The Northern Daily Times.
Liverpool, Merseyside, England, 1856-05-19 00:00:00

son Cie from the administration of strychnia ? —Witness
No.

The Attorney General : Have you seen a person suffer
from an overdose ? Witness : Yes I perfectly recollect

on 3 instance

The Attorney-General : What was the effect ? Witness :
There was the effect which I Lave described in animals.
There was consciousness, there was irritation and tetanic
convulsions of the muscles of the trunk. The limbs were
stiffened.
The Attorney-General : Was there in that case any action
of the jaw ?—Witness : My impression is that if there was
it was very slight.
The Attorney-General : How long was the patient labour-
ing under the strychnia ? Witness : Nut more than an
hour or a couple of hours.

The Attorney-General : Judging of cases of animal life
and the case of your patient on the one hand, and the cases
of idiopathic and traumatic tetanus on the other, and having
heard described the symptoms of Cook's attack and death,
to what cause do you ascribe that death ? Are the symp-
toms those of idiopathic or traumatic tetanus, or the symy-
toms of tetanus by strychnia ? Witness : I think they are
those of tetanus from strychnine.
Cross -examined by Mr. Grove : There are cases of every
degree of tetanus sloping into each other. I have published
lectures on diseases of the brain and the nervous system,
and adhere to the opinions therein expressed. 0 f traumatic
tetanus there are a great variety of symptoms. Sometimes
one set of muscles are more affected than the other. I don't
think the limbs are affected before the jaws. In a patholo-
gical point of view an examination of the spinal cord shortly
after death is of great importance in cases of this kind.
Decomposition would alter the signs of the spinal chord. In
the animals to which I saw strychnine administered I
remarked that by touching them the spasms appeared to be
Increased, and that on being touched they went off into a
second spasm. That is usually observed in animals which
are po'soned. Icm speak distinctly as to the state of the
heart in cases which I have examined—it was generally
empty on both sides. I think death from strychnia is partly
due to the difficulty of action of the respiratory muscles,
but chiefly, I think, to the general nervous exhaustion,
which the violence of the paryoxisms produce. I do not
agree in the opinion expressed by Dr. Taylor, and several
other medical writers, who have expressed the same opinion,
that in the cases of persons dying of tetanus death is caused
by asphyxia, or suffocation. If they did they should have
the right side of the heart filled with blood. The terms
" asphyxia" and " suffocation" are sometimes very loosely
used. A spasm of the glottis will produce suffocation. I

believe convulsions sometimes follow the use of morphia,
but T have not witnessed them.

Re-examined by the Attorney-General : In cases of
ordinary tentanus I should not expect to find anything
particular about the heart. My impression is that the
heart became strongly contracted with tetanic convulsions
caused by strychnine, more so than after ordinary tetanus.
By Lord Campbell : Do the spasms extend to the heart ?

