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

14e Attorney-General : How many have you seen ?

Witaess

AV itn.
heli, 'B3 : I can speak confidently of 40 or 50, but I
disease first
„._4-.vre 100 would be nearer the mark.
The
tiffness at
the 1. ests itself by a stiffness of the jaws, by a - • ()-
back
the at Of the neck, by a rigidity in tliß muscles r
the pit of
the
e4todornen, attended by a dragging pain at
nolach. In many cases, the muscles of the backare
4.11.131 Y affected. These symptoms, although continuous,
te:Blable to aggravation in paroxysms, and as the diseasere
IVll,n"t',Lthe Paroxysms become more frequent• and seve
instance the
occur, the body is drawn backwards. In some
• s though less frequently, it is bent forward. A
'll%'ult '
11 ,l's 3' of swallowing is a very prominent feature. There
Tit,'(l°. a difficulty of breathing during the paroxysms..
Iscase may end in two ways—the patient may die
eitnwhat
c)ls the suddenly from suffocation, owing to the closure
'Worn °Pening of the windpipe; or the patient may •
- °tit bY the severe and painful spasms, and the

muscles may relax, and the patient sink and die.
The disease is generally fatal. The locking of
the jaw is the constant symptom. of traumatic tetanus•
The difference is only in degree. The locking of
the jaw is an early symptom of the disease. Another
symptom is the peculiar expression of the countenance.
It generally shows !itself throughout the whole counten-
ance. The appearance is this—there is a contracted
condition of the eyelids, the raising of angles on the mouth,
and a contraction of the brow. The lower extremities
are sometimes affected, and sometimes, but somewhat
rarely, the upper. The chief affection is in the lower
extremities. When the muscles of the extremities are
affected, the time at which that symptom appears is
various, hut if there is no wounds on the arms or legs the
extremities are not generally affected u itil late in the
progress of the disease. I never knew traumatic tetanus
produced by a sore throat or from sypilis. I think sypilis
is a very unlikely cause.

The Attorney-General : There is another important
question which I wish to ask you. flow lung, ordinarily
speaking, does a case of traumatic tetanus, which ter-
minates fatally, last before death takes place: Witness
It varies from twenty-fours to three or four days or
longer.

The Attorney-general: What is the shortest period
which ever came to your knowledge in which the disease
ran through its course and ended fatally ? Witness :
Eight or ten hours.

,The Attorney.general : If I understand right, the disease
when once commenced, is continuous ? Witness : Yes.

The Attorney-general: Did you ever know a case in
which a man would be attacked one day, and then have
24 hours' respite, and be attacked again the next day.
Witness: Never.

The Attorney-general: Is it your opinion that such a
thing could be? Witness : No, I think not.
The Attorney-general: You have heard the account
given by Mr. Jones, the surgeon; on the death of Cook.
Witness : Yes.

Th 9 Attorney-general: Were the symptoms there con-
sistent with any form of traumatic tetanus which has
come under your notice ? Witness : No.
The Attorney-general : You heard the description given
by Elizabeth Mills of the symptoms' of Cook's death.
Witness : Yes.

The Attorney-general: Were those symptoms the
symptoms of tetanus ? Witness : No, there was the
absence of the continuance of the attacks.

The Attorney General : Assuming tetanus to be synoni-
mous with the convulsive and spasmodic action of the
muscles, was there in that case tetanus ? Witness : No
doubt there was a spasmodic action of the muscles.
The Attorney-General : But there was not an idiopathic
or traumatic tetanus on the Monday [night ? Witness :
No ; there was the sudden onset and the sudden subsi-
dence.

The Attorney-General: The sudden onset and the
sudden subsidence are not consistent with the two forms
of tetanus ? Witness : No.

The Attorney-General : You know certain poisons that
will produce tetanus ? Witness : Yes.
The Attorney-General : What are they ? Witness :
Nux vomica, strychnia, and bruschia.
The Attorney-General: Have you seen human or
animal life destroyed by strychnia? Witness : No.
Cross—examined by Mr. Sergeant Shee ; I have known
tetanus arise from a disease of the spinal chord, irrita-
tion on the spinal chord, or the afferent nerves might
produce it.

