Part 10
After the post-mortem examination on the body of Mr. Cook some portion was sent up to me. I experimented to ascertain if there were any poison present. We sought for prussic acid, oxalic acid, morphia, strychnia, veratrea, a poison of white hellebore, the poison of tobacco, hemlock, arsenic, mercury, antimony, and other mineral poisons generally. We only found small traces of antimony. The part which we had to operate upon was in the most unfavourable condition for finding strychnia if it had been there. The stomach had been completely cut from end to end; all the contents were gone, and the fine mucous surface, on which any poison if present would be found, was lying in contact with the outside of the intestines, all thrown together. There was also succulent matter on the surface of the mucous membrane, derived from the intestines, the contents of which partly escaped. The inside of the stomach had been forced into this mass of intestinal succulent matter; at any rate, it was lying so. In journeying up to London it must have been shaken in every possible way. The contents of the intestines were there, but the contents of the stomach were gone. If there had been any of this poison present I should have expected to have found it in the contents of the stomach and on the mucous membrane. At my request other portions of the body were sent--the liver, the spleen, and the two kidneys; in addition, a small bottle of blood, unlabelled, giving us no idea whence it was taken. We analysed all those portions. We searched for mineral poison in the liver and kidneys, and discovered antimony in an eighth part of the liver; we analysed only the left kidney and the spleen, and there were traces of antimony in each. The quantity was less in proportion in the spleen than in the other parts. The blood contained antimony.
Would its being found in the blood enable you to form any opinion how shortly before death the antimony had been given?--It is impossible to say with any precision, but I should say shortly before death--within some days; the longest period known at which antimony has been found in the blood, after a person has ceased to take it, was eight days. I heard the account by the servant girls of the vomiting of Mr. Cook; I also heard the account given of his vomiting at Shrewsbury, and by the medical men, Gibson and Jones, and Dr. Bamford’s deposition as to the concomitant symptoms. In my opinion, the vomiting would be such as might be produced by antimony. Tartar emetic is soluble in fluids, and if mixed with broth or toast and water would not affect the colour.
From these traces of the antimony can you form any judgment as to the time when the antimony was taken?--It is impossible to say with any precision, but I should say within two or three weeks at the outside. We did not find any perceptible quantity dissolved in the fluids of the body and the washings of the stomach; therefore I should infer there was no evidence of any given within some hours of death. I think that which I found in the liver might have been administered within eighteen hours of death or within two days. I know by experience it takes a shorter time to get to the liver. Antimony does not affect the taste of anything if it is given in quantities which would cause vomiting. If a large quantity was taken at once it might leave a choking or constricting sensation, as if the throat was contracted. There was no trace of mercury. I should have expected to find mercury according to the quantity taken. If a few grains had been taken recently before death I should expect to find some trace in the liver. Supposing a man had been taking mercury for any syphilitic affection within anything like a recent period before death I should expect to find it. I heard the evidence which was given as to the deaths of Mrs. Smith, Agnes French, and the lady referred to, and also the case of the gentleman of whom Mr. Moore spoke. Judging by the results of my own experiments and studies, I agree that those deaths were occasioned by strychnia. Mr. Cook’s attacks appear to me to be of a similar character.
As a professor of medical science do you know any other cause in the nature of human diseases to which the symptoms of Mr. Cook’s death can be referred except to strychnia?--I do not.
[Sidenote: Alfred Taylor]
Cross-examined by Mr. SERJEANT SHEE--In the course of your examination you have frequently used the words “traces of antimony.” What was the meaning of “trace”?--A very small quantity.
In analytical chemistry does it mean an imponderable quantity?--I do not apply it in that shape. Some chemists mean that. I mean we obtained some quantity in that sense from many parts, and that the quantity thus calculated would make a ponderable quantity in the whole. We have about half a grain.
You did not actually ascertain it to amount to half a grain?--No. I do not think a quarter of a grain would have explained the quantity we obtained. I will undertake to say there was half a grain to the best of my judgment.
In all parts of the body you examined?--There was more in the parts of the body examined, but we extracted that quantity.
In your judgment would that be sufficient to cause death?--No. I was first asked to investigate this case on Tuesday, 27th November, by Mr. Stevens. Either on that day or subsequently he mentioned the name of Mr. Gardner to me. After Mr. Stevens spoke to me he and Mr. Boycott came together with these jars.
