Dr. George Robinson, examined by Mr. Kenealy—I am a Licentiate of the Royal College of Physicians and Fellow of the Royal Medical Chirurgical Society of London, and physician to the Newcastle-on-Tyne Dispensary and Fever Hospital. I have devoted considerable attention to pathology, and have published essays on it. I have practised as a physician for ten years. From the symptoms I have heard described my opinion is that Mr. Cook died from tetanic convulsions, by which I mean, not the disease of tetanus, but convulsions similar to those witnessed in tetanus. Convulsions of that kind occasionally assume the nature of epilepsy. I know of no department of pathology which is more obscure than that of convulsive diseases. I have been present at post-mortem examinations of persons who died from convulsive diseases. I have sometimes seen no morbid appearance whatever, and in other cases the morbid appearances which were visible were common to a variety of diseases. Convulsive diseases undoubtedly depend very much on the state of the nerves. They are all connected with disorders of the nervous action. The brain has great influence in producing convulsive diseases, but the spinal cord has a greater influence. The presence of gritty granules in the neighbourhood of the spinal cord would be likely to produce convulsive diseases. There is such a disease as spinal epilepsy, which is accompanied by strong convulsions, which might resemble in a great degree those described in the present case. Periodicity would belong to convulsions arising from spinal epilepsy. I should think from the evidence I have heard that Mr. Cook’s mode of life would predispose him to epilepsy.
Cross-examined by the Attorney-General—In all cases of epilepsy there are violent convulsions. I cannot tell you how many I have seen assume a tetanic character; perhaps twenty.
Has it gone as far as opisthotonos?—Not the extreme opisthotonos of tetanus. The whole body has been straightened out and the head thrown back. I heard Mr. Jones describe Mr. Cook’s symptoms, that the body was so bowed that he could not raise it, so bowed that it would lean upon its heels and the back of its head if it had been turned over.
G. Robinson
Have you ever seen anything in epilepsy approaching to these symptoms?—I have never seen anything approaching to it. I have never seen a body so stiffened that it would rest on the head and heels.
Is that symptom peculiar to tetanus?—You may have convulsions of the same character occurring from other causes—tetanic convulsions from the operation of various poisons.
Keep to natural diseases. Did you ever know these symptoms of opisthotonos, in that shape or to that extent, arise from anything but tetanus?—Not within my own experience. I have read of epilepsy being accompanied with tetanic convulsions. Epilepsy, when it assumes that marked character, is accompanied with unconsciousness. I have read in a case of Dr. Marshall Hall’s that sometimes unconsciousness is not present. He does not mention whether death took place in this case or not. That would make all the difference.
You said that gritty granules would be likely to produce convulsive diseases. What extent of development, in your judgment, must such granules reach to produce an action in the spinal marrow?—I should say there is no relation between the size of the granules and the extent of the effect produced.
Would you expect when they began to get to the size that they would have any effect on the nervous system—that they would begin to show their effect more or less gradually?—No, in epilepsy I have myself observed several granules in the membrane of the brain; and any disturbing cause in the system, I think, would be likely to produce convulsions. I believe that the granules in this case were very likely to irritate the spinal cord, and an attack might very likely come on at once in a fit of epilepsy. There would be pain during the continuance of the violent spasms of the patient, not necessarily pain merely from the spasms. These granules might or might not produce arachnitis.
You would expect to find inflammation in that case?—Not necessarily. Irritation, not inflammation. Granules of that description do not often exist in healthy spines. In the dissections of epilepsy in the large hospitals, these small granules have been found very frequently. The granules, in my opinion, would be likely to produce epilepsy. In my experience I have never known epilepsy unaccompanied by unconsciousness, nor have I known epilepsy producing the marked symptoms of tetanic character which occur in Mr. Cook’s case.