Letters of Condolence on death of Jane Stanford, 1905

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Testimony of Dr. Waterhouse

Question. Considering the symptoms, without regard to the fact that strychnine was found to be present in the contents of the intestine, would you be willing to say that Mrs Stanford died of strychnine poisoning

Answer. Decidedly not.

In looking over the evidence in regard to the death of Mrs Stanford I fail to find one characteristic symptom of strychnine poisoning. As far as the testimony of the various witnesses goes, no one saw Mrs Stanford in a convulsion or spasm until the spasm just predeeding death. Mrs Stanford, when she walked out into the hall to call Miss Berner & Miss Hunt, did say she was awakened by a spasm which threw her out of bed, and followed this by saying she thought she had been poisoned. Now, this spasm might have been hysteria, or a mild attack of angina pectoris or a sudden start from a dream due to her indigestion, or what not, but she never would have got up and walked out into the hall immiedeatily [sic] after a typical convulsion from strychnine poisoning, and even if she had not got up and walked out into the hall, she would have shown signs of extreme exhaustion. These were entirely absent, only nervous excitement being present. In fact, she did not even want to sit down when Miss Berner wished her to. But laying this aside, if it were strychnine poisoning, there followed

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an interval of some twenty-five minutes during which if she were suffering from strychnine poisoning and had already had one convulsion, she would have been in the highest degree of muscular irritability, the slightest external irritation setting her off into another convulsion, and everything affecting the sensory nerves jarring on the patient. Instead of this, we find that Miss Berner and May Hunt, the maid, were constantly rubbing her, putting her feet in warm water & giving her water to drink, but this did not produce a muscular contraction, nor the sign of a convulsion, nor did she even object to what would set a patient suffering from strychnine poisoning nearly wild, with the single exception of the time when Miss Berner first asked her to take a drink of warm water to make her vomit and then Mrs. Stanford said she could not, because her jaws were rigid. Miss Berner distinctly states that Mrs. Stanford said this was a {regidity} & not a mere queer feeling in the muscles of the jaws such as occasionally comes as a premonitory symptom with other things of strychnine poisoning. Now this is a symptom which in strychnine poisoning usually comes late and only when all the

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rest of the body is in a violent convulsive seizure, which is the classical diagnostic point between strychnine poisoning and lock jaw. She also, according to Miss Berner, said this by opening her mouth and not through closed teeth, and besides this to remedy it Miss Berner rubbed her cheeks "until they were red" which is the very thing which if any of the muscles of the body were rigid already, would have set the patient off into a violent convulsion. Instead of this Miss. Berner gets her to take two glasses of warm water after it. Clearly this was hysteria or at least a nervous symptom. Now, in spite of all this external stimulation, there is not the slightest sign of a convulsion. In the case of strychnine poisoning, surely if there had already been one convulsion, and there was one coming later, the slightest irritation, a draft of air, a bright light, touching the patient, giving the patient water to drink, much more the violent rubbing and putting the feet and hands in warm water, would have set up a violent convulsion with opisthotonos, muscular twitchings.

During all this time Mrs Stanford was either standing or sitting, not very characteristic of strychnine poisoning. And now after this very atypical

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interval for strychnine poisoning comes the only spasm noted by witnesses and we would expect to see in a convulsion sufficiently strong to cause death, twitchings of individual muscles followed by violent tetanic convulsions, with opisthotonos (curving backward in an arch) abdominal muscles hard as a board, chest fixed, face livid, eye balls staring, risus sardonicus, and, when there is a slight let up, a slight stimulus setting up a still more violent convulsive seizure. Instead of this striking picture we find that Mrs. Stanford continues sitting in a chair, the body is not thrown forward, the knees remain flexed, the neck does not become rigid as Miss. Berner states who was standing behind her at the time. But Mrs. Stanford simply grips Miss Berner's hands more tightly, and the muscles of her calf stiffen, and her feet turn in somewhat towards the vessel which is between them into which Mrs. Stanford has attempted to vomit. Then she says Oh! oh! oh! (no contraction around the mouth) and finally Mrs. Stanford's head falls to the side just as Miss. Berner disengages one hand to hold Mrs. Stanford's head from falling.

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Her muscles gradually stiffen but not with the sudden muscular jerking of strychnine poisoning. This is the picture of many deaths which take place in a sitting posture. The very fact that the patient could remain sitting on an ordinary stiff backed chair would almost rule out a convulsion from strychnine poisoning.

The whole history of the case, so far as can be told from the evidence, lacks entirely the exaggerated reflexes and muscular excitability which is so striking a feature of strychnine poisoning during and between the attacks. Of the fact that this undue sensibility of the sensory end organs sending up at the least stimulus are impulse to the cord and a tremendously exaggerated impulse down to a muscle, being the most characteristic, and par excellance the distinguishing feature of strychnine poisoning there is no doubt, not only from clinical experience (the slightest external stimulus setting the patient off into the most marked muscular contractions) but it is also shown by experiments on the lower animals. For