You wrote a letter, the whole of which I will read to you. It is in reply to a letter received from Mr. Gardner--
Dr. Rees and I have compared the analysis to-day. We have sketched a report, which will be ready to-morrow or next day. As I am going to Durham Assizes on the part of the Crown, in the case of _Reg._ v. _Wooler_, the report will be in the hands of Dr. Rees, No. 26 Albemarle Street. It will be most desirable that Mr. Stevens should call on Dr. Rees, read the report with him, and put such questions as may occur. In reply to your letter received here this morning, I beg to say that we wish a statement of all the medicines prescribed for deceased (until his death) to be drawn up and sent to Dr. Rees. We did not find strychnia nor prussic acid or any trace of opium. From the contents having been drained away, it is now impossible to say whether any strychnine had or had not been given just before death. But it is quite possible for tartar emetic to destroy life if given in repeated doses; and, as far as we can at present form an opinion, in the absence of any natural cause of death, the deceased must have died from the effects of antimony in this or some other form.
Was that your opinion at the time?--It was. That was all we could infer from the chemical analysis.
[Sidenote: Alfred Taylor]
Have you not told me to-day that the quantity of antimony that you found in Cook’s body was not sufficient to account for death?--Perfectly so; but what was found in Cook’s body was not all he took. We found antimony, and we could not account for its being there. I wrote to know whether antimony had been given as a medicine, and I considered, as people had died from antimony, it was necessary to have information of the symptoms connected with the man’s death, which I knew nothing about at the time; finding antimony there and no explanation, I put it as the only hypothesis to me to account for death.
Had you any reason to think any undue quantity had been administered to him?--I could not speculate on that from the quantity there, for I did not know at all what quantity he had taken, and whether it had been prescribed medicinally.
May not the injudicious use of quack medicines containing antimony, such as James’ powder or other mixtures, have accounted for as much antimony as you found in the body of Mr. Cook?--Any antimonial preparation would account for it. I knew strychnia was bought before we sent in the report. Mr. Gardner gave the information in a letter in reply to that which has been read that strychnia, prussic acid, Batley’s sedative of opium, had been bought by the prisoner. After giving my evidence at the inquest I returned to town. Soon after I knew that the prisoner had been committed on the charge of wilful murder.
You knew, of course, that his life depended in a great degree on your opinion?--No; my opinion was in reference to the death by poison; I expressed no opinion of the prisoner’s guilt. I knew I would be examined as a witness upon his trial. I wrote a letter to the _Lancet_ on the subject, contradicting several misstatements which were made regarding my evidence. I have never had under my own observation the effects of strychnia on the human body; but I have written a book upon the subject.
Do you, from your reading, know of any fatal case in which the patient under strychnia poison has had, while the paroxysm lasted, as much command over the muscles and voluntary motion as Mr. Cook had on the Monday and Tuesday nights, according to the evidence of Mills and Jones?--I do not see that he had much command over the muscles of voluntary life. His symptoms are quite in accordance with the ordinary action of strychnia.
Can you tell me a single case of a patient seized with tetanic symptoms by strychnia poison sitting up in his bed talking?--He was seized with the tetanic symptoms after he sat up in his bed.
Do you know of a single case of the symptoms of poison by strychnia commencing or exhibiting themselves during any time of the paroxysm by the operation of beating the bed?--There have been only about fifteen cases altogether; I have not heard of a person taken ill in bed before.
[Sidenote: Alfred Taylor]
Is not the beating of the bed well known under the name of malasaux; is it not a very common symptom of ordinary convulsions?--No, I do not think it is the case, not to my knowledge. I have not a case of a person sitting up in bed and beating the bed.
Have you known any instances in which the patient has screamed before he was seized with the fit?--No. That is common in convulsions not occasioned by strychnia poisoning. In many cases they scream very soon after the spasm sets in; the pain felt is very severe.
This is before the convulsions begin?--No, I have never known that. I have known cases in which they speak freely, but not after the paroxysm has commenced; I do not remember a case at the present time.
Can you tell me or refer me to any one case in which the effect of the strychnia affection or paroxysm in a fatal case has been as long after the ingestion of the poison as in Cook’s case on Tuesday night?--Yes. In a case communicated to the _Lancet_ of 31st August, 1850, p. 259, by Mr. Bennett, one grain and a half of strychnia, taken by mistake, destroyed the life of a healthy young female in an hour and a half, which is remarkable, as no symptoms appeared for an hour.
May I take it that is the longest period which has elapsed between the ingestion of the poison and the commencement of the symptoms on record?--No, I think not.
Do you know a single case in which the symptoms have manifested themselves as long as an hour and a half after the ingestion of the poison?--No, I do not.
Do you know any case of strychnia poison in which the patient has recovered from a paroxysm in as short a time as Mr. Cook did, he being well before the morning?--I do not remember any, but I can conceive in medical practice such cases.
Do you know any case of strychnia poison in which there was so long an intermission of the paroxysm as between the two fits of Monday and Tuesday night?--No, I do not.
