In another case, at the Royal Free Hospital, in 1843, on the 28th of July, a boy was brought in with the middle toe of his left foot smashed by a stone, which Mr. John Gay amputated. The accident had happened a week before, and the wound became very unhealthy. When the surgeon first saw him, his mouth was almost closed, and continued so until the 1st of August, but a small quantity of medicine could be introduced.
“During the first three days,” said Mr. J. Gay, “his paroxysms were of unusual severity; he complained of a stiff neck, and during the first night 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, and the muscles of the face in a state of great contraction. He was in the same state the next day, but at two o’clock there was much less rigidity of the muscles, especially those of the abdomen and back. On the following morning the rigidity had gone, he opened his mouth and could talk; he was thoroughly relieved. He had no return of spasms till half-past five on the following day. He then asked the nurse to change his linen, and as she lifted him up in 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 ended his life. Before the paroxysm came on the rigidity had been completely relaxed. Tartar emetic (containing antimony), which I gave on the second and third day, did not produce vomiting; the rigidity of the muscles of the chest would go far to prevent it. The wound might have rubbed against the bed when he was raised, but I don’t think it possible. Some peculiar irritation of the nerves would give rise to the affection of the spinal cord. There may be various causes for this irritation of the spinal cord, which ends in tetanus, but it would be very difficult merely from seeing symptoms of tetanus, and in the absence of knowledge of how it had been occasioned, to ascribe it to any particular cause. No doubt the death took place in consequence of something produced by the injury of the toe.”
The seriousness of the wound in this case, in comparison with any signs of wounds found on Cook’s body, and the severity of the shock occasioned by such a painful accident, renders this example almost valueless.
In a third case, at the London Hospital, on the 22nd of March of 1856, a patient, aged thirty-seven, was brought in about half-past seven in the evening. When in the receiving room, he had one paroxysm, and another soon after when in the ward. After the first, his pulse was feeble and rapid, his jaws closed and fixed, an expression of anxiety on his countenance, and his features sunken; he was unable to swallow, and the muscles of the abdomen and the back were somewhat tense. After the second paroxysm, his body became arched for about a minute. He was quieter for a few minutes, had a third attack, and died. He had some old neglected sores of a chronic character, particularly at the right elbow, a peculiarly sensitive spot, and Mr. Ross, the house-surgeon, who attended the case, admitted that the disease had been coming on since the morning, that he had felt symptoms of lockjaw at breakfast, and had had successive attacks all the afternoon before coming to the hospital. Here again the case had been progressive until death, and commenced with lockjaw, the admitted signs of ordinary tetanus as distinguished from that due to poison.
The last case proved was that of Catherine Wilson, of Garnkirk, near Glasgow, who “was attacked with a fit,” as she deposed, “in October last year at night, felt heavy all the day from the morning, but had no pain till night. My first pain,” she said, “was in the stomach, and then I had cramp in the arm, and became quite insensible.” By the administration of chloroform the spasms were relieved, and she recovered.
Dr. William Macdonald, of Edinburgh, who saw the case about an hour after the attack, admitted that lockjaw came on in about an hour or two after he was called in.
This witness was also put forward as a medical expert in cases of strychnia, and attributed Cook’s death to “epileptic convulsions with tetanic complications,” and was subjected to the following cross-examination by the Attorney-General:—
“I believe,” said Dr. Macdonald, “that all convulsive diseases, including the epileptic forms and the various tetanic complications, arise from the decomposition of the blood acting upon the nerves. Any mental excitement might have caused Cook’s death. Cook was excited at Shrewsbury, and whenever there is excitement there is a consequent depression. I think Cook was afterwards depressed. When a man is lying in bed and vomiting he must be depressed.”
Attorney-General.—“This gentleman was much overjoyed at his horse winning, and you think he vomited in consequence?”