Re-examined by Mr. Grove: Besides the symptom which I have mentioned as being inconsistent with the theory of death by strychnine, there are others—namely, sickness, beating the bed clothes, want of sensitiveness to external impressions, and sudden cessation of the convulsions and apparent complete recovery. There was apparently an absence of the usual muscular agitation. Symptoms of convulsive character arising from an injury to the spine vary considerably in their degrees of violence, in their periods of intermission, and in the muscles which are attacked. Intermission of the disease occurs, but is not frequent, in traumatic tetanus. I don’t remember that death has ever taken place in fifteen hours; it may take place in forty-eight hours during convulsions. Granules about the spine are more unusual in young people than in old. I don’t know of any case in which the spine can preserve its integrity, so as to be properly examined, for a period of nine weeks. I should not feel justified in inferring that there was no disease from not finding any at the end of that time. The period of decomposition varies from a few hours to a few days. It is not in the least probable that it could be delayed for nine weeks.
By the Attorney-General: Supposing the stomach were acted on by other causes, I do not think sickness would be inconsistent with tetanus.
John Gay, examined by Mr. Gray: I am a Fellow of the Royal College of Surgeons, and I have been a surgeon to the Royal Free Hospital. A case of traumatic tetanus in a boy came under my observation in that hospital in 1843. The patient was brought in during the time he was ill. He was brought on the 28th of July and died on the 2nd of August. He had met with an accident a week before. During the first three days he had paroxysms of unusual severity. His mother complained that he could not open his mouth, and he complained of stiff neck. During the night he started up and was convulsed. On the following night he was again convulsed. At times the abdominal muscles, as well as those of the legs and back, were rigid; the muscles of the face were also in a state of great contraction. On the following (third) day he was in the same state. At two o’clock there was much less rigidity of the muscles, especially those of the abdomen and back. On the following morning the muscular rigidity had gone, he opened his mouth and was able to talk; he was thoroughly relieved. He had no return of spasms till half-past five the following day. He then asked the nurse to change his linen, and as she lifted him up in the bed to do so violent convulsions of the arms and face came on, and he died in a few minutes. About thirty hours elapsed between the preceding convulsion and the one which terminated his life. Before the paroxysm came on the rigidity had been completely relaxed. I had given the patient tartar emetic (containing antimony) in order to produce vomiting on the second day; it produced no effect. I gave a larger dose on the third day, which also produced no effect. I gave no more after the third day.
Cross-examined by the Attorney-General.—The accident which had happened to him was that a large stone had fallen upon the middle toe of the left foot, and completely smashed it. The wound had become very unhealthy. I amputated the toe. The mouth was almost closed up when I first saw him. The jaw remained closed until the 1st of August, but I could manage to get a small quantity of tartar emetic into the mouth. The convulsions were intermitted during the day, but the muscles of the body, chest, abdomen, back, and neck, were all rigid, and continued so for the two days on which I administered tartar emetic. Rigidity of the muscles of the chest and stomach would no doubt go far to prevent vomiting. The symptoms began to abate on the morning of the 1st of August (the fourth day), and gradually subsided until the rigidity entirely wore off. I then thought he was going to get well. The wound might have been rubbed against the bed when he was raised, but I don’t think it probable. Some peculiar irritation of the nerves would give rise to the affection of the spinal cord. No doubt the death took place in consequence of something produced by the injury to the toe.
Re-examined by Mr. Gray.—There may be various causes for that irritation of the spinal cord which ends in tetanic convulsions. It would be very difficult merely from seeing symptoms of tetanus, and in the absence of all knowledge as to how it had been occasioned, to ascribe it to any particular cause.
