“The premonitory signs of general convulsions are (inter alia), vertigo and dizziness, irritability of temper, flushings, or alternate flushing and paleness of the face, nausea, retching or vomiting, or pain and distension of stomach and left hypochondrium, unusual flatulence of the stomach and bowels, or other dyspeptic symptoms.”
In further describing these convulsions, the article says:—
“In many instances the general sensibility and consciousness are but very slightly impaired, particularly in the more simple cases, and when the proximate cause is not seated in the encephalon; but in proportion as this part is affected, primarily or consecutively, and the neck and face tumid and livid, the cerebral functions are obscured, and the convulsions attended by stupor, delirium, &c., or rapidly pass into, or are followed by, these states.”
Then, it adds:—
“The paroxysm may cease in a few moments or minutes, or continue for some or even many hours. It generally subsides rapidly, the patient experiencing, at its termination, fatigue, headache, or stupor; but he is usually restored in a short time to the same state as before the seizure, which is liable to recur in a person once affected, but at uncertain intervals. After repeated attacks the fit sometimes becomes periodic (the convulsio recurrens of authors.)”
And, in detailing the origin of these convulsions, it says:—
“The most common causes are (inter alia), all emotions of the mind which excite the nervous power, and determine the blood to the head, as joy, anger, religious enthusiasm, excessive desire, &c., or those which greatly depress the nervous influence, as well as diminish and derange the actions of the heart, as fear, terror, anxiety, sadness, distressing intelligence, frightful dreams, &c.—the syphilitic poison and repulsion of gout or rheumatism.”
Do you believe, if Dr. Taylor had read that before the inquest, that he would have dared to say that the man died from strychnine? Is there one single symptom in the statement made in the depositions by Elizabeth Mills and Mr. Jones which may not be classed under one of the varieties of convulsions which Dr. Copland describes? It is not for me to suggest a theory; but the gentlemen whom I shall call before you—men of the highest eminence in their profession, and not mere hospital surgeons, who have seen nothing of this nature but traumatic tetanus—will tell you that Mr. Cook’s symptoms were those of general convulsions, and not of tetanus. My belief is—and I hope you will confirm it by your verdict—that Mr. Cook’s complaint was not tetanus at all, although it may well have been—according to the descriptions to which I shall call your attention—some form of traumatic or idiopathic tetanus, there being no broad, general distinction or certain confine between idiopathic, or self-generating tetanus, and many forms of convulsions. The tetanic form of convulsions is pretty much the same thing as idiopathic tetanus; and when we are told by medical witnesses that they never saw a case of idiopathic tetanus, my answer to that is that they must have had a very limited experience. It is not a disease of very frequent occurrence, it is true; but there are gentlemen here who have seen cases of idiopathic tetanus, and they are by no means of that rare occurrence which has been represented to you by the witnesses for the prosecution. There is one gentleman here, of very large practice at Leeds, whom I shall call before you, who attended at the bedside of Mrs. Dove, who has himself seen four cases of idiopathic tetanus. Traumatic tetanus very frequently occurs in hospitals—in fact, it often supervenes upon the operations of the surgeon; but the persons to give you correct information upon idiopathic tetanus are the general practitioners who enjoy the confidence of families, and who have the opportunity of visiting at their dwellings, both rich and poor, when they are attacked by any of those convulsive diseases or fits which heads of families and brothers and sisters are so careful not to disclose to the world at large. Dr. Watson is a general practitioner, and he says in his Lectures on the Principles and Practice of Physic, that most cases of tetanus may be traced to one of two causes—which are, exposure to the cold or sudden alternations of temperature, and bodily injury. “It has been known to arise,” he says, “from causes so slight as these,—the sticking of a fishbone in the fauces, the air caused by a musket shot, the stroke of a whip-lash under the eye, leaving the skin unbroken, the cutting of a corn, the biting of the finger by a tame sparrow, the blow of a stick on the neck, the insertion of a seton, the extraction of a tooth, the injection of a hydrocele, and the operation of cupping.” He goes on to say that when the disease arises from exposure to the cold or damp it comes on earlier than on other occasions—often in a few hours—so that if the exposure takes place in the night, the complaint may begin to manifest itself next morning. He also says that, although tetanus may be occasioned by a wound, independently of exposure to cold, or by exposure to cold without bodily injury, there is good reason for thinking that in many instances one of the causes would fail to produce it where both together would call it forth.
