Part 25

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.

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[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]

Cross-examined by Mr. JAMES--I do not know how long before I was called in she had this quarrel. I learned that during the quarrel she had had a blow given her on her side by her husband. I observed the setting in of the lockjaw at that time. I saw her in March, 1855, when she was under my care for about a week. The locking of the jaw continued the whole week. She has never got thoroughly well. She has tetanic extensions of the limbs in any case of excitement. In my opinion the disease is in action in her system at the present time.

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[Sidenote: G. Robinson]

Dr. GEORGE ROBINSON, examined by Mr. KENEALY--I am a Licentiate of the Royal College of Physicians and Fellow of the Royal Medical Chirurgical Society of London, and physician to the Newcastle-on-Tyne Dispensary and Fever Hospital. I have devoted considerable attention to pathology, and have published essays on it. I have practised as a physician for ten years. From the symptoms I have heard described my opinion is that Mr. Cook died from tetanic convulsions, by which I mean, not the disease of tetanus, but convulsions similar to those witnessed in tetanus. Convulsions of that kind occasionally assume the nature of epilepsy. I know of no department of pathology which is more obscure than that of convulsive diseases. I have been present at post-mortem examinations of persons who died from convulsive diseases. I have sometimes seen no morbid appearance whatever, and in other cases the morbid appearances which were visible were common to a variety of diseases. Convulsive diseases undoubtedly depend very much on the state of the nerves. They are all connected with disorders of the nervous action. The brain has great influence in producing convulsive diseases, but the spinal cord has a greater influence. The presence of gritty granules in the neighbourhood of the spinal cord would be likely to produce convulsive diseases. There is such a disease as spinal epilepsy, which is accompanied by strong convulsions, which might resemble in a great degree those described in the present case. Periodicity would belong to convulsions arising from spinal epilepsy. I should think from the evidence I have heard that Mr. Cook’s mode of life would predispose him to epilepsy.

Cross-examined by the ATTORNEY-GENERAL--In all cases of epilepsy there are violent convulsions. I cannot tell you how many I have seen assume a tetanic character; perhaps twenty.

Has it gone as far as opisthotonos?--Not the extreme opisthotonos of tetanus. The whole body has been straightened out and the head thrown back. I heard Mr. Jones describe Mr. Cook’s symptoms, that the body was so bowed that he could not raise it, so bowed that it would lean upon its heels and the back of its head if it had been turned over.

[Sidenote: G. Robinson]

Have you ever seen anything in epilepsy approaching to these symptoms?--I have never seen anything approaching to it. I have never seen a body so stiffened that it would rest on the head and heels.

Is that symptom peculiar to tetanus?--You may have convulsions of the same character occurring from other causes--tetanic convulsions from the operation of various poisons.

Keep to natural diseases. Did you ever know these symptoms of opisthotonos, in that shape or to that extent, arise from anything but tetanus?--Not within my own experience. I have read of epilepsy being accompanied with tetanic convulsions. Epilepsy, when it assumes that marked character, is accompanied with unconsciousness. I have read in a case of Dr. Marshall Hall’s that sometimes unconsciousness is not present. He does not mention whether death took place in this case or not. That would make all the difference.

You said that gritty granules would be likely to produce convulsive diseases. What extent of development, in your judgment, must such granules reach to produce an action in the spinal marrow?--I should say there is no relation between the size of the granules and the extent of the effect produced.

Would you expect when they began to get to the size that they would have any effect on the nervous system--that they would begin to show their effect more or less gradually?--No, in epilepsy I have myself observed several granules in the membrane of the brain; and any disturbing cause in the system, I think, would be likely to produce convulsions. I believe that the granules in this case were very likely to irritate the spinal cord, and an attack might very likely come on at once in a fit of epilepsy. There would be pain during the continuance of the violent spasms of the patient, not necessarily pain merely from the spasms. These granules might or might not produce arachnitis.

You would expect to find inflammation in that case?--Not necessarily. Irritation, not inflammation. Granules of that description do not often exist in healthy spines. In the dissections of epilepsy in the large hospitals, these small granules have been found very frequently. The granules, in my opinion, would be likely to produce epilepsy. In my experience I have never known epilepsy unaccompanied by unconsciousness, nor have I known epilepsy producing the marked symptoms of tetanic character which occur in Mr. Cook’s case.

[Sidenote: G. Robinson]

Do you feel yourself warranted in giving an opinion that these granules caused epilepsy in this case?--I think I might have done so. If I put aside the hypothesis of poisoning by strychnia I would. Several of the symptoms described by Mr. Jones, the severe paroxysm, the stiffening of the body, the convulsions of all the muscles of the trunk and limbs, and the complete opisthotonos, are also common to other convulsions. The symptoms are certainly consistent with death by strychnia.

