Читать книгу Trial of William Palmer - Various - Страница 13
Fourth Day, Saturday, 17th May, 1856.
The Court met at ten o’clock.
ОглавлениеGeorge Bate
George Bate, examined by Mr. James—I am a farmer, and was in the employment of the prisoner during September, October, and November of last year. I was engaged to look after his horses, and received no stated salary, sometimes two sovereigns and sometimes one sovereign a week. I remember in the month of September, 1856, being in the company of Mr. Cook and Mr. Palmer. Something was said by one of them to me about an insurance being proposed on my life.
Mr. Serjeant Shee objected to this evidence, and his objection was sustained.
T. B. Curling
Mr. Thomas Blizzard Curling, examined by the Attorney-General—I am a Fellow of the College of Surgeons, and surgeon to the London Hospital. I have published a work on the subject of tetanus. Tetanus signifies spasmodic affection of the voluntary muscles of the body. There are two sorts of tetanus, idiopathic and traumatic. Idiopathic tetanus is tetanus originating, as it were, as a primary disease, without any wound. Traumatic is from a wound. During twenty-two years I have been surgeon to the London Hospital. I have never seen a case of idiopathic tetanus. I have seen over fifty cases of traumatic tetanus. Traumatic tetanus first manifests itself by a stiffness about the jaws and the back of the neck; rigidity of the muscles of the abdomen usually sets in; a dragging pain at the pit of the stomach is almost a constant attendant of spasm of the diaphragm, and in many cases the muscles of the back are sensibly affected. Then the spasms, though continuous, are liable to aggravation in paroxysms. As the disease goes on these paroxysms become more frequent and more severe. When they occur, the body is drawn backwards; in some instances, though less frequently, it is bent forwards; then, in an acute case, a difficulty in swallowing is a very common thing; a difficulty in breathing also during the paroxysm, a choking sensation. The disease may end, supposing it be fatal, in two ways; the patient may die somewhat suddenly of suffocation, owing to closure of the opening of the windpipe, or the patient may be worn out by the severe and painful spasms, and the muscles may relax and the patient gradually sink and die. Traumatic tetanus is generally fatal, and the locking of the jaw is an almost invariable symptom. A symptom very characteristic of the disease is a contracted condition of the eyelids, a raising of the angles of the mouth, and a contraction of the brow. The lower extremities are sometimes affected, and sometimes the upper; the muscles affected are chiefly those of the trunk. I have never heard of traumatic tetanus being produced from sore throat or from chancre. A case of traumatic tetanus which ends fatally takes from one day to four days, or longer, before death ensues. I never heard of a case in which a man would be attacked one day and then have twenty-four hours’ respite, and be again attacked the next. The symptoms of the death of Mr. Cook, given by Mr. Jones, the surgeon, were not consistent with any form of traumatic tetanus I ever heard of. There was the sudden onset of the fatal symptoms; in all cases that have fallen under my notice the disease has been preceded by the milder symptoms of tetanus. The symptoms given by the woman Mills as to the Monday night were not those of tetanus. The sudden onset and rapid subsidence are not consistent with what I call the true form of tetanus. The poison, nux vomica, produces tetanic convulsions.
Cross-examined by Mr. Serjeant Shee—Any irritation of the nerves proceeding to the spinal cord might produce tetanus. I agree with Dr. Watson in his “Lectures on the Principles and Practice of Physic,” that all the symptoms of tetanic convulsions may arise from such slight causes as the sticking of a fish bone, the mere stroke of a whip lash under the eye, from the cutting of a corn, from the bite on the finger by a tame sparrow, from the extraction of a tooth, from the operation of cupping, and simple things of that character. Idiopathic tetanus would not be so likely to bring the patient to the hospital as a sudden wound leading to traumatic tetanus. A syphilitic sore would not be likely to lead to tetanus.
Re-examined by the Attorney-General—A medical practitioner who saw a case of convulsions would be able at once to know the difference between symptoms of general convulsions and of tetanus. One of the characteristic features of tetanus is that the consciousness is not affected.
