A MEDICAL SURVEY 
OF THE 
TRIAL OF MRS. E. G. WHARTO® 
ON THE CHARGE OF 
Poisoning Gen. W. S- Ketchlw 
S. C. CHEW, M. D., 
PROF. OF MATERIA. MEDIC A AND CLINICAL MEDICINE IN 
THE UNIVERSITY OF MARYLAND, BALTIMORE, MD. 
[From the Richmond and Louisville Med. Journal, July, 1872.] 
The object of the present article is to make a plain state- 
ment of those facts connected with the recent trial at Annapo- 
lis, which are likely to be of interest to the readers of this 
Journal. 
This is a debt which we feel to be due to them, and which we 
propose to discharge in consequence of the ample opportunities 
afforded us for observing every stage of the proceedings. 
For certain reasons we had intended postponing our remarks 
for a later number, but the appearance in the April issue of the 
“American Journal of the Medical Sciences ” of a review of the 
trial, which tends both by its statements and its omissions to 
mislead the mind of the Profession, justifies us, we believe, in 
presenting our view of the case without further delay. 2 
The questions involved in this discussion are of universal 
professional interest, such as may present themselves in the ex- 
perience of any medical man; they are questions of diagnosis, 
of treatment, and, most important of all, of moral duty. 
We shall endeavor to discuss them in a spirit free from pas- 
sion, or from the influence of any personal consideration, but 
with the desire of vindicating the Profession, of defending 
opinions naturally and conscientiously formed, and of throwing 
upon the whole subject the cold, clear light of scientific truth. 
We seek no personal controversy, nor is it our primary object 
to uphold the professional reputation of any individuals who 
have been subjected to misrepresentation and reproach. When 
we consider, however, that in this trial the Profession itself has 
been assailed, its capabilities questioned, its methods of reason- 
ing disparaged, and its claims to accuracy derided, then on the 
ground of simple duty we base the right to defend it, and with 
it those who were guided in their opinions by its legitimate 
methods. 
Both within the Profession and beyond its borders misappre- 
hensions have arisen, from the supposition that different physi- 
cians were led by the same data to opposite conclusions. On 
this account some of the laity have expressed the belief that 
medicine is not at unity with itself on most important issues; 
and certain members of the Profession have too hastily and 
upon insufficient knowledge charged the physicians most nearly 
concerned in the case, with giving an incorrect interpretation 
to facts which they observed. 
An analysis of these facts and of the testimony* will show 
the true explanation of the difference to be this; that opinions 
on the one side were based upon direct personal observation, 
while on the other they accorded with a theory which was the 
offspring of imperfect acquaintance with the case. 
In the discussion of this subject our opinions might be eluci- 
dated and strengthened by many facts that could be fairly ad- 
* Our extracts from the testimony are taken mainly from the Report of the 
Trial published by the “ Baltimore Gazette,” and in some instances from the 
Report of the “ Baltimore American.” 3 
duced as a part of the history of the case. But we prefer to 
waive as far as possible all such aid, and to take the same stand 
upon strictly technical grounds of diagnosis before our readers, 
that the physicians examined as witnesses were required to as- 
sume before the jury. This seems the fairest course, and the 
one most worthy of the spirit in which all scientific discussions 
should be conducted. Circumstantial evidence will therefore 
be adverted to as briefly as possible, nor will reference be made 
to the train of facts which were alleged to indicate a motive for 
the commission of the crime. 
The question of guilt or innocence is entirely beyond our 
province, and one more fitted for the “ dusky purlieus of the 
law,” than for the templa serrena of science. 
Investigating the case therefore as a medical problem, we 
shall confine ourselves to its symptoms taken in connection with 
such collateral circumstances as must needs be regarded in any 
question of diagnosis. In professional practice it constantly 
happens that some facts entirely apart from the phenomena of 
a case must be taken into account; for they are as legitimate 
elements in the formation of an opinion as any presented by 
the physical condition of the patient. 
The following is a brief statement of the case which gave 
rise to the trial: 
On the evening of Saturday, June 24, 1871, General W. S. 
