twenty-eight years surgeon to the Bristol Hospital. I have seen fully
thirty cases of tetanus, of which two were idiopathic. One of these two
ended fatally. Idiopathic tetanus is of very rare occurrence. The
symptoms are not so severe as those in traumatic tetanus. The symptoms
which accompanied the attack of Mr. Cook before his death were quite
distinguishable from those cases of tetanus which have come within my
experience. In pointing out the differences I would repeat very probably
the words of Sir Benjamin Brodie. Tetanus, so far as my experience goes,
begins with uneasiness in the lower jaw, followed by spasms of the
muscles of the trunk, and most frequently extending to the muscles of
the limbs. Lockjaw is almost invariably a symptom of traumatic in
particular. It is one of the earliest symptoms. I have seen the
clenching of the hands, but I do not think it is an ordinary symptom of
common tetanus. I cannot recollect a case the duration of which has been
less than from thirty to forty hours. I have never known a syphilitic
sore producing tetanus. The symptoms I have heard described in Mr.
Cook’s case are not referable to either apoplexy or epilepsy. In both
these there is a loss of consciousness, but in cases of tetanus that I
have seen consciousness has been retained throughout all the period. In
my experience of tetanus the symptoms have been invariably continuous
without any interruption. In my judgment the symptoms of Mr. Cook could
not be referred to idiopathic or traumatic tetanus.
[Sidenote: Henry Daniel]
Cross-examined by Mr. GROVE--I do not know that cases are mentioned in
books where there is a long interval of some hours between the symptoms.
I have not read Dr. Todd’s book, nor Mr. Curling’s book, nor Dr.
Copland’s book on the subject. I have been out of practice some
seventeen or eighteen months, and have not looked into the reported
cases of tetanus of late. In my opinion the symptoms of tetanic
convulsions do not vary much in different cases. There may be an
affection of a muscle in this man that there is not in the other, in a
leg or an arm. In tetanic affections death is caused by exhaustion and
suffocation.
[Sidenote: Samuel Solly]
Mr. SAMUEL SOLLY, examined by Mr. WELSBY--I have been connected with St.
Thomas’s Hospital as lecturer and surgeon for twenty-eight years. I have
either seen or had under my care twenty cases of tetanus, all of which
were traumatic, except one, in which I was doubtful whether it was
traumatic or idiopathic. In the latter case the symptoms were slower in
their progress and generally rather milder. The shortest period I can
remember before the disease arrived at a point is thirty hours. The
difference between Mr. Cook’s attacks and the cases I have seen is that,
in my experience, there has been a marked expression of the
countenance--that is the first symptom; it is a sort of grin, and the
symptoms have always been continuous. The symptoms in Mr. Cook’s case
are not referable to either epilepsy or apoplexy, or any disease that I
ever witnessed.
Cross-examined by Mr. SERJEANT SHEE--A marked expression of the
countenance, a sort of grin, frequently occurs in all violent
convulsions, which assume, without being tetanus, a tetanic form and
appearance. They are not a numerous class. It is difficult to
distinguish between them and idiopathic tetanus in the onset, but not in
the progress. I heard the account given by Mr. Jones of the last few
moments before Mr. Cook died.
That he uttered a piercing shriek, fell back, and died, did he
not?--Yes.
The ATTORNEY-GENERAL--I beg your pardon; there was an interval.
Mr. SERJEANT SHEE--No, no; five or six minutes.
LORD CAMPBELL--He died very quietly.
Cross-examination resumed--I heard the description of the shriek with
the convulsion; but it was the shriek that called the medical man into
the room. That was at the height of the attack. In some respects that
last shriek and the paroxysm that occurred immediately afterwards bear a
resemblance to epilepsy. Death from tetanus accompanied with convulsions
seldom leaves any trace behind; but death from epilepsy leaves behind it
some few effusions of blood on the brain or congestion of the vessels.
[Sidenote: Samuel Solly]
Re-examined by the ATTORNEY-GENERAL--Convulsions that take place in
epilepsy are not at all of tetanic character. I say that Mr. Cook did
not die from epilepsy, because there were none of the symptoms there.
When a patient dies with epilepsy he dies perfectly unconscious.
