A.P. Wolf
04-23-2008, 03:40 PM
I enjoyed this find.
William Gull spouting on a supposed case of murder in 1888 at the Old Bailey:
SIR WILLIAM GULL . I am a physician, carrying on my practice in Brook Street, London—I am the Senior Consulting Physician of Guy's Hospital—I have made myself acquainted with the details of this case, and have perused the clinical report very accurately—I cannot say that I have also perused the evidence of the medical men called before the Coroner—I am not acquainted with the evidence of my colleagues—I have perused the clinical report—tubercular disease of the brain occurs in two forms: when it forms slowly it is yellow, and frequently in masses; when it forms more quickly it is disseminated, scattered, and is more or less transparent—I should describe the latter condition as the grey tubercle—yellow tubercle is of common occurrence—the course of the disease is insidious, and attended with equivocal symptoms—the symptoms are headache; occasional sickness, or not; sometimes slight rise of temperature, but nothing much; 100° or 100.5° or 99° are about the temperature of the deposit of yellow tubercle, and sometimes a depression of temperature—the symptoms are equivocal, but they have a dreadful significance to the experienced physician, although they may seem trifling to bystanders—the natural course for the yellow tubercle is into inflammatory mischief of the brain itself, or its membranes—it is an invariably fatal malady—the course of the malady
See original (http://www.oldbaileyonline.org/images.jsp?doc=188008030138) http://www.oldbaileyonline.org/i/genericThumb.jpg (http://www.oldbaileyonline.org/images.jsp?doc=188008030138)
is uncertain, except in its closing stages, which may vary from a few days to a week or two—that is after the inflammation has set in—when I say "a week or two," I do not mean literally a week or two; I mean indefinitely one or two—I think it is not strictly governed by time—the yellow tubercle may exist in a latent form for a long time; and the grey tubercle for days, probably a fortnight or more; not before the inflammatory mischief, with the inflammatory mischief—in the case of yellow tubercle you would be guided by the symptoms of the patient as to when it was first formed—I doubt whether a patient would live six weeks with the yellow tubercle without symptoms—loss of power in the limbs would be a symptom of brain mischief—the inability to control the motions would be a striking symptom of brain mischief—it is a brain symptom; it does not occur in hysteria; never, I think—I do not know hysteria as associated with tubercular disease—I have the clinical report before me—assuming that this woman, when she came into the hospital, two days after was complaining or suffering from nausea, from sickness, and that for some time she suffered continuously from headache, and her temperature was from 100.4° to something slightly over that, and sometimes something slightly under it; assuming also that she had lost power in her limbs, that she had been unable to stand when she got up to dress, and that she had inability to control her her evacuations, then I say she had brain disease; whether tubercular or not would depend.—Q. But in your view should a skilful physician have known that brain disease existed?—A. There I must be careful—there is no doubt great difficulty in recognising brain disease at that stage—there is no doubt it is one of the most difficult parts of medical practice, but I cannot doubt that suspicion should have existed—there is great difficulty in determining with any degree of certainty, perhaps only suspicion—supposing this woman was suffering from brain disease on the 5th July, which rendered her incapable of using her limbs, in my opinion the administration of the bath would be most improper—I should say if there was the presence of yellow tubercle in the brain an ordinary bath might be used for washing purposes, but it would require immense care not to exhaust the patient or tire her—the skin or flesh of a woman who has been in bed and suffering for some time is easily discoloured, in strumous people, and this woman was—the attempt to lift herself from the bath might have produced discolouration—I do not think that the fact of the woman being put in the bath and kept there for some time would itself produce or give rise to the tubercle; if so, we should have tubercles all over the community every day—I very much doubt whether death would be accelerated by this treatment—the course of the malady is continuous and universally fatal—the bath did not produce any injury to the head, which is the chief seat of the malady—the dragging of the limbs would not increase inflammation of the brain, though in this case it was much to be deplored dragging the poor thing to the bath; but I doubt of its doing anything to the brain itself—it would subject her to dreadful suffering, I should think, as far as she was conscious—such people are not so alive as people who are well, I mean alive to suffering, not perfectly conscious—supposing the excitement or the shock of the bath had caused inflammation to set in, I should have expected to find an alteration in temperature; there was, however, no rise in temperature for two days after the bath, at least as appears from this report—four days after the bath there is no more rise in the temperature than half a degree—that does
See original (http://www.oldbaileyonline.org/images.jsp?doc=188008030139) http://www.oldbaileyonline.org/i/genericThumb.jpg (http://www.oldbaileyonline.org/images.jsp?doc=188008030139)
not lead me to the conclusion that the bath did not cause anything; it had not much to do with it—then, again, the bath could not in the nature of the case do it—you might batter a person about the head, and set up inflammation of the brain; but taking a bath would not, for remember this woman had not active disease in the lung—the evidence shows that the disease in the lung was quite latent, inactive—the yellow tubercle presses on the brain, but the transparent tubercle does not much—if the bath had been cold I do not think it would have caused inflammation of the brain—we put ice to the head in inflammation of the brain to check it.