Ketchum came from Washington to Baltimore, and between 8 
and 9 o’clock took supper with the family at whose house he 
was staying, partaking of coffee, bread and butter, cold ham, 
and raspberries. 
About 11 o’clock he retired, and during the night suffered 
apparently from cholera morbus, which compelled him to leave 
his room. On the following morning he arose, dressed and 
went out, but soon returned, complaining of feeling still unwell, 
and consequently remained in his room until the hour for tea, 
between 8 and 9 o’clock, when he took a glass of lemonade with 
brandy in it. During the night symptoms of cholera morbus 
recurred, causing him to leave his room again. On the next 
day, Monday, he suffered with nausea, which increased to such 4 
a degree that about 4 P. M., Dr. P. C. Williams was summoned 
to visit him, and found him much prostrated, with a cool clam- 
my skin, a rapid and feeble pulse, and vomiting repeatedly. 
He was directed to take two drops of creasote with half an 
ounce of lime water every two hours, which relieved him. 
On Tuesday at 10 A. M. he was again visited by his physi- 
cian, to whom he stated that he was well enough to return to 
Washington, and would go that day. He did not go, however, 
and in the evening was heard to vomit violently, shortly after 
taking some porter or brown stout. 
On Wednesday at 10 A. M. he was found by Dr. Williams in 
a semi-comatose state, imperfectly conscious, with a clammy skin 
and a feeble pulse; the face livid, the pupils natural in size but 
insensitive to light; the muscles of the neck, back and lower 
extremities were rigid. A slight tremor passed over him when 
touched. When asked in a loud tone how he felt, he replied, 
“ tolerably,” and relapsed into a drowsy state. The urinenvas 
tested and found free from albumen. 
About 11 A. M. 40 drops of tinct. of gelseminum were ad- 
ministered, which had the effect of diminishing the congestion 
of the face. At five minutes before 1 o’clock a dose containing 
two tablespoonsful of liquid was administered, and in fifteen 
minutes tetanic convulsions ensued; the jaws were firmly 
clenched, and the surface of the throat and abdomen was 
abraded with the finger nails. At 2 P. M. a moderate quantity 
of chloroform was given by inhalation. In answer to a ques- 
tion, as to the seat of pain, addressed to him at this time, he 
said, “ in my stomach.” Half an hour later, 30 grains of hy- 
drate of chloral were administered without arresting the con- 
vulsions, which increased in violence until his death at 3 o’clock 
P. M. 
On post-mortem examination, patches of redness indicative 
of irritation were found at various parts of the intestines. The 
lungs, heart, liver, kidneys, and spleen were healthy; some 
degree of passive congestion of the pia mater was observed, but 
no further abnormal appearance, no effusion of lymph or fluid 
being found in the ventricles or upon the membranes of the 5 
brain. The upper part of the spinal cord was also examined 
to the extent of two inches, and found free from disease, except- 
ing slight passive congestion. 
The single question with which medicine was here concerned, 
was, whether the diagnostic points of the case were sufficiently 
clear and well defined to furnish ground for the opinion that 
death resulted from causes other than natural. It is, of course, 
freely admitted that to justify this opinion, something more 
was necessary than the exclusion of all definitely known 
diseases; otherwise the argument would be based upon the 
faulty premise that there are no conditions of natural dis- 
ease except those which have been fully defined and de- 
scribed. 
Besides excluding known diseases, it was necessary therefore 
in maintaining the opinion that death resulted from the pres- 
ence of poison in the system, to show a resemblance between 
the symptoms of the case, and those which are known to be 
produced by poisonous agents. If this could be done, then the 
combination of negative and positive evidence would warrant 
the opinion upon strictly medical grounds that death was due 
to poison. 
We do not use the word opinion here as synonymous with a 
definite conclusion; for that, something more was necessary. 