Robert Todd
Dr. Robert Todd, examined by the Attorney-General—I have been in practice as a doctor for twenty-five years, and have been a physician to King’s College Hospital for many years. I have lectured on the disease called tetanus, and have published the lectures. I have seen two cases of what seemed to be idiopathic tetanus. It is a very rare thing. The term tetanus ought not to be applied to cases of poisoning, for the symptoms are so essentially distinct from the disease. I have had under my own observation cases of traumatic tetanus. When once the disease has begun there are remissions, but not complete; rather a diminution of the severity of the symptoms. There are two classes—an acute class and a chronic class. The acute cases will terminate in the course of three or four days, and the chronic cases will go on from nineteen to twenty-two or twenty-three days, perhaps longer. Sometimes epilepsy will produce convulsions, and sometimes the convulsions from epilepsy assume somewhat of a tetanic character, but they are essentially distinct from tetanus. When the epileptic convulsions assume somewhat of the tetanic form, it is quickly over, not continuous. In epilepsy there is an abolition of consciousness for the time. I have heard the symptoms described which accompanied this gentleman’s seizure and death, and also the appearances after death and the post-mortem examination. I am of opinion there was neither apoplexy nor epilepsy. There are poisons which will produce tetanic convulsions. The chief of these poisons is nux vomica. I have seen animal life destroyed by strychnia, but never human life. The effects of a large dose, such as a grain of strychnia given in a liquid form to a cat or dog, would be apparent in the course of ten minutes. The symptoms would be spasmodic action of the muscles, chiefly of the trunk, the spine, the spinal muscles, producing a very marked opisthotonos, as it is called, where the spine is thrown back, the head thrown back, and the trunk bowed in a very marked manner. The extremities are generally stiffened, jerked out with violent jerks. The muscles are rendered stiff and rigid from the spasms. The stiffness remains, and does not perfectly relax. Fresh paroxysms come in always attended with the peculiar curving back of the head and neck and spine. The extremities of the animals are powerfully stiffened out, distended, every now and then powerfully bent, and jerked out again. Death ensues within half an hour, unless it is a small dose. There is a marked difference between cases where death ensues after taking strychnia and a case of tetanus such as I was describing just now from idiopathic or traumatic causes. The continuity of the symptoms in strychnia poisoning is very characteristic: as long as the poisonous influence lasts, the symptoms last, but the poisonous symptoms will subside after a time. The shortness of the duration of the symptoms is decidedly in favour of strychnine poisoning. There are no other poisons that I know of that produce convulsions of a tetanic character. The symptoms described which attended this gentleman’s death are not referable to idiopathic or traumatic tetanus. I have never seen a person die from the administration of strychnia, but I have seen a person suffer from the consequences of an overdose. There was the opisthotonos and there was the consciousness perfectly retained. There was also dilation of the pupils, a peculiar convulsion of the muscles of the trunk, and the limbs were stiffened out. Difficulty of breathing is common to both tetanus and to tetanic convulsions from strychnia. In the case of Mr. Cook, I think it is an important distinction that he seems to have been able to swallow sufficiently easy, and there was no rigidity of the muscles of the jaw which is characteristic of tetanus, of disease, or of wound. I think the symptoms in his case, judging from my own experience, were those of tetanus from strychnia.
Cross-examined by Mr. Grove—The proximate effect of tetanus, whether caused by idiopathic or traumatic tetanus, or strychnia, is probably the same on the nerves leading from the spine. The particular affection of the nerves is unknown. In the disorder of convulsions there are cases of very slight affection, others more serious, and so on. I adhere to the opinion given by me in my lectures on “Diseases of the Brain and Nervous System,” that the results of the administration of strychnine exactly imitate the convulsions of tetanus. It does not produce the exact phenomena of the disease in a clinical sense. I have no doubt the peculiar irritation of the nerves in tetanus is identical with the peculiar irritation of the nerves in strychnine poisoning. In traumatic tetanus I do not recollect any instance of the limbs being affected before the jaw. An examination of the spinal cord in tetanic affections shortly after death is of importance. If it were deferred as late as two months, there would be, to a certain extent, a fallacy. There are morbid appearances produced by wounds after death which sometimes simulate diseased conditions before death.