Witness : They do, and by th it means expel the blood.
By the Attorney-General : Medical practitioners would
have no difficulty in understanding the distinction between
violent convulsions arising from other causes and those
which occur in tetanus. I have heard the description given
by the witnesses of the state of the spinal cird on the
second examination of the body of Cook. I should have
expected that the bony substances referred to might
have been discovered, as they do not decompose until
some time after death. What struck me as a most
remarkable feature in this case, and one which is quite
new to me, was the rigidity of the extremities of the
body. In the case of a cat which was poisoned by
strychynine the muscles, I was informed, continued rigid
for six days after death, but I did not see it myself. In the
case of death by ordinary tetanus I am not aware whether
the rigidity of the muscles continues for any time after death.
Sir Benjamin Brodie, examined by Mr. James, said : I
am the senior surgeon of Guy's Hospital, and in the course
of my practice I have had a great many cases of death by
tetanus. Deaths from idiopathic tetanus are very rare in
this country. According to my experience deaths frequently
occur from traumatic tetanus. I have heard the evidence
given in this case respecting the death of Cook, and, so far
as the spasmodic contractions are concerned, they were the
same as those of traumatic tetanus, but with respect to the
course which they took, they were entirely different. I
noticed, also, this point of difference—that he had an attack
on the Monday night, I think, and that the next day he was
composed and comfortable, while, on the next night, the
symptoms returned. Now, the symptoms of tetanus always
begin, as far as I have ever seen, in a gradual stiffening of
the lower jaw ; that is, I believe, invariably the first sym-
tom complained of—at least, so far as my experience is con-
cerned. The contraction of the muscles of the back is al-
ways a later symptom —generally much later. The muscles
of the extremities are affected in a much less degree than
those of the neck and trunk, except in some cases where the
injury has been in a limb, and an early symptom has been
spasmodic contraction of the muscles of that limb. I do not
myself recollect a case of ordinary tetanus in which there
was that contraction of the muscles of the hand which I
have heard took place in this instance. Then, ordinary
tetanus rarely runs its course in less than two or three days,
and is often protracted to a much longer perked. I knew
one case only in which the disease was said to have termi-
nated in so short a time as twelve hours; but pr )bably, in
that case, the early symptoms had been overlooked. I never
knew the symptoms of ordinary tetanus to last for a few
minutes, then subside, and come on again after twenty-four
hours. I think that these are the principal points of
difference which I perceived between the symptoms of ordi-
nary tetanus and those which I have heard described. Ihave
not witnessed the symptoms of tetanic convulsions arising
from strychnine. Ido not believe that death in this case
arose from what we call ordinary tetanus, either idiopathic
or traumatic. I never knew or heard of tetanus as the result
of a so-e throat or canker, or any other form of syphilitic
disease, nor as the result of apoplexy, or epilepsy. Perhaps
I had better say at once, that I never saw a case in which
the symptoms which I have heard described, arose from any
disease. When I say that, I refer of course not to general
symptoms, but to the general course which the symptoms
took. _ _ _

Cross-examined by
.111 r. Sergeant Shee: I remember one

C3SO in an hospital, which was shown me as a case of idopa-
thic tetanus, but I doubted whether it deserved the name
of tetanus. It was a slight convulsion from tetanus, but I
do not renomber the particulars of the case. I never saw
syphilitic poison produce tetanic convulsions, except in the
event of the bone of the head being affected.
Mr. Sergeant Shee : Would you be disposed to place so
much reliance upon the description of the symptoms given
by chambermaids and local practitioners, as to say positively
that the symptoms were not those of ordinary tetanus ?
Witness : I thought the evidence was very clearly given.
Mr. Sergeant Shee : In the event of any difference of
opinion between the chambermaid and the medical prac-
titioner irelative to the symptoms, to which would you
attach the greatest weight ?

Mr. Baron Alderson: That is hardly medical evidence,
but it is a very proper observation for you to make to the
j ury.
The Court here adjourned for a short time, and the
proceedings were resumed by the examination of
Mr. Daniel, who was examined by the Attorney-General.
He said : I have been for eight years surgeon to the Bristol
Hospital. I have seen a considerable number of cases of
tetanus, perhaps as many as thirty cases. They were of
all from wounds. There were two cases certainly of idio-
pathic character. One of these cases did not terminate
fatally. Cases of such sort are very rare, indeed. It appeared
to my judgment that in the case of idiopathic tetanus, the
symptoms were merely of a milder form than those of the
traumatic. I was not able to trace these two cases of
idiopathic tetanus to any particular cause. I agree with
the opinions of the other witnesses respecting the
course of the symptoms described in this case. I
have heard the description of the symptoms of
the attack cf which Cook died ; those symptoms
were most assuredly different from those of any cases

