the Crown might say it is remarkable in this sense, that Palmer knew it,
and said not a word about it. But it seems it was a matter, in the
opinion of Cook, so little serious, that he never said a word of it to
Mr. Jones, because, if Cook had thought that those words which he used
to Elizabeth Mills were not an exaggerated description of what had
occurred, do you not think, when Mr. Jones came to see him, and felt his
pulse, and inquired what his symptoms were, that Cook would have said
(he being in full possession of his senses), “You cannot judge now from
my appearance how I am--I was in a state of madness last night--I was in
the greatest possible agony--I do not know what it was--I was attacked
in the middle of the night in such a way that I thought I was going to
die”? As he had Mr. Jones with him, would he not have mentioned that in
the conversation? My inference from that is, that in all probability
this first statement of Elizabeth Mills was the correct statement of
what occurred; and if we find it is consistent with what Mr. Jones says
as to what occurred the next night in its general character, it would be
very nearly the same on both nights. We may reasonably infer that
anything in excess of that, on which the medical evidence was given, has
been the result of imagination, and not so strictly consistent with the
truth as the original statement. Let us see what Mr. Jones says. (The
learned Serjeant read a portion of the deposition of Mr. Jones before
the coroner.) Observe the significance of that. Palmer, in the presence
of Mr. Jones, brings up two pills, which it is supposed were the pills
that poisoned him--pills containing a substance which sometimes does its
work in a quarter of an hour, which has done it in less, but never
hardly exceeds half an hour; and so we are to be asked to believe that
Palmer, Jones being present, and Cook in his presence objecting to take
the pills, positively forced them down his throat, at the imminent peril
of his falling down, like the rabbit, in two or three minutes afterwards
in convulsions evidently and manifestly tetanic. He states what did take
place. (The learned Serjeant read a further portion of Mr. Jones’
deposition.) But, as I am reminded by one of my lords, that in the
course of the examination of Mr. Jones the word “tetanus” is used, it is
right I should say a word on that, lest I should forget it. The word
“tetanus” is not in the deposition, and it is very remarkable that the
suggestion which has been put forward by the Crown was the suggestion of
Dr. Taylor. I do not think it is impossible that Mr. Jones, when he gave
that evidence, had in his mind’s eye what he had seen that night and not
seen very correctly. He had not light enough to see the patient’s face.
There was only one candle, and he could not tell whether there was any
change in his countenance on the Tuesday--a very important symptom. They
say it cannot have been tetanic, because there is a peculiar expression
in the face--a fact which nobody observed. It was too dark, in this case
of Cook’s, to take notice. Mr. Jones gave his evidence, and he is a
competent professional man, and it is quite clear that the notion of
tetanus, tetanic, tetaniform, or something like tetanus, must have
entered into his mind, because the clerk has put down “tetinus”; he
probably had not heard of the word before, and the probability is
something like it was used. He said he did use it, and afterwards it was
struck out, and Mr. Jones corrected his deposition, read it all over,
and signed it, and left it with the word struck out. There are strong
symptoms of “compression,” that is, one word struck out; then afterwards
there is the word “tetinus,” and then those two words are struck out,
with Mr. Jones’ entire approbation, because otherwise he would have
corrected it when he signed it; and he said he read it over, and the
words “violent convulsions” were substituted. What is the fair inference
from that?--that the man who saw Cook in the paroxysm did not think
himself justified in saying it was tetanus. It might be very like; it
might have a tetaniform appearance; but it was not tetanus.
Gentlemen, I will call your attention to the features of general
convulsions. I cross-examined several of the medical witnesses for the
purpose of inducing what I consider to be a true belief as to this case,
that the convulsions in which Cook died were not tetanus or tetanic
properly speaking; but that they were convulsions of that strong and
violent character which are tetaniform, though not classed under
idiopathic or traumatic tetanus, but under the head of general
convulsions.