Cross-examined by MR. POLAND. We do not put ice to the feet and body to drive the blood to the head; we do not drive the blood to the head at all; we put it to the head—supposing this woman's head was not in the cold, but her body and legs in the cold, and she was kept for half an hour or more shivering in the cold, that would have a tendency to interfere with the circulation, but will you tell me what cold you mean?—this woman had brain disease, and they are given to shivering—supposing I found that she did not shiver at all till she had the bath, and that she did shiver afterwards, even that would not be a fair inference that the cold caused the shivering and not disease of the brain—it might be the first shivering—this shivering might fairly be considered the first symptom of brain disease—I mean it might be a nervous shivering—it might have been the first shivering of brain disease—a sense of cold often goes with real heat—with great care a person may have a bath and be washed, with disease of the brain, without doing any serious injury—I should think with brain disease the woman ought not to be put into a chair, but I should think it might be done without any injurious effects—I should not do it—it is not possible to tell when tubercle commences—you may suspect from the symptoms—I will not say that often suspicion is very inaccurate—you judge of the tubercular commencement from the symptoms—the symptoms are equivocal—they are uncertain—we cannot tell with any degree of certainty; we only suspect—the clinical report is a report made by the clinical clerk, who is a student—I sent for it when I read the report of the Coroner's inquest—I sent to the house, not to the Treasurer of the hospital, to Doctor Steele—I read the report in the paper—I had then two reports, the physician's report, which he said was singularly accurate, and this report—you cannot tell positively how long the yellow tubercle existed before the inflammatory symptoms set in; you can only suspect from the symptoms, sickness and headache.
By the COURT. It was in the post-mortem examination I found that there had been tubercular inflammation of the brain, and if I could go back and have a record of the symptoms attending the patient during her lifetime for six weeks or two months, and obtain an accurate account of the symptoms, I then should be able to say, "I put my finger upon that day"—perhaps not that day, but that time—you find one symptom one day, and that joined with something else the next, and I should say that at that time the mischief was commencing—until the acute symptoms show themselves you cannot say with certainty there are tubercles—when on the post-mortem examination it was discovered that yellow tubercles existed during lifetime on the brain, and in that way caused death, then you might trace back and get the origin of it.
By MR. POLAND. You cannot trace back to any particular time with
See original (http://www.oldbaileyonline.org/images.jsp?doc=188008030140) http://www.oldbaileyonline.org/i/genericThumb.jpg (http://www.oldbaileyonline.org/images.jsp?doc=188008030140)
great accuracy—the common time after the inflammatory grey tubercles set in till death followed would be about fourteen days—they remain quiescent; I will not say for a long time; we have no evidence of a long time—the best judge of the state of the patient ought to be the physician who sees the patient from day to day—a person who knows the case from the commencement at the hospital, and sees it from time to time, and watches it, and attends to it as the physician, no doubt ought to be the best judge of the state of the patient—his eye can descry the difference in the patient on the one day between what is done in that case, and what is alleged afterwards—in this case I should certainly put my judgment against the judgment of the physician who attended the case from the commencement; and I will tell you the ground of it; upon the students' report I would put my opinion against that of Dr. Pavy—the physician governs the students' report—his duty is to see it—I am not assuming that it is the same as if it was made by the physician himself; but I was a physician of Guy's for 20 years and my clinical reports were my own reports—I always dictated the report myself.
Re-examined. In this case I put my judgment against that of the physician who attended to the case; because, when I read the report, I found there was headache, nausea, sickness, and rise of temperature, and all the signs of brain disease, and she dies with grey and yellow tubercles of the brain, and I know that these yellow tubercles would not be set up in fourteen days; I did not receive a report from the physician himself from the Coroner's inquest, which the physician said was singularly accurate—I did not find any symptom of hysteria—hysteria was said by the late Sir Benjamin Brodie to be a paralysis of the will, and the duty is to urge and rouse the patient—supposing a woman is suffering from hysteria, or there is reason to believe it, and she thought she could not walk, when in truth she could, trying to get her to exert herself would be the right thing to do—it would be the best thing to do; the late Dr. Jeffe, of Leamington, who had great reputation in cases of hysteria, used to treat it in this way, by taking the girls in his carriage a mile or two from home, and, then turning them out and making them walk home—that was proper treatment.
