Part 26

Could it be detected, under those circumstances, in the coats of the stomach?--Not knowing the dose administered, and the power of absorption, I cannot say that it could certainly be detected, but probably it could.

When death has taken place after one paroxysm, and an hour and a half after ingestion of the poison, can you form an opinion as to whether the dose was considerable or inconsiderable?--I cannot.

Mr. Baron ALDERSON: How do you suppose strychnine acts when taken into the stomach?--I cannot form an opinion.

Mr. Baron ALDERSON: It goes, I suppose, from the stomach to the blood, and from the blood somewhere else, and, arriving at that somewhere else, it kills.

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

Mr. Serjeant SHEE requested to be allowed to ask the witness whether a strong dose was likely to pass through all the stages his lordship had mentioned.

Mr. Baron ALDERSON: That depends on where the killing takes place.

Professor PARTRIDGE, examined by Mr. GROVE: I have been many years in extensive practice as a surgeon, and I am a Professor of Anatomy in King’s College. I have heard the evidence as to Cook’s symptoms and _post-mortem_, examination. I have heard the statements as to the granules that were found on his spine. They would be likely to cause inflammation, and no doubt that inflammation would have been discovered if the spinal cord or its membranes had been examined shortly after death. It would not be likely to be discovered if the spinal cord was not examined until nine weeks after death. I have not seen cases in which this inflammation has produced tetanic form of convulsions, but such cases are on record. It sometimes does, and sometimes does not, produce convulsions and death.

Can you form any judgment as to the cause of death in Cook’s case?--I cannot. No conclusion or inference can be drawn from the degree or kind of the contractions of the body after death.

Lord CAMPBELL: Can you not say, from the symptoms you heard, whether death was produced by tetanus, without saying what was the cause of tetanus?

Witness: Hypothetically I should infer that he died of the form of tetanus which convulses the muscles. Great varieties of rigidity arise after death from natural causes. The half-bent hands and fingers are not uncommon after natural death. The arching of the feet, in this case, seemed to me rather greater than usual.

Cross-examined by the ATTORNEY-GENERAL: Granules are sometimes, but not commonly, found about the spine of a healthy subject--not on the cord itself; they may exist consistently with health. No satisfactory cases of the inflammation I have described have come under my notice without producing convulsions. It is a very rare disease. I cannot state from the recorded cases the course of the symptoms of that disease. It varies in duration, sometimes lasting only for days, sometimes much longer. If the patient lives, it is accompanied with paralysis. It produces no effect upon the brain which is recognisable after death. It would not affect the brain prior to death. I do not know whether it is attended with loss of sensibility before death. The size of the granules which will produce it varies. This disease is not a matter of months, unless it terminates in palsy. I never heard of a case in which the patient died after a single convulsion. Between the intervals of the convulsions I don’t believe a man could have twenty-four hours’ repose. Pain and spasms would accompany the convulsions. I cannot form a judgment as to whether the general health would be affected in the intervals between them.

You have heard it stated, that from the midnight of Monday till Tuesday Cook had complete repose. Now, I ask you, in the face of the medical profession, whether you think the symptoms which have been described proceeded from that disease?--I should think not.

Did you ever know the hands completely clinched after death except in case of tetanus?--No.

Have you ever known it even in idiopathic or traumatic tetanus?--I have never seen idiopathic tetanus. I have seen the hands completely clinched in traumatic tetanus. A great deal of force is often required to separate them.

Have you ever known the foot so distorted as to assume the form of a club foot?--No.

You heard Mr. Jones state that if he had turned the body upon the back it would have rested on the head and the heels. Have you any doubt that that is an indication of death from tetanus?--No; it is a form of tetanic spasm. I am only acquainted with tetanus resulting from strychnine by reading. Some of the symptoms in Cook’s case are consistent, some are inconsistent, with strychnine tetanus. The first inconsistent symptom is the intervals that occurred between the taking of the supposed poison and the attacks.

Are not symptoms of bending of the body, difficulty of respiration, convulsions in the throat, legs, and arms, perfectly consistent with what you know of the symptoms of death from strychnine?--Perfectly consistent. I have known cases of traumatic tetanus. The symptoms in those cases had been occasionally remitted, never wholly terminated. I never knew traumatic tetanus run its course to death in less than three or four days. I never knew a complete case of the operation of strychnine upon a human subject.

Bearing in mind the distinction between traumatic and idiopathic tetanus, did you ever know of such a death as that of Cook according to the symptoms you have heard described?--No.

