W. M‘Donnell
Dr. William M‘Donnell, examined by Mr. Kenealy—I am a licentiate of the College of Surgeons of Edinburgh, and have been in practice for about eight years. I have had practical as well as theoretical knowledge of idiopathic and traumatic tetanus. Tetanus will proceed from very slight causes. Almost any internal disorder or alteration of the internal secretions will produce idiopathic tetanus. Exposure to cold or damp would produce it. Mental excitement would be a probable cause.
By Lord Campbell—Mental excitement would be the proximate cause of tetanus. The presence of gritty particles or granules in any part connected with the nervous structure, in either the spine or the brain, might produce tetanic convulsions. I have seen small deposits or tubercles in the brain, the only assignable cause for death terminating in convulsions.
W. M‘Donnell
Examination resumed—In addition to those slight causes, I believe that tetanic convulsions arise from causes as yet quite undiscoverable by science. I have had many post-mortem examinations of patients who have died of tetanus, and no trace of any disease whatever could be discovered beyond the congestion or vascularity of some of the vessels surrounding the nerves. Though tetanus is not easily discoverable, strychnia is easily discoverable by scientific men. I had a case of idiopathic tetanus—a female, Catherine Watson. I was fortunate enough to restore her, and she is here. (Dr. M‘Donnell read his notes of the case of Catherine Watson.) In her case lockjaw set in about the middle of the attack. She was able to speak. In acute idiopathic tetanus, ending fatally, trismus is generally a later symptom. I had a case of tetanus which ended fatally, a man named Copeland. It must have been idiopathic, as there was no external cause. Death took place in somewhat less than half an hour. I cannot say precisely. He was dead before I could reach the house.
By Lord Campbell—Do you know what the cause of the disease was?—Yes. I examined the patient carefully, and made inquiry as to the symptoms.
Examination resumed—I have made a number of experiments on animals with reference to strychnia poison. I have found the muscles of the brain highly congested, the sinuses gorged with blood, and in one case hæmorrhage from the nostrils. That would indicate a very high state of congestion. I have found extravasation of the blood in some cases, likewise in the brain. I have cut through the substance of the brain and found numerous red points. I have found the lungs of these animals either collapsed or congested. The heart has been invariably filled in the right side with blood, and very often on the left. The liver has been congested, the kidneys normal generally, the spleen in its ordinary condition. I have found the vessels of the stomach on the outer surface congested, and on the mucous or inner surface highly vascular. In the spinal cord I have found the vessels of the membranes congested, and also red points seen on cutting it through, not invariably, but sometimes. I have experimented in many cases for the discovery of strychnia. You may discover the smallest dose that will kill the animal. If you kill an animal with a grain of strychnia you may discover traces of it.
What do you mean by a trace of it?—Evidence of its appearance.
Does that mean an imponderable quantity?—It may.
Do you mean by traces to convey the idea that you can discover the smallest quantity?—That will kill.