Answer.—“Sickness often indicates it. I can’t say whether the attack of Sunday night was an attack of convulsions. I think that the Sunday attack was one of a similar character, but not so intense, as the attack of Tuesday, in which he died. I don’t think he had convulsions on the Sunday, but he was in that condition which often precedes convulsions. I think he was mistaken when he stated that he was awoke by a noise. I believe he was delirious. That is one of the symptoms on which I found my opinion. Any intestinal irritation will produce convulsions in a tetanic form. I have known instances in children. I have not seen an instance in an animal. Medical writers state that such cases do occur. I know no name for convulsions of that kind.”
Question.—“Have you ever known a case of convulsions of that kind, terminating in death, in which the patient remained conscious to the last?”
Answer.—“I have not. Where epilepsy terminates in death consciousness is gone. I have known four cases of traumatic, and five or six of idiopathic tetanus.”
Question.—“You heard Mr. Jones make this statement of the symptoms of Cook after the commencement of the paroxysms:—‘After he swallowed the pills he uttered loud screams, threw himself back in the bed, and was dreadfully convulsed. He said, “Raise me up! I shall be suffocated.” The convulsions affected every muscle of the body, and were accompanied by stiffening of the limbs. I endeavoured to raise Cook with the assistance of Palmer, but found it quite impossible owing to the rigidity of the limbs. When Cook found we could not raise him up, he asked me to turn him over. He was then quite sensible. I turned him on to his side. I listened to the action of his heart. I found that it gradually weakened, and asked Palmer to fetch some spirits of ammonia, to be used as a stimulant. When he returned, the pulsations of the heart were gradually ceasing, and life was almost extinct. Cook died very quietly a very short time afterwards. When he threw himself back in bed he clinched his hands, and they remained clinched after death. When I was rubbing his neck, his head and neck were unnaturally bent back by the spasmodic action of the muscles. After death his body was so twisted or bowed that if I had placed it upon the back it would have rested upon the head and feet!’ Now, I ask you to distinguish in any one particular between those symptoms and the symptoms of tetanic convulsions.”
Answer.—“It is not tetanus at all; not idiopathic tetanus.”
Question.—“I quite agree with you that it was not idiopathic tetanus. But point out any distinction that you can see between these symptoms and real tetanus?”
Answer.—“I do not know that there is any distinction, except that in a case of tetanus I never saw rigidity continue till death and afterwards.”
Question.—“Can you tell me of any case of death from convulsions in which the patient was conscious to the last?”
Answer.—“I do not know any. Convulsions occurring after poison has been taken are properly called tetanic.”