As you choose to go upon rabbits, do you not know that it constantly happens, even in rabbits, that the spasm and the contraction instantly cease immediately with death, or just before death, and that the body becomes perfectly pliant?--No, I do not. It does so in some instances, in one out of five cases.
[Sidenote: Alfred Taylor]
Do you agree in this opinion of Dr. Christison--“I have not altered the statement as to this point in the former edition, that is, that the rigidity supervenes at an early period after death; yet I strongly suspect the authors who describe the spasm which precedes death to continue as it were without the rigidity that occurs after death must have observed inaccurately, for, in the numerous experiments that I have made and witnessed upon animals, flaccidity of limb continued after death”?--Dr. Christison speaks from his own experience; I speak from my own.
Have you any reason to say that the clenching of the hand is a distinctive feature of strychnia poison?--It is the result of violent tetanic spasms. It occurs in other violent spasms.
In all forms of convulsion?--No; the great point is this, that in tetanus it remains so; in other convulsions it comes and goes.
Is it always so?--That is according to my knowledge.
Re-examined by the ATTORNEY-GENERAL--I have met with three cases in a human subject in which it has appeared that the heart was found empty after death, where the death had taken place from strychnia. I think the emptiness of the heart is owing to spasmodic affection, the effect upon the heart in the last moment of life. I know of no reason why that should be more likely to be the case in the human subject than in a small animal like a rabbit. The only thing I would observe is, that I think the heart is generally more affected by the paroxysm, so that the blood accumulates.
Suppose the paroxysms short and violent, and cause death in a few minutes?--That is the kind of case in which I should expect to find it empty. The rigidity after death in the cases where I found it always affected the same muscles, the muscles of the limbs, specially the muscles of the back. In the case of poisoning by strychnia, where the rigidity was relaxed in death, it returns while the body is warm.
Would the rigidity of the extremities as long as two months after death, the clenching of the hands, and the twisting of the feet, afford you any indication of whether the person died of tetanus?--I have never known such a case. That would indicate, in my opinion, great violence of the spasm with which the party died.
With regard to the duration of time in which the effects of the poison would begin to act, to show itself, would it be uniform, do you think, in all persons to whom the same quantity of poison might be given?--It would vary according to the constitution and the strength, according to the power of absorption.
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[Sidenote: G. O. Rees]
Dr. GEORGE OWEN REES, examined by Mr. JAMES--I am a Fellow of the College of Physicians, and Lecturer on Materia Medica at Guy’s Hospital. I believe strychnia is absorbed always before it produces the symptoms. If enough strychnia is given to destroy life, that might be done without our being able to discover it after death. I agree with Professor Taylor that it is the excess that is found. Where vitality is destroyed by the effects of the poison, and an excess remains, I would expect with care to discover that excess. The symptoms in the cases of death from strychnia that have been given are analogous, in my opinion, to those of Mr. Cook, and to those produced by strychnia in the experiments I have seen made on animals.
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[Sidenote: R. Christison]
Professor ROBERT CHRISTISON, examined by the ATTORNEY-GENERAL--I am a Fellow of the Royal College of Physicians and Professor of Materia Medica to the University of Edinburgh. I published in 1845 a treatise on poisons in relation to medical jurisprudence. Among other poisons, I have turned my attention to strychnia. It acts upon the human frame by absorption into the blood, and then by acting on the nervous system. I have seen a case of strychnia poisoning, but not a fatal one, in a human subject. I have frequently seen experiments tried upon animals--frogs, rabbits, cats, dogs, and one wild boar. In most of my experiments I have given very small doses, a sixth part of a grain, but sometimes as much as a grain. The first symptom that I have observed has been a slight tremor and unwillingness to move, then frequently the animal jerks its head back slightly, and very soon after that all the symptoms of tetanus come on, which have been so often described in the evidence of previous witnesses. There is occasionally an intermission of the spasms for a short while. Where the poison has been introduced into the stomach, between five or six minutes and twenty-five minutes have elapsed from the commencement of the symptoms to the death of the animal. From the giving of the poison to the first symptoms coming on, the appearance of tremor, I have seen as long as twelve minutes elapse, and from the first commencement of the symptoms to their termination in death from five or six minutes to twenty or twenty-five minutes. The symptoms have always been very much the same. Where we can trace it very correctly, I think the jaws and the back of the neck are affected first, then the trunk and the extremities in such rapidity that it is very difficult to follow them in succession. I have sometimes observed differences in individuals of the same species; the intermission sometimes is wanting; some lie in one long continuous spasm, with scarcely any intermission, but that is uncommon. I have generally found that the animal is in a state of flaccidity about the period of the termination of life. I have always observed an interval before the rigidity that takes place after death. There is a cessation of the symptoms immediately before death; the rigidity is gone, the body is flaccid. The rigidity is renewed very soon after death. I