subsided. They appeared to have subsided during the night. I saw the child during the middle of the day, and I found that they had subsided, and in fact had entirely gone off. I thought he was going to get well.

You told us the woman set him up in bed for the purpose of changing his linen. Would that in any way have brought the toe, that part that had been attacked, into any friction with some parts of the bed?--It must have done so. But I do not think the simple irritation of the toe at that part would have any effect.

But there not having been, in your judgment, nervous irritation set up from the original seat of the disease, can you account in any way for the nervous or muscular disease of tetanus?--If the cause had not entirely gone the symptoms were brought back by the act of sitting up in bed. My impression is there must be some action about the spinal cord as the immediate cause of the symptoms.

Action set up in the spinal cord by irritation of the nerves in the immediate site of the laceration or wound?--Quite so.

May it not be reasonable to infer that any irritation of the part originally injured, exciting or irritating the nerve or the nerves connected with the part, may support its action over the whole system, and so produce convulsion?--I had removed the end of the diseased part, so I cannot conceive that the same cause could exist.

[Sidenote: John Gay]

If you imagine you feel yourself justified in saying that the irritation of the spinal cord once set up continues, why should you infer that the irritation of the nerve may not also continue?--There must be some peculiar irritation of the nerve to give rise to the affection of the spinal cord from which tetanus arises. There appear to be some particular circumstances which produce it.

You have no doubt the state of the toe was the original cause of the convulsions?--I have not.

And that death took place by something or other distinct from the first cause?--Yes.

Re-examined by Mr. GRAY--I think you told my friend that, with regard to the convulsions which end in death, you thought they arose from some irritation set up in the spinal cord?--I did, from that and other causes.

May the causes of such irritation be very various in different cases? May the cause of the irritation in the spinal cord which would end in tetaniform be very various?--I think so.

Suppose in one you have a death accompanied with tetaniform symptoms and opisthotonos, and the various symptoms of a tetanic character; in the absence of any knowledge of the case--of the cause you state, probably the irritation of the spinal cord--do you think it is possible to ascribe them to any particular cause?--I think it would be extremely difficult to do so.

Will you give me the proposition you lay down?--In the event of a given set of symptoms, tetanic symptoms I should say, being proposed, it would be extremely difficult, if not impossible, without some other evidence, or collateral evidence, to assign it to any given disease.

LORD CAMPBELL--Or cause?--Or cause.

* * * * *

[Sidenote: W. M‘Donnell]

Dr. WILLIAM M‘DONNELL, examined by Mr. KENEALY--I am a licentiate of the College of Surgeons of Edinburgh, and have been in practice for about eight years. I have had practical as well as theoretical knowledge of idiopathic and traumatic tetanus. Tetanus will proceed from very slight causes. Almost any internal disorder or alteration of the internal secretions will produce idiopathic tetanus. Exposure to cold or damp would produce it. Mental excitement would be a probable cause.

By LORD CAMPBELL--Mental excitement would be the proximate cause of tetanus. The presence of gritty particles or granules in any part connected with the nervous structure, in either the spine or the brain, might produce tetanic convulsions. I have seen small deposits or tubercles in the brain, the only assignable cause for death terminating in convulsions.

[Sidenote: W. M‘Donnell]

Examination resumed--In addition to those slight causes, I believe that tetanic convulsions arise from causes as yet quite undiscoverable by science. I have had many post-mortem examinations of patients who have died of tetanus, and no trace of any disease whatever could be discovered beyond the congestion or vascularity of some of the vessels surrounding the nerves. Though tetanus is not easily discoverable, strychnia is easily discoverable by scientific men. I had a case of idiopathic tetanus--a female, Catherine Watson. I was fortunate enough to restore her, and she is here. (Dr. M‘Donnell read his notes of the case of Catherine Watson.) In her case lockjaw set in about the middle of the attack. She was able to speak. In acute idiopathic tetanus, ending fatally, trismus is generally a later symptom. I had a case of tetanus which ended fatally, a man named Copeland. It must have been idiopathic, as there was no external cause. Death took place in somewhat less than half an hour. I cannot say precisely. He was dead before I could reach the house.

By LORD CAMPBELL--Do you know what the cause of the disease was?--Yes. I examined the patient carefully, and made inquiry as to the symptoms.

Examination resumed--I have made a number of experiments on animals with reference to strychnia poison. I have found the muscles of the brain highly congested, the sinuses gorged with blood, and in one case hæmorrhage from the nostrils. That would indicate a very high state of congestion. I have found extravasation of the blood in some cases, likewise in the brain. I have cut through the substance of the brain and found numerous red points. I have found the lungs of these animals either collapsed or congested. The heart has been invariably filled in the right side with blood, and very often on the left. The liver has been congested, the kidneys normal generally, the spleen in its ordinary condition. I have found the vessels of the stomach on the outer surface congested, and on the mucous or inner surface highly vascular. In the spinal cord I have found the vessels of the membranes congested, and also red points seen on cutting it through, not invariably, but sometimes. I have experimented in many cases for the discovery of strychnia. You may discover the smallest dose that will kill the animal. If you kill an animal with a grain of strychnia you may discover traces of it.

