Samuel Solly
Mr. Samuel Solly, examined by Mr. Welsby—I have been connected with St. Thomas’s Hospital as lecturer and surgeon for twenty-eight years. I have either seen or had under my care twenty cases of tetanus, all of which were traumatic, except one, in which I was doubtful whether it was traumatic or idiopathic. In the latter case the symptoms were slower in their progress and generally rather milder. The shortest period I can remember before the disease arrived at a point is thirty hours. The difference between Mr. Cook’s attacks and the cases I have seen is that, in my experience, there has been a marked expression of the countenance—that is the first symptom; it is a sort of grin, and the symptoms have always been continuous. The symptoms in Mr. Cook’s case are not referable to either epilepsy or apoplexy, or any disease that I ever witnessed.
Cross-examined by Mr. Serjeant Shee—A marked expression of the countenance, a sort of grin, frequently occurs in all violent convulsions, which assume, without being tetanus, a tetanic form and appearance. They are not a numerous class. It is difficult to distinguish between them and idiopathic tetanus in the onset, but not in the progress. I heard the account given by Mr. Jones of the last few moments before Mr. Cook died.
That he uttered a piercing shriek, fell back, and died, did he not?—Yes.
The Attorney-General—I beg your pardon; there was an interval.
Mr. Serjeant Shee—No, no; five or six minutes.
Lord Campbell—He died very quietly.
Cross-examination resumed—I heard the description of the shriek with the convulsion; but it was the shriek that called the medical man into the room. That was at the height of the attack. In some respects that last shriek and the paroxysm that occurred immediately afterwards bear a resemblance to epilepsy. Death from tetanus accompanied with convulsions seldom leaves any trace behind; but death from epilepsy leaves behind it some few effusions of blood on the brain or congestion of the vessels.
Samuel Solly
Re-examined by the Attorney-General—Convulsions that take place in epilepsy are not at all of tetanic character. I say that Mr. Cook did not die from epilepsy, because there were none of the symptoms there. When a patient dies with epilepsy he dies perfectly unconscious. Ulceration of the brain from injury, a sudden injury to the spinal cord, irritation of the teeth in infants, all produce convulsions. But those convulsions in their progress are not similar to the convulsions of tetanus. There is no progressive movement and no appearance about the face or jaw of having tetanus.