Mr. Sergeant Shee ; You have stated that in your
opinion the traumatic tetanus commences by lock-law,
with greater or less violence? Witness Yes.

Mr. Sergeant. Shee : Do you agree with Dr. Watson in
the opinion which he has expressed in his lectures, that
four cases perhaps out of five the disease begins with the
lower jaw ? Witness : I do.
Mr. Sergeant Shee : Do you agree with Dr. Watson that
it may arise from causes so slight as these—from concussion
of the air from a musket shot, from the stroke of a whip-
lash under the eye, from the cutting of a corn, from a bite
on a finger, from a blow of a stick on the neck or hand,
from the insertion of a seton, or from the extraction of a
tooth ? Witness : Except from the concussion of the air
from a musket-ball.

Mr. Sergeant Shee : Do you know from your reading
that a case occurred in Edinburgh where!a negro lacerated
his thumb by a fracture of a dish, and died whilst guests
were in the room ?

An objection was taken to the form :of this :question,
and it was not pressed.
.Cross-examination continued: Idiopathic tetanus has
not come under my notice. It is not so likely to bring
patients to the hospital as traumatic tetanus. Idiopathic
tetanus would be more likely to come under the notice of
a physician. I have heard of such cases.

Mr. Sergeant Shee : Don't you know that, very lately,
in the London Hospital a case came on so unaccountably
that it was referred to strychnine, and that it was thought
necessary to examine the stomach of a patient to see if
strychnine existed? Witness : The case did not come
under my notice I think a syphilitic sore would not be
likely to lead to tetanus, Epilepsy is sometimes accom-
panied with contractions. It is not the character of
spasms• It ;frequently happens that convulsions are
attributable to no discernible cause. I have not known
any instance in which epilepsy has resembled tetanus.
Mr. Sergeant Shee ; Do you agree with Dr. Copland in
his remarks under the head of " Convulsions," that the
character of abnormal contraction of the muscles is in some
cases of a most violent nature, in some cases of long con-
tinuance, and in some cases approaching tetanus ? e W;t-
ness I would rather speak of my own observations. I
have not seen anything of the sort.

Mr. Sergeant Shee : Does it not often happen that the
patient dies of convulsions, spasmodic in the sense of
their being tumultuous and attenuating, and: yet after
death no disease is found.? Witness : Are you speaking
of children or adults ?

Mr. Sergeant Shee : Of adults. Does it often happen ?
Witness : I know of no instance.

Mr. Sergeant Shee : Don't you know from your reading
or from Science that it is so? Witness : No, Ido not.
Mr. Sergeant Shee : In cases of convulsion are they not
preceded by nausea, retching, vomiting, pain, and dis-
tension of the stomach, and flatulence of stomach and
bowels ? Witness : That class of cases do not come under
my notice

Mr. Sergeant Shee: Do: you know that general
convulsions are oftea, accompanied, with yelling and
shriekingl? Witness: Yes.

The Attorney-General : Would a medical practitioner,
who saw a case of general convulsion, know the difference
between such symtoms as those, and the symptoms of
tetanus which you know ? Witness : Yes.

The Attorney-General: Is it one of the characteristic
features of tetanus that, consciousness is not affected ?
Witness : Yes.

