Re-examined by the Attorney-General—A medical practitioner who saw a case of convulsions would be able at once to know the difference between symptoms of general convulsions and of tetanus. One of the characteristic features of tetanus is that the consciousness is not affected.
Robert Todd
Dr. Robert Todd, examined by the Attorney-General—I have been in practice as a doctor for twenty-five years, and have been a physician to King’s College Hospital for many years. I have lectured on the disease called tetanus, and have published the lectures. I have seen two cases of what seemed to be idiopathic tetanus. It is a very rare thing. The term tetanus ought not to be applied to cases of poisoning, for the symptoms are so essentially distinct from the disease. I have had under my own observation cases of traumatic tetanus. When once the disease has begun there are remissions, but not complete; rather a diminution of the severity of the symptoms. There are two classes—an acute class and a chronic class. The acute cases will terminate in the course of three or four days, and the chronic cases will go on from nineteen to twenty-two or twenty-three days, perhaps longer. Sometimes epilepsy will produce convulsions, and sometimes the convulsions from epilepsy assume somewhat of a tetanic character, but they are essentially distinct from tetanus. When the epileptic convulsions assume somewhat of the tetanic form, it is quickly over, not continuous. In epilepsy there is an abolition of consciousness for the time. I have heard the symptoms described which accompanied this gentleman’s seizure and death, and also the appearances after death and the post-mortem examination. I am of opinion there was neither apoplexy nor epilepsy. There are poisons which will produce tetanic convulsions. The chief of these poisons is nux vomica. I have seen animal life destroyed by strychnia, but never human life. The effects of a large dose, such as a grain of strychnia given in a liquid form to a cat or dog, would be apparent in the course of ten minutes. The symptoms would be spasmodic action of the muscles, chiefly of the trunk, the spine, the spinal muscles, producing a very marked opisthotonos, as it is called, where the spine is thrown back, the head thrown back, and the trunk bowed in a very marked manner. The extremities are generally stiffened, jerked out with violent jerks. The muscles are rendered stiff and rigid from the spasms. The stiffness remains, and does not perfectly relax. Fresh paroxysms come in always attended with the peculiar curving back of the head and neck and spine. The extremities of the animals are powerfully stiffened out, distended, every now and then powerfully bent, and jerked out again. Death ensues within half an hour, unless it is a small dose. There is a marked difference between cases where death ensues after taking strychnia and a case of tetanus such as I was describing just now from idiopathic or traumatic causes. The continuity of the symptoms in strychnia poisoning is very characteristic: as long as the poisonous influence lasts, the symptoms last, but the poisonous symptoms will subside after a time. The shortness of the duration of the symptoms is decidedly in favour of strychnine poisoning. There are no other poisons that I know of that produce convulsions of a tetanic character. The symptoms described which attended this gentleman’s death are not referable to idiopathic or traumatic tetanus. I have never seen a person die from the administration of strychnia, but I have seen a person suffer from the consequences of an overdose. There was the opisthotonos and there was the consciousness perfectly retained. There was also dilation of the pupils, a peculiar convulsion of the muscles of the trunk, and the limbs were stiffened out. Difficulty of breathing is common to both tetanus and to tetanic convulsions from strychnia. In the case of Mr. Cook, I think it is an important distinction that he seems to have been able to swallow sufficiently easy, and there was no rigidity of the muscles of the jaw which is characteristic of tetanus, of disease, or of wound. I think the symptoms in his case, judging from my own experience, were those of tetanus from strychnia.
Cross-examined by Mr. Grove—The proximate effect of tetanus, whether caused by idiopathic or traumatic tetanus, or strychnia, is probably the same on the nerves leading from the spine. The particular affection of the nerves is unknown. In the disorder of convulsions there are cases of very slight affection, others more serious, and so on. I adhere to the opinion given by me in my lectures on “Diseases of the Brain and Nervous System,” that the results of the administration of strychnine exactly imitate the convulsions of tetanus. It does not produce the exact phenomena of the disease in a clinical sense. I have no doubt the peculiar irritation of the nerves in tetanus is identical with the peculiar irritation of the nerves in strychnine poisoning. In traumatic tetanus I do not recollect any instance of the limbs being affected before the jaw. An examination of the spinal cord in tetanic affections shortly after death is of importance. If it were deferred as late as two months, there would be, to a certain extent, a fallacy. There are morbid appearances produced by wounds after death which sometimes simulate diseased conditions before death.
Supposing the spine to be affected by decomposition, would not what may be called the diseased softening of the spine previous to death be confused or obliterated?—You would not be able to speak with certainty as to simple softening if the examination had been long after death. There is nothing in the post-mortem examination on which any one could positively say that the patient died from the ordinary disease of tetanus. I think granules on the spinal cord, such as I have heard of here, are not likely to cause tetanus. In the cases of the animals to whom strychnia was administered they went off into a second spasm immediately they were touched. They retained that tendency as long as the influence of the poison lasted. I examined the animals that were killed by strychnia anatomically. The right side of the heart was not generally full; it was empty, and the heart contracted. Death where strychnine was administered is partly due to the difficulty of action of the respiratory muscles, but chiefly to a general nervous exhaustion which the violence of the paroxysm produces.
Would not the difficulty of action of the respiratory muscles producing death tend to leave the heart full?—I do not think it was asphyxia.
Robert Todd
Then I think I may take you as differing from the great mass of authorities on strychnia poisoning?—I don’t know; I think there are differences of opinion on that subject. Persons sometimes have convulsions after poison by morphia. The time in which convulsive symptoms come on after morphia would depend on the dose entirely. I cannot say whether it would be later than strychnia. It is not a question I have devoted attention to.
Re-examined by the Attorney-General—In death resulting from tetanus I should not expect to find anything peculiar about the heart. I heard the evidence of the gentlemen who examined the spinal cord after Mr. Cook’s death. From their description it appeared to me that those parts were in such a condition that any indication of disease might have been discovered.
Sir B. Brodie