Serjeant Shee
Gentlemen, I am instructed—I shall be able to show—by eminent men that what I am about to read from Dr. Copland’s book, as part of my speech, is a true description of convulsions that are not idiopathic or traumatic, but of a general kind. He first gives the definition of “general convulsions,” which he says are “violent and involuntary contractions of a part or of the whole of the body, sometimes with rigidity and tension (tonic convulsions), but more frequently with tumultuous agitations, consisting of alternating shocks (clonic convulsions), that come on suddenly, either in recurring or in distinct paroxysms, and after irregular and uncertain intervals.” We will see what he says about it—“If we take the character of the spasm in respect of permanency, rigidity, relaxation, and recurrence as a basis of arrangement of all the diseases by abnormal action of involuntary muscles, we shall have every grade, passing imperceptibly from the most acute form of tetanus through cramp, epilepsy, eclompsia, convulsions, &c., down to the most atonic states of chorea and tremor. Also if we consider the affections called convulsions, and which are usually irregular in their forms, with reference to the character of the abnormal contraction of the muscles, we shall see it in some cases of the most violent and spastic nature, frequently of some continuance, the relaxations being of brief duration, or scarcely observable, and in others nearly or altogether approaching to tetanic. These constitute the more tonic form of convulsions, from which there is every possible grade, down to the atonic or most clonic observed in chorea or tremor. The premonitory signs of general convulsions are, inter alia, vertigo and dizziness, irritability of temper, flushings or alternate flushing and paleness of the face, nausea, retching or vomiting, or pain and distension of the stomach or left hypochondrium, unusual flatulence of the stomach and bowels, and other dyspeptic symptoms. In many instances the general sensibility and consciousness are but very slightly impaired, particularly in the more simple cases, and when the proximate cause is not seated in the encephalon; but in proportion as this part is affected primarily or consecutively, and the neck and face tumid and livid, the cerebral functions are obscured, and the convulsions attended by stupor, delirium, &c., or pass into or are followed by these states. The paroxysm may cease in a few moments, or minutes, or continue for some or even many hours. It generally subsides rapidly, the patient experiencing at its termination fatigue, headache, or stupor, but he is usually restored in a short time to the same state as before the seizure, which is liable to recur in a person once affected, but at uncertain intervals. After repeated attacks the fit sometimes becomes periodic (the convulsio recurrens of authors). The most common causes are, inter alia, all emotions of the mind which excite the nervous power and determine the blood to the head, as joy, anger, religious enthusiasm, excessive desire, &c., or those which greatly depress the nervous influence, as well as diminish and derange the actions of the heart, as fear, terror, anxiety, sadness, distressing intelligence, frightful dreams, &c., the syphilitic poison and repulsion of gout or rheumatism.”
Serjeant Shee
Now, do you believe that if Dr. Taylor had read that before he went to the inquest he would have dared to say that this man died of strychnia poison? Is there one single symptom in the statement made in the depositions of Elizabeth Mills and Mr. Jones which may not be classed under one of the varieties of the degrees of convulsions which Dr. Copland describes? Now, it is not for me to suggest a theory, but the gentlemen whom I shall call before you, men of the highest eminence in their profession, not mere surgeons of hospitals who never see anything hardly except it is of that nature, that is, of the traumatic kind—gentlemen, do not suppose that I should be capable of speaking disrespectfully of Sir Benjamin Brodie, or of any of the gentlemen called except in terms of the highest respect; but they are surgeons of hospitals, and obtain a certain experience as to those misfortunes under which, through violence, the human frame suffers; who have not so much opportunity of witnessing and of knowing the symptoms of the class of convulsions which constantly attack people in their own residences in the dead of the night—those convulsions which heads of families and brothers and sisters are most anxious to conceal from anybody but the medical man—those convulsions, the known existence of which deprives a young woman of the hope, or a young man of the hope, of marriage. It is the men who have that sort of experience—the general practitioners—men who enjoy the entire confidence of numerous families, and have the opportunity of visiting, in the way of their profession, the poor at their lowly dwellings, suffering under sudden convulsions when affected by serious disease—those are the men that we want to tell us about convulsions. Do not let me mislead you for a moment—the evidence I have read to you is not the whole of the evidence of Elizabeth Mills. There is her evidence, differing in some material particulars from the evidence given by her before the coroner. As to Mr. Jones, the evidence does not so much differ, though there may be some particulars in which