Dr. Todd examined by the Attorney-General: I am a
physician, and have been in practice 25 years. lam lec-
turer at King's College Hospital. I have lectured upon
tetanus, and written upon it, and upon diseases of the
nervous system generally. I agree entirely with Mr.
Curling's opinion. I have seen two eases of idiopathic
tetanus. It is that form of tetanus which is produced
without any apparent wound, and from internal
causes, apparently constitutional causes. I have
had limier my observation, cases of traumatic
tetanus. The symptoms are precisely the same as in
idiopathic tetanus, The symptoms begin with stiffness
about the jaw. The symptoms then extend themselves
to other parts of the body. These symptoms come on and
gradually develop themselves. When once the disease
has begun, there are remissions, diminutions of severity,
but not a total sut sidence. I speak from my own expe-
rience. The cases may be divided into two classes; the
acute cases will terminate in the course of three or four
days ; the chronic cases will go on from 19 to 22 or 23
days. I have not known a case terminate within four
days in my own experience, but such cases are related.
The extremities are affected, but the affection comes on
late. The locking of the jaw is an 'early symptom.
Epilepsy does not produce tetantc symptoms. It will
sometimes produce convulsious, which occasionally
asszane a tetanic character, but the symptoms are very
and net continuous. In epilepsy there is
different, epileptic convulsions assuming that form, are
n abolition of consciousness for a time. Apoplexy
aqluwi cakylsy
ao v er ,
is not accompanied with tetanic convulsion. smnptitnes,
when there is an effusion of blood on the brain, the patient
may exhibit something of tetanic convulsions. In that
ease the consciousness would be completely deStroyed.
In my opinion, in the ease ,ef Cook, there was neither
epilepsy nor apoplexy.
The Attorney-General said he wished to put some dues •
Vona to Dr. Todd, arising out of Mr. Bamford's examina-
tion; but as that gentleman was unable to attend, he
proposed to put in his deposition.
After a short conversation, Dr. Todd was questioned
as to the state of Mr. Bamford's health, and stated that
he was labouring under an attack of English _cholera, and
was unablo to attend the court.

Dr. Tweedy gave similar testimony as to Mr. Bamford's
illness.

Mr. I3amford's deposition was then put in and read. It
was as follows :

" I am a surgeon, residing at Rugeley. I attended upon
Mr. Cook at the request of Mr. Palmer. I first saw him
about three o'clock on Saturday, the 17th day of Novem-

