Mr. John Brown Ross, examined by Mr. Grove—I am house surgeon to the London Hospital. On 22nd March a labourer, aged thirty-seven, was brought to the hospital about half-past seven in the evening. He had had one paroxysm in the receiving room of our hospital before I saw him. He had a rapid but feeble pulse, breathing quickly though not laboriously. The jaws were closed and fixed, there was an expression of anxiety about the countenance, and the features were sunken. He was unable to swallow, the muscles of the abdomen and back were somewhat tense. After he had been in the ward about ten minutes he had another paroxysm and opisthotonos, which lasted about one minute. He was then quiet for a few minutes; he had then another, and died. He had only been in the hospital about half an hour. An inquest was held on the body, but no poison was found. I attribute the cause of death to tetanus. There were three wounds, two on the back of the right elbow, about the size of a shilling each, and one on the left elbow, about the size of a sixpence. The man told me he had had them about twelve or sixteen years. They were old, chronic, indurated ulcers, circular in outline, the edges thickened round, undermined, and covered with a dirty white coating without any granulations. I am unable to say what produced those ulcers. I have seen old, chronic syphilitic wounds in the legs similar to those in the elbow, but I cannot say that these were so. These wounds were the only things to account for tetanus. There was no other cause found.
Cross-examined by the Attorney-General—I learned from the man’s wife that a linseed meal poultice had been applied to this ulcer a day or two before. The jaws were completely fixed when he came, so as to render him incapable of swallowing anything. He said he had just been taken with strange symptoms about the jaws at dinner that morning about eleven o’clock. He was able to speak, though he could not open his jaw. That is the case in tetanus.
Were there also symptoms of rigidity when he was brought in about the abdominal and lumbar muscles; did you learn from him how long this rigidity had been coming on?—Not further than that the first symptoms of the illness he had felt were that morning. He did not say how long he had felt this rigidity about the neck. He was seen by the parish surgeon in the afternoon before coming to the hospital. I have no doubt that the disease had been coming on from the morning.
J. B. Ross
Though you cannot speak as to the precise character of these sores, were they ugly sores?—Yes; sores of a chronic character—ulcers. The two on the right elbow were perfectly running into one another. A piece of integument connected the two, so that they would be likely to run into one another eventually. By saying that those sores were undermined I mean that the wounds continued under the skin. There were no signs of healing, and they had the appearance of old, neglected sores.
Were they near the site of any particular nerve?—They were near the ulnar nerve, a very sensitive nerve connected with what we call the “funny bone.”
How soon was he seized with the first paroxysm after he came in?—He had one directly he came into the hospital, but I did not see it. Half an hour from that time he died.
Had he had any paroxysms before he came to the hospital?—I believe he had, all the afternoon.
That was not one continuous paroxysm?—No; there was a twitching of the muscles of the legs and arms.
What are the particular symptoms of the case to which you refer as indicative of death from tetanus?—From the tetanic symptoms and from having wounds.