[Sidenote: Serjeant Shee]
Gentlemen, I now propose to read a description of general convulsions
from the work of Dr. Copland. I called the attention of the very learned
gentlemen who were examined for the Crown to what was laid down in that
work, which is admitted to be one of authority, and I cannot conceive
how you, to whom this matter of fact is to be submitted, can form an
opinion whether or not my theory, or rather my belief, that he died by
the visitation of God, in violent general convulsions, be a probable
one, unless you hear from what was not written for the purposes of this
case what the features of general convulsions are; so, if you please, I
will read to you what I have myself copied from the work of Dr. Copland.
This, I may say, as I am upon the point, that the only persons in the
profession who can be supposed to have any competent or reliable
information on the subject of tetanus, not traumatic, are physicians;
and not one physician--properly so speaking--not one of that most
honourable body of men who see the sudden attacks of patients in their
beds, and not in hospitals, has been called to speak to this. Dr. Todd
was called, and Dr. Todd gave his evidence in a way to command the
respect of everybody; but Dr. Todd is a gentleman whose practice does
not appear to have been so much that of a physician as that of a
surgeon; he is physician to the King’s College Hospital, and has held
that office about twenty years; he has lectured on diseases of the
nervous system and tetanus, but he does not appear to have been a
physician in general practice.
[Sidenote: Serjeant Shee]
Gentlemen, I am instructed--I shall be able to show--by eminent men that
what I am about to read from Dr. Copland’s book, as part of my speech,
is a true description of convulsions that are not idiopathic or
traumatic, but of a general kind. He first gives the definition of
“general convulsions,” which he says are “violent and involuntary
contractions of a part or of the whole of the body, sometimes with
rigidity and tension (tonic convulsions), but more frequently with
tumultuous agitations, consisting of alternating shocks (clonic
convulsions), that come on suddenly, either in recurring or in distinct
paroxysms, and after irregular and uncertain intervals.” We will see
what he says about it--“If we take the character of the spasm in respect
of permanency, rigidity, relaxation, and recurrence as a basis of
arrangement of all the diseases by abnormal action of involuntary
muscles, we shall have every grade, passing imperceptibly from the most
acute form of tetanus through cramp, epilepsy, eclompsia, convulsions,
&c., down to the most atonic states of chorea and tremor. Also if we
consider the affections called convulsions, and which are usually
irregular in their forms, with reference to the character of the
abnormal contraction of the muscles, we shall see it in some cases of
the most violent and spastic nature, frequently of some continuance, the
relaxations being of brief duration, or scarcely observable, and in
others nearly or altogether approaching to tetanic. These constitute the
more tonic form of convulsions, from which there is every possible
grade, down to the atonic or most clonic observed in chorea or tremor.
The premonitory signs of general convulsions are, _inter alia_, vertigo
and dizziness, irritability of temper, flushings or alternate flushing
and paleness of the face, nausea, retching or vomiting, or pain and
distension of the stomach or left hypochondrium, unusual flatulence of
the stomach and bowels, and other dyspeptic symptoms. In many instances
the general sensibility and consciousness are but very slightly
impaired, particularly in the more simple cases, and when the proximate
cause is not seated in the encephalon; but in proportion as this part is
affected primarily or consecutively, and the neck and face tumid and
livid, the cerebral functions are obscured, and the convulsions attended
by stupor, delirium, &c., or pass into or are followed by these states.
The paroxysm may cease in a few moments, or minutes, or continue for
some or even many hours. It generally subsides rapidly, the patient
experiencing at its termination fatigue, headache, or stupor, but he is
usually restored in a short time to the same state as before the
seizure, which is liable to recur in a person once affected, but at
uncertain intervals. After repeated attacks the fit sometimes becomes
periodic (the convulsio recurrens of authors). The most common causes
are, _inter alia_, all emotions of the mind which excite the nervous
power and determine the blood to the head, as joy, anger, religious
enthusiasm, excessive desire, &c., or those which greatly depress the
nervous influence, as well as diminish and derange the actions of the
heart, as fear, terror, anxiety, sadness, distressing intelligence,
frightful dreams, &c., the syphilitic poison and repulsion of gout or
rheumatism.”
