Baron Alderson: This is hardly a question to put to a medical witness, although it may be a very proper observation for you to make.
Cross-examination continued: I never knew syphilitic poison produce tetanic convulsions, except in cases where there was disease of the bones of the head.
[Sir Benjamin Brodie gave his evidence with great clearness—slowly, audibly, and distinctly,—matters in which other medical witnesses would do well to emulate so distinguished an example.]
Dr. Daniell, examined by the Attorney-General: I was for many years surgeon to the Bristol Hospital, but have been out of practice for some time. In the course of a long practice I should think that I have seen at least thirty cases of tetanus. Two of those were certainly cases of idiopathic tetanus: one of them terminated fatally, the other did not. I quite agree with the other medical witnesses, that idiopathic tetanus is of very rare occurrence in this country. The only difference in the symptoms between idiopathic and traumatic tetanus that I perceived was, that the former were more modified—not so severe—in their character. I was not able to trace these two cases of idiopathic tetanus to any particular cause. I have heard the description given of the symptoms which accompanied the attack upon Mr. Cook before his death, and it appears to me that the circumstances of that attack are assuredly distinguishable from those which came under my experience in dealing with cases of tetanus. The evidence of Sir B. Brodie quite expresses my opinion with respect to the difference of the symptoms between ordinary tetanus and tetanic convulsions produced by strychnine. Tetanus begins with uneasiness in the lower jaw, followed by spasms of the muscles of the trunk, and most frequently extending to the muscles of the limbs. Lock-jaw is almost invariably a symptom of those cases of tetanus—of traumatic tetanus especially. I do not recollect that clinching of the hands is a usual symptom of ordinary tetanus, nor do I remember any twisting of the foot. I do not believe that any of the cases which came under my experience endured for a shorter time than from thirty to forty hours. I never knew a case of syphilitic sore producing tetanus. The symptoms, as they have been described, certainly cannot be referable to apoplexy or epilepsy. I never heard of such a thing. In all the cases of tetanus which came under my observation consciousness has been retained to the last, throughout the whole disease. The symptoms have never set in in their full power from the commencement, but have invariably commenced in a milder form, and have then gone on increasing, being continuous in their character, and without intermission. In my judgment the symptoms in the case of Mr. Cook could not be referred either to idiopathic or traumatic tetanus.
Cross-examined by Mr. Grove, Q.C.: I have not read Dr. Curling’s or Dr. Copeland’s books on the subject of tetanus; nor have I of late studied much the reported cases. I am not aware that excitement or irritation from vomiting has ever been given as the cause of tetanus. The main symptoms of tetanus are, in my opinion, always very similar, although the inferior symptoms may vary simply. I cannot undertake to say that the convulsions of tetanus arise from the spine. I do not like the term “asphyxia;” but I think that death from tetanic convulsions may probably arise from suffocation. It is many years since I saw a post mortem upon a case of tetanus. I cannot say whether, in the case of death from suffocation, the heart would be full of blood or the reverse. An examination of the spinal cord or marrow never, so far as I know, afforded evidence of the cause to which the tetanus was to be attributed.
Mr. Samuel Solly, surgeon of St. Thomas’s Hospital, examined by Mr. Welsby: I have been connected with St. Thomas’s Hospital, as lecturer and surgeon, for 28 years, and during that time I have seen many cases of tetanus. I have had six or seven under my own care, and I may have seen ten or fifteen more. Of those cases it was doubtful in one whether the disease was idiopathic or traumatic—the wound was so slight and the symptoms so obscure, that it was difficult to decide which it was. The others were all decidedly traumatic cases. The shortest period that I recollect during which the disease lasted before it terminated in death, was 30 hours. The disease was always progressive in its character. I have heard the description given by the witnesses of Mr. Cook’s attacks, and they differ essentially from those cases which I have seen. In my experience of tetanus there has always been a marked expression of the countenance as the first symptom. It is a sort of grin, and so peculiar, that having once seen it you can never mistake it. In the symptoms that I heard detailed with regard to Mr. Cook, there were violent convulsions on Monday night, and on Tuesday the individual was entirely free from any discomfort about the face or jaw; whereas, in the cases under my notice, the disease was always continuous, and the fixedness of the jaw was the last symptom to disappear. In my judgment, the symptoms detailed in Mr. Cook’s case are referable neither to apoplexy, epilepsy, nor to any disease that I have ever witnessed.
Cross-examined by Mr. Serjeant Shee: The sort of grin which I have described is known as risus sardonicus. It is not common to all convulsions. Epilepsy is a disease of a convulsive character. I heard the account given by Mr. Jones of the last few minutes of Mr. Cook’s death—that he uttered a piercing shriek, and died after five or six minutes quietly. That last shriek and the paroxysm which accompanied it bear in some respects a resemblance to epilepsy. All convulsions which may be designated as of an epileptic character are not attended with an utter want of consciousness. Death from tetanus accompanied with convulsions seldom leaves any trace behind it; but death from convulsions arising from epilepsy does leave its trace in the shape of a slight effusion of blood on the brain, and a congestion of the vessels.
Re-examined by the Attorney-General: The convulsions of epilepsy are accompanied by a variety of symptoms. When a patient dies of epilepsy he dies perfectly unconscious and comatose. I never saw any case of convulsive disease at all like this. There are cases of convulsive disease which are similar to tetanus in their onset, but not in their progress. For example, laceration of the brain, a sudden injury to the spinal cord, and the irritation from teething in infants, will produce convulsions resulting in death; but there would be wanting the marked expression of the face which I have described, which I have never missed in cases of tetanus.
Mr. Henry Lee, surgeon to King’s College, and to the Lock Hospital, examined by Mr. Bodkin: The Lock Hospital is exclusively devoted to cases of a syphilitic character, and at present I see probably as many as 3,000 of those cases in the course of a year. I have never known an instance of that disease terminating in tetanus.
By the Court: I have never seen or read of a case either of primary or secondary symptoms resulting in tetanus.