there is a difference—and there is one remarkable one. He said in his depositions, “The body was resting on its head and its heels”; but in his evidence he says, “It was so bent that if it had been turned on its back, it would, or might, have rested on its head and its heels”—that is, if it did not rest on the back; but he in substance says it did. Mr. Bamford says he found it resting on its head, its back, and its heels, thereby excluding the supposition that a part of the body was not supported by the back. However, before I go to that, perhaps you will permit me to call your attention to the symptoms of traumatic disease. My belief is, and I submit it to you, and it is what I shall hope you will confirm by your verdict, that this complaint was not strychnia tetanus at all, but it was, according to this description—the description to which I will call your attention—it may well have been some form of traumatic tetanus or idiopathic tetanus—there being no broad general distinction or certain confine between idiopathic or self-generating tetanus, or tetanus not arising from any extreme hurt or any violence to the interior part of the system; and many forms of convulsions, that is tetaniform, are pretty much the same as idiopathic tetanus, and we have had numbers of medical gentlemen who have told us they never saw a case of idiopathic tetanus. The answer to that is, you have had very limited experience. They are not very frequent; but there are gentlemen here who have seen cases of idiopathic tetanus, and they are not of such unfrequent occurrence by any means. There is one gentleman who is here, and whom I will call before you—a gentleman who attended at the bedside of the lady at Leeds who was suffering under strychnia, who has himself seen four cases of idiopathic tetanus; and there are other gentlemen here who have seen them also—they are not so rare, but they very rarely fall under the notice of surgeons of hospitals; they are not so frequent as traumatic tetanus. Cases of traumatic tetanus do frequently supervene from the operations of the surgeons themselves; sometimes after operations, however skilfully performed, a lockjaw is the consequence. The persons to give you information on the subject are the general practitioners.
Serjeant Shee
Now, we shall see that none of those symptoms which were spoken to on the day of the inquest by Elizabeth Mills and Mr. Jones may not range under one of these forms of tetanus, the idiopathic or traumatic. The idiopathic mingling in all directions with general violent convulsions is not to be distinguished from them, inasmuch as convulsions have constant tetaniform appearances; and the meaning I take it of that is this, it is true, as Dr. Watson says in a passage which I called to the attention of one of their witnesses—it is true that in four cases out of five traumatic tetanus begins with a seizure of the lower jaw, unless, as Sir Benjamin Brodie tells us, it may begin, as it did in two cases which he attended many years ago, in the limbs. He told us so when he was here; it began there before it attacked the jaw; but generally trismus or lockjaw is the first symptom. But there is a fifth case in which it is not, and Mr. Curling told us that that was about the proportion—four out of five; so that even traumatic, or that kind of tetanus which sets in after a wound, does not always begin with some affection of the jaw or neck. Now, gentlemen, having gone so far, and having endeavoured to satisfy you that the symptoms which were spoken to by those two witnesses on the depositions may be the symptoms, as I think—that is to say, as I am told, having no experience of my own in the matter—that these symptoms are rather referable to that violent description of general convulsions than to any form of tetanus, let us go to the question, whether or not the symptoms are consistent with what we know of tetanus produced by strychnia, because if we are satisfied on a full inquiry that they are not consistent with the symptoms unquestionably produced by strychnia tetanus, then the hypothesis of the Crown entirely fails, and John Parsons Cook cannot have died of strychnia poison.
Now, gentlemen, whether that be so or not will depend in a great degree, as it strikes me—but, of course, it is entirely for you—on what you think of the evidence of Elizabeth Mills; but before I go to the evidence of Elizabeth Mills I will call your attention to what the description of strychnia tetanus is, as given us by two very eminent gentlemen who were called the other day for the Crown—Dr. Taylor and Dr. Christison; and if we find on looking at it that that description of the poison of strychnia tetanus, given by them, is a different thing from the picture first given of the complaint, of the paroxysms of John Parsons Cook by Elizabeth Mills and Mr. Jones, I think it would be rather too bad on their mere opinion to say that this is strychnia tetanus. Let us take Dr. Taylor’s description of strychnia tetanus—I am not sure whether Dr. Taylor stated he had ever seen strychnia tetanus in the human subject; however, we must be just to Dr. Taylor. Dr. Taylor has had an extensive reading upon the subjects upon which he writes, and it is not to be supposed that Dr. Taylor would hastily set down in his book what he did not find established on high authority; therefore, though having it at second hand, Dr. Taylor knows something upon the subject.