which have come under my knowledge. The opinion of
Sir Benjamin Brodie is one in which I fully concur. In the
wises of my experience, tetanus usually begins with uneasi-
ness in the lower jaw, followed by spasm of the muscles of
the trunk, and most frequently extending to the muscles of
the limbs. Lockjaw is an almost invariable symptom in
traumatic tetanus especially, and this is one of the earliest
symptoms. Ido not recollect that clenching of hands was a
fre-quent symptom, I think I have seen them. I do not remem-
ber to have seen the twisting outward of the foot. I cannot
recollect an instance of death occurring from tetanus in a
less period than from thirty to forty hours. I never knew
a base of syphilitic sore producing tetanus, nor in my opinion,
can the symptoms I have heard described be ref :ralde either
to apoplexy or epilepsey, In all the eases of tetanus which
have come under my experience consiousness has remained
to the last moment. The symptoms have never commenced
violently, they have been continuous without any entire
intertnissiq. When the symptoms do set in they generally,
commence very mildly, and gradually increase in vio-
lence. In my judgment, the symptome exhibited by Cook
could not be referred to any known descriqtion of tetanus.
Cross-examined by Mr. Grove : I am not aware that
several cases have occurred in which long intervals have
intertened between the symptoms, nor have I read the
remarks of Curtis on the subject. lam not aware that
excitenaelft and vomiting are given as the cause of tetanus.
The symptoms of tetanie convulsion vary very much, but the
leading symptoms are usually the same. Ido not think that
in a series of traumatic tetanus the symptoms vary much in
their character. I believe the cause of death tetanically
arises from exhaustion or suffocation. I have seen a post
mortoot examination of a person who had died from tetanus,
but I do not remember the appearance which the body pre-
sented.

Re•examined byr, the Attorney-general ; No examination
of the spinal cord, however, soon after the death of a person
who had died of tetanus could afford any evidence of the
cause which had produced the disease,
Sully, surgec-4 of SF. Thomas's Ifospl.tal. examinea
by Mr. Welsby, said ; I have been connected with St.
Thomas's Hospital, as lecturer and surgeon, for 28 years,

and have durin'g tha t period had six or seven cases of tetanus
under my own care, and have seen several others. There
was one case only in which any doubt existed as to its being

one of traumatic tetanus. Tf;a symptorna in that ease were
slower, and generally rather milder. The shortest period
which occurred of death from tetanus was not less than

thiny hours, and the symptoms were invaiably progressive.
I have heard the evidence given of the symptoms in Cook's
case, and they differ essentially from all that I have seen.
In all the cases of tetanus I have attended, there has been a
marked expression of countenance as the first symptom. It
is a sort of grin so peculiar, that having once seen it, it can
never be mistaken. There was also this difference, that in
the symptoms I heard described there were violent convul-
sions on the Monday, and on the following day the indi-
vidual was entirely free from any discomfort about the face
or jaw. In the cases that have come under my notice the
symptoms are always continuous, and the fixedness of the
jaw is the last to disappear. The symptoms described in
Mr. Cook's case were not referable to apoplexy, epilepsy, or
any other disease that I have ever witnessed.
Cross-examined by Mr. Sergeant Shce : The grin in case
of tetanus is called rises sardonicus." I have only seen
one case of idiopathic tetanus. Epilepsy sometimes occurs
in the midst of violent convulsions, it is itself a disease of
convulsions. In some respects, the last shriek, and the
paroxysms which followed in this case, resembled epileptic
convulsions. Death by convulsions arising from epilepsy
leaves trace behind in the shape of some blood in the
brain.

Re-examined by the Attorney-General: The convulsions
which take place in epilepsy are not of a tetanic character,
and are accompanied by a variety of symptoms. There were
none of the symptoms of epilepsy in this case. Persons
dying of epilepsy are unconscious, and I have never peen
any case of c mvulstons similar to those which have been
described. Laceration of the brain, injury to the spinal
cord, and the process of teething in infants, will produce
convulions, but in such cases there would not be that
expression in the face which I have never missed in cases of
tetanus.