Ulceration of the brain from injury, a sudden injury to the spinal cord,
irritation of the teeth in infants, all produce convulsions. But those
convulsions in their progress are not similar to the convulsions of
tetanus. There is no progressive movement and no appearance about the
face or jaw of having tetanus.
* * * * *
[Sidenote: R. Corbett]
Dr. ROBERT CORBETT, examined by Mr. JAMES--I am a physician in Glasgow.
I remember a patient of the name of Agnes Sennet who died in the Glasgow
Royal Infirmary on 29th September, 1845, after taking some strychnia
pills intended for another patient. I saw her while she was under the
influence of the poison. The symptoms I noticed were a retraction of the
mouth, face much suffused and red, the pupils dilated, the head bent
back, the spine curved, and the muscles rigid and hard like a board. She
died about an hour and a quarter after taking the pills. There would be
a quarter of a grain in each of the three pills she took.
Cross-examined by Mr. SERJEANT SHEE--The retraction of the angles of the
mouth was continuous, but it was worse at times. I did not observe it
after death. The hands were not clenched, but semi-bent after death.
That semi-bending of the hand is a very common thing in cases of death
by violent convulsions. Twenty minutes after taking the medicine she was
attacked by the symptoms.
* * * * *
[Sidenote: Dr. Watson]
Dr. WATSON, examined by the ATTORNEY-GENERAL--I am one of the physicians
in the Glasgow Royal Infirmary, and attended the case of Agnes Sennet
spoken to by the last witness. I saw her about a quarter of an hour
after the symptoms first began. She was in violent convulsions; her arms
were stretched out and rigid; her feet and legs were also rigid. Just at
that moment she did not breathe. That paroxysm subsided almost
immediately, and fresh ones came on after a very short interval. They
occurred at intervals until they destroyed her. She was about half an
hour in dying. She seemed perfectly conscious during the time. At the
post-mortem examination the spinal cord was quite healthy. The heart was
contracted.
* * * * *
[Sidenote: Mary Kelly]
MARY KELLY, examined by Mr. BODKIN--I was a patient in the Glasgow Royal
Infirmary, and saw Agnes Sennet take the pills, which were intended for
another patient. I saw her take two pills only. After taking the pills
she went and sat down by the fire, and in about three-quarters of an
hour she was taken ill. She fell back on the floor, and a nurse and I
lifted her into bed. The nurse cut her clothes off, and she never moved
after she was put upon the bed; she was just like a poker. She never
spoke after she fell.
* * * * *
[Sidenote: C. Hickson]
CAROLINE HICKSON, examined by Mr. JAMES--In October, 1848, I was nurse
and lady’s maid in the family of Mrs. Serjeantson Smith, at Romsey, in
Hampshire. On the 30th of that month Mrs. Smith was unwell, and some
medicine was sent to her in the afternoon, about six o’clock, by a Mr.
Jones, a druggist in Romsey. Shortly after seven o’clock next morning I
saw her take about half a wineglass of the medicine. About five or ten
minutes afterwards I was summoned to her bedroom, and on entering I saw
her leaning upon a chair, and I thought she had fainted. She appeared to
suffer from what I thought spasms. I went out and sent for Mr. Taylor,
surgeon, and on returning to the bedroom I found some of the other
servants assisting to support Mrs. Smith. She was then lying on the
floor and screaming very much, very loudly, but did not open her teeth.
She asked me to have her legs pulled straight, and I found them drawn up
very much. She still screamed as if in great agony, and requested some
water to be thrown over her, which I did. Her feet were turned inwards.
I put a hot-water bottle to them, but this had no effect. Shortly before
she died she said she felt easier, and her last words were, “Turn me
over.” I did so. A few minutes after this she died. She was conscious,
and knew me during the whole time. From the time she took the medicine
until she died would be about an hour and a quarter.
Cross-examined by Mr. GROVE--From the time I first saw her in the spasms
she could not sit up at all. It was a continuous, recurring fit, and
lasted about an hour. She only seemed easy for a very short time before
her death. Her teeth were clenched during the whole time.
* * * * *
[Sidenote: F. Taylor]
Mr. FRANCIS TAYLOR, examined by Mr. WELSBY--I am a surgeon at Romsey. I
was summoned one morning to the house of Mrs. Serjeantson Smith. I
arrived between eight and nine o’clock, shortly after she died. I saw
the body then. The hands were clenched; the feet were contracted, turned
inwards; and the soles of the feet were hollowed up. This appeared to
have been from recent spasmodic action. The limbs were remarkably stiff.