“ Opinion,” says Sir Matthew Hale, “ is, when the assent of the 
understanding is so far gained by evidence of probability, that 
it rather inclines to one persuasion than to another, yet not 
altogether without a mixture of uncertainty or doubting.” But 
that which, upon medical grounds, was only an opinion—suffi- 
cient, albeit, to justify and to demand chemical investigation— 
would become an assured conviction, if chemistry should es- 
tablish the presence of a poisonous substance. Assuming the 
chemical evidence to be correct, a perfect example would be 
here afforded of the accuracy which medical reasoning can at- 
tain unto; an exact science setting upon its opinions the seal of 
certainty, and proving them ineontrovertibly true. The cor- 
rectness of this chemical evidence will 'be the subject of inquiry 
hereafter. 6 
The medical opinion thus formed independently of the chem- 
ical evidence was the study of two series of phenomena, the 
first consisting of the symptoms presented during life; the 
second, of the post-mortem revelations. 
Neither of these series by itself could establish this opinion ; 
but taken in connection with each other, they justified it fully. 
Some symptoms in the case might have suggested various dis- 
eases, which, had they existed, would have left lesions discover- 
able after death; and, on the other hand, the absence of post- 
mortem changes is characteristic of some affections, which, 
however, were excluded, because the symptoms did not corre- 
spond with them. This argument, by exclusion, was challenged 
by the counsel for the defence, and has since been faulted by a 
medical expert employed by them,* as fallacious and illogical. 
We maintain that as a reasoning process, it is unassailable, and 
that to doubt its force indicates either ignorance of the first 
elements of logic, or a wilful attempt to discredit fair argument. 
The former alternative none will admit who know the acute- 
ness and ingenuity which were exhibited in the conduct of the 
defence. 
Professor John J. Reese, in his “ Review of the Trial,” quotes 
Professors Miles and Chew as testifying that, while they could 
not ascribe the death to a non-natural cause, either from the 
symptoms alone, or the post-mortem alone, it was nevertheless 
their opinion, judging from both combined, “ that he did not 
die from natural causesand he asks the question : “ Is the 
above a logical conclusion ? ” We reply that it is logical to the 
very strictest requirements of logic, as must be evident to any 
one desirous of seeing and presenting the truth. 
But what must be thought of Professor Reese’s handling of 
Professor Donaldson’s testimony upon the same point ? This 
witness had stated that the 11 preceding history of the case, and the 
absence of the characteristic post-mortem lesions, precludes 
the idea of cerebro-spinal meningitis; ” but Professor Reese 
* See Review of the Trial by John J. Reese, M. D., Professor of Medical Ju- 
risprudence and Toxicology in the University of Pennsylvania. Amer. Jour. 
Med. Sciences, April, 18T2, p. 336. 7 
makes the argument appear inconclusive by deliberately omit- 
ting the words “ the preceding history of the case.” 
Again, Professor Reese states that Dr. Donaldson in enumer- 
ating the symptoms of tartar-emetic poisoning as reported by 
authors, “ makes no mention of the most prominent ones—viz., 
vomiting, purging, extreme relaxation, insensibility of the skin, 
and increase in the urinary secretion.” Turning to the same 
report of Professor Donaldson’s testimony, to which Prof. Reese 
referred, we find that he used these words, “ they speak of 
violent vomiting, purging, and disturbance of the cerebral func- 
tions.” By what words is such manipulation of testimony to 
be characterized ? 
The medical witnesses for the State, in response to a direct 
question, expressed the opinion that the death resulted from 
causes other than natural. 
This opinion was opposed by experts upon the other side on 
the ground that it was not supported either by the medical 
facts or by the chemical analysis. 
Two distinct questions are thus presented for consideration, 
the one medical, the other chemical: 
First. Did the symptoms presented during life, taken in con- 
nection with the post-mortem revelations, indicate a natural 
cause of death ? 
Secondly. If the former question be answered in the negative, 
was the cause of death poisoning by tartar-emetic ? 
The discussion of the first question may be kept within nar- 
row limits. 
Two of the medical witnesses for the defence expressed a 
decided belief that the cause of death was cerebro-spinal men- 
ingitis. 
