Part 24
Re-examined by Mr. GRAY--I think you told my friend that, with regard to the convulsions which end in death, you thought they arose from some irritation set up in the spinal cord?--I did, from that and other causes.
May the causes of such irritation be very various in different cases? May the cause of the irritation in the spinal cord which would end in tetaniform be very various?--I think so.
Suppose in one you have a death accompanied with tetaniform symptoms and opisthotonos, and the various symptoms of a tetanic character; in the absence of any knowledge of the case--of the cause you state, probably the irritation of the spinal cord--do you think it is possible to ascribe them to any particular cause?--I think it would be extremely difficult to do so.
Will you give me the proposition you lay down?--In the event of a given set of symptoms, tetanic symptoms I should say, being proposed, it would be extremely difficult, if not impossible, without some other evidence, or collateral evidence, to assign it to any given disease.
LORD CAMPBELL--Or cause?--Or cause.
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[Sidenote: W. M‘Donnell]
Dr. WILLIAM M‘DONNELL, examined by Mr. KENEALY--I am a licentiate of the 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.
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[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.