Serjeant Shee
Now, Dr. Taylor, in his work on strychnia poison, has this under the head of strychnia, “that from five to twenty minutes after the poison has been swallowed the patient is suddenly seized with tetanic symptoms, affecting the whole of the muscular system; the body becomes rigid, the limbs stretched out, and the jaws so fixed that considerable difficulty is experienced in introducing anything into the mouth.” On both the depositions and the other evidence it is stated that Mr. Cook was sitting up in bed, beating the bed-clothes, frequently telling the people about him to go for Palmer, asking for the remedy, and willing to take whatever was given him; there was no considerable difficulty in introducing anything into the mouth, and the paroxysms, instead of beginning within from five to twenty minutes after the poison was supposed to have been swallowed, did not begin for an hour and a half afterwards. Dr. Taylor further on states, “After several such attacks, increasing in severity, the patient dies asphyxiated.” That there were some of these symptoms in this case there can be no doubt, and there will be some of them in every case of violent convulsions, yet it is not the description of such a case as that of John Parsons Cook. Now, let us see what Dr. Christison says—“The symptoms produced by strychnia are very uncommon and striking—the animal begins to tremble, and is seized with stiffness and starting of the limbs. Those symptoms increase till at length the animal is attacked by general spasms.” Is that the description of either of these paroxysms? Who can say with any degree of truth that it is? Just observe these last indications of strychnia tetanus, which are consistent with all the cases stated in their books. It is only justice to those gentlemen who have taken pains to look to the authorities to which they refer to say that the statements which they give of their cases are in the main correct, but not in all their details. The books would be five times their size if they were; but they are in the main correct, when we look to the foreign authorities on which they are founded—“The fit is then succeeded by an interval of calm, during which the senses are impaired or are unnaturally acute; but another paroxysm soon sets in, and then another and another, until at last a fit occurs more violent than any that had preceded it, and the animal perishes suffocated.” I know exactly what Dr. Christison means by this, because there is a gentleman here who will state an experiment which I saw myself; it was an experiment, and for the purpose of this case, and to assist me; and I disagree with Dr. Taylor that there can be a moment’s hesitation in sacrificing ten or twenty dogs for the purpose of ascertaining the truth of this theory when a man’s life is involved. These experiments were performed by Dr. Letheby while I was there. I will state them to you, because he will prove it by and by. A dog had some strychnia put in his mouth, one grain, and then for about—I cannot be sure as to the time exactly, but about twenty or twenty-five minutes—I cannot be sure, it might not be so much—the dog was perfectly well. There were two rabbits on the table which were also about to be subjected to the operation, and the dog, when the chain was sufficiently relaxed to enable him to do so, showed all the indications which a dog naturally does to get at the rabbits; he was pulling at his chain, and was smelling and pawing and taking an interest in the rabbits; suddenly it fell down on its side, and its legs were stretched out in a most violent way. It panted, and then it remained for some time—two or three minutes—quiet, occasionally a little jerking, but generally quiet. It recovered again for a time, got up and looked at the rabbits, but was dizzy, seemed afraid to move; and, if you touched it, shuddered and twitched, to use Miss Elizabeth Mills’ description; seemed to be afraid, and after another moment down it went again. It got up again, and down it went again, and at last it had a tremendous struggle, and it died. That is what Dr. Christison means by this description; it would be true if the dose had been a strong one. If the dose had not been sufficient to kill the dog it would probably be a longer time—at least, I suppose so—in producing its effect, and the interval between the paroxysms, as stated by Dr. Taylor and Dr. Christison, would get longer and longer, until at last the animal would recover. If the dose is strong enough to kill, the interval between the paroxysms is shorter, till at last the violent one comes which destroys life; the eyes are fixed, and there it lies, and just before its death—and I thought it was dead, but I was told immediately before its death—just before it dies, the limbs become as supple and as free as it is possible to conceive the limbs of an animal to be; whichever way you placed them after the animal is quite dead, if you place them in any form, the rigor-mortis comes on, and they remain in the position in which you place them. Dr. Christison says they assume rigidity. I saw this operation performed, and also on the two rabbits, and their symptoms were substantially the same, and their limbs in both cases were quite as flaccid immediately on death. The animals during the time of the intervals between the paroxysms were exceedingly touchy, and seemed afraid of being touched at all; if you were to touch them they would shrink away. It was more so in the dog; it was, in fact, a sort of shudder—that is what Dr. Christison means.
Serjeant Shee