Dr. Watson adds that, although the pathology of tetanus is obscure, we may fairly come to the conclusion that the symptoms are the result of some peculiar condition of the spinal cord, produced and kept up by irritation of the substance, and that the brain is not involved in the disease; the modern French writers upon the disease hold that it is an inflammable complaint, and that it consists essentially of inflammation of the spinal marrow. Now, who shall say that those symptoms which were spoken to on the day of the inquest by Elizabeth Mills and Mr. Jones may not be ranged under one of those forms of tetanus? Idiopathic tetanus is so like general convulsions that in many cases it cannot be distinguished from them; and to such an extent is this so that Dr. Copland states that convulsions frequently assume a tetanic appearance. It is true that traumatic tetanus begins in four cases out of five by a seizure of the lower jaw; but then in the fifth case it does not so commence; and Sir B. Brodie mentions two instances in which it began in the limb which was wounded. Now, having gone so far, and having endeavoured to satisfy you that the symptoms which were spoken to by those two witnesses in their depositions may be, as I am told and instructed that they are, rather referable to a violent description of general convulsions than to any form of tetanus, let us proceed to inquire whether or not the symptoms are consistent with what we know of tetanus produced by strychnine; because, if you shall be satisfied, upon full investigation, that they are not consistent with the symptoms, which are the unquestionable result of strychnia tetanus, then the hypothesis of the Crown entirely fails and John Parsons Cook can’t have died of strychnine poison. Whether that be so or not will depend in a great degree, as it strikes me—although, of course, that will be for you to decide upon what you think of the evidence of Elizabeth Mills; but, before I go to that evidence, I will call your attention to the description of strychnia tetanus as given by two very eminent gentlemen, Dr. Taylor and Dr. Christison, who were called for the Crown the other day; and, if you find from their description that strychnia tetanus is a different thing from the picture first given of the attack and paroxysms by Elizabeth Mills and Mr. Jones, you will, I think, have great difficulty in determining that Mr. Cook died from strychnine.
Let us first take Dr. Taylor’s description of strychnia tetanus. I am not sure whether he stated that he had ever seen a case of strychnia tetanus in a human subject; but we must be just to Dr. Taylor. He has had large and extensive reading on the subject on which he writes, and it is not to be supposed that he has set down in his book what he has not found established upon respectable authority. Therefore, although we have it secondhand in the book, we must suppose that Dr. Taylor knows something of the subject. In his work upon strychnia poisoning, Dr. Taylor says, “that in from five to twenty minutes after the poison has been swallowed the patient is suddenly seized with tetanic symptoms affecting the whole of the muscular system, the body becoming rigid, the limbs stretched out, and the jaws so fixed that considerable difficulty is experienced in introducing anything into the mouth.” But, according to the statement of the witnesses, Mr. Cook was sitting up in bed, beating the bedclothes, talking, frequently telling the people about him to go for Palmer, asking for “the remedy,” and ready to swallow whatever was given him. There was no “considerable difficulty in introducing anything into the mouth,” and the paroxysm, instead of beginning within “from five to twenty minutes after the poison was supposed to have been swallowed” did not begin for an hour and a half afterwards. Dr. Taylor further on states, “After several such attacks, increasing in severity, the patient dies asphyxiated.” Now I submit, although there are some of these systems in this case, as there will be in every case of violent convulsions, that this is not a description of the case of John Parsons Cook.