T. Nunneley
But it is during a state of fit we are inquiring?—I have not.
Examination resumed—I know by my reading as a medical man that that does occur sometimes. The degree of consciousness in epilepsy varies very much; in some attacks the consciousness is altogether lost. Convulsive attacks are sometimes accompanied by violent spasms and with rigidity of portions of the body. Convulsions arising from a convulsive disease, either from infancy or from other causes, but not exactly tetanus, sometimes assume something of the complexion of tetanic affection. Such convulsions might arise from any cause—worms in children, affections of the brain in adults, hysteria, administration of chloroform to some persons. Indigestible food will sometimes produce convulsions in adults. I agree with Dr. Copland, whose book was referred to yesterday, that these convulsions sometimes end immediately in death. Asphyxia is frequently the cause of death when a man dies in one of these convulsions. I have seen convulsions of the character I have described recurring at various intervals, sometimes in hours, in other cases days. The time also varies very much when a patient, suffering from a violent paroxysm of such convulsions, becomes easier; it may be hours or minutes. When death takes place in the paroxysm of such convulsions it sometimes happens in post-mortem examinations that there is no trace of organic disease in the body.
Have you known at all or frequently in persons, not further advanced in years than the age of twenty-eight, granules between the dura mater and the arachnoid?—They are not common to any age that I am aware of.
Do you know whether granules have been part of the symptoms of tetaniform convulsions?—I have seen three preparations in St. Thomas’s Hospital museum where granules are found in the membranes of the spinal cord, in which patients are said to have died of tetanus. In order to ascertain with satisfaction the nature and probable extent of the injury of such granules the spinal cord should be examined immediately after death. Not the most remote medical judgment could be formed if the examination was made two or three months after death. If an examination of the spinal cord is made so long after death, if there had been a large tumour or some similar change, it might have been discovered; but neither softening nor induration of the minute structure of the cord could be detected. The minute nervous structures change within two hours after death.
T. Nunneley
I have in the course of my experience had cases of traumatic tetanus. It generally begins by an attack of the jaw. I have had under my personal observation four cases of idiopathic tetanus. One of them was my own child. In three cases the symptoms commenced with lockjaw. In the fourth case the symptoms commenced in the body; the power of swallowing easily was retained to the last. Within the last twelve months I have made a post-mortem examination of two women who have died from the poison of strychnia. In both cases it was by chemical analysis that I ascertained the deaths had been caused by strychnia. In one case the post-mortem took place forty-two hours after death, in the other case thirty hours.
(The witness produced his report to the coroner on these two cases.)
I have not seen a fatal case, but several of taking too large a dose. One, a middle-aged man, took one-sixth of a grain of strychnia, given in solution. In a very few minutes the symptoms manifested themselves by the want of power of controlling the muscles, by twitching and rigidity, with some cramp, more violent in the legs than any part of the body. He was up and walking about. It was not a severe case. In six hours the spasms entirely disappeared. They were intermittent in character, every two or three seconds at first. The other case was similar with one-twelfth of a grain.
I have experimented on upwards of sixty animals—dogs, cats, mice, rats, guinea pigs, rabbits, frogs, and toads. After the ingestion of the poison the symptoms appear from two minutes to thirty, more generally about five or six. The symptoms in their order are—a desire to be quite still; hurried breathing; slavering at the mouth when given at the mouth; twitching of the ears; trembling of the muscles; inability to walk; convulsion of all the muscles of the body; the jaws generally being firmly closed during convulsions; these convulsions followed by a total want of power in the muscles, which, in the last attacks, were thrown into violent spasms with a galvanic-like shock running through them. Spasms come on if the animal is either touched or attempts to move. These spasms occur at various periods. The animals die at various periods up to three and a half hours. In every case before death the rigidity ceases, and the muscles are quite soft and powerless. The longest intervals between the violent convulsions in the animals to which strychnia has been administered has been about half an hour, but that is not common. After death the hearts of the animals have been invariably full on the right side, very generally the left ventricle firmly contracted, and the blood usually dark and often fluid. There is no particular appearance attached to the spine. I have attended to the evidence as to the symptoms of Mr. Cook on the Monday and Tuesday nights.