William Gull spouting on a supposed case of murder in 1888 at the Old Bailey:
SIR WILLIAM GULL . I am a physician, carrying on my practice in Brook Street, London—I am the Senior Consulting Physician of Guy's Hospital—I have made myself acquainted with the details of this case, and have perused the clinical report very accurately—I cannot say that I have also perused the evidence of the medical men called before the Coroner—I am not acquainted with the evidence of my colleagues—I have perused the clinical report—tubercular disease of the brain occurs in two forms: when it forms slowly it is yellow, and frequently in masses; when it forms more quickly it is disseminated, scattered, and is more or less transparent—I should describe the latter condition as the grey tubercle—yellow tubercle is of common occurrence—the course of the disease is insidious, and attended with equivocal symptoms—the symptoms are headache; occasional sickness, or not; sometimes slight rise of temperature, but nothing much; 100° or 100.5° or 99° are about the temperature of the deposit of yellow tubercle, and sometimes a depression of temperature—the symptoms are equivocal, but they have a dreadful significance to the experienced physician, although they may seem trifling to bystanders—the natural course for the yellow tubercle is into inflammatory mischief of the brain itself, or its membranes—it is an invariably fatal malady—the course of the malady
See original (http://www.oldbaileyonline.org/images.jsp?doc=188008030138) http://www.oldbaileyonline.org/i/genericThumb.jpg (http://www.oldbaileyonline.org/images.jsp?doc=188008030138)
is uncertain, except in its closing stages, which may vary from a few days to a week or two—that is after the inflammation has set in—when I say "a week or two," I do not mean literally a week or two; I mean indefinitely one or two—I think it is not strictly governed by time—the yellow tubercle may exist in a latent form for a long time; and the grey tubercle for days, probably a fortnight or more; not before the inflammatory mischief, with the inflammatory mischief—in the case of yellow tubercle you would be guided by the symptoms of the patient as to when it was first formed—I doubt whether a patient would live six weeks with the yellow tubercle without symptoms—loss of power in the limbs would be a symptom of brain mischief—the inability to control the motions would be a striking symptom of brain mischief—it is a brain symptom; it does not occur in hysteria; never, I think—I do not know hysteria as associated with tubercular disease—I have the clinical report before me—assuming that this woman, when she came into the hospital, two days after was complaining or suffering from nausea, from sickness, and that for some time she suffered continuously from headache, and her temperature was from 100.4° to something slightly over that, and sometimes something slightly under it; assuming also that she had lost power in her limbs, that she had been unable to stand when she got up to dress, and that she had inability to control her her evacuations, then I say she had brain disease; whether tubercular or not would depend.—Q. But in your view should a skilful physician have known that brain disease existed?—A. There I must be careful—there is no doubt great difficulty in recognising brain disease at that stage—there is no doubt it is one of the most difficult parts of medical practice, but I cannot doubt that suspicion should have existed—there is great difficulty in determining with any degree of certainty, perhaps only suspicion—supposing this woman was suffering from brain disease on the 5th July, which rendered her incapable of using her limbs, in my opinion the administration of the bath would be most improper—I should say if there was the presence of yellow tubercle in the brain an ordinary bath might be used for washing purposes, but it would require immense care not to exhaust the patient or tire her—the skin or flesh of a woman who has been in bed and suffering for some time is easily discoloured, in strumous people, and this woman was—the attempt to lift herself from the bath might have produced discolouration—I do not think that the fact of the woman being put in the bath and kept there for some time would itself produce or give rise to the tubercle; if so, we should have tubercles all over the community every day—I very much doubt whether death would be accelerated by this treatment—the course of the malady is continuous and universally fatal—the bath did not produce any injury to the head, which is the chief seat of the malady—the dragging of the limbs would not increase inflammation of the brain, though in this case it was much to be deplored dragging the poor thing to the bath; but I doubt of its doing anything to the brain itself—it would subject her to dreadful suffering, I should think, as far as she was conscious—such people are not so alive as people who are well, I mean alive to suffering, not perfectly conscious—supposing the excitement or the shock of the bath had caused inflammation to set in, I should have expected to find an alteration in temperature; there was, however, no rise in temperature for two days after the bath, at least as appears from this report—four days after the bath there is no more rise in the temperature than half a degree—that does
See original (http://www.oldbaileyonline.org/images.jsp?doc=188008030139) http://www.oldbaileyonline.org/i/genericThumb.jpg (http://www.oldbaileyonline.org/images.jsp?doc=188008030139)
not lead me to the conclusion that the bath did not cause anything; it had not much to do with it—then, again, the bath could not in the nature of the case do it—you might batter a person about the head, and set up inflammation of the brain; but taking a bath would not, for remember this woman had not active disease in the lung—the evidence shows that the disease in the lung was quite latent, inactive—the yellow tubercle presses on the brain, but the transparent tubercle does not much—if the bath had been cold I do not think it would have caused inflammation of the brain—we put ice to the head in inflammation of the brain to check it.