[Sidenote: Serjeant Shee]
Now, do you believe that if Dr. Taylor had read that before he went to
the inquest he would have dared to say that this man died of strychnia
poison? Is there one single symptom in the statement made in the
depositions of Elizabeth Mills and Mr. Jones which may not be classed
under one of the varieties of the degrees of convulsions which Dr.
Copland describes? Now, it is not for me to suggest a theory, but the
gentlemen whom I shall call before you, men of the highest eminence in
their profession, not mere surgeons of hospitals who never see anything
hardly except it is of that nature, that is, of the traumatic
kind--gentlemen, do not suppose that I should be capable of speaking
disrespectfully of Sir Benjamin Brodie, or of any of the gentlemen
called except in terms of the highest respect; but they are surgeons of
hospitals, and obtain a certain experience as to those misfortunes under
which, through violence, the human frame suffers; who have not so much
opportunity of witnessing and of knowing the symptoms of the class of
convulsions which constantly attack people in their own residences in
the dead of the night--those convulsions which heads of families and
brothers and sisters are most anxious to conceal from anybody but the
medical man--those convulsions, the known existence of which deprives a
young woman of the hope, or a young man of the hope, of marriage. It is
the men who have that sort of experience--the general practitioners--men
who enjoy the entire confidence of numerous families, and have the
opportunity of visiting, in the way of their profession, the poor at
their lowly dwellings, suffering under sudden convulsions when affected
by serious disease--those are the men that we want to tell us about
convulsions. Do not let me mislead you for a moment--the evidence I have
read to you is not the whole of the evidence of Elizabeth Mills. There
is her evidence, differing in some material particulars from the
evidence given by her before the coroner. As to Mr. Jones, the evidence
does not so much differ, though there may be some particulars in which
there is a difference--and there is one remarkable one. He said in his
depositions, “The body was resting on its head and its heels”; but in
his evidence he says, “It was so bent that if it had been turned on its
back, it would, or might, have rested on its head and its heels”--that
is, if it did not rest on the back; but he in substance says it did. Mr.
Bamford says he found it resting on its head, its back, and its heels,
thereby excluding the supposition that a part of the body was not
supported by the back. However, before I go to that, perhaps you will
permit me to call your attention to the symptoms of traumatic disease.
My belief is, and I submit it to you, and it is what I shall hope you
will confirm by your verdict, that this complaint was not strychnia
tetanus at all, but it was, according to this description--the
description to which I will call your attention--it may well have been
some form of traumatic tetanus or idiopathic tetanus--there being no
broad general distinction or certain confine between idiopathic or
self-generating tetanus, or tetanus not arising from any extreme hurt or
any violence to the interior part of the system; and many forms of
convulsions, that is tetaniform, are pretty much the same as idiopathic
tetanus, and we have had numbers of medical gentlemen who have told us
they never saw a case of idiopathic tetanus. The answer to that is, you
have had very limited experience. They are not very frequent; but there
are gentlemen here who have seen cases of idiopathic tetanus, and they
are not of such unfrequent occurrence by any means. There is one
gentleman who is here, and whom I will call before you--a gentleman who
attended at the bedside of the lady at Leeds who was suffering under
strychnia, who has himself seen four cases of idiopathic tetanus; and
there are other gentlemen here who have seen them also--they are not so
rare, but they very rarely fall under the notice of surgeons of
hospitals; they are not so frequent as traumatic tetanus. Cases of
traumatic tetanus do frequently supervene from the operations of the
surgeons themselves; sometimes after operations, however skilfully
performed, a lockjaw is the consequence. The persons to give you
information on the subject are the general practitioners.