What do you mean by a trace of it?--Evidence of its appearance.

Does that mean an imponderable quantity?--It may.

Do you mean by traces to convey the idea that you can discover the smallest quantity?--That will kill.

What is the smallest quantity you can discover?--The fifty-thousandth part of a grain.

Have you actually experimented so as to discover that quantity?--Yes.

[Sidenote: W. M‘Donnell]

You have heard a theory propounded in the course of this inquiry by Dr. Taylor--I mean the destruction by the supposed decomposition of strychnia--to your knowledge has any scientific man of eminence ever propounded that theory at all?--I never heard of it until mentioned in this Court. In my opinion there are no well-grounded reasons for that theory. I have proved that that theory is false by numerous experiments. I have taken the blood of an animal poisoned with 2 grains of strychnia, about the least quantity which would kill an animal, and have injected it into the abdominal cavities of some animals, and have destroyed them, with the symptoms and post-mortem appearances of strychnia. It should not make it any more difficult to detect if the strychnia is administered in the form of pills. If the pills were hard, and not readily solved, you would find it much easier, because you might find some remains of the pill. I do not agree with Dr. Taylor’s opinion about the fallacy of colour tests. I believe a colour test is a reliable mode of ascertaining strychnia. I agree with Mr. Herepath that it is found in urine that has been ejected. I have found it invariably.

Does it first pass into the blood and then into that watery excretion?--Part of it may be drawn off by that means. It is not true that strychnia can be confounded with pyroxanthine. In these animals which I have killed with strychnia I have generally observed an increased flow of saliva; that was a very marked symptom. The animals were very susceptible to touch. A stamp of the foot, a slight touch, or a breath, or a sharp word, would drive them into tetanic convulsions. We recognised them by the straightened condition of the muscles.

Supposing that a dose of strychnia sufficient to kill a man were administered to him, do you think he could bear to have his neck rubbed?--I think it would be very likely to throw him into convulsions before the paroxysm came on.

By LORD CAMPBELL--As soon as the poison is taken into his system?--No. It requires a certain time. You must have the first symptoms of poison developed. It would be after the first symptoms.

[Sidenote: W. M‘Donnell]

Examination resumed--What would be the effect of a man pulling a bell violently if he was poisoned by strychnia?--I think it would be extremely probable, if the dose had been sufficient, to destroy life, provided the symptoms had made their appearance. I quite agree with Mr. Herepath that, if a sufficient dose to poison has been administered, it can and ought to be discovered. I have heard the medical evidence that was given in this case and the evidence as to the symptoms. The symptoms I attach very little importance to as the means of diagnosis, as you may have the same symptoms developed from many different causes. There is one principal reason I have, which is this--a dose of strychnia sufficient to destroy life in one paroxysm would hardly require an hour and a half or two hours. The cause of death was from convulsions, epileptic convulsions with tetanic symptoms.

Does the interval of repose from the Monday night to the Tuesday at all operate on your judgment in coming to that conclusion?--If my opinion that it was of an epileptic character were correct, it would.

It is your opinion that if that were of an epileptic character--then what follows?--The intermission from the Monday night would be considered important, as epilepsy seizures very often recur about the same hours, as I have seen them.

Assuming that a man was in such an excitable state of mind that he was silent for two or three minutes after his horse winning a race, that he exposed himself to cold and damp, that he excited his brain by drinking, and he was attacked by violent vomiting, and after his death gritty granules were found in the neighbourhood of his spine, could not, in the present instance, such a death as it was arise from these causes?--Any of these causes might aggravate or hurry it.

You say any one of those causes?--Might cause it.

Cross-examined by the ATTORNEY-GENERAL--I am a general practitioner at Garnkirk, near Glasgow, general surgeon to the ironworks, and parochial medical officer. I have had personal experience of two cases of idiopathic tetanus--this one I have recorded and another.

What you have been telling us about mental excitement, sensual excitement, is not within your own observation?--This case might have arisen from those causes.

Have you any reason to think it did?--I have no reason to do so.

Then do not tell us what it might have done. Now, in the case of Catherine Wilson?--I saw her about half-past ten at night. She had been ill very nearly an hour before I saw her. She had convulsions. She had gone about her usual duties up to the evening. She felt a slight lassitude previous to that time. It was only by close pressing that she could call it to mind. The lockjaw, I think, came on in an hour or two; I could not be positive.

In the other case, of Mr. Copeland?--It was a young child between three and four months old.

Was that the person of the name of Copeland?--Yes.