Re-examined by Mr. GROVE: Besides the symptom which I have mentioned as being inconsistent with the theory of death by strychnine, there are others--namely, sickness, beating the bed clothes, want of sensitiveness to external impressions, and sudden cessation of the convulsions and apparent complete recovery. There was apparently an absence of the usual muscular agitation. Symptoms of convulsive character arising from an injury to the spine vary considerably in their degrees of violence, in their periods of intermission, and in the muscles which are attacked. Intermission of the disease occurs, but is not frequent, in traumatic tetanus. I don’t remember that death has ever taken place in fifteen hours; it may take place in forty-eight hours during convulsions. Granules about the spine are more unusual in young people than in old. I don’t know of any case in which the spine can preserve its integrity, so as to be properly examined, for a period of nine weeks. I should not feel justified in inferring that there was no disease from not finding any at the end of that time. The period of decomposition varies from a few hours to a few days. It is not in the least probable that it could be delayed for nine weeks.

By the ATTORNEY-GENERAL: Supposing the stomach were acted on by other causes, I do not think sickness would be inconsistent with tetanus.

JOHN GAY, examined by Mr. GRAY: I am a Fellow of the Royal College of Surgeons, and I have been a surgeon to the Royal Free Hospital. A case of traumatic tetanus in a boy came under my observation in that hospital in 1843. The patient was brought in during the time he was ill. He was brought on the 28th of July and died on the 2nd of August. He had met with an accident a week before. During the first three days he had paroxysms of unusual severity. His mother complained that he could not open his mouth, and he complained of stiff neck. During the night he started up and was convulsed. On the following night he was again convulsed. At times the abdominal muscles, as well as those of the legs and back, were rigid; the muscles of the face were also in a state of great contraction. On the following (third) day he was in the same state. At two o’clock there was much less rigidity of the muscles, especially those of the abdomen and back. On the following morning the muscular rigidity had gone, he opened his mouth and was able to talk; he was thoroughly relieved. He had no return of spasms till half-past five the following day. He then asked the nurse to change his linen, and as she lifted him up in the bed to do so violent convulsions of the arms and face came on, and he died in a few minutes. About thirty hours elapsed between the preceding convulsion and the one which terminated his life. Before the paroxysm came on the rigidity had been completely relaxed. I had given the patient tartar emetic (containing antimony) in order to produce vomiting on the second day; it produced no effect. I gave a larger dose on the third day, which also produced no effect. I gave no more after the third day.

Cross-examined by the ATTORNEY-GENERAL.--The accident which had happened to him was that a large stone had fallen upon the middle toe of the left foot, and completely smashed it. The wound had become very unhealthy. I amputated the toe. The mouth was almost closed up when I first saw him. The jaw remained closed until the 1st of August, but I could manage to get a small quantity of tartar emetic into the mouth. The convulsions were intermitted during the day, but the muscles of the body, chest, abdomen, back, and neck, were all rigid, and continued so for the two days on which I administered tartar emetic. Rigidity of the muscles of the chest and stomach would no doubt go far to prevent vomiting. The symptoms began to abate on the morning of the 1st of August (the fourth day), and gradually subsided until the rigidity entirely wore off. I then thought he was going to get well. The wound might have been rubbed against the bed when he was raised, but I don’t think it probable. Some peculiar irritation of the nerves would give rise to the affection of the spinal cord. No doubt the death took place in consequence of something produced by the injury to the toe.

Re-examined by Mr. GRAY.--There may be various causes for that irritation of the spinal cord which ends in tetanic convulsions. It would be very difficult merely from seeing symptoms of tetanus, and in the absence of all knowledge as to how it had been occasioned, to ascribe it to any particular cause.

Dr. W. MACDONALD, examined by Mr. KENEALY.--I am a licentiate of the Royal College of Surgeons of Edinburgh. I have been in practice for fourteen years, and have had considerable experience, practical and theoretical, of idiopathic and traumatic tetanus. I have seen two cases of idiopathic tetanus, and have made that disease the subject of medical research. Tetanus will proceed from very slight causes. An alteration of the secretions of the body, exposure to cold or damp, or mental excitement would cause it. Sensual excitement would produce it. The presence of gritty granules in the spine or brain might produce tetanic convulsions. I have seen cases in which small gritty tubercles in the brain were the only assignable cause of death, which had resulted from convulsions. I believe that in addition to the slight causes which I have named, tetanic convulsions result from causes as yet undiscoverable by human science. In many _post-mortem_ examinations of the bodies of persons who had died from tetanus no trace of any disease could be discovered beyond congestion or vascularity of some of the vessels surrounding the nerves. Strychnia, however, is very easily discoverable by a scientific man. I remember the case of a woman, Catherine Watson, who is now present, and who was attacked with idiopathic tetanus on the 20th of October, 1855. [The witness read a report of the circumstances attending this case, the subject of which was a young woman twenty-two years of age, who, after going about her ordinary occupation during the day, was attacked with tetanus at ten o’clock at night. By the administration of chloroform the violence of the spasms was gradually diminished and she recovered. After her recovery she slept for thirty-six hours.] In that case there was lockjaw, which set in about the middle of the attack. It is generally a late symptom. I had a patient named Coupland who died of tetanus. It must have been idiopathic, as there was no external cause. The patient died in somewhat less than half an hour, before I could reach the house. I have made a number of experiments upon animals with reference to strychnia poison. I have found the _post-mortem_ appearances very generally to concur. The vessels of the membranes of the brain have generally been highly congested. The sinuses gorged with blood. In one case there was hemorrhage from the nostrils. That was a case of very high congestion. In some cases there has been an extravasation of blood at the base of the brain. I have cut through the substance of the brain, and have found in it numerous red points. The lungs have been either collapsed or congested. The heart has invariably been filled with blood on the right side, and very often on the left side also. The liver has been congested, the kidneys and spleen generally healthy. The vessels of the stomach on the outer surface have been congested, and on the mucous or inner surface highly vascular. The vessels of the membranes of the spinal cord have been congested, and sometimes red points have been displayed on cutting it through.

