The last important medical witness called for the defence, Dr. Benjamin Ward Richardson, physician, of London, took the prosecution somewhat by surprise by attributing Cook’s death to Angina pectoris, a cause not as yet hinted at. As the counsel for the Crown were not prepared with information requisite for an effective cross-examination on this point, at the close of the prisoner’s case the Attorney-General asked leave to recall this witness, as he was then prepared with the books required for that purpose. The Court, however, refused the application, and the evidence therefore must be accepted with caution.
Dr. Richardson said:—“I am a physician, practising in London. I have never seen a case of tetanus, properly so called, but I have seen many cases of death by convulsions. In many instances they have presented tetanic appearances without being strictly tetanus. I have seen the muscles fixed, especially those of the upper part of the body. I have observed the arms stiffened out, and the hands closely and firmly clinched until death. I have also observed a sense of suffocation in the patient. In some forms of convulsions I have seen contortions both of the legs and the feet, and the patient generally expresses a wish to sit up. I have known persons die of a disease called angina pectoris. The symptoms of that disease, I consider, resemble closely those of Mr. Cook. Angina pectoris comes under the denomination of spasmodic diseases. In some cases the disease is detectable upon post-mortem examination; in others it is not. I attended one case. A girl ten years old was under my care in 1850. I supposed she had suffered from scarlet fever. She recovered so far that my visits ceased. I left her amused and merry in the morning; at half-past ten in the evening I was called in to see her, and I found her dying. She was supported upright at her own request, her face was pale, the muscles of the face rigid, the arms rigid, the fingers clinched, the respiratory muscles completely fixed and rigid, and with all this there was combined intense agony and restlessness, such as I have never witnessed. There was perfect consciousness. The child knew me, described her agony, and eagerly took some brandy and water from a spoon. I left for the purpose of obtaining some chloroform from my own house, which was thirty yards distant. When I returned her head was drawn back, and I could detect no respiration; the eyes were then fixed open, and the body just resembled a statue; she was dead. On the following day I made a post-mortem examination. The brain was slightly congested; the upper part of the spinal cord seemed healthy; the lungs were collapsed; the heart was in such a state of firm spasm and solidity, and so emptied of blood, that I remarked that it might have been rinsed out. I could not discover any appearance of disease that would account for the death, except a slight effusion of serum in one pleural cavity. I never could ascertain any cause for the death. The child went to bed well and merry, and immediately afterwards jumped up, screamed, and exclaimed, ‘I am going to die.’”
By the Attorney-General.—“I consider that the symptoms I have described were those of angina pectoris. It is the opinion of Dr. Jenner that this disease is occasioned by the ossification of some of the small vessels of the heart. I did not find that to be the case in this instance. There have been many cases where no cause whatever was discovered. It is called angina pectoris, from its causing such extreme anguish to the chest. I do not think the symptoms I have described were such as would result from taking strychnia. There is this difference,—that rubbing the hands gives ease to the patient in cases of angina pectoris. I must say there would be great difficulty in detecting the difference in cases of angina pectoris and strychnia. As regards symptoms I know of no difference between the two. I am bound to say that if I had known so much of these subjects as I do now, in the case I have referred to I should have gone on to analysis to endeavour to detect strychnia. In the second case I discovered organic disease of the heart, which was quite sufficient to account for the symptoms. The disease of angina pectoris comes on quite suddenly, and does not give any notice of its approach. I did not send any note of this case to any medical publication. It is not at all an uncommon occurrence to find the hands firmly clinched after death in cases of natural disease.”
By Mr. Serjeant Shee.—“There are cases of angina pectoris in which the patient has recovered and appeared perfectly well for a period of twenty-four hours, and then the attack has returned. I am of opinion that the fact of the recurrence of the second fit in Cook’s case is more the symptom of angina pectoris than of strychnia poison.”[59]
Dr. Wrightson was recalled, and in answer to a question put by Mr. Serjeant Shee he said it was his opinion that when the strychnia poison was absorbed in the system it was diffused throughout the entire system.
By the Attorney-General.—“The longer time that elapsed before the death would render the absorption more complete. If a minimum dose to destroy life were given, and a long interval elapsed to the death, the more complete would be the absorption and the less the chance of finding it in the stomach.”
By Mr. Serjeant Shee.—“I should expect still to find it in the spleen and liver and blood.”
CASES OF TETANUS BROUGHT FORWARD FOR THE DEFENCE.
In answer to the cases of undoubted poisoning by strychnia proved on the part of the prosecution, four cases of tetanus were brought forward on behalf of the prisoner, with the object of showing that the symptoms then exhibited were identical with those in Cook’s case, and, therefore, raising the presumption that he might have died from ordinary tetanic convulsions, and not from those produced by strychnia.
The first of these cases was described by Mr. Robert Edward Gay, a member of the College of Surgeons, who had attended a patient of the name of Forster for tetanus in October, 1855. Apparently, at first the patient was suffering only from sore throat and its usual attendant pains in the neck and upper portion of the spine, for which he was duly treated. On the fourth day of his illness the muscular pains extended to the face, and particularly to the lower jaw, and by evening lockjaw had come on, with pains of the muscles of the bowels, legs, and arms. “He became very convulsed throughout the entire muscular system, had frequent involuntary contractions of the arms, hands, and legs; his difficulty of swallowing increased, and not a particle of food, solid or liquid, could be introduced into the mouth, the attempt to do so bringing on violent convulsions; so strong were they, that I could compare him to nothing but a piece of warped board.” The head was thrown back, the abdomen thrust forward, the legs frequently drawn up and contracted; the attempt to feed him with a spoon, the opening a window, or placing the fingers on the pulse, brought on violent convulsions. While the patient was suffering in this manner, he complained of great hunger, repeatedly exclaimed that he was hungry, and could not eat. He was kept alive to the fourteenth day entirely by injections of a milky and farinaceous character. He was insensible on the 12th, and continued so till he died. There was no sore or hurt about his body, and Mr. Gay attributed his death to an inflammatory sore throat, from cold and exposure to the weather, assuming a tetanic form, from the patient being a very nervous, excited, and anxious person. Mr. Gay, whilst satisfied that this was a case of idiopathic tetanus, admitted that he never met with such another case; that it was altogether progressive from the first onset; that although for a short time there was a remission of symptoms, they invariably recurred, and that the locking of the jaw was the very first symptom that made its appearance.