ber. I found him suffering from violent vomiting. His
stomach could not retain a tablespoonful of anything. He
was in bed. I saw no other symptoms except sickness.
He was in no fever. His pulse did not exceed 72—perfect
moisture of skin—perfectly sensible—no other symptoms
whatever. I prescribed the medicine for him. Mr. Palmer
went up to my house. I !prescribed a saline medicine
to be taken in an effervescent state. In the evening Mr.
Palmer called upon me between seven and eight o'clock
to request I would go with him again. II then saw that
the deceased's sickness still continued. I gave him a
slight opiate. Palmer staid until I prepared the pills,
and he then took them away with him. I did not go with
Mr. Palmer when he took the;:pills• Between eight and
nine o'clock on Sunday morning Mr. Palmer called on
me again• I went alai' him. I saw Mr. Cook in presence
of Mr. Palmer. He was still sick, and continued so. I
remained with him ten minutes. He continued to eject
all he took. He then' asked me to neutralise the medi-
cine, as he did not like to take it in an effervescent
state. I did not see him take any thing. I did not
examine what came from him. I saw several basins and
saw him throw up. The vomit was clear. I saw no
appearance of bile, nor was it in any way discoloured.
He did not throw any blood from his throat, and what
did come from him was as clear as water. I saw him
again between six and seven o'clock on the following
evening. Mr. Palmer asked me to go with him. He
still continued sick and bad. No pain whatever. The
skin quite moisla When I saw him he said his bowels
had been moved two or three times. His motions were
in a natural state, and;rcontained bile. No blood was
with the motion. I made pressure upon the stomach,
but he did not complain of lany tenderness or pain
whatever. 1 last saw him on Sunday, between eight and
nine o'clock in the morning. He still complained of
sickness and had thrown up. On Monday I altered the
medicine. I mixed the mepiciue and sent it to the Talbot.
It was a draught to be taken every three hours.
It was composed of three drachms of sulphate of magnesia,
two of thyasimns dogolasyrup, twelve drachms of tincture,
and five ounces of infusion of roses, made up in a six
ounce bottle, a fourth part to be taken every three or
four hours. I did not See him take the medicine. I saw
the bottle in his bedroom, and some of it had been
taken. He said the medicine agreed with him, and he had
not been sick since he took it. He had taken a basin of
coffee and a basin of broth. He said he should continue
the medicine as it had done him a great deal of good. I
saw him in the evening again, between six and seven
o'clock. He said he had been up and was comfortable,
and wanted two pills again in the evening, which I pre-
pared, and sent down. I sent them by my servant. I
did not at any time see any pill box in the room. He had
taken pills on each night from Saturday. They contained
one grain and a half of morphia, one grain of calomel, and
four grains of rhubarb, divided into two pills. They
were made with a conserve of hip. Between seven
and eight o'clock on Tuesday morning met Mr.
Palmer in the street. He said he had been with
Mr. Cook, that he was composed, and appeared
very quiet and comfortable, and he did not wish him
disturbed. Mr. Palmer called upon me between seven
and eight o'clock, and asked me to go down. He intro-
duced me to Dr. Jones, of Lutter worth. In the presence
of Mr. Jones and Mr. Palmer I again examined Mr. Cook.
This was the first time I had seen any change in him.
His mind appeared disturbed and irritable. He turned
himself round in the bed, his face from me. I stood on
the left hand side of the bed, and Mr. Jones and Mr.
Palmer on the other. He turned towards Mr. Palmer
and said, "I'll have no more pills to night." Cook said
he would take no more medicine. Mr. Jones and Mr.
Palmer came out of the room with me. We had a con-
sultation together. Afterwards Mr. Palmer and I went
to my house. I made the pills in his presence. He asked
me to write a direction. It was on a slip of paper, and
was wrapped up in the box. They were the same pills I
had before prescribed. I sealed them and gave them to
Mr. Palmer. About half-past twelve on Wednesday
morning I was again called up, and desired to go imme-
diately to the Talbot. I there found Mr. Cook dead, and
Mr. Jones and Mr. Palmer standing by his
bedside. The body was not then cold. The
body was perfectly straight, and he lay on his
back.'" I left Mr. Palmer and Mr. Jones in the room.
I was present at the post mortem examination. Dr. Devon-
shire made it. Dr. Harland, Mr. Palmer, and Mr. Newton
were also present. The examination was ',made on the
26th day of November, six days after death. The body
had not changed colour. The stomach was opened, and
nothing particular was found there. There were secre-
tions in the lower part of the bowels. I could not discern
the cause of death. The heart was quite empty. I
thought the vessels of the brain,' after the skull was re-
moved, were rather full. There did not appear to be any
congestion of the brain. The lungs were perfectly healthy.
They were not in the least congealed. They did not
appear diseased. I did-not then notice the blood. There
was nothing in the blood to attract my attention. The
effervescing medicine was 20 grains of carbonate of potash,
two drachms of compound tincture of cardumus, and about
two drachms of simple syrup and water. The acid was
fifteen grains of tartaric acid in powder—fifteen grains in
each paper. I keep the preparations of antimony, but
gave him none. It was the acetate of morphia I gave
him. I keep strychnia, locked up in a cupboard in the
parlour. I may have about two drachms. It is sometimes
used as a medicine. I have not used it for the last four or
five years. I have antimony and tartaric acid—tartarised
antimony in a pot and bottle, and tartaric acid in a four oz.
bottle. I did not see the effervescing mixture after I made it.