From a _post-mortem_ examination you may generally judge of the cause of death. I have in a great many cases experimented for the discovery of strychnia. You may discover in the stomach the smallest dose that will kill. If you kill with a grain you may discover traces of it. By traces I mean evidences of its presence. You can discover the fifty-thousandth part of a grain. I have actually experimented so as to discover that quantity. The decomposition of strychnia is a theory which no scientific man of eminence has ever before propounded. I first heard of that theory in this court. In my opinion, there is no well-grounded reason whatever for it. I have disproved the theory by numerous experiments. I have taken the blood of an animal poisoned by two grains of strychnia, about the least quantity which would destroy life, and have injected it into the abdominal cavities of smaller animals, and have destroyed them, with all the symptoms and _post-mortem_ appearances of poisoning by strychnia. Strychnia being administered in pills would not affect its detection. If the pills were hard they would keep it together, and you might find its remains more easily. I do not agree with Dr. Taylor that colour tests are fallacious. I believe that such tests are a reliable mode of ascertaining the presence of strychnia. I have invariably found strychnia in the urine which has been ejected. Strychnia cannot be confounded with pyrozanthe. After strychnia has been administered there is an increased flow of saliva. In my experiments that has been a very marked symptom. Animals to which strychnia had been given have always been very susceptible to touch. The stamp of a foot or a sharp word would throw them into convulsions. Even before the paroxysms commenced touching them would be likely to throw them into tonic convulsions.

Lord CAMPBELL: As soon as the poison is swallowed? No; it would be after a certain time. The first symptoms of poisoning must have been developed.

Examination continued: I do not think rubbing them would give them relief. I think it extremely improbable that a man who had taken a dose of strychnia sufficient to destroy life could after the symptoms had made their appearance pull a bell violently. I have attended to the evidence as to Cook’s symptoms. To the symptoms I attach little importance as a means of diagnosis, because you may have the same symptoms developed by many different causes. A dose of strychnia sufficient to destroy life would hardly require an hour and a-half for its absorption. I think that death was in this case caused by epileptic convulsions with tetanic complications. I form that opinion from the _post-mortem_ appearances being so different from those that I have described as attending poisoning with strychnia, and from the supposition that a dose of strychnia sufficient to destroy life in one paroxysm could not, so far as I am aware, have required even an hour for its absorption before the commencement of the attack. If the attack were of an epileptic character, the interval between the attacks of Monday and Tuesday would be natural, as epileptic seizures very often recur at about the same hours of successive days.

Assuming that a man was in so excited a state of mind that he was silent for two or three minutes after his horse had won a race, that he exposed himself to cold and damp, excited his brain by drink, and was attacked by violent vomiting, and that after his death deposits of gritty granules were found in the neighbourhood of the spinal cord, would these causes be likely to produce such a death as that of Cook?--Any one of these causes would assist in the production of such a death.

As a congeries, would they be still more likely to produce it?--Yes.

Cross-examined by the ATTORNEY-GENERAL: I am a general practitioner, and am parochial medical officer. I have had personal experience of two cases of idiopathic tetanus. What I have said about mental and sensual excitement, and so on, has not come within my own observation. In the case of Catherine Watson, I saw the patient at about half-past ten at night. She had been ill nearly an hour, and had five or six spasms. She had gone about her usual duties up to evening. She felt a slight lassitude for two days previous to the attack. It was only by close pressing that I ascertained that lock-jaw came on about an hour or two after I was called in. The case of Coupland was that of a young child between three and four years old. I was attending the mother, and saw the child in good health half an hour before it came on. It was seized with spasm, what I conjectured to be of the diaphragm, and died in about half an hour. I had seen the child asleep, but I did not examine it. I don’t know whether I saw the face of the child, but it was in bed; I judged that it was asleep.