Dr. W. Macdonald, examined by Mr. Kenealy.—I am a licentiate of the Royal College of Surgeons of Edinburgh. I have been in practice for fourteen years, and have had considerable experience, practical and theoretical, of idiopathic and traumatic tetanus. I have seen two cases of idiopathic tetanus, and have made that disease the subject of medical research. Tetanus will proceed from very slight causes. An alteration of the secretions of the body, exposure to cold or damp, or mental excitement would cause it. Sensual excitement would produce it. The presence of gritty granules in the spine or brain might produce tetanic convulsions. I have seen cases in which small gritty tubercles in the brain were the only assignable cause of death, which had resulted from convulsions. I believe that in addition to the slight causes which I have named, tetanic convulsions result from causes as yet undiscoverable by human science. In many post-mortem examinations of the bodies of persons who had died from tetanus no trace of any disease could be discovered beyond congestion or vascularity of some of the vessels surrounding the nerves. Strychnia, however, is very easily discoverable by a scientific man. I remember the case of a woman, Catherine Watson, who is now present, and who was attacked with idiopathic tetanus on the 20th of October, 1855. [The witness read a report of the circumstances attending this case, the subject of which was a young woman twenty-two years of age, who, after going about her ordinary occupation during the day, was attacked with tetanus at ten o’clock at night. By the administration of chloroform the violence of the spasms was gradually diminished and she recovered. After her recovery she slept for thirty-six hours.] In that case there was lockjaw, which set in about the middle of the attack. It is generally a late symptom. I had a patient named Coupland who died of tetanus. It must have been idiopathic, as there was no external cause. The patient died in somewhat less than half an hour, before I could reach the house. I have made a number of experiments upon animals with reference to strychnia poison. I have found the post-mortem appearances very generally to concur. The vessels of the membranes of the brain have generally been highly congested. The sinuses gorged with blood. In one case there was hemorrhage from the nostrils. That was a case of very high congestion. In some cases there has been an extravasation of blood at the base of the brain. I have cut through the substance of the brain, and have found in it numerous red points. The lungs have been either collapsed or congested. The heart has invariably been filled with blood on the right side, and very often on the left side also. The liver has been congested, the kidneys and spleen generally healthy. The vessels of the stomach on the outer surface have been congested, and on the mucous or inner surface highly vascular. The vessels of the membranes of the spinal cord have been congested, and sometimes red points have been displayed on cutting it through.
From a post-mortem examination you may generally judge of the cause of death. I have in a great many cases experimented for the discovery of strychnia. You may discover in the stomach the smallest dose that will kill. If you kill with a grain you may discover traces of it. By traces I mean evidences of its presence. You can discover the fifty-thousandth part of a grain. I have actually experimented so as to discover that quantity. The decomposition of strychnia is a theory which no scientific man of eminence has ever before propounded. I first heard of that theory in this court. In my opinion, there is no well-grounded reason whatever for it. I have disproved the theory by numerous experiments. I have taken the blood of an animal poisoned by two grains of strychnia, about the least quantity which would destroy life, and have injected it into the abdominal cavities of smaller animals, and have destroyed them, with all the symptoms and post-mortem appearances of poisoning by strychnia. Strychnia being administered in pills would not affect its detection. If the pills were hard they would keep it together, and you might find its remains more easily. I do not agree with Dr. Taylor that colour tests are fallacious. I believe that such tests are a reliable mode of ascertaining the presence of strychnia. I have invariably found strychnia in the urine which has been ejected. Strychnia cannot be confounded with pyrozanthe. After strychnia has been administered there is an increased flow of saliva. In my experiments that has been a very marked symptom. Animals to which strychnia had been given have always been very susceptible to touch. The stamp of a foot or a sharp word would throw them into convulsions. Even before the paroxysms commenced touching them would be likely to throw them into tonic convulsions.
Lord Campbell: As soon as the poison is swallowed? No; it would be after a certain time. The first symptoms of poisoning must have been developed.
Examination continued: I do not think rubbing them would give them relief. I think it extremely improbable that a man who had taken a dose of strychnia sufficient to destroy life could after the symptoms had made their appearance pull a bell violently. I have attended to the evidence as to Cook’s symptoms. To the symptoms I attach little importance as a means of diagnosis, because you may have the same symptoms developed by many different causes. A dose of strychnia sufficient to destroy life would hardly require an hour and a-half for its absorption. I think that death was in this case caused by epileptic convulsions with tetanic complications. I form that opinion from the post-mortem appearances being so different from those that I have described as attending poisoning with strychnia, and from the supposition that a dose of strychnia sufficient to destroy life in one paroxysm could not, so far as I am aware, have required even an hour for its absorption before the commencement of the attack. If the attack were of an epileptic character, the interval between the attacks of Monday and Tuesday would be natural, as epileptic seizures very often recur at about the same hours of successive days.
Assuming that a man was in so excited a state of mind that he was silent for two or three minutes after his horse had won a race, that he exposed himself to cold and damp, excited his brain by drink, and was attacked by violent vomiting, and that after his death deposits of gritty granules were found in the neighbourhood of the spinal cord, would these causes be likely to produce such a death as that of Cook?—Any one of these causes would assist in the production of such a death.