The body was still warm. The eyelids were totally adherent, almost to
the eyeballs. I made a post-mortem examination three days after death.
The contraction of the feet continued, but it was gone off somewhat from
the rest of the body. No trace of disease was found. The heart was
contracted and perfectly empty, and the blood was fluid. I analysed the
medicine Mrs. Smith had taken. It originally contained nine grains of
strychnia, and Mrs. Smith had taken one-third. As the truth was so
apparent, only a very general examination of the stomach and bowels was
made, but still sufficient to find traces of strychnia.
* * * * *
[Sidenote: Jane Witham]
JANE WITHAM, examined by Mr. JAMES--In March last I was in attendance on
a lady who died. I remember her taking some medicine, after which she
became ill. She first complained of her back, and when I went to her I
observed her head was drawn back, and I could not get at her back. She
was in bed. I noticed she had twistings of the ankles, and her eyes were
drawn aside and staring. She first complained of illness on the 25th of
February, and she died on 1st March. She had several attacks, between
each of which she got better. She generally complained of a pricking in
her legs and twitching of the muscles in the hands, and she compared
them to a galvanic shock. During the attacks she requested her husband
to rub her legs and arms. The first attack was on the Monday, and she
died on the Saturday about ten minutes to eleven at night.
(This case was that of Dr. Dove’s wife.)
Cross-examined by Mr. SERJEANT SHEE--It was on the commencement of the
spasms that she requested her legs to be rubbed. On the Saturday night
she could not bear them to be touched. On that night the spasms were
much stronger than on the other days. On the Saturday she did not speak
but once or twice. During the interval of the spasms on the Saturday
touching her brought the spasms on. She could swallow on each of the
days except the Saturday, when her mouth was quite closed. After death
her body was stiff.
* * * * *
[Sidenote: G. Morley]
Mr. GEORGE MORLEY, examined by Mr. WELSBY--I was the medical attendant
on the lady referred to by the last witness. I had been attending her
for about two months before her death for a functional derangement. I
saw her on the Monday before her death lying in her bed. I observed
several convulsive twitchings of her arms. I saw her on the Saturday
about the middle of the day. She was much better, and in a composed
state. She complained of an attack she had had in the night, and spoke
of pains and spasms, affections of the back and neck. I and another
medical gentleman made a post-mortem examination on the Monday. We found
no disease which would account for death. There were no abrasions, nor
any wound or sore. The hands were semi-bent, the fingers curved, and the
feet were strongly arched. We applied several colour tests to the
contents of the stomach for the purpose of detecting the presence of
poison. On each occasion we produced the appearance characteristic of
strychnia. After the separation of the strychnine by chemical analysis
we inoculated two mice, two rabbits, and one guinea pig with the stuff
taken from the stomach. We observed in each of the animals more or less
the effects usually produced by the poison strychnia--general
uneasiness, difficult breathing, convulsions of the tetanic kind,
muscular rigidity, bending backwards, especially of the head and neck, a
violent stretching of the legs. In the case of the animals where death
resulted the muscular rigidity continued without any intermission.
There was an interval of relaxation, but immediately after death the
muscles became very rigid, more so than at rigor-mortis. We afterwards
made a similar series of experiments on some animals with strychnia
itself, both in solid and liquid forms. The symptoms and the results
generally were exactly the same as those I have described in the case of
the other animals.
Cross-examined by Mr. GROVE--I did not see the patient during any severe
attack. I observed that when the animals were touched it brought on the
symptoms. That is a very marked result. Directly they are touched they
give a sudden start, and pass into a severe spasm. At the post-mortem
examination the lungs were very much congested. The muscles generally
were dark and stiff. There was a decided quantity of bloody serous
effusion over the brain. There was a notable quantity, but not a large
quantity, of serum slightly tinged with blood in the membranes of the
spinal cord. The large spinal veins were very much congested, as were
the membranes of the spinal marrow. We opened the head first, and that
led to a great deal of blood flowing from the head. That would make it
uncertain whether the heart was full or empty. The right sides of the
hearts of animals that have been poisoned by strychnia are generally
full. From one to two hours is the longest time in animals at which I
have perceived the first effect of strychnia come on after it has been
taken. I made experiments in conjunction with Mr. Nunneley, and my
impression is that the interval has been as long as one hour. I
discovered strychnia with all the tests I applied with more or less
distinctness. I have detected strychnia in the stomach two months after
death, and after decomposition had proceeded to a considerable extent.