Professor Edward Warren testifies, “ the case of General 
Ketchum illustrates nothing more nor less than a typical exam- 
ple of that form of cerebrospinal fever, to which the name 
fulminant has been so aptly given.” 
Dr. John R. McClurg testified upon the hypothetical case 
offered by the defence, “ I have no hesitation in saying that 
death was the result of natural causes i it reserqhles, undopbtr 8 
edly, cerebro-spinal meningitis more particularly than any other 
disease.” “ The symptoms are apparently of the same disease ; 
all are due to cerebro-spinal meningitis.” 
The other witnesses for the defence, without committing 
themselves absolutely to this view of the case, advanced no 
other opinion. So far as the medical question was concerned, 
they spoke of cerebro-spinal meningitis as among the possible 
causes of death. 
Professor Beese testified, “ I do not wish to be understood as 
asserting that General Ketchum died of cerebro-spinal menin- 
gitis. I think the cause of his death obscure; but the absence 
of certain pathological lesions would indicate that he died from 
that disease.” 
Dr. John Morris, of Baltimore, testifying to the hypothetical 
case, said: “ I see nothing to exclude the theory of death from 
a natural cause ; but at the same time, I cannot venture to say 
what that natural cause was.” 
Professor Harvey L. Byrd, of the Washington University, 
Baltimore, testifying also to the same case, said: “ In some of 
its features it resembles the disease known as cerebro-spinal 
meningitis; taken as a whole, however, it bears no identity to 
any disease with which I am acquainted; the symptoms in the 
hypothetical statement are not sufficiently connected to enable 
me to decide that it was a case of cerebro-spinal meningitis.” 
Others expressed opinions to the same effect, and some dis- 
sented from the view that tartar-emetic was the fatal agent, on 
the ground that the symptoms did not correspond with the 
effects of that substance. 
We shall show that such an assertion must have been due 
either to want of knowledge of the history of the case, or to 
imperfect acquaintance with the records of toxicology. 
It is not incumbent, therefore, upon those who take the State’s 
view of the case, to disprove the existence of any other disease 
than cerebro-spinal meningitis; for none other was affirmed to 
exist. 
Was cerebro-spinal meningitis present ? 
In support of this theory several circumstances were appealed 9 
to. The first of these was the alleged existence of an epidemic 
of the disease in Baltimore. In reference to this it need only 
be said that the records of the Health Department of the Mu- 
nicipal Government of this city show not one single death from 
this malady in 1870 or 1871. Now, granting that there may 
be some inaccuracies in the management of this department, (as 
doubtless is the case in all other cities), and granting also that 
some cases of the disease have occurred, it is yet certain that 
there could have been no such epidemic of cerebro-spinal men- 
ingitis as would involve a liability to be attacked by the disease 
within a few hours of one’s arrival in the city.. No evidence 
was offered of any case of the disease having occurred within 
half a mile of the house in which Gen. Ketchum died; and 
even had there been an unquestionable epidemic in that section 
of the city, it is utterly unreasonable to suppose that the disease 
would have been developed so speedily after entering the 
infected district. Professor Stille has shown that troops sta- 
tioned in a region of country where the malady was prevailing, 
have entirely escaped its attack.* 
We maintain, therefore, that epidemic prevalence of this 
affection cannot rightfully be adduced as an argument in sup- 
port of the theory of the defence. Secondly, hypersesthesia of 
the skin was dwelt upon, as a symptom of the case indicative of 
cerebro-spinal meningitis. It is, no doubt, common enough in 
this disease, but we look in vain for any evidence of it in Gen. 
K.’s case. 
