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.
What was the matter with the child?--I saw it in good health half an
hour before the attack came on. It had an attack of convulsions and
opisthotonos. I rode away from the house, and they supposed I had not
gone a couple of miles when it died.
[Sidenote: W. M‘Donnell]
It was seized with a fit?--Apparently a spasm, which I consider to be of
the tetaniform character. I had seen the child half an hour before.
There was nothing the matter with it then. It was in bed, I believe,
with the mother, who was laid up. I did not see its face. I saw it lying
in bed, but did not examine it. I judged it to be asleep.
With regard to the animals that you experimented on with strychnia, when
did you begin with them?--I began this series of experiments for this
case in January.
Had you ever made any before?--Yes; I think eight or ten years ago. The
dose by which I killed the animals was from 1¾ to 2 grains. The animals
experimented upon were dogs, cats, rabbits, and fowls. These experiments
will relate to dogs. A grain is the smallest dose I administered. In
four cases I used a grain, in five 1½ grains, in one, I think, 1¼
grains, and in two 2 grains.
You never tried them with half a grain?--Yes, I did; I did not mention
it before. I gave half a grain for the purpose of ascertaining the least
dose that would kill.
Did you try if you could detect it afterwards?--How could I try before I
killed the dog?
Do you mean on your oath you do not understand my question? Show me one
instance where you have given half a grain?--I did not make a note,
because it did not kill. I have never destroyed a dog with half a grain;
I tried it, and it did not answer.
Now let us come to your symptoms. You say you have always found the
brain highly congested?--By the stoppage of the circulation in the
system.
Have you not found in some cases that the brain was not congested?--No;
I think in every case there were more or less congestion.
Is that greater in proportion to the length of the paroxysm?--No; it is
greatest where the animal was young and in a full state of health.
Have you ever seen any case of traumatic tetanus?--I think two in my own
practice, but I have seen a few others in hospital.
Have you ever seen a case of strychnia in the human subject?--No, I have
not.
I understand you to say that, in your opinion, this was a case of
epilepsy with tetanic complications?--As far as I can judge from hearing
the evidence in Court.
What does epilepsy proceed from?--Nobody can answer that question.
You have no theory upon the subject?--I have not exactly arrived at any
distinct theory, not quite as distinct as strychnia or tetanus. I have
seen one case of death from epilepsy. The patient was not conscious when
he died.
Can you find me any case in which consciousness has preceded death?--I
cannot recollect.
[Sidenote: W. M‘Donnell]
You have studied on purpose for these cases?--No; I am pretty well up in
most branches.
Being so universally proficient in the science of your profession, do
you know of any single recorded case of consciousness at the time of
death?--I do not from my own knowledge. I have heard what Sir Benjamin
Brodie said on this subject.
You mean deliberately to state that you believe this to have been from
epilepsy?--I do state so.
Without being able to refer to any cause whatever as producing the
disease?--When I have told you before that deaths often take place in
idiopathic tetanus without leaving any trace behind, I think I may
say----
That is idiopathic tetanus?--They are all of the same class. I think all
forms of convulsions arise from a decomposition of the blood, and, if a
person has probably an incipient tendency to disease of the brain, that
it always may be affected, and that the decomposition of the blood might
set up the diseased action.
Do I understand you that mental excitement had anything to do with
this?--I do not say it had. I said it might have caused it.
Do you find any excitement in this case?--I find at Shrewsbury he was
excited, and wherever you have excitement you have a consequent
depression.
Do you find he was depressed?--When you find a man in bed sick, he must
be depressed.
I was speaking of the depression consequent on these symptoms. Where do
you find any symptom of illness until he begins to vomit?--If I have
much excitement, if I am up all night, it upsets me the next day, and I
generally vomit the food I take. Cook was overjoyed at winning his race.
And you think he vomited in consequence?--He might.
Do you mean to swear that you think the excitement of the three minutes
on the course on the Tuesday accounts for the vomiting?--I do not mean
to say anything of the kind.
Do you find any excitement or depression from that time till the time he
died?--There is nothing reported that I can recollect just now.
On the contrary, do you not recollect that the man, when he was not
vomiting, on that very night, was joking and laughing; was that
sufficient to make him vomit?--That may well be where a man is subject
to bilious fits.
We are talking of excitement--of epilepsy with tetanic complications; I
want to know on what you can put your hand in the way of excitement or
depression which will account for the remarkable symptoms?--I have told
you that almost any one of them is sufficient.
