Dr. Benjamin Ward Richardson, examined by Mr. Serjeant Shee—I practise in London, and I am a licentiate of the Faculty of Physicians and Surgeons in Glasgow and a member of the College of Physicians in London. I have never seen a case of idiopathic or traumatic tetanus, but I have seen a considerable number of deaths by convulsions, and I have known these cases, when they have ended in death, sometimes assume tetaniform appearances without being, strictly speaking, tetanus. The patient, if conscious, generally desires to sit up. I have known persons to die from a disease called angina pectoris. The symptoms of the disease, when it is fatal, resemble closely the symptoms of the paroxysms in which Mr. Cook died. It is classed amongst the convulsive or spasmodic diseases, and has no distinctive feature in post-mortem examination.
B. W. Richardson
Will you state what symptoms you particularly refer to?—I could not do better than describe a case which I myself saw. A child, ten years of age, was under my care in November, 1850. I supposed she had suffered from scarlet fever. She had a slight feverish attack. She recovered so far that my visits ceased on 20th November. I left her merry in the morning, and at half-past ten I was called to see her dying. She was supported upright at her own request. The face was pale; the whole of the face and arms rigid, the fingers clenched, the respiratory muscles completely fixed and rigid, and, with all, complained of an intense agony and restlessness such as I had never witnessed. There was perfect consciousness. The child knew me, and explained her intense agony; eagerly took from my hands some brandy and water from a spoon. I then left to get some chloroform for the purpose of producing relaxation by chloroform vapour. On returning, I found the head was thrown back. I could detect no respiration. The eyes remained fixed open, and the body just resembling a fit. She was dead. I did not observe whether the rigor-mortis came on at its usual time or later. I made a post-mortem examination the following day. Unfortunately I left the body in the arms of the sister, and, of course, it was laid out afterwards. At the post-mortem examination I observed that the brain was slightly congested; a portion of the upper part of the spinal cord seemed normal and healthy, the lungs were collapsed, the heart was in such a state of firm spasms and so empty that I remarked it might have been rinsed out, it was so perfectly clean and free from blood. There were no appearances of functional disturbances except a slight effusion of serum in one pleural cavity, I believe the right side. The other part of the spinal cord was in a normal state. They told me the child was unusually well and merry at supper; that she then went to bed with her sister, and in lying down suddenly jumped up and said, “I am going to die,” and begged her sister to rub her.
Cross-examined by the Attorney-General—This case accords with all the descriptions of angina pectoris by the best authors—Latham, Watson, Boyeau, Pratt, and Sir Everett Holme.
What is the true nature and cause of angina pectoris?—It has been laid down as disease of the valves of the heart. There have been many cases in which there has been no discovered cause.
Are the symptoms of angina pectoris not those that would be produced by taking strychnia?—Not exactly. In angina pectoris the patient requests to be rubbed to give relief.
Did you hear the Leeds case?—Assuming that that was a case of strychnia, I must say that the two forms are so strictly analogous that there would be great difficulty in detecting angina from strychnia, with this difference, that angina is paroxysmal, it comes and goes, and strychnia would not be so likely to do that. You would not expect it for many months.
B. W. Richardson
But in this case you are speaking as if it ended in the first paroxysm?—Yes.
How then can you be justified, in cases where you discover no abnormal conditions of the heart or its arteries, in setting down the death to angina?—Precisely as if I saw the symptoms of epilepsy I should accept them as such.