and Palmer took it away. I saw the mixture afterwards,
when a portion had been taken, but I did not the powders.
The bottle containing the morphia is an ounce one, and is
a stopper bottle. The other, strychnine, has a cork. The
strychnine is tied up with leather. Deceased's tongue was
perfectly clean all the three days I saw him. I Prepared
the pills by candlelight. I did not particularly observe
deceased's eyes on Thursday. evening. I mixed up eight
pills altogether, but at different times. ;His skin was
moist. Therel was no fever. The heart was entirely
empty. When I saw Mr. Cook on the Monday he did not
complain that he had been ill. When I saw Mr. Palmer
on the Tuesday he did say Mr. Cook had had a fit. He
also said that Mr. Cook had had two fits before ; but that
he had not been called to him. When Mr. Palmer called
upon me first it was on the Saturday, and he told me he
had dined with Mr. Cook the previous day, and he had
taken too much champagne. Mr. Cook said ha believed
he had taken a little too much, and that he was not in the
habit of taking much. I have attended other patients for
Mr. Palmer. The paper produced containing the words
One pill directly, 'and repeated towards ten o'clock,'
was the direction I sent with the first box of pills on
the Saturday night. The other directions were differ-
ent. They were 'the pills to be taken at bed time,' or
words to that effect. My opinion at the time deceased
died was, that he died of apoplexy. I certified to that
effect. I think deceased died from excitement, from
what I saw on the Tuesday night. I observed when the
skull was taken off that the blood vessels of the dura mater
seemed enlarged and full. I have been a medical prac-
!loner 53 years. I saw the brain divided. I am still of
the same opinion as I was before I saw the body opened. I
stated in the presence of Dr. Harland and those present
that I believed deceased died of apoplexy. I saw the brain
divided, and still I am of the same opinion. I should say the
appearances I saw on the brain after the skull was taken off
were sufficient to cause death. I attended Mrs. Palmer be-
fore her decease •, also Mr. Palmer's two children ; also a
gentleman who had been staying at Mr. Palmer's a week or
two. He was no relation. I cannot say that I have
attended any one else for Mr. Palmer. Those I attended
all died. Mr. Palmer applied to me on the Monday fol-
lowing deceased's death for a certificate, as deceased was to
be buried the day following. I told him that, as it was
his patient, he certainly ought, to give a certificate. He
asked mo to fill the certificate up. H 3 said, I had rather
yon would give it.' I filled one up out of my own book at
Any own house. He asked me what my opinion was as to
the cause of death. I believe Mr. Palmer asked me for the
certificate before he asked me my opinion as to the cause of
death. I cannot say that I ever knew apoplexy to produce
rigidity of the limbs. I attributed the sickness the first two
days I saw him to the state of the stomach. On the Monday
I saw Mr. Cook. He said he did not want to take any
medicine prepared either by Mr. Palmer or Mr. Jones, and
that he wished me to prepare PI! his medicines. He told me
on the Monday that ho respected Mr. Jones as a friend ; that
Air. Palmer had had a letter from him that day, and that he
would he here on the Tuesday."
Dr. Todd's examination was then continued : I do not
believe that Cook died from apoplexy or epilepsy. I have
never known tetanus arise from a sylphilitic sore or from
sore throat. There are poisons which will prnduce tetanic
convulsion. Nux vomica, and those poisons which contain
as their active principle strychnia and bruschia, are poisons
which produce convulsions. I have not seen human life
destroyed by these means, but I have seen animal life
destroyed. I should not like to give a human subject a
quarter of a gran of strychnia. I think half a grain would
destroy life. A grain would do so most certainly. Half a
grain would destroy a cat. When I have seen it given, it
has generally been given in solution. I believe it acts more
rapidly in that manner. The manner in which the animal '
is effected,dcpends on the dose. A moderate dose would show
its effects in half an hour. The first effect from which, is
a convulsion of the spinal muscles. The head is drawn back,
the trunk bowed in a most remarkable manner. The extre-
mities are generally stiffened, and the muscles rendered
stiff and rigid. The stiffness once set in does not perfectly
relax, and fresh paryoxsms occur. The motion of the muscles
is a rigid jerking motion. The feet are forced out of their
natural position and powerfully extended. Death would be
over in a quarter of an hour, or half an hour, unless the dose
is a small one, and the spasms then subside,
The Atterney-General : Is there a masked difference be-
tween a case where death ensues after taking strychnia and
a case of tetanus from idiopathic or traumatic tetanus ?
Witness : I think the distinction is very marked.

The Attorney. General : Wherein ?-Witness.: The con-
tinuity a the symptoms. As long as the poisonous influence
lasts, the symptoms last. but the posonous influence will
subside afier a time, if the dose is not strong enough to
cause death, and then the spasms will return. In tetanus
the symptoms from the commencement are continuous, and
go on as long as the patient's powers are capable of endur-
ing them. the alertness of the duration of the symptom
is decidedly a symptom of strychnia ap a poison,
The Attorney-General ; Brusohia is analogous iu ite effects
to strychnia ? Witness : Yes,
but weaker.
The Attorney-General : Are there any other poisons that
produce conyulsions of a tetanic nature ? Witness : There
are no other that I am aware of.

The Attorney General : You have heard the syrnptems
described attending the death of Cook. Arc you of opinion
that they are referrable to idiopathic or to traumatic teta-
nus ? Witness: No.

The Attorney-General : You say you never saw a per.