Sir Benjamin Brodie, examined by Mr. James—I was surgeon at St. James’s Hospital for a great number of years, and have had a considerable practice. I have had many cases of death from tetanus. Death from idiopathic tetanus is very rare in this country. I heard the description of the symptoms attending the death of Mr. Cook. As far as the spasmodic contraction of the muscles is concerned, the symptoms resemble those of traumatic tetanus; as to the course the symptoms took, that was entirely different. I heard about the attack on the Monday night and its ceasing, and the patient being comfortable and composed during the Tuesday, and then the attack again about ten minutes before twelve on the Tuesday night. The symptoms of traumatic tetanus always begin, so far as I have seen, very gradually; the stiffness of the lower jaw being, I believe, invariably the symptom first complained of; then the contraction of the muscles of the back is always a later symptom; the muscles of the extremities are affected in a much less degree than those of the neck and trunk, except in some cases where the injury has been in a limb, and an early symptom has been a spasmodic contraction of the muscles of that limb. I do not recollect a case in which in ordinary tetanus there was that contraction of the muscles of the hand which I understand was stated to have existed in this instance. Ordinary tetanus rarely runs its course in less than two or three days, and often is protracted to a much longer period; I know one case only in which the disease was said to have terminated in twelve hours.
Lord Campbell—Probably in that case the early symptoms had been overlooked?—I never knew these symptoms of ordinary tetanus to last for a few minutes, then subside, then come on again after twenty-four hours.
Sir B. Brodie
Examination continued—I do not believe that death here arose from what we ordinarily call tetanus, either idiopathic or traumatic. I never knew a death from tetanus to result from a sore throat, or a chancre, or any other form of syphilitic disease. The symptoms of the death of Mr. Cook are not consistent with a fit of apoplexy. I never saw a case in which the symptoms that I heard described arose from any disease.
Cross-examined by Mr. Serjeant Shee—I remember one case of idiopathic tetanus in our hospital, but I doubted its deserving the name of tetanus.
Considering how rare tetanus is, would you think that the description of a chambermaid and of a provincial medical man, who had only seen one case of tetanus, could be relied upon by you as to what the disease observed was?—I must say I thought the description very clearly given. I have never seen the syphilitic poison produce convulsions except as a consequence of disease in the bones of the head.
Henry Daniel
Mr. Henry Daniel, examined by the Attorney-General—I was for upwards of twenty-eight years surgeon to the Bristol Hospital. I have seen fully thirty cases of tetanus, of which two were idiopathic. One of these two ended fatally. Idiopathic tetanus is of very rare occurrence. The symptoms are not so severe as those in traumatic tetanus. The symptoms which accompanied the attack of Mr. Cook before his death were quite distinguishable from those cases of tetanus which have come within my experience. In pointing out the differences I would repeat very probably the words of Sir Benjamin Brodie. Tetanus, so far as my experience goes, begins with uneasiness in the lower jaw, followed by spasms of the muscles of the trunk, and most frequently extending to the muscles of the limbs. Lockjaw is almost invariably a symptom of traumatic in particular. It is one of the earliest symptoms. I have seen the clenching of the hands, but I do not think it is an ordinary symptom of common tetanus. I cannot recollect a case the duration of which has been less than from thirty to forty hours. I have never known a syphilitic sore producing tetanus. The symptoms I have heard described in Mr. Cook’s case are not referable to either apoplexy or epilepsy. In both these there is a loss of consciousness, but in cases of tetanus that I have seen consciousness has been retained throughout all the period. In my experience of tetanus the symptoms have been invariably continuous without any interruption. In my judgment the symptoms of Mr. Cook could not be referred to idiopathic or traumatic tetanus.
Henry Daniel
Cross-examined by Mr. Grove—I do not know that cases are mentioned in books where there is a long interval of some hours between the symptoms. I have not read Dr. Todd’s book, nor Mr. Curling’s book, nor Dr. Copland’s book on the subject. I have been out of practice some seventeen or eighteen months, and have not looked into the reported cases of tetanus of late. In my opinion the symptoms of tetanic convulsions do not vary much in different cases. There may be an affection of a muscle in this man that there is not in the other, in a leg or an arm. In tetanic affections death is caused by exhaustion and suffocation.