Supposing the spine to be affected by decomposition, would not what may be called the diseased softening of the spine previous to death be confused or obliterated?—You would not be able to speak with certainty as to simple softening if the examination had been long after death. There is nothing in the post-mortem examination on which any one could positively say that the patient died from the ordinary disease of tetanus. I think granules on the spinal cord, such as I have heard of here, are not likely to cause tetanus. In the cases of the animals to whom strychnia was administered they went off into a second spasm immediately they were touched. They retained that tendency as long as the influence of the poison lasted. I examined the animals that were killed by strychnia anatomically. The right side of the heart was not generally full; it was empty, and the heart contracted. Death where strychnine was administered is partly due to the difficulty of action of the respiratory muscles, but chiefly to a general nervous exhaustion which the violence of the paroxysm produces.
Would not the difficulty of action of the respiratory muscles producing death tend to leave the heart full?—I do not think it was asphyxia.
Robert Todd
Then I think I may take you as differing from the great mass of authorities on strychnia poisoning?—I don’t know; I think there are differences of opinion on that subject. Persons sometimes have convulsions after poison by morphia. The time in which convulsive symptoms come on after morphia would depend on the dose entirely. I cannot say whether it would be later than strychnia. It is not a question I have devoted attention to.
Re-examined by the Attorney-General—In death resulting from tetanus I should not expect to find anything peculiar about the heart. I heard the evidence of the gentlemen who examined the spinal cord after Mr. Cook’s death. From their description it appeared to me that those parts were in such a condition that any indication of disease might have been discovered.
Sir B. Brodie
Sir Benjamin Brodie, examined by Mr. James—I was surgeon at St. James’s Hospital for a great number of years, and have had a considerable practice. I have had many cases of death from tetanus. Death from idiopathic tetanus is very rare in this country. I heard the description of the symptoms attending the death of Mr. Cook. As far as the spasmodic contraction of the muscles is concerned, the symptoms resemble those of traumatic tetanus; as to the course the symptoms took, that was entirely different. I heard about the attack on the Monday night and its ceasing, and the patient being comfortable and composed during the Tuesday, and then the attack again about ten minutes before twelve on the Tuesday night. The symptoms of traumatic tetanus always begin, so far as I have seen, very gradually; the stiffness of the lower jaw being, I believe, invariably the symptom first complained of; then the contraction of the muscles of the back is always a later symptom; 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 a spasmodic contraction of the muscles of that limb. I do not recollect a case in which in ordinary tetanus there was that contraction of the muscles of the hand which I understand was stated to have existed in this instance. Ordinary tetanus rarely runs its course in less than two or three days, and often is protracted to a much longer period; I know one case only in which the disease was said to have terminated in twelve hours.
Lord Campbell—Probably in that case the early symptoms had been overlooked?—I never knew these symptoms of ordinary tetanus to last for a few minutes, then subside, then come on again after twenty-four hours.
Sir B. Brodie
Examination continued—I do not believe that death here arose from what we ordinarily call tetanus, either idiopathic or traumatic. I never knew a death from tetanus to result from a sore throat, or a chancre, or any other form of syphilitic disease. The symptoms of the death of Mr. Cook are not consistent with a fit of apoplexy. I never saw a case in which the symptoms that I heard described arose from any disease.
Cross-examined by Mr. Serjeant Shee—I remember one case of idiopathic tetanus in our hospital, but I doubted its deserving the name of tetanus.
Considering how rare tetanus is, would you think that the description of a chambermaid and of a provincial medical man, who had only seen one case of tetanus, could be relied upon by you as to what the disease observed was?—I must say I thought the description very clearly given. I have never seen the syphilitic poison produce convulsions except as a consequence of disease in the bones of the head.
Henry Daniel
Mr. Henry Daniel, examined by the Attorney-General—I was for upwards of twenty-eight years surgeon to the Bristol Hospital. I have seen fully thirty cases of tetanus, of which two were idiopathic. One of these two ended fatally. Idiopathic tetanus is of very rare occurrence. The symptoms are not so severe as those in traumatic tetanus. The symptoms which accompanied the attack of Mr. Cook before his death were quite distinguishable from those cases of tetanus which have come within my experience. In pointing out the differences I would repeat very probably the words of Sir Benjamin Brodie. Tetanus, so far as my experience goes, begins with uneasiness in the lower jaw, followed by spasms of the muscles of the trunk, and most frequently extending to the muscles of the limbs. Lockjaw is almost invariably a symptom of traumatic in particular. It is one of the earliest symptoms. I have seen the clenching of the hands, but I do not think it is an ordinary symptom of common tetanus. I cannot recollect a case the duration of which has been less than from thirty to forty hours. I have never known a syphilitic sore producing tetanus. The symptoms I have heard described in Mr. Cook’s case are not referable to either apoplexy or epilepsy. In both these there is a loss of consciousness, but in cases of tetanus that I have seen consciousness has been retained throughout all the period. In my experience of tetanus the symptoms have been invariably continuous without any interruption. In my judgment the symptoms of Mr. Cook could not be referred to idiopathic or traumatic tetanus.