Dr. Williams had stated that on laying his hand upon his 
patient’s shoulder, a slight convulsive tremor passed over the 
whole body, which, however, did not occur again, even when 
the General was repeatedly shaken ; nor was there afterwards 
the least sign of exalted sensitiveness when he was moved and 
his hands were rubbed. Such evidence of agitation is not at 
all unusual in one who has been suddenly aroused, but is widely 
different from true hypermsthesia, showing itself by painful re- 
sponse to every touch. And yet this slight convulsive tremor 
seems the only reason for the supposition that hyperaesthesia 
* Treatise on Cerebro-Spinal Meningitis, p. 96. 10 
existed, and it was regarded as an essential point in the diag- 
nosis. “ No fact in this case, said Professor Warren in his tes- 
timony, “except that Dr. Williams found that a shiver passed 
over General Ketchum, when he touched him, brought me to 
the opinion that he had hypersesthesia ”; “ the tremor observed 
was a sufficient indication to my mind of the presence of hy- 
persesthesia.” 
Thirdly. Suppression and retention of urine were referred to 
as criteria of cerebro-spinal meningitis. The existence of these 
symptoms seems to be assumed without evidence. Previously 
to Dr. Williams’ second visit on Wednesday some urine had 
been passed, and sent out of the room.* At the second visit 
the introduction of a catheter showed the presence of a suffi- 
cient amount of healthy urine to make it certain that the kid- 
neys were properly performing their function. The fact that a 
certain quantity of the secretion had been passed earlier in the 
day, proves that there was no retention; the fact that a consid- 
erable amount was subsequently drawn off by the catheter, 
proves with equal certainty that there was no suppression. Yet 
the share which these alleged symptoms bore in the construc- 
tion of the theory of cerebro-spinal meningitis, is shown by 
Professor Warren’s words, “the fact that there was suppres- 
sion of the urine furnishes the data for an exact discrimination 
between the malady of which he actually died and the antimo- 
nial poisoning to which it is alleged that he succumbed.” Or, 
as it is reported in the “Baltimore American,” “the suppression 
and retention of urine show that it was cerebro-spinal menin- 
gitis; this furnishes me the culminating symptom, and proves 
cerebro-spinal meningitis.” Thus the culminating diagnostic 
sign is shown to be entirely unsupported by evidence. 
It may be well to remark in this connection that albuminuria 
is an extremely common symptom, and, according to Dr. Rad- 
cliffe,t is “ perhaps invariably present ” in the fulminant form 
of cerebro-spinal meningitis, of which it was argued that Gene- 
ral Ketclium died; and that the examination of the urine 
showed not the slightest trace of it. 
* See Report in the “ Baltimore American.” 
f See Reynolds’ System of Medicine, vol. ii., p. 684, edition 1868. 11 
Fourthly. Headache was appealed to as another sign of 
cerebro spinal meningitis. Let us examine Professor Reese’s 
testimony upon this point, to show how small a foundation the 
alleged symptom rests upon. Drawing a comparison between 
General Ketchum’s case and one he had himself attended, 
and regarded as cerebro-spinal meningitis, this witness stated, 
“ the symptoms were very similar to those of General Ketchum, 
viz., violent pain in the head and back,” etc. 
But what reason there was for importing headache into the 
account of General Ketchum’s case, let Professor Reese’s owm 
words tell; “ I do not remember that it was here testified that he 
had a headache ; I got a decided impression that he had a head- 
ache from his putting his hands to his head, the throwing back 
of his head. He might, however, have put his hands to his 
head because of the pain caused by the ice-bag.” 
An examination of the record shows no testimony whatever 
in proof of this symptom, which was simply assumed on utterly 
insufficient grounds. 
But in addition to these positive symptoms, a circumstance of 
a negative character was also referred to in support of the same 
theory. It was argued that the absence of pathological changes 
vras another indication of cerebro-spinal meningitis. “ In 
order to complete the picture,” said Professor Warren, “ and 
make the description perfect, it is necessary to add that the 
post-mortem examination gave negative results, or nearly so'.”* 
We would merely ask in this connection wdiether the picture 
would have been less complete, and the description less perfect, 
if inflammatory changes in the membranes of the brain and 
cord had been present instead of absent? The question carries 
its own answer, and yet absence of inflammatory changes in a 
tissue is gravely referred to as a crowning proof of the pres- 
ence of inflammation therein. It is true no doubt that cases of 
the fulminant form of cerebro-spinal meningitis some times ter- 
minate fatally at an early period, before time has elapsed for the 
occurrence of coarse changes perceptible to the unaided eye. 
