The examination of Dr. Todd by the Attorney-General was then proceeded with as follows:—
“Having heard the deposition of Dr. Bamford read, I do not believe that the deceased died from apoplexy or from epilepsy. I never knew tetanus arise either from syphilitic sores or from sore throat. There are poisons which will produce tetanic convulsions. The principal of these poisons are nux vomica and those which contain as their active ingredients strychnia and brucia. I have never seen human life destroyed by strychnia, but I have seen animals destroyed by it frequently. The poison is usually given in a largish dose in those cases, so as to put an end to the sufferings and destroy life as soon as possible. I should not like to give a human subject a quarter of a grain. I think that it is not unlikely that half a grain might destroy life; and I believe that a grain certainly would. I think that half a grain would kill a cat. The symptoms which would ensue upon the administration of strychnine when given in solution—and I believe that poisons of that nature act more rapidly in a state of solution than in any other form—would develope themselves in ten minutes after it was taken, if the dose was a large one; if not so large, they might be half an hour or an hour before they appeared. Those symptoms would be tetanic convulsions of the muscles—more especially those of the spine and neck; the head and back would be bent back, and the trunk would be bowed in a marked manner; the extremities also would be stiffened and jerked out. The stiffness, once set in, would never entirely disappear; but fresh paroxysms would set in, and the jerking would reappear, and death would probably ensue in a quarter of an hour or so. The difference between tetanus produced by strychnia and other tetanus is very marked. In the former case the duration of the symptoms is very short, and instead of being continuous in their development, they will subside if the dose has not been strong enough to produce death, and will be renewed in fresh paroxysms: whereas in other descriptions of tetanus the symptoms commence in a mild form, and become stronger and more violent as the disease progresses. The difficulty experienced in breathing is common alike to tetanus properly so called, and to tetanic convulsions occasioned by strychnia, arising from the pressure on the respiratory muscles. I think it is remarkable that the deceased was able to swallow, and that there was no fixing of the jaw, which would have been the case with tetanus proper, resulting either from a wound or from disease. From all the evidence that I have heard, I think that the symptoms which presented themselves in the case of Mr. Cook arose from tetanus produced by strychnia.”
Cross-examined by Mr. Grove, Q.C.—“There are cases sloping into each other, as it were, of every grade and degree, from mild convulsions to tetanic spasms. I have published some lectures upon diseases of the brain, and I adhere to the opinion there expressed, that the state of a person suffering from tetanus is identical with that which strychnia is capable of producing. In a pathological point of view, an examination of the spinal cord shortly after death, in investigating supposed deaths from strychnia, is important. The signs of decomposition, however, could be easily distinguished from the evidence of disease which existed previously to death, but it would be difficult to distinguish in such a case whether mere softening resulted from decomposition or from pre-existing disease. There is nothing in the post-mortem examination that leads me to think that the deceased died from tetanus proper. I think that granules upon the spinal cord, such as I have heard described, would not be likely to cause tetanus. In animals to which strychnia has been administered I cannot say that I have observed what you call an intolerance of touch, but by touching them spasms are apt to be excited. That sensibility to touch continues as long as the operation of the poison continues. I have examined the interior of animals that have been killed by strychnia, but I have not observed in such cases that the right side of the heart was usually full of blood. It is some years since I made such an examination, but I am able, nevertheless, to speak positively as to the state of the heart. It is usually empty on both sides. I do not agree with Dr. Taylor, or other authorities, that, in cases of tetanus, animals died asphyxiated. If they did, we should invariably have the right side of the heart full of blood, which is not the case. I think the term asphyxiated is sometimes very loosely used. I know, from my reading, that morphia sometimes produces convulsions, but believe they would be of an epileptic character. I think that the symptoms of morphia would be longer deferred in making their appearance than from strychnia, but cannot speak positively on the point. Morphia, like strychnia, is a vegetable poison. I have not observed in animals the jaw fixed after the administration of strychnia.”
Re-examined by the Attorney-General.—“Whatever may be the true theory as to the emptiness of the heart after strychnia, I should say that the heart is more ordinarily empty than filled after tetanus, and more contracted after strychnia, than in ordinary tetanus. I do not believe that a medical practitioner would have any difficulty in distinguishing between ordinary convulsions and tetanic convulsions. I have heard the evidence of the gentlemen who made the post-mortem examination, and I apprehend that there was nothing to prevent the discovery of disease in the spinal cord had any existed previously to death.”
Sir Benjamin Brodie’s evidence, which follows, was given “with great clearness, slowly, audibly, and distinctly,” and produced a marked effect.
Sir Benjamin Brodie, examined by Mr. James, Q.C.—“I have been for many years senior surgeon to St. George’s Hospital, and have had considerable experience as a surgeon. In the course of my practice I have had under my care many cases of death from tetanus. Death from idiopathic tetanus is, according to my experience, very rare in this country. The ordinary tetanus in this country is traumatic tetanus. I have heard the symptoms which accompanied the death of Mr. Cook, and I am of opinion that so far as there was a general contraction of the muscles they resembled those of traumatic tetanus; but, as to the course those symptoms took, they were entirely different. I have attended to the detailed description of the attack suffered by Mr. Cook on the Monday night, its ceasing on Tuesday, and its renewal on the Tuesday night. The symptoms of traumatic tetanus always begin, so far as I have seen, very gradually, the stiffness of the lower jaw being, I believe, invariably, the symptom first complained of—at least, so it has been in my experience. The contraction of the muscles of the back is always a later symptom—generally much later. The muscles of the extremities are affected in a much less degree than those of the neck and trunk, except in some cases where the injury has been in a limb, and an early symptom has been spasmodic contraction of the muscles of that limb. I do not myself recollect a case of ordinary tetanus in which occurred that contraction in the muscles of the hand which I understand was stated to have taken place in this instance. Again, ordinary tetanus rarely runs its course in less than two or three days, and often is protracted to a much longer period. I knew one case only in which the disease was said to have terminated in so short a time as twelve hours; but probably in that case the early symptoms had been overlooked. Again, I never knew the symptoms of ordinary tetanus to last for a few minutes, then subside, and then come on again after twenty-four hours. I think that these are the principal points of difference which I perceived between the symptoms of ordinary tetanus and those which I have heard described in this case. I have not witnessed tetanic convulsions from strychnia on animal life. I do not believe that death in the case of Mr. Cook arose from what we ordinarily call tetanus—either idiopathic or traumatic. I never knew tetanus result from sore throat or from a chancre, or from any other form of syphilitic disease. The symptoms were not the result either of apoplexy or of epilepsy. Perhaps I had better say at once that I never saw a case in which the symptoms that I have heard described here rose from any disease. (Sensation.) When I say that, of course I refer not to particular symptoms, but to the general course which the symptoms took.”
Cross-examined by Mr. Serjeant Shee.—“I believe I remember one case in the physician’s ward of St. George’s Hospital, which was shown to me as a case of idiopathic tetanus, but I doubted whether it was tetanus at all. It was a slight case, and I do not remember the particulars.”
Question.—“Considering how rare cases of tetanus are, do you think that the description given by a chambermaid and a provincial medical man, who had never seen but one case, is sufficient to enable you to form an opinion as to the nature of the case?”
Answer.—“I must say I thought that the description was very clearly given.”