Cross-examined by MR. POLAND. We do not put ice to the feet and body to drive the blood to the head; we do not drive the blood to the head at all; we put it to the head—supposing this woman's head was not in the cold, but her body and legs in the cold, and she was kept for half an hour or more shivering in the cold, that would have a tendency to interfere with the circulation, but will you tell me what cold you mean?—this woman had brain disease, and they are given to shivering—supposing I found that she did not shiver at all till she had the bath, and that she did shiver afterwards, even that would not be a fair inference that the cold caused the shivering and not disease of the brain—it might be the first shivering—this shivering might fairly be considered the first symptom of brain disease—I mean it might be a nervous shivering—it might have been the first shivering of brain disease—a sense of cold often goes with real heat—with great care a person may have a bath and be washed, with disease of the brain, without doing any serious injury—I should think with brain disease the woman ought not to be put into a chair, but I should think it might be done without any injurious effects—I should not do it—it is not possible to tell when tubercle commences—you may suspect from the symptoms—I will not say that often suspicion is very inaccurate—you judge of the tubercular commencement from the symptoms—the symptoms are equivocal—they are uncertain—we cannot tell with any degree of certainty; we only suspect—the clinical report is a report made by the clinical clerk, who is a student—I sent for it when I read the report of the Coroner's inquest—I sent to the house, not to the Treasurer of the hospital, to Doctor Steele—I read the report in the paper—I had then two reports, the physician's report, which he said was singularly accurate, and this report—you cannot tell positively how long the yellow tubercle existed before the inflammatory symptoms set in; you can only suspect from the symptoms, sickness and headache.
By the COURT. It was in the post-mortem examination I found that there had been tubercular inflammation of the brain, and if I could go back and have a record of the symptoms attending the patient during her lifetime for six weeks or two months, and obtain an accurate account of the symptoms, I then should be able to say, "I put my finger upon that day"—perhaps not that day, but that time—you find one symptom one day, and that joined with something else the next, and I should say that at that time the mischief was commencing—until the acute symptoms show themselves you cannot say with certainty there are tubercles—when on the post-mortem examination it was discovered that yellow tubercles existed during lifetime on the brain, and in that way caused death, then you might trace back and get the origin of it.
By MR. POLAND. You cannot trace back to any particular time with
See original (http://www.oldbaileyonline.org/images.jsp?doc=188008030140) http://www.oldbaileyonline.org/i/genericThumb.jpg (http://www.oldbaileyonline.org/images.jsp?doc=188008030140)
great accuracy—the common time after the inflammatory grey tubercles set in till death followed would be about fourteen days—they remain quiescent; I will not say for a long time; we have no evidence of a long time—the best judge of the state of the patient ought to be the physician who sees the patient from day to day—a person who knows the case from the commencement at the hospital, and sees it from time to time, and watches it, and attends to it as the physician, no doubt ought to be the best judge of the state of the patient—his eye can descry the difference in the patient on the one day between what is done in that case, and what is alleged afterwards—in this case I should certainly put my judgment against the judgment of the physician who attended the case from the commencement; and I will tell you the ground of it; upon the students' report I would put my opinion against that of Dr. Pavy—the physician governs the students' report—his duty is to see it—I am not assuming that it is the same as if it was made by the physician himself; but I was a physician of Guy's for 20 years and my clinical reports were my own reports—I always dictated the report myself.
Re-examined. In this case I put my judgment against that of the physician who attended to the case; because, when I read the report, I found there was headache, nausea, sickness, and rise of temperature, and all the signs of brain disease, and she dies with grey and yellow tubercles of the brain, and I know that these yellow tubercles would not be set up in fourteen days; I did not receive a report from the physician himself from the Coroner's inquest, which the physician said was singularly accurate—I did not find any symptom of hysteria—hysteria was said by the late Sir Benjamin Brodie to be a paralysis of the will, and the duty is to urge and rouse the patient—supposing a woman is suffering from hysteria, or there is reason to believe it, and she thought she could not walk, when in truth she could, trying to get her to exert herself would be the right thing to do—it would be the best thing to do; the late Dr. Jeffe, of Leamington, who had great reputation in cases of hysteria, used to treat it in this way, by taking the girls in his carriage a mile or two from home, and, then turning them out and making them walk home—that was proper treatment.