Henry Daniel
Cross-examined by Mr. Grove—I do not know that cases are mentioned in books where there is a long interval of some hours between the symptoms. I have not read Dr. Todd’s book, nor Mr. Curling’s book, nor Dr. Copland’s book on the subject. I have been out of practice some seventeen or eighteen months, and have not looked into the reported cases of tetanus of late. In my opinion the symptoms of tetanic convulsions do not vary much in different cases. There may be an affection of a muscle in this man that there is not in the other, in a leg or an arm. In tetanic affections death is caused by exhaustion and suffocation.
Samuel Solly
Mr. Samuel Solly, examined by Mr. Welsby—I have been connected with St. Thomas’s Hospital as lecturer and surgeon for twenty-eight years. I have either seen or had under my care twenty cases of tetanus, all of which were traumatic, except one, in which I was doubtful whether it was traumatic or idiopathic. In the latter case the symptoms were slower in their progress and generally rather milder. The shortest period I can remember before the disease arrived at a point is thirty hours. The difference between Mr. Cook’s attacks and the cases I have seen is that, in my experience, there has been a marked expression of the countenance—that is the first symptom; it is a sort of grin, and the symptoms have always been continuous. The symptoms in Mr. Cook’s case are not referable to either epilepsy or apoplexy, or any disease that I ever witnessed.
Cross-examined by Mr. Serjeant Shee—A marked expression of the countenance, a sort of grin, frequently occurs in all violent convulsions, which assume, without being tetanus, a tetanic form and appearance. They are not a numerous class. It is difficult to distinguish between them and idiopathic tetanus in the onset, but not in the progress. I heard the account given by Mr. Jones of the last few moments before Mr. Cook died.
That he uttered a piercing shriek, fell back, and died, did he not?—Yes.
The Attorney-General—I beg your pardon; there was an interval.
Mr. Serjeant Shee—No, no; five or six minutes.
Lord Campbell—He died very quietly.
Cross-examination resumed—I heard the description of the shriek with the convulsion; but it was the shriek that called the medical man into the room. That was at the height of the attack. In some respects that last shriek and the paroxysm that occurred immediately afterwards bear a resemblance to epilepsy. Death from tetanus accompanied with convulsions seldom leaves any trace behind; but death from epilepsy leaves behind it some few effusions of blood on the brain or congestion of the vessels.
Samuel Solly
Re-examined by the Attorney-General—Convulsions that take place in epilepsy are not at all of tetanic character. I say that Mr. Cook did not die from epilepsy, because there were none of the symptoms there. When a patient dies with epilepsy he dies perfectly unconscious. Ulceration of the brain from injury, a sudden injury to the spinal cord, irritation of the teeth in infants, all produce convulsions. But those convulsions in their progress are not similar to the convulsions of tetanus. There is no progressive movement and no appearance about the face or jaw of having tetanus.
R. Corbett
Dr. Robert Corbett, examined by Mr. James—I am a physician in Glasgow. I remember a patient of the name of Agnes Sennet who died in the Glasgow Royal Infirmary on 29th September, 1845, after taking some strychnia pills intended for another patient. I saw her while she was under the influence of the poison. The symptoms I noticed were a retraction of the mouth, face much suffused and red, the pupils dilated, the head bent back, the spine curved, and the muscles rigid and hard like a board. She died about an hour and a quarter after taking the pills. There would be a quarter of a grain in each of the three pills she took.
Cross-examined by Mr. Serjeant Shee—The retraction of the angles of the mouth was continuous, but it was worse at times. I did not observe it after death. The hands were not clenched, but semi-bent after death. That semi-bending of the hand is a very common thing in cases of death by violent convulsions. Twenty minutes after taking the medicine she was attacked by the symptoms.