The Sun.
London, England, 1859-08-26 00:00:00

THE SMETHURST CASE.

TO THE EDITOR OF THE TINES.
Sir,—My evidence at the Smethurst trial, which
has been very briefly reported, was given not from
any sympathy with the accused, but solely because
I considered that an important element of the case
—namely, the existence of pregnancy, had teen
almost, if not entirely overlooked. For the same
reason I ask your permission to remark upon cer-
tain facts to which, as it appears to me, due weight
has not been given.
First, as regards the actual pregnancy of Miss
Bankes. This was first discovered at the postmortem
examination by Mr. Barwell, but so little conse-
quence was attached to it that the matter was
scarcely heard of until the recent trial. It must be
remarked that the duration of the pregnancy corres-
ponded as nearly as possible to the length of the
illness of the patient. Mrs. Robinson deposed that
Miss Bankes was taken ill three weeks before she
left her house. She went from Mrs. Robinson's to
Mrs. Wheatley's on the 3d of April, and on the 3d
of May—seven weeks from the commencement of
her malady—she died. Mr. Bar well gives seven
weeks as the limit which the pregnancy might have
reached at the time of death.
Was the illness of Miss Bankes such as could pos-
sibly have been caused by pregnancy? Obstinate and
irrepressible vomiting, with violent purging, were
the chief symptoms detailed at the inquest and at
the trial. It is an undoubted fact, recognised by
every obstetric authority, that women are often re-
duced to great peril, and sometimes killed, by the
vomiting of pregnancy. Constant diarrhoea is also
met with as a disorder of pregnancy, either alone
or in connexion with vomiting. It is in the early
part of pregnancy that vomiting is most severe and
dangerous, and it often begins at the very com-
mencement of this state. It is most likely to hap-
pen in the case of a woman such as Miss Bankes is
described to have been, pregnant for the first time
in mature age, of bilious temperament, and the
subject of previous internal disorder. Stress was
laid by some of the witnesses on the burning sen-
sations complained of in the stomach and throat.
Pregnancy is constantly accompanied by heartburn,
and in certain cases there is an enormous amount of
acid secretion and eructation from the stomach.
The sickness of pregnancy is commonly most dis-
tressing in the morning on first taking food, or on
moving the body. This was spoken to as the fact
in the case of Miss Bankes, by one of the witnesses.
In the worst cases the vomiting is wholly intract-
able. The remedies which arrest ordinary sickness
are of no avail. Food and medicine are alike re-
jected, and the patient dies of starvation. For the
last two days of her life Miss Bankes was under the
care of her sister, and a nurse provided by Dr.
Julius. It told very forcibly against the prisoner,
that at this time, although the stomach rejected
medicine, it retained food. In two out of four fatal
cases from this kind of vomiting in which I have
been consulted the patients were able to take food
for a short time before death ; the sickness ceased
when fatal exhaustion had set in. The same is re-
lated to have been the case in the history of Char-
lotte Bronte. Her biographer states that towards
the close " she begged constantly for food, and even
for stimulants. She swallowed eagerly now ; but
it was too late." Her illness is described as having
lasted six weeks.

Is it possible that the physician in attendance ur on
Miss Bankes made an error of diagnosis in assigning
poison as the cause of her illness and death ? It was
strongly insisted on as a proof of poisoning, that
Dr. Todd, Dr. Julius, and Dr. Bird, should, either
individually or concurrently, have formed the opi-
nion that their patient was suffering from slow
irritant poisoning. Against this it is only fair to
place the fact that they did concurrently overlook
the existence of pregnancy, although it was before
them, and marked by one of its most common and
distinctive symptoms. It cannot but be considered
as remarkable that three medical men should have
been in attendance upon a woman 42 years of age,
living for the first time as a married person, who
had been suddenly seized with an illness of which
vomiting was a prominent symptom," without de-
tecting pregnancy. They appear to have been mis-
led by the information given to them by Smethurst
as to the absence of one of the common symptoms
of pregnancy, and they made no examination.
Smethurst himself appears not to have suspected
pregnancy. As regards Dr. Todd, it may be
accounted for by the circumstance that, however
undisputed his great eminence as a pure physician
may be, he is not accustomed to treat the disorders
of pregnancy. However the fact may be, the medi-
cal attendants certainly formed a conclusion while
they were without the knowledge of a very im-
portant element of the case.
Do the symptoms of a fatal ease of vomiting from
pregnancy so far resemble poisoning as to be liable
to be mistaken for them ? There is no limit to the
reflex irritation which the pregnant uterus may
excite in various organs of the body, especially the
stomach. In my " Manual of Obstetrics," published
in 1858, I state that " an almost poisonous influence

seems to be exerted by the graid uterus in some
constitutions." Several years ago I knew of a case of
this kind in which poison was actually suspected.
Dr. Todd laid considerable emphasis on an extra-
ordinary expression of Miss Bankes's countenance,
such as he had never observed in a case of natural
disease. Dr. Paul Dubois, the present physician-
accoucher to the Empress of the French, who related
that he saw 20 cases of death from the vomiting of
pregnancy in 13 years, refers to " a marked change
in the features," as one of the signs indicating
a state of danger, and calling for the induction of
abortion to save the patient's life.
I do not offer any opinion on the moral or chemi-
cal evidence in the case, but merely testify to that
which I have seen and known in my own depart-
ment of the profession.—l am, sir, your obedient
servant,

W. TYLER SMITH, M.D.,
Physician-Accoucheur to St. Mary's
Hospital.
Upper Grosvenor-street, Aug. 25.