Is that the same as seeing it asleep?--Sometimes a medical man can form a better judgment than a lawyer. Mr. Smith applied to me to be a witness in this case. I communicated to him the case of Catherine Watson, as resembling the case of Cook. I furnished my notes to be copied the night before last. I have been here since the commencement of the trial. I have been at all the consultations. I began the experiments for this case in January. I had made experiments before. That was eight or ten years ago. I then found out that strychnia could be discovered by chemical and physiological tests. I killed dogs, cats, rabbits, and fowls. The doses I administered were from three-quarters up to two grains. To dogs, the smallest quantity administered was a grain. In four cases, I killed with one grain, five with a grain and a half, one with a grain and a quarter, and two with two grains. I never killed a dog with half a grain of strychnia, and therefore never experimented to find that quantity after death. I have always found the brain and heart highly congested. The immediate cause of the fulness of the heart is, that the spasm drives the blood from the small capillaries into the large vessels. The spasm of the respiratory muscles prevents the expansion of the lungs. The congestion of the brain is greatest when the animal was young, and in full health. It does not depend upon the frequency of the spasms. I have seen cases of traumatic tetanus. I have had two in my own practice. One lasted five or six days, the other six or seven days, and the patient recovered. I have never seen a case of strychnia in the human subject. So far as I can judge, Cook’s was a case of epileptic convulsions, with tetanic complications. Nobody can say from what epilepsy proceeds. I have not arrived at any opinion on the subject. I have seen one death from epilepsy. The patient was not conscious when he died. I can’t mention a case in which a patient dying from epilepsy has preserved his consciousness to the time of death.

You have been reading up this subject?--I am pretty well up in most branches of medicine. (A laugh.) I know of no case in which a patient dying from epilepsy has been conscious. My opinion is Cook died of epileptic convulsions with tetanic complications.

By Lord CAMPBELL.--That is a disease well known to physicians. It is mentioned in Dr. Copland’s Dictionary.

Examination continued. I believe that all convulsive diseases, including the epileptic forms and the various tetanic complications, arise from the decomposition of the blood acting upon the nerves. Any mental excitement might have caused Cook’s attack. Cook was excited at Shrewsbury, and wherever there is excitement there is consequent depression. I think Cook was afterwards depressed. When a man is lying in bed and vomiting he must be depressed.

This gentleman was much, overjoyed, at his horse winning, and you think he vomited in consequence?--It might predispose him to vomit.

I am not speaking of “mights.” Do you think that the excitement of the three minutes on the course at Shrewsbury on the Tuesday accounts for the vomiting on the Wednesday night?--I do not. I find no symptoms of excitement or depression reported between that time and the time of his death. The white spots found in the stomach of the deceased might, by producing an inflammatory condition of the stomach, have brought on the convulsions which caused death.

The ATTORNEY-GENERAL.--But the gentlemen who made the _post-mortem_ examination say that the stomach was not inflamed.

Witness.--There were white spots, which cannot exist without inflammation. There must have been inflammation.

The ATTORNEY-GENERAL.--But these gentlemen say that there was not inflammation.

Witness.--I do not believe them. (A laugh.) Sensual excitement might cause epileptic convulsions with tetanic complications. The chancre and syphilitic sores were evidence that Cook had undergone such excitement. That might have occurred before he was at Shrewsbury.

Might sexual intercourse produce epilepsy a fortnight after it occurred?--There is an instance on record in which epilepsy supervened upon the very act of intercourse.

Have you any instance in which epilepsy came on a fortnight afterwards? (A laugh.)--It is within the range of possibility.

Do you mean, as a serious man of science, to say that?--The results might.

What results were there in this case?--The chancre and the syphilitic sores.

Did you ever hear of a chancre causing epilepsy?--No.

Did you ever dream of such a thing?--I never heard of it.

Did you ever hear of any other form of syphilitic disease producing epilepsy?--No; but tetanus.

The ATTORNEY-GENERAL: But you say this was epilepsy; we are not talking of tetanus?

Witness: You forget the tetanic complications. (Roars of laughter.)

The ATTORNEY-GENERAL: If I understand right, then, it stands thus--the sexual excitement produces epilepsy, and the chancre superadds tetanic complications?

Witness: I say that the results of sexual excitement produce epilepsy.

Mr. Baron ALDERSON said he had heard some person in court clap his hands. On an occasion on which a man was being tried for his life such a display was most indecent.

Examination continued: I cannot remember any fatal case of poisoning by strychnia in which so long a period as an hour and a half intervened between the taking of the poison and the appearance of the first symptoms.

What would be the effect of morphia given a day or two previously? Would it not retard the action of the poison?--No; I have seen opium bring on convulsions very nearly similar.