They are the symptoms that you would expect after strychnia?--I think there would have been some slight premonitory symptoms. If I had no other cause to which I could ascribe the death I would ascribe it to epilepsy.

But in this case you admit some of the symptoms are inconsistent with your experience of epilepsy?--Yes.

Re-examined by Mr. SERJEANT SHEE--They are consistent with the possibility of epilepsy. They are consistent with convulsions of an epileptic form ending in death, though perhaps not actually amounting to epilepsy.

Supposing it to have been actual epilepsy, at what period of the last attack should you say the epilepsy commenced?--When Mr. Cook sat up in bed and cried out. I should imagine that would be the sense of suffocation which would be the premonitory symptoms.

After the final shriek, and throwing himself back in his bed, is there any symptom from which you would infer consciousness after that moment?--Except that he swallowed some pills.

The ATTORNEY-GENERAL--Allow me to remind you he asked them to turn him over.

By Mr. SERJEANT SHEE--Would you consider that a body which immediately, or within ten minutes after death, when it is quite warm, lay perfectly straight, the hands extended, resting on its heels and its back and its head, was in a state of opisthotonos?--Not if it rested on its back. In my judgment it might be that the body might assume, without actual rigidity, the bow-like shape and appearance which has been spoken of, and yet, when turned over, lie flat in the bed, resting on the head, back, and heels.

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[Sidenote: B. W. Richardson]

Dr. BENJAMIN WARD RICHARDSON, examined by Mr. SERJEANT SHEE--I practise in London, and I am a licentiate of the Faculty of Physicians and Surgeons in Glasgow and a member of the College of Physicians in London. I have never seen a case of idiopathic or traumatic tetanus, but I have seen a considerable number of deaths by convulsions, and I have known these cases, when they have ended in death, sometimes assume tetaniform appearances without being, strictly speaking, tetanus. The patient, if conscious, generally desires to sit up. I have known persons to die from a disease called angina pectoris. The symptoms of the disease, when it is fatal, resemble closely the symptoms of the paroxysms in which Mr. Cook died. It is classed amongst the convulsive or spasmodic diseases, and has no distinctive feature in post-mortem examination.

[Sidenote: B. W. Richardson]

Will you state what symptoms you particularly refer to?--I could not do better than describe a case which I myself saw. A child, ten years of age, was under my care in November, 1850. I supposed she had suffered from scarlet fever. She had a slight feverish attack. She recovered so far that my visits ceased on 20th November. I left her merry in the morning, and at half-past ten I was called to see her dying. She was supported upright at her own request. The face was pale; the whole of the face and arms rigid, the fingers clenched, the respiratory muscles completely fixed and rigid, and, with all, complained of an intense agony and restlessness such as I had never witnessed. There was perfect consciousness. The child knew me, and explained her intense agony; eagerly took from my hands some brandy and water from a spoon. I then left to get some chloroform for the purpose of producing relaxation by chloroform vapour. On returning, I found the head was thrown back. I could detect no respiration. The eyes remained fixed open, and the body just resembling a fit. She was dead. I did not observe whether the rigor-mortis came on at its usual time or later. I made a post-mortem examination the following day. Unfortunately I left the body in the arms of the sister, and, of course, it was laid out afterwards. At the post-mortem examination I observed that the brain was slightly congested; a portion of the upper part of the spinal cord seemed normal and healthy, the lungs were collapsed, the heart was in such a state of firm spasms and so empty that I remarked it might have been rinsed out, it was so perfectly clean and free from blood. There were no appearances of functional disturbances except a slight effusion of serum in one pleural cavity, I believe the right side. The other part of the spinal cord was in a normal state. They told me the child was unusually well and merry at supper; that she then went to bed with her sister, and in lying down suddenly jumped up and said, “I am going to die,” and begged her sister to rub her.

Cross-examined by the ATTORNEY-GENERAL--This case accords with all the descriptions of angina pectoris by the best authors--Latham, Watson, Boyeau, Pratt, and Sir Everett Holme.

What is the true nature and cause of angina pectoris?--It has been laid down as disease of the valves of the heart. There have been many cases in which there has been no discovered cause.

Are the symptoms of angina pectoris not those that would be produced by taking strychnia?--Not exactly. In angina pectoris the patient requests to be rubbed to give relief.

Did you hear the Leeds case?--Assuming that that was a case of strychnia, I must say that the two forms are so strictly analogous that there would be great difficulty in detecting angina from strychnia, with this difference, that angina is paroxysmal, it comes and goes, and strychnia would not be so likely to do that. You would not expect it for many months.