But the irrelevancy of this foot, at applied to the case in ques- 
* See report in “ Baltimore American.” tion, is seen, when it is stated that the membranes of the brain 
and upper part of the cord of General Ketchum were subjected 
to a most careful examination with the microscope, and found 
to be entirely free from lesion. Professor Miles, an accom- 
plished microscopist, whose preparations of these tissues were 
examined by Dr. Williams, and the present writer also, could 
find in them not the least evidence of incipient inflammatory 
changes. 
Several authorities speak of the occasional absence of lymph 
and pus after death from cerebro-spinal meningitis; but we 
have yet to find one who states as the result of microscopic 
investigation that the membranes of the brain and cord were 
free from all traces of disease. 
Dr. Radcliffe, in his article upon the subject in “ Reynolds’ 
System of Medicine,” mentions as the “ essential anatomical 
characteristics of the disease, hyperaesmia of the pia mater of 
the brain and spinal cord, with more or less copious subarach- 
noid and interstitial effusion into the meshes of the congested pia 
mater. ... In fatal cases of the simple and purpuric forms, 
the characteristic anatomical lesions are almost invariably found. 
In the fulminant form of the disease they are often absent.” 
They, that is, the characteristic lesions above enumerated, are 
often absent; but it is nowhere stated that there is an absence of 
such changes as the microscope can show. 
Referring to the observations of Dr. Woodward upon the 
pathology of cerebro-spinal meningitis, quoted in “Aitken’s 
Science and Practice of Medicine,” Professor Warren remarked, 
that “ Dr. Woodward is the best microscopist in the world, and 
has made more discoveries with the microscope than any other 
person.” We admit Dr. Woodward’s proficiency as a micro- 
scopist, but inasmuch as in the passage referred to, he gives 
merely the recorded observations of others, without reference to 
the microscope, we do not see that his microscopical knowledge 
has any bearing upon the case in question. If cerebro-spinal 
meningitis have really existed, then, although death may have 
occurred too speedily for the formation of coarse structural 
lesions, yet we believe the microscope would surely bring to 
light the incipient traces of such lesions. 13 
In support of this opinion, we refer to the Treatise of Dr. 
Bosenthal, of Vienna, upon “ Diseases of the Nervous System,” 
one of the ablest and most recent works upon the subject, 
which, however, has not yet been translated into English. In 
the section devoted to cerebro-spinal meningitis, after mention- 
ing the various epidemics of the disease that have prevailed in 
Europe and the United States, he thus speaks of its pathology: 
“The true seat of purulent meningitis is the pia mater; in 
quite recent cases this appears merely injected; at later periods, 
on the other hand, it is dim, lustreless, and covered with a 
gelatinous, transparent exudation*” 
Perceptible active congestion is thus regarded as a constant 
result, which may, or may not, according to the duration of the 
case, be followed by the products of inflammation. 
We have now seen that the prominent symptoms appealed to 
as indicating cerebro-spinal meningitis had absolutely no exist- 
ence at all; what becomes ihen of the opinions founded upon 
their alleged presence ? 
The story is told of Cuivier, we believe, that when the crab 
was spoken of as a red fish that walks backwards, he replied, 
“ the description is admirably correct, with the slight defects, 
however, that the crab is not red, it is not a fish, and it does 
not walk backwards.” So it must b$ remarked that the resem- 
blance to cerebro-spinal meningitis as shown in the case under 
discussion by cutaneous hyperaesthesia, suppression and reten- 
tion of urine, and headache, is somewhat marred by the facts 
that there was no hyperaesthesia, there was no suppression or 
retention of urine, and there was no headache. 
Its supports thus demolished, the whole structure wrought 
with such elaborate detail, proves to be “the baseless fabric of 
a vision.” 