[Sidenote: Serjeant Shee]
Now, we shall see that none of those symptoms which were spoken to on
the day of the inquest by Elizabeth Mills and Mr. Jones may not range
under one of these forms of tetanus, the idiopathic or traumatic. The
idiopathic mingling in all directions with general violent convulsions
is not to be distinguished from them, inasmuch as convulsions have
constant tetaniform appearances; and the meaning I take it of that is
this, it is true, as Dr. Watson says in a passage which I called to the
attention of one of their witnesses--it is true that in four cases out
of five traumatic tetanus begins with a seizure of the lower jaw,
unless, as Sir Benjamin Brodie tells us, it may begin, as it did in two
cases which he attended many years ago, in the limbs. He told us so when
he was here; it began there before it attacked the jaw; but generally
trismus or lockjaw is the first symptom. But there is a fifth case in
which it is not, and Mr. Curling told us that that was about the
proportion--four out of five; so that even traumatic, or that kind of
tetanus which sets in after a wound, does not always begin with some
affection of the jaw or neck. Now, gentlemen, having gone so far, and
having endeavoured to satisfy you that the symptoms which were spoken to
by those two witnesses on the depositions may be the symptoms, as I
think--that is to say, as I am told, having no experience of my own in
the matter--that these symptoms are rather referable to that violent
description of general convulsions than to any form of tetanus, let us
go to the question, whether or not the symptoms are consistent with what
we know of tetanus produced by strychnia, because if we are satisfied on
a full inquiry that they are not consistent with the symptoms
unquestionably produced by strychnia tetanus, then the hypothesis of the
Crown entirely fails, and John Parsons Cook cannot have died of
strychnia poison.
Now, gentlemen, whether that be so or not will depend in a great degree,
as it strikes me--but, of course, it is entirely for you--on what you
think of the evidence of Elizabeth Mills; but before I go to the
evidence of Elizabeth Mills I will call your attention to what the
description of strychnia tetanus is, as given us by two very eminent
gentlemen who were called the other day for the Crown--Dr. Taylor and
Dr. Christison; and if we find on looking at it that that description of
the poison of strychnia tetanus, given by them, is a different thing
from the picture first given of the complaint, of the paroxysms of John
Parsons Cook by Elizabeth Mills and Mr. Jones, I think it would be
rather too bad on their mere opinion to say that this is strychnia
tetanus. Let us take Dr. Taylor’s description of strychnia tetanus--I am
not sure whether Dr. Taylor stated he had ever seen strychnia tetanus in
the human subject; however, we must be just to Dr. Taylor. Dr. Taylor
has had an extensive reading upon the subjects upon which he writes, and
it is not to be supposed that Dr. Taylor would hastily set down in his
book what he did not find established on high authority; therefore,
though having it at second hand, Dr. Taylor knows something upon the
subject.
[Sidenote: Serjeant Shee]
Now, Dr. Taylor, in his work on strychnia poison, has this under the
head of strychnia, “that from five to twenty minutes after the poison
has been swallowed the patient is suddenly seized with tetanic symptoms,
affecting the whole of the muscular system; the body becomes rigid, the
limbs stretched out, and the jaws so fixed that considerable difficulty
is experienced in introducing anything into the mouth.” On both the
depositions and the other evidence it is stated that Mr. Cook was
sitting up in bed, beating the bed-clothes, frequently telling the
people about him to go for Palmer, asking for the remedy, and willing to
take whatever was given him; there was no considerable difficulty in
introducing anything into the mouth, and the paroxysms, instead of
beginning within from five to twenty minutes after the poison was
supposed to have been swallowed, did not begin for an hour and a half
afterwards. Dr. Taylor further on states, “After several such attacks,
increasing in severity, the patient dies asphyxiated.” That there were
some of these symptoms in this case there can be no doubt, and there
will be some of them in every case of violent convulsions, yet it is not
the description of such a case as that of John Parsons Cook. Now, let us
see what Dr. Christison says--“The symptoms produced by strychnia are
very uncommon and striking--the animal begins to tremble, and is seized
with stiffness and starting of the limbs. Those symptoms increase till
at length the animal is attacked by general spasms.” Is that the
description of either of these paroxysms? Who can say with any degree of
truth that it is? Just observe these last indications of strychnia
tetanus, which are consistent with all the cases stated in their books.