[Sidenote: W. M‘Donnell]
Where is there one which you say might have occasioned death?--These
white spots in the stomach might have caused death by an inflammatory
condition of the stomach.
But there was no inflammation of the stomach, was there?--I have given
you my opinion.
If there had been any, would not the gentlemen who examined it have seen
it?--If those white spots were present you would have had inflammation.
They say there was none?--I do not believe them.
Sensual excitement is a cause of epilepsy with tetanic complications; is
that what you say?--Yes, it might be.
Do you find a tittle of evidence of any such excitement?--I think
so--the syphilitic spots. There was no doubt about it.
Do you mean to say that you attribute this to some excitement at some
anterior period long before?--I am not called upon to say that. I take
my opinion from what was seen.
Supposing the man had any such excitement a week before, do you mean
that is sufficient?--Yes; we have instances on record of convulsions in
the very act you allude to.
Have you any instance a fortnight afterwards?--It is quite within the
range of possibility.
Would epilepsy, with tetanic complications, set in from that cause? Do
you mean to stand there, as a serious man of science, and tell me
that?--Yes, the results of sensual excitement--chancre in one of them,
and syphilitic sore throat.
Did you ever hear or know of such a thing as chancre or any other form
of syphilis producing epilepsy?--Not epilepsy, but tetanus. You are
forgetting the tetanic complications.
If I understand it rightly, it stands thus: the sensual excitement
produces the epilepsy, and the chancre produces tetanic
complications?--You are quite mistaken. I say the results of a sensual
excitement.
You have just now said that your reason for thinking and referring it to
epilepsy was that, amongst other things, an hour or an hour and a half
intervened between the taking of the poison and the appearance of the
first symptoms. Do you mean that in your reading you have not met with
cases quite as long as that when the death has arisen from strychnia?--I
cannot recollect where death has followed.
Would the fact of morphia having been given for an hour or two
previously in any way touch your opinion with regard to poison?--No; I
have seen opium bring on convulsions very nearly the same.
Will opium bring on convulsions?--Yes, but a different form of
convulsions from epilepsy.
Because opium brings on convulsions, you assume in this case that
morphia accelerated the disease?--Drawing the inference, I should say it
might.
[Sidenote: W. M‘Donnell]
Suppose not a case of epilepsy, but of strychnia; what would be the
action of morphia? How would it attack the disease?--In some cases it
stimulates. It is exceedingly apt to cause congestion of the brain.
In which disease does it cause excitement?--It depends on the
idiosyncrasy, on the habit of body, if I might use a common term.
Having taken it on the Saturday and Sunday night, and having been free
from nervous excitement on the Sunday and Monday, what would you assume
judging from the result?--If it were opium, yet it is only presumed to
be opium, it appears to have soothed him.
And why, when the man was tranquil on the Sunday and Monday, did you,
after that, venture to say that these pills irritated him?--I do not
mean to say they did.
Re-examined by Mr. SERJEANT SHEE--You stated that, though you had seen
no case of epileptic convulsions with tetanic complications, your
reading informed you that there had been, and you mentioned Dr. Mason
Goode?--Yes. He is a well-known author on the subject of convulsions.
There is a class of convulsions called epileptic--not, strictly
speaking, epilepsy--though they resemble it in some of its features.
Epilepsy, properly so called, is sudden in its attacks. The patient
falls down at once with a shriek. Within my knowledge, the disease
constantly occurs at night and in bed.
Are the convulsions which the authors do not class as properly epilepsy,
but as convulsions of an epileptic character, sometimes attended with
premonitory symptoms?--Sometimes the patient is thrown into tetanic and
tetaniform convulsions. Pending the struggle or the convulsions, actual
epilepsy may come on in this way, and the patient die. In epilepsy and
in convulsions of an epileptic character, a patient may have suffered in
the night and be well the next morning, and as well the next day as if
he had had no fit at all, more especially where adults are seized for
the first time. When an adult is seized for the first time it is in my
experience that several fits follow each other during a short period.
If it were true that Cook’s mind appeared distressed and irritable the
afternoon before he died, would you infer from that, considering the
former excitement and elation, he was in a state of depression or
not?--Yes.
What would you infer from what happened in the middle of the Sunday
night, supposing it were true that he represented himself to be mad for
ten minutes, and it was occasioned by a quarrel in the streets?--That he
had been seized with some sudden cramp or spasm.
[Sidenote: W. M‘Donnell]
Supposing there was no such cramp, and that he meant to tell the truth,
would you refer what he said to any nervous and mental excitement?--Yes,
decidedly.