Certain other clinical phenomena, referable to the nervous 
system, were mentioned in illustration of the theory of the 
defence, such as rigidity of the muscles of the neck and convul- 
sive movements of a tetanic character. Depending upon dis- 
turbed innervation, they are met with in cerebro-spinal menin- 
gitis, but are by no means characteristic of that disease. That 14 
they occasionally occur in the clinical history of tartar-emetic 
poisoning is abundantly evident; and that the possibility of a 
superficial examiner mistaking them for signs of idiopathic 
cerebro-spinal disease is shown by an interesting passage in 
“ Virchow’s Pathology and Therapeutics,” edition of 1855, in 
which he speaks of cerebro-spinal affections resulting from the 
use of tartarized antimony, and even terms the condition cerebro- 
spinal stibism; the word being derived from stibium, anti- 
mony. 
But again, the State’s view of the case was objected to by 
certain of the medical experts for the defence, on. the ground 
that neither the symptoms nor the post-mortem appearances 
corresponded with those of poisoning. 
Professor Warren testified, “ the action of tartar-emetic can 
not account for the phenomena observed in this case, either for 
the symptoms or the pathological revelations.” 
In the testimony of Professor Beese, we find the following 
statement: “ Neither the symptoms nor post-mortem revelations 
present to my mind an indication of tartar-emetic poisoning ; 
the post-mortem signs are not such as I should expect to find in 
a case of tartar-emetic poisoning, chiefly for the absence of 
signs of decided inflammation in the stomach and the alimentary 
canal.” 
But when cross-examined, the same witness admits that “ in 
cases of tartar-emetic poisoning, there may be no signs of 
irritation in the intestines and alimentary canal.” Now, if this 
latter assertion be true, as it undoubtedly is, how can the 
absence of these signs be regarded as in any degree excluding 
tartar-emetic as the cause of death ? In fact, the objection, 
whatever it be worth, is fully answered by this very admission. 
While it is true that tartar-emetic in poisonous quantities 
generally causes muscular relaxation, it is yet equally certain 
that through an influence on the nervous centres it sometimes 
occasions rigidity and convulsions. 
Taylor refers in his work on Poisons to a case in which four 
grains of tartar-emetic were followed by strong convulsions, 
lasting for half an hour. In another case, reported by the 15 
same author, a man twenty-eight years of age took, by accident, 
two grains of tartar-emetic, and suffered with a constant spas- 
modic contraction of all the muscles, especially of the abdomen 
and upper extremities. 
“Among the phenomena of poisoning by tartar-emetic,” says 
Professor Stille, in his work on Materia Medica,* “ is rigidity 
of the muscles of the neck, jaws, abdomen, and extremities.” 
And Professor Wood, in his Therapeutics,! states that under 
the influence of the same drug “ convulsive movements are 
sometimes induced.” Therefore the absence of muscular relax- 
ation cannot be urged in disproof of the action of tartar-emetic. 
On the other hand, while it is true that an agent possessing 
the irritant properties of tartar-emetic will often leave signs of 
its local action, yet to this are by no means rare. 
The experiments of Buyer, says Christison,J “show that 
death may occur from tartar-emetic without inflammation being 
excited anywhere. Professor Stills refers to a case in which 
two grains given to an adult proved fatal after producing vio- 
lent symptoms; no lesion of the stomach was found after death.” 
Professor Wormley mentions a case in which death was caused 
by vomiting and purging occasioned by an unknown quantity 
of antimony; “ thirty-nine hours after death there were no 
well-marked morbid appearances in any of the abdominal 
organs.” Therefore the absence of conspicuous post-mortem 
traces cannot be regarded as excluding tartar-emetic. 
So far we have been discussing the medical aspect of the 
case. In concluding this portion of the subject, we contend 
that the characteristic symptoms of cerebro-spinal meningitis 
were not present; and that such prominent points in the his- 
tory of the case as vomiting and purging present at one time 
and subsequently absent; pain in the stomach, rigidity of the 
muscles, convulsions, and ultimately post-mortem results nearly 
negative in character, are compatible with and are best ex- 
plained by the presence and action of a poisonous substance. 