[Sidenote: B. W. Richardson]

But in this case you are speaking as if it ended in the first paroxysm?--Yes.

How then can you be justified, in cases where you discover no abnormal conditions of the heart or its arteries, in setting down the death to angina?--Precisely as if I saw the symptoms of epilepsy I should accept them as such.

Supposing the disease was referable to two causes, in the absence of all evidence, what is your reason for setting it down to one in preference to the other?--I quite admit that if I had known as much of the nature of strychnia as I do now I should have gone on to make analysis.

Is the disease of angina pectoris attended with painful symptoms before it terminates in death?--Most painful. The paroxysms terminating in death may run on for more than eight minutes. It comes on suddenly. It does not always kill at the first attack. It generally spreads itself over a certain period of time.

You said that the head was somewhat bent back. Was that opisthotonos?--There was rigidity, not amounting to opisthotonos, but still very marked. The neck was so stiffly bent back that if the body had been laid down, and the lower limbs, which I did not see, had been the same, I have no doubt the body would be resting on its head and heels.

You say in epileptic convulsions you have seen the hands clenched firmly till death. Did you ever see them so long after death?--I have seen them firmly clenched, not in epilepsy only.

In what cases have you seen them firmly clenched after death?--In cases where there has been violent convulsion. I saw them once from hæmorrhage.

In other cases have you?--I can only say, in a general sense, I have seen the hands clenched over and over again, and have paid no attention to it. My belief, from seeing people die, is that the clenching of the hands is, in many cases, mere matter of accident.

Re-examined by Mr. SERJEANT SHEE--Have you known cases personally or from your reading where patients recover from angina pectoris, and whether within a short time afterwards they sometimes have another attack?--They do, sometimes in so short an interval as twenty-four hours.

During the interval between the two attacks what is the condition of the patient?--Perfectly healthy, to all appearance.

Are the symptoms described in the evidence more like the symptoms of angina pectoris or strychnia poison?--I should certainly say angina pectoris.

You had no reason to suspect poison of any kind in that case, either before or now?--Not the slightest.

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[Sidenote: Dr. Wrightson]

Dr. WRIGHTSON, recalled, examined by Mr. SERJEANT SHEE--In your opinion, when the strychnia poison is absorbed into the system, does it become diffused by the circulation of the blood through the system, or does it collect in the tissues?--I should think it is diffused throughout the entire system by circulation if it be wholly absorbed, and it would depend on the rapidity with which death takes place after complete absorption, and on the quickness of circulation.

Cross-examined by the ATTORNEY-GENERAL--Would the absorption be more complete if a longer time were given for the process between the administration and the death?--Certainly, it would be.

Is that supposing a minimum dose given sufficient to destroy life; if a long interval elapses between the taking of the poison and the death, the more complete the absorption the less the chance of finding it in the stomach?--_Cæteris paribus_ that would be so.

By Mr. SERJEANT SHEE--Would you have a very good chance of finding it in the kidneys and spleen and in the blood?--Yes.

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[Sidenote: C. Watson]

CATHERINE WATSON, examined by Mr. GROVE--I live at Garnkirk, in Scotland. Last October I was affected with a fit. I had no wound nor injury on my body before. I had taken no poison.

Cross-examined by the ATTORNEY-GENERAL--I was not ill during the day. I was in low spirits, but not in pain. A few minutes before eleven at night I took a pain in the stomach, then two cramps in my arms, then I was very ill. I have never had cramps like this before nor since.

The Court then adjourned.

Tenth Day, Saturday, 24th May, 1856.

The Court met at ten o’clock.

[Sidenote: O. Pemberton]

Mr. OLIVER PEMBERTON, examined by Mr. SERJEANT SHEE--I am Lecturer in Anatomy at Queen’s College, Birmingham, and surgeon to the General Hospital at Birmingham. I was present at the examination of the body of the late Mr. Cook after it had been exhumed in January or February. I observed the condition of the spinal cord. In my judgment it was not in a condition to enable one to state with confidence in what state it had been immediately after death. The upper part, where the brain had been separated, was green in colour from the effects of decomposition. The remaining portion, though fairly preserved for a body buried two months, was so soft as not to enable me to form any opinion as to its state immediately after death.

Cross-examined by the ATTORNEY-GENERAL--I did not see the body till the day after the bony canal had been opened, which, to a certain extent, would expose the interior substance of the cord to the atmosphere. So far as I recollect, it was still covered with a very hard, dense membrane. Mr. Bolton, the professor at Queen’s College, was also present on Palmer’s behalf.