It is only justice to those gentlemen who have taken pains to look to
the authorities to which they refer to say that the statements which
they give of their cases are in the main correct, but not in all their
details. The books would be five times their size if they were; but they
are in the main correct, when we look to the foreign authorities on
which they are founded--“The fit is then succeeded by an interval of
calm, during which the senses are impaired or are unnaturally acute; but
another paroxysm soon sets in, and then another and another, until at
last a fit occurs more violent than any that had preceded it, and the
animal perishes suffocated.” I know exactly what Dr. Christison means by
this, because there is a gentleman here who will state an experiment
which I saw myself; it was an experiment, and for the purpose of this
case, and to assist me; and I disagree with Dr. Taylor that there can be
a moment’s hesitation in sacrificing ten or twenty dogs for the purpose
of ascertaining the truth of this theory when a man’s life is involved.
These experiments were performed by Dr. Letheby while I was there. I
will state them to you, because he will prove it by and by. A dog had
some strychnia put in his mouth, one grain, and then for about--I cannot
be sure as to the time exactly, but about twenty or twenty-five
minutes--I cannot be sure, it might not be so much--the dog was
perfectly well. There were two rabbits on the table which were also
about to be subjected to the operation, and the dog, when the chain was
sufficiently relaxed to enable him to do so, showed all the indications
which a dog naturally does to get at the rabbits; he was pulling at his
chain, and was smelling and pawing and taking an interest in the
rabbits; suddenly it fell down on its side, and its legs were stretched
out in a most violent way. It panted, and then it remained for some
time--two or three minutes--quiet, occasionally a little jerking, but
generally quiet. It recovered again for a time, got up and looked at the
rabbits, but was dizzy, seemed afraid to move; and, if you touched it,
shuddered and twitched, to use Miss Elizabeth Mills’ description; seemed
to be afraid, and after another moment down it went again. It got up
again, and down it went again, and at last it had a tremendous struggle,
and it died. That is what Dr. Christison means by this description; it
would be true if the dose had been a strong one. If the dose had not
been sufficient to kill the dog it would probably be a longer time--at
least, I suppose so--in producing its effect, and the interval between
the paroxysms, as stated by Dr. Taylor and Dr. Christison, would get
longer and longer, until at last the animal would recover. If the dose
is strong enough to kill, the interval between the paroxysms is shorter,
till at last the violent one comes which destroys life; the eyes are
fixed, and there it lies, and just before its death--and I thought it
was dead, but I was told immediately before its death--just before it
dies, the limbs become as supple and as free as it is possible to
conceive the limbs of an animal to be; whichever way you placed them
after the animal is quite dead, if you place them in any form, the
rigor-mortis comes on, and they remain in the position in which you
place them. Dr. Christison says they assume rigidity. I saw this
operation performed, and also on the two rabbits, and their symptoms
were substantially the same, and their limbs in both cases were quite as
flaccid immediately on death. The animals during the time of the
intervals between the paroxysms were exceedingly touchy, and seemed
afraid of being touched at all; if you were to touch them they would
shrink away. It was more so in the dog; it was, in fact, a sort of
shudder--that is what Dr. Christison means.
[Sidenote: Serjeant Shee]
Now, gentlemen, without going through the whole of these details, I will
state to you my reasons for saying, on the authorities and from my study
of the books of those two gentlemen, that, according to their
principles, this cannot have been strychnia poison. Now, I object to the
theory of its being strychnia poison, first, on this ground, that no
case can be found in the books in which the patient while the paroxysm
lasted has had so much command over the muscles of animal life and
voluntary motion as Mr. Cook had on the Monday and Tuesday nights. You
heard that Mr. Cook was sitting up in his bed, that Mr. Cook was beating
the bed-clothes, that Mr. Cook was talking and crying out for Palmer,
and to have the remedy given to him; that Mr. Cook, so far from being
afraid of people touching him, asked to have his neck rubbed, and it was
rubbed. There is not a single instance in the books of Dr. Taylor, or in
the books of Dr. Christison, or any other books of any medical man
describing the symptoms of the strychnia poison, in which the well-known
symptoms the malasaux took place--not one, and it is inconsistent with
their description, and what I tell you will be the proof Dr. Letheby
will give of the experiment that I saw, and of many others he had
performed.
[Sidenote: Serjeant Shee]