[Sidenote: G. Morley]
Re-examined by the ATTORNEY-GENERAL--I have given to the animals which I
have killed from half a grain to two grains. The animals experimented on
were cats, rabbits, and dogs. The strychnia, I think, acts on the
nerves, but a part may be taken into the blood also and act through the
blood. The poison is absorbed. We searched the stomach to find the
presence of the strychnia. The strychnia which we found in the stomach
would be that which was there in excess beyond that which had been
absorbed in the system. The strychnia that has been absorbed into the
system is sufficient to destroy life. The excess that remains in the
stomach is inactive. I should expect to fail sometimes to find strychnia
in the stomach if the minimum quantity capable of operating to the
destruction of life had been administered. If death resulted from a
series of minute doses of this poison, administered for a space of
several days, it is my opinion that the appearances would be likely to
be different after death from what they would, supposing death was
produced rapidly by one dose.
Re-cross-examined by Mr. SERJEANT SHEE--Is it your theory that in the
act of poisoning the poison is absorbed and ceases to exist as poison,
as strychnia?--I am inclined to think so. I have thought much upon that
question. I am not decided in my own mind.
What chemical reason can you give for your opinion?--My opinion rests on
the general fact that organic substances acting on the human body, such
as food or medicine, are frequently changed in composition. It is
possible that strychnia may have been discovered in the blood and liver
after effecting the operation of poisoning, but I do not know that it
has.
Do you know whether strychnia can be decomposed by any sort of
putrefying or fermentative process?--I have no fact to show that it can,
and I doubt if it is.
* * * * *
[Sidenote: E. D. Moore]
Mr. EDWARD DUKE MOORE, examined by Mr. HUDDLESTON--I was formerly in
practice as a surgeon. About fifteen years ago I was attending a
gentleman for paralysis, and had been giving him some very small doses
of strychnia. Subsequently I made him up a stronger dose containing a
quarter of a grain. In about three-quarters of an hour I was summoned to
come back and see him. He was stiffened in every limb. His head was
drawn back, and he was screaming, frequently requesting that we should
turn him, move him, and rub him. His spine was arched. We tried to give
him a mixture of ammonia with a spoon. He snapped at the spoon with a
sort of convulsive grasp to take it. He was suffering about three hours
altogether. He survived the attack, and was perfectly conscious the
whole time.
Cross-examined by SERJEANT SHEE--He recovered from the spasms in about
three hours, but the rigidity of the muscles remained for the rest of
the day and part of the next day. He was completely recovered the next
day after the attack, and the patient himself said he thought his
paralysis was better.
The Court then adjourned.
Fifth Day, Monday, 19th May, 1856.
[Sidenote: Alfred Taylor]
Dr. ALFRED TAYLOR, examined by the ATTORNEY-GENERAL--I am a Fellow of
the College of Physicians, a lecturer on medical jurisprudence at Guy’s
Hospital, and the author of a well-known treatise on poisons and on
medical jurisprudence. Among other poisons, I have made strychnia the
subject of my attention. It is the produce of the nux vomica. There is
also in the nux vomica a poison of an analogous nature called bruchsia,
which differs from it only in point of strength. The difference of the
two poisons is relatively estimated from one-sixth to one-twelfth,
bruchsia being one-sixth to one-twelfth the strength of strychnia. I
have never witnessed an instance of the action of strychnia on the human
subject. I have tried a variety of experiments, I think about ten or
twelve, on animal life with strychnia. Rabbits have always been used for
these experiments. The symptoms produced by the poison have been on the
whole very uniform. I have given a quantity varying from one-half to two
or three grains. I have found half a grain sufficient to destroy the
life of a rabbit. I have given it in both solid and liquid form. When
given in a fluid state it produced its operation in two or three
minutes; when given in a solid state, in the form of pill or bolus, from
about six to eleven minutes, I think. The time is influenced by the
strength of the dose, and also by the strength of the animal. The poison
is first absorbed into the blood; it is then circulated through the
body, and the poison especially acts on the spinal cord. That is the
part of the body from which the nerves affecting the voluntary muscles
proceed. The entire circulation through the whole system is considered
to take place about once in four minutes.