have frequently opened the bodies of the animals that have thus been killed. I never could find that the poison had produced any apparent effect upon the stomach or intestines. I have never found any apparent effect on the spinal cord or brain which I could trace satisfactorily to the poison. I have always found that the heart of the animal after death contained blood. Others have found it devoid of blood, but I have not. In the one case of the human subject which I saw the symptoms were the fixing of the jaw, spasmodic retraction of the head, slight grinning expression of the mouth, and a slight stiffness of the arms and legs. There was no convulsion of the muscles of the trunk, nor any convulsive movement of the arms and legs in that case. I have collected all the cases that have occurred up to the time of the publication of my book as far as I am aware. The poison appears to require a longer time in producing its effect in the larger animals than the small. In the case of the wild boar, the poison was injected into the chest. The animal died in ten minutes, from the third of a grain. I think there are cases where strychnia, given to the human subject in the shape of nux vomica, has not operated for about an hour. Strychnia itself is generally given in the solid form, sometimes in the fluid form. When given in the fluid form the symptoms are not so long in appearing as when given in the solid form. When given in the shape of a pill the time it takes to act depends very much upon the material used for making the pill. To make the appearance of the symptoms as late as possible the poison might be mixed up with resinous materials, which are all difficult of digestion. Such materials would be within the knowledge and reach of a medical man, and some are often used for making ordinary pills. Absorption would not begin until the pill came to be broken up or digested; the less soluble the pill the longer would be the period required.
Now, independently of that, does the state of knowledge upon this subject enable you to predicate with anything like certainty or accuracy the period that would be required in the human subject before such poison would begin to operate after it has been taken into the stomach; does the state of science enable you to form an opinion as to the precise time, or near the precise time, that it would require for this poison to operate?--I do not think we can fix from our present knowledge the precise time for the poison beginning to operate. When we give poison to an animal for the purpose of watching the effect of the poison, we give it in a manner in which it would act most rapidly, whether in the fluid or the solid form. We take care that the animal is fasting, and have every circumstance favourable for the action of poison. We mix it up with materials that are readily soluble in the stomach. I have seen a good many cases of tetanus arising from wounds, but very few from natural diseases.
[Sidenote: R. Christison]
Is there, in your opinion, any marked difference between what I may call natural tetanus and the tetanus of strychnia?--I would not rest much upon the little difference of particular symptoms, but rather upon the course and the general circumstances attending them. First, that in all the natural forms of tetanus the symptoms begin and advance much more slowly; and, secondly, they prove fatal much more slowly. When once set up in natural forms of tetanus there is no intermission. Where the first paroxysm does not prove fatal there are short intermissions in tetanus from strychnia. I heard the evidence given by Elizabeth Mills of what took place on the Monday, and by Mr. Jones of what took place on the Tuesday night when Mr. Cook died.
Now, of the two classes of tetanus, to which should you refer the spasm and other symptoms spoken to by those two witnesses?--To strychnia, or one of the natural poisons containing it--nux vomica, St. Ignatius’s bean, snakewood, and a poison called exhetwick. They belong to different plants of the same genus, from all of which strychnia may be obtained. There is no natural disease that I have ever seen or that I otherwise know to which I can refer these symptoms which I have heard described.
When death takes place from tetanus or tetanic convulsions, does consciousness continue?--As long as one can make an observation upon it, it remains. When the animal is in a state of strong universal spasm it is impossible to make any observation on its consciousness. The heart of a human subject killed by strychnia has sometimes blood in it and sometimes not. Whether the heart contains blood or not depends upon the particular mode of death, or the dose varying. Spasms of the heart would expel the blood.
Where death has taken place from strychnia I should not expect to find it where the quantity taken is small, but where there is a considerable excess over the quantity necessary to destroy life by absorption I should expect to find it. Colouring tests are, I think, uncertain in some respects. Vegetable poisons are generally more difficult to detect. There is one I know for which there is no test I know of. The stomach that was sent to Dr. Taylor to operate upon, from the description that he gave of it to-day, was in a very unsatisfactory condition. If I had been called upon to analyse such a stomach, I should not have entertained any reasonable expectation of doing any good with it if I had not been informed that there was a considerable quantity of strychnia present. I have no doubt, from the evidence I have heard as to the Leeds case, the Glasgow case, and the Romsey case, that they were deaths from strychnia. The symptoms in these cases appear to me very similar to those of Mr. Cook.
[Sidenote: R. Christison]
Cross-examined by Mr. GROVE--From my own observation, I should say that animals who die from strychnia die of suffocation--asphyxia; but in another part of my book which is referred to, I leave the question open. By asphyxia I mean stopping of the respiration.
Where is it in your book?--It is under the head of nux vomica, at the bottom of page 898.