Are not convulsions not, strictly speaking, tetanic, constantly preserved by retching, distention of the stomach, flatulence of the stomach and bowels, and other dyspeptic symptoms?—Such cases do not come under my observation as a hospital surgeon. I think it is very probable that general convulsions are accompanied by yelling. I don’t know that they frequently terminate fatally, and that the proximate cause of death is spasm of the respiratory muscles, inducing asphyxia.
Re-examined by the Attorney-General: These convulsions are easily distinguished from tetanus, because in them there is an entire loss of consciousness.
Is it one of the characteristic features of tetanus that the consciousness is not affected?—It is.
Dr. Todd, examined by the Attorney-General: I am physician at King’s College Hospital, and have held that office about twenty years. I have also lectured on physiology and anatomy, on tetanus and the diseases of the nervous system, and have published my lectures. I agree with the last witness in his distinction between idiopathic and traumatic tetanus. I have seen two cases of what appeared to me to be idiopathic tetanus, but such cases are rare in this country.
By Lord Campbell: I define idiopathic tetanus to be that form of the disease which is produced without any external wound, apparently from internal causes—from a constitutional cause.
Examination resumed: In my opinion, the term “tetanus” ought not to be applied to disease produced by poisons; but I should call the symptoms tetanic, in order to distinguish the character of the convulsions. I have observed cases of traumatic tetanus. Except that in all such cases there is some lesion, the symptoms are precisely the same as those of idiopathic tetanus. The disease begins with stiffness about the jaw. The symptoms gradually develop themselves and extend to the muscles of the trunk.
When the disease has begun is there any intermission?—There are remissions, but they are not complete; only diminutions of the severity of the symptoms—not a total subsidence. The patient does not express himself as completely well, quite comfortable. I speak from my own experience.
What is the usual period that elapses between the commencement and the termination of the disease?—The cases may be divided into two classes. Acute cases will terminate in three or four days, chronic cases will go on as long as from nineteen to twenty-two or twenty-three days, and perhaps longer. I do not think that I have known a case in which death occurred within four days. Cases are reported in which it occurred in a shorter period. In tetanus the extremities are affected, but not so much as the trunk. Their affection is a late symptom. The locking of the jaw is an early one. Sometimes the convulsions of epilepsy assume somewhat of a tetanic character, but they are essentially distinct from tetanus. In epilepsy the patient always loses consciousness. Apoplexy never produces tetanic convulsions. Perhaps I might be allowed to say that when there is effusion of blood upon the brain, and a portion of the brain is involved, the muscles may be thrown into short tetanic convulsions. In such case the consciousness would be destroyed. Having heard described the symptoms attending the death of the deceased, and the post-mortem examination, I am of opinion that in this case there was neither apoplexy nor epilepsy.
The Attorney-General said that, as Dr. Bamford was so unwell that it was doubtful whether he would be able to appear as a witness, he proposed to put in his deposition, in order to found upon it a question to the witness now under examination.
Dr. Todd and Dr. Tweedie deposed that they had seen Dr. Bamford on the previous day, and that he was then suffering from a severe attack of English cholera. He was too unwell to be able to attend and give evidence.