Henry Lee, surgeon to the King's College Lock Hos-
pital, examined by Mr. Bodkin : I have been connected
for eighteen years with he Lock Hospital. That establish-
ment is exclusively devoted to syphilitic affections, and I
have occasion to see no less than 3,000 cases of syphilis in
the year. I have seen many cases of ssphilitic affection
in the throat, but never knew them to end in tetanus. I
have not had any experience in cases of tetanus. I have
heard of one case of tetanus arising from primary or
secondary symptoms.
Dr. Corbett, physician, examined by Mr. James, said : I
am in practice at Barrhead, near Glasgow. In 1815 I was
medical clerk in the Glasgow Infirmary. I remembar the
case of Agnes Sennet, who died on the .27th of September,
1845. She died from the effects of strychnine. I saw her
shortly before her death, when she was under the influence
of the poison. I saw her during the previous day perfectly
well. She was a patient in the hospital for a skin disease.
I was told when sent for that she had taken some strychnine
pills, but made up for a paralytic patient. She was in bed
when I saw her. She bad a retraction of her mouth, her
face was suffused and red, the pupils of her eyes dilated.
Her head was bent back, the spine curved, and the muscles
were rigid and hard like a board ; her arms were stretched
out, and hands clenched, and severe paroxysms recurred at
short intervals of a few seconds. She died in about an hour
and a quarter after taking the pills. From the time that I
was called to her until her death nearly an hour elapsed.
The quantity of strychnine to each pill was a quarter of a
grain. She took three pills. The paralytic patient was to
take one of the pills night and morning.
Cross-examined by Mr. Sergeant Shea : The retraction of
the mouth was continuous before, but I did not see the
body after death. The hands of the patient were semi-bent,
not clenched. Bending of the hand in that form is not
uncommon in cases of death by violent convulsions. It
was about twenty minutes after taking the pills before
she was attacked by the symptoms. I tried to make
her vomit with a feather, by tickling her throat. She
did vomit a little—not much. It was after I had given her
an eme'ic.

Re-examined by the Attorney-General : There was no
lock-jaw in that case. Then was grinding of the teeth,
but she swallowed quite well during the interval of the
spasms. She could open her mouth and swallow.
By Mr. Sergeant Shee : I do not recollect whether,
while under the influence of the poison, the slightest touch
would send her into paroxysms.
W. Watson examined by the Attorney-General, said : I
am surgeon to the Glasgow Infirmary. I remember the case
of Agnes Sennet. I was called in to attend her a quarter
of an hour after the symptoms commenced. I found her in
a state of violent convulsions. Her arms were stretched
out. The muscles of the body were rigid, as were also those
of her feet and legs. During the paroxysms the rigidity of
the muscles and the violent tetanic action prevented breath-
ing, for the short intervals during which they lasted. The
paroxysms subsided, but returned again immediately. She
died in about half-an-hour after I saw her, and during the
whole of the time she appeared perfectly conscious Ido not
recolect the state of her hands, and did not observe them
after death Her body was opened after death, when the
heart was found distended, stiff, and the [cavities we e
emptied.
Cross-examined by Mr. Grove: In that case the spinal
cord was quite healthy.
ZDr. James Patterson, examined by Mr. Welsby : I
was an apprentice in the Glasgow Lahoratory in 1845. It
was my business to dispense the prescriptions. In
Sebtember of that year I dispensed a prescription for a
patient named Mintyre. It was in the form o! pills. They
contained strychina. There were four pills, containing

one grain

Mi. Baron Alderson : Was there any noise about their
being taken by another person ? Witness : There was.
Mary Belly, examined by Mr. Bodkin ; In September,
1845, I was in the infirmary at Glasgow. I was a patient
there. There was a paralytic patient in the same ward, to
whom I had to attend. There was also a patient who
went by the name of French, who died whilst I was there.
She was suffering from a sore head. In the oourse of the
afternoon on which she died I was turning a wheel which
was applied to the skin of a paralytic patient. Whilst
I was doing that a box with same pills came up. I saw
the paralytic) woman take one of the pills out of the box,
and swallow it. The order was, that she was to take one
pill at a time. After that was done she handed the box to
the patient with the sore head, and I saw her take two of
the pills and swallow them. She than went and sat before
the ward fire. In about three quarters of au hour after that
she was taken ill. She fell brick on the floor, and I went
for a nurse. We got her into bed, and the doctor wa3 sent
for. I remained up with her. We were obliged to cut
her clothes off, for she never moved. She was like a
poker. I did not notice her hands r feet. I wai stand-
ing on the floor when she died. She never spoke after she
fell.