With regard to the spots on the stomach, which you mentioned when my
friend was examining you, you stated you differed from some gentlemen of
your profession?--Yes.
The ATTORNEY-GENERAL--He said he did not believe them?--I did not. I did
not believe that inflammation could be absent and these spots present.
Re-examination resumed--Have you known any serious consequence of a
convulsive character reasonably imputed to spots of that description?--I
have. There was a case about twenty years ago. It was published. I saw a
case myself, about eighteen months ago. I examined the body after death.
It was a case of fever, I thought. I did not know what the spots were,
and consulted all the authors who had treated on the mucous structure of
the stomach, and could find no account of it but in one which I have
here, an essay by Dr. Sproshoid, a medical man practising in Edinburgh,
but now deceased.
* * * * *
[Sidenote: J. N. Bainbridge]
Dr. JOHN NATHAN BAINBRIDGE, examined by Mr. GROVE--I am a doctor of
medicine and medical officer to the St. Martin’s Workhouse. I have had
considerable experience of convulsive disorders. They admit of a very
great variety of symptoms. There are causes of them varying from what
are called chronic diseases to rigid opisthotonos. Hysterical
convulsions are very frequently accompanied with opisthotonos;
convulsions of the muscles of the back and of the limbs. The different
cases vary very much as to the frequency of the recurrences, and as to
the muscles attacked. Periodicity is very common, that is, occurring at
the same hour, the same day, and at an interval of a year. I have known
this very common at shorter periods, such as twelve or twenty-four
hours. These disorders run so imperceptibly one into the other that it
is almost impossible for the most experienced medical man to decide
where one kind of convulsion terminates and the other begins. Epileptic
attacks are frequently accompanied with tetanic complications, or
tetanic spasms.
Cross-examined by the ATTORNEY-GENERAL--Do hysterical convulsions ever
end in death without being attended by these tetanic symptoms?--Very
rarely indeed. I have known one case within the last three months.
Can you undertake to say that that was not a death by apoplexy?--No. The
symptoms were somewhat of the same character, but more of the character
of epilepsy. It would be very difficult for any man to define the
difference in some instances between hysteria and epilepsy.
[Sidenote: J. N. Bainbridge]
In fact, had not the man been subject to these fits for a long series
of years, and at last he died in one of them?--Yes, he had.
In attacks of this nature is there in the fits a loss of
consciousness?--Sometimes. I have seen several cases in which there has
been, and in others they can almost understand anything you say to them,
not perfectly perhaps, but you may rouse them.
Have you ever known an instance in which a man was able to speak when
the paroxysm has set in?--They will scream, and recollect what we have
said to them. I never knew any of them, in the actual violence of the
paroxysm, ask to have their position changed. Epilepsy, when it is very
bad, is sometimes attended with opisthotonos.
When the convulsions are so violent that opisthotonos is produced, have
you ever known patients conscious?--Partly conscious. If they were asked
subsequently they would recollect what had occurred. I have seen cases
of traumatic tetanus. As far as I have observed the patient always
retains his consciousness. I have frequently known epilepsy end in
death, and also hysteria with tetanic complications end in death.
Because you tell me you have known of hysteria ending in death, I wish
you to inform me what in your opinion is the distinction between
them?--The less consciousness more especially found in epilepsy, and the
sudden falling down.
Did you ever know a case of death in epilepsy where consciousness was
not destroyed before death?--No, I do not know one.
Mr. SERJEANT SHEE--I think it is an assumption that Mr. Cook was
conscious between the last shriek and his death.
* * * * *
[Sidenote: E. A. Steady]
Mr. EDWARD AUSTIN STEADY, examined by Mr. GRAY--I am a member of the
Royal College of Surgeons, and am in practice as a surgeon at Chatham.
In June, 1854, I attended a person for trismus and pleurosthotonos, the
head depending on one side, and not backwards as is the case in
opisthotonos. Convulsions came on in paroxysms. The first attack
continued for a fortnight. She had trismus all the time. For twelve
months there were remissions of the pleurosthotonos. She appeared to get
better to a certain extent, and walked about, but the tendons of one
knee were contracted. About twelve months after she was again seized.
The seizure continued about a week.
Did you ascertain the cause which had brought about this disease?--It
was detailed to me as excitement. A passion, I believe, brought it on. I
believe she had had some quarrel with her husband. I discovered no other
cause.
[Sidenote: E. A. Steady]