LORD CAMPBELL--Are you speaking of the human circulation?--Yes; the
circulation in the rabbit is quicker.
Examination resumed--How is it the absorption would be quicker in a
rabbit?--I think it is from the effects produced; that will also depend
on the state of the stomach, as to whether there be much food in the
stomach and whether the poison comes in immediate contact with the inner
surface of the stomach. The poison must first, I believe, be absorbed
before it acts on the nervous system.
[Sidenote: Alfred Taylor]
Will you describe the series of symptoms from the commencement to the
close?--The animal for about five or six minutes does not appear to
suffer; it moves about freely and actively. It then, when the poison
begins to act, suddenly falls on its side. There is a trembling of the
whole muscles of the body, a sort of quivering motion arising from the
poison producing those violent and involuntary contractions. There is
then a sudden paroxysm of it; the fore legs and the hind legs are
stretched out, the head and the tail are drawn back so as to give it the
form of a bow. The jaws are spasmodically closed, the eyes are
prominent, protruding. After a short time there is a slight remission of
the symptoms, and the animal appears to lie quiet, but the slightest
noise or touch reproduces convulsive paroxysms. There is sometimes a
scream or sort of shriek; the heart beats very violently during the fit,
and after a succession of these fits the animal dies quietly.
There is not invariably, immediately prior to death, a remission of the
symptoms?--I have only known an animal has died by having the hand over
the heart. It has been in a state of spasms at that time. In one or two
cases the animal has died quietly, as if there was a remission;
sometimes it dies apparently during the spasms itself.
What appearance have you observed after death which would be different
from the ordinary appearances--the outward appearances? Are the muscles
more than usually rigid?--In some instances the animal has been rigid
throughout; that is to say, it has died in a spasm, and the rigidity has
continued, the muscles so strongly contracted that for a week afterwards
it was possible to hold the animal horizontally extended by the hind
legs without the body falling. In an animal killed the other day the
body was flexible at the time of death, but it became rigid about five
minutes after death. I have opened the bodies of animals that have been
thus destroyed. I have found no appearances in the stomach or intestines
which would indicate any injury there. I have found in one or two cases
congestion of the vessels of the membranes. In other cases I have not
found any departure from the ordinary state of blood. The membranes of
the spinal cord and brain are a continuation one of the other, so that
it is not easy to have congestion of one without congestion of the
other. The congestion of those membranes has been due to fits which the
animal has had before death. In three out of five cases I failed to
discover any abnormal condition of the spinal cord or brain. As to the
hearts of animals thus killed, from all that I have seen the heart has
been congested with blood, the right side especially. The description
given by Elizabeth Mills and Mr. Jones of the symptoms which accompanied
the attack on Mr. Cook are similar to those I have seen in animals to
which I have administered strychnia.
[Sidenote: Alfred Taylor]
How long does it take in the case of rabbits to which you have
administered strychnia from the time the first symptoms manifest
themselves to the time of the death?--They have died in various
periods--one died in thirteen minutes, one in seventeen minutes; that, I
should mention, would be the whole time. The symptoms appear more
rapidly when the poison is administered in a fluid state, and death has
taken place in five or six minutes after. The experiments which I have
particularly noticed and performed lately, and which I am about to
detail, have been in reference to solid strychnia. In the first the
symptoms began in seven minutes, and the animal died in thirteen minutes
from the time the poison was given; in the second the symptoms appeared
in nine minutes, the animal died in seventeen minutes; in the third the
symptoms appeared in ten minutes, the animal died in eighteen minutes;
in the fourth the symptoms appeared in nine minutes, and the death took
place in twenty-two minutes; in the fifth the symptoms appeared in
twelve minutes, and the death took place in twenty-three minutes. In the
human subject, supposing this poison to be administered in the shape of
pills, I should expect it would take a longer period before the poison
began to act, because it requires that the pill structure should be
broken up in order to bring the poison in contact with the mucous
membrane of the stomach.
[Sidenote: Alfred Taylor]