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Mr. SERJEANT SHEE--My lord, this closes the medical testimony.

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[Sidenote: H. Matthews]

HENRY MATTHEWS, examined by Mr. GROVE--I am an inspector of police at Euston Station. I was there on 19th November last. The two o’clock afternoon train is the last that stops at Rugeley. The express for Stafford leaves at five, and is due at Stafford at 8.42. On 19th November it arrived at 8.45. From Stafford to Rugeley it is nineteen miles by railway. I do not know how far by road. After the two o’clock train to Rugeley, the quickest way to get there is by the five o’clock to Stafford, and then by road.

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[Sidenote: Joseph Foster]

JOSEPH FOSTER, examined by Mr. GRAY--I have known the late John Parsons Cook for many years, and, from what I saw of him, he was of weak health and constitution. I have been with him when he has had a bilious attack and sick headache.

Cross-examined by Mr. JAMES--He hunted regularly about three days a week. He was a member of the Welford Cricket Club, but I have not seen him playing for three or four years.

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[Sidenote: George Myatt]

GEORGE MYATT, examined by Mr. GROVE--I am a saddler at Rugeley. I was at Shrewsbury races, and saw Palmer and Cook at the Raven Hotel there on the Wednesday evening of the race week. It was about twelve at night, and Cook seemed the worse of liquor. We had some brandy and water together. Cook drank most of his, and remarked that it was not good, and thought there was something in it. Cook proposed having some more, but Palmer told him to finish what he had first. Cook then drank his up. We all then went to bed. I slept in the same room as Palmer. The brandy we had was brought in a decanter and poured out. I did not leave the room from the time Palmer and Cook came in till we went to bed. Had anything been put in the brandy and water I should have seen it. As far as I can remember, when Palmer and I went to our bedroom we left Cook in the sitting room. I locked our door, and Palmer never left the bedroom during the night. In the morning Palmer asked me to call Mr. Cook, which I did. Cook then told me how ill he had been during the night. He said he had been obliged to send for a doctor, and asked me what was put in the brandy and water. I told him I did not know that anything was put in. He then asked me to send Palmer to him, which I did. After Palmer and I had finished our breakfast, I next saw Cook, who came into the sitting room and had his breakfast. That night the three of us had dinner at the Raven, and left for Rugeley about six o’clock. We went by express from Shrewsbury to Stafford. Palmer took the three tickets and paid. We took a fly from Stafford, there being no train. In the fly from Stafford to Rugeley Palmer was sick, and vomited through the window. They could not account for it, unless it was cooking in some brass utensil, or the water. I heard other people speak about being ill at Rugeley, and they could not account for it. It is 9 miles by the road from Stafford to Rugeley.

[Sidenote: George Myatt]

Cross-examined by Mr. JAMES--I have known the prisoner all my life, and he deals with me for his saddlery at his racing stables. I am not in the habit of going to racing meetings with him, although I attend them myself. He paid my expenses at Shrewsbury races, but never at any other race meeting. About four or five weeks ago I went with Mr. Smith to Stafford gaol, and was with Palmer for about two hours. I have now and then stood in half a sovereign or a sovereign with Palmer when betting on his horses. On the Wednesday night in which I saw Palmer and Cook I dined at home at Rugeley, and reached Shrewsbury between eight and nine. I went straight from the station to the Raven Hotel, and up to Palmer’s room, where I saw Cook. Palmer was out, and I went to the town for about an hour, and returned to Palmer’s room. He was not in; I waited about two hours, when he came in with Cook, about twelve o’clock. Cook was drunk, but not very drunk. The decanter of brandy and the tumblers were brought in directly. The water, I think, was on the table. I do not remember Mrs. Brooks calling, or Palmer being called out of the room to speak to her. I remember Mr. Fisher coming in. I will swear that Palmer did not at any time that evening take out a glass of brandy and water and leave the room. He never left the room from the time I joined him till we went to bed. When Cook drank his brandy and water he made a remark to the effect that it was not good, and that there was something in it. I will swear that he did not say, “It burns my throat dreadfully,” or anything to that effect. The brandy and water was then given to some one to taste. I think there were but four people in the room when Cook drank the brandy and water. Palmer sipped from the glass Cook had drank from, and said he could not taste anything the matter. He held the glass to Mr. Fisher. I do not remember whether Fisher said, “It is no good giving me the glass, it is empty.” I will not swear he did not. Palmer and I went to bed about half an hour after, and left Cook in the room. That I will swear. The first I heard of Cook being ill during the night was when he told me of it next morning.

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[Sidenote: John Sargent]