Cross-examined by Mr. Sergeant Shee : From the time
she took the pills to the time she was carried to the bed
wvs about three quarters of an hour;
Caroline H lessen, examined by Mr. James : In October,
1842, I was nurse in the family of Mr. Sergeantson Smith.
I Was nurse and lady's maid. The family was at that time
residing about two miles from Romney. o.a the 30th of
October Mrs. Smith was unwell. We dealt with Mr. Jones,
of Romsey, for drugs. A prescription was sent to him and
it was made up. I remember the medicine being brought
back from Jones's. That was about six o'clock in the after-
noon. The medicine was a mixture in a bottle. I saw my
mistress take it. She took about half a wine glass full.
That was on the following morning ahout five Or ten
minutes past seven. Having given her the medicine I left
the room. In the puree of five or ten minutes I was
aldrmed by the Tinging of the bell. I returned 01 the room
and found my misterss up from the bed, loaning on a chair
in her night dress. She appeared to be suffering from
what I thought spasms. I ran down and sent the
coachman for Mr. Taylor, surgeon, and returned to my
mistress's room. I then found some of the other servants
in the room. My mistress was lying on the floor. She
screamed very much. Her teeth were clenched. She asked
to have her arms and legs held straight. I toot hold of her
arms and legs, they were drawn up very much. She still
Screamed and was in great agony, and requested that same
water should be thrown over her. That was done. Her
feet were bent inward. I put hot water to her feet, but it
did not cause them to relax at all. Shortly before she died
she said she felt cagier. The last words she uttered were
" tura me me' We did turn her over on the floor. She
died a very few minutes afterwards. She died very quietly.
She was quite Conscious during the whole time, and knew
In all. From the time she took the medicine, until her
death, was about an hour and a quarter. The quantity
of medicine which she had taken was about half a wine
glass full.
Cross-examined by Mr. trove : After she had taken the
medicine she could not sit up at all. It was when she was
in the paroxysms that we endeavoured to straighten her
limbs. It was a continual attack, and lasted about an hour
or an hour and a quarter altogether. Her teeth were quite
clenched during the whole time.

By the Attorney-General : The At came on five or ten
minutes after the medicine was administered. She remained
quite stiff, only for a few minutes. She was conscious all
the while.

Mr. Francis Taylor, examined by Mr. Welsby ; I am a
surgeon and apothecary at Romsey. I was so in 1848. I
attended Mrs. Sergaantson Smith. I was summoned there
one morning and found her dead. I got there between eight
and nine o'clock. The body was on the floor, between the
bed and some pieces of furniture. The hands were very
much contracted—clenched. The feet mre contracted and
turned inwards. The soles of the feet were unnaturally
hollowed up, and the toes contracted. I believe that it had
arisen from a recent spasm° lie aotion. The inner edge of
each foot was turned up. The limbs were remarkably rigid
and stiff. The body seemed warm. The eyelids were
tightly adherent, almost to the eyeballs. The druggist who
made the prescription was Mr. Jones. I saw him running
to the house shortly afterwards. 1 made a post mortal;
examination three days after death. The contraction of
the feet" continued, but it laad &One off somewhat from
the rest of the body. The hands were rigid. I did not
and any trace of disease in the body. The heart was con-
tracted. It was perfectly empty, All the large arteries
leading from the heart tvere quiet empty. The blood was
flui3. I subsequently analysed the medicine alone with
Mr. Ranm, of Southampton, I found it to contain
a large quantity of strychnine. I knew the mixture
eriginally contained nine grains, of which Mrs. Smith
had taken one-third, or three grains. I took out the
stomach and bowels. I made a very casual examination,
because the proof of having poison was perfectly clear. We