What was that substance? Medical investigation alone could 
* Vol ii., p. 372. f Vol ii., p. 62. J Work on Poisons, vol. i., 371. 16 
not determine this; and we have therefore to examine next the 
chemical question involved. We shall do so briefly, because the 
fallacy of the position taken by the defence is readily exposed 
Avoiding as far as possible all minute details, the chemical 
facts of the case are these. Professor Aikin, to whom the 
analysis of the contents of General Ketchum’s stomach was 
committed, had by the application of certain tests detected, as 
he testified, the presence of antimony. In the endeavor to 
throw doubt upon the results of his examination, the chemical 
experts for the defence showed certain reactions obtained from 
a combination of substances alleged to represent the contents of 
the stomach. They argued that inasmuch as results similar to 
Professor Aikin’s had been gotten by tests like his from matter 
containing no antimony, therefore his own conclusions as to the 
presence of antimony were vitiated. A perfectly just argu- 
ment, had the premises been true; we shall show that they were 
false. 
Professor R. S. McCulloch, of the Washington-Lee Univer- 
sity, produced in court a bottle containing a mixture of chloral 
and tincture of yellow jasmine, medicines, it will be remem- 
bered, which had been administered to General Ketchum. To 
this he added what, according to his statement, Professor Aikin 
had added to the contents of the stomach—viz., tartaric acid 
neutralized by bi-carbonate of soda. Putting a part of this 
fluid in a test-tube, he poured upon it a few drops of hydrosul- 
phate of ammonia. A color reaction took place, which was 
represented as similar to what Professor Aikin had attributed 
to the formation of sulphide of antimony. On inspection, how- 
ever, it was evident that in Professor McCulloch’s experiment 
the change in color really took place in the supernatant liquid, 
and not in the precipitate, and that this bore no resemblance to 
the antimonial precipitate. This was much more apparent on 
the following day, when Professor McCulloch’s tube being 
brought into court, and placed beside one containing a true an- 
timonial precipitate, the appearance of the two was striking, 
not from their resemblance, but from their violent contrast. 
The precipitate obtained by Professor McCulloch was on this 17 
day shown to Dr. Genth, a chemist summoned by the defence, 
who stated that “it did not, so far as he knew, resemble that 
from tartar-emetic.” And two days later, when a phial con- 
taining Professor McCulloch’s precipitate, and one containing 
an antimonial precipitate were held up in court, Professor Beese 
stated that “ they were not now identical in color.” 
The whole exhibition was indeed more suggestive of legerde- 
main than a scientific procedure. In feats of slight-of-hand 
advantage is taken of distance from the eye, whereas in this 
piece of forensic jugglery the element of time was counted 
upon, the “jest’s prosperity” depending upon the chance that 
the glass might not be kept. 
But a still graver charge must be brought against the chem- 
ical experts .for the defence. It was of course essential to the 
fairness of any comparative experiments, that in both cases the 
same reagents should be used, and the same conditions complied 
with in all respects. 
To show the presence of antimony in a solution containing it, 
sulphuretted hydrogen is first added, which produces an orange- 
red sulphide of antimony; the precipitate thus formed is dis- 
solved in boiling hydrochloric acid; this solution dropped into 
water gives a white precipitate, and if this white precipitate be 
tested with sulphide of ammonium, the orange-red color will 
reappear. Professor McCulloch affirmed that he had applied 
these reagents (using, however, cold instead of boiling hydro- 
chloric acid) to his chloral and jasmine solution, and had gotten 
results similar to those obtained by Professor Aikin. What his 
notion of resemblance in color reaction was, we have already 
seen. But at this point he stopped short, and deliberately 
omitted to apply a further test which was used by Professor 
Aikin, and regarded by him as furnishing additional proof of 
the presence of antimony. The white precipitate obtained by 
dropping the hydrochloric acid solution into water, if antimo- 
nial, is soluble in tartaric add. Professor Aikin testified that 
he had added tartaric acid, and found the precipitate soluble 
therein; “ that completed all that was needed to satisfy me that 
I had been dealing with a preparation of antimony.” 18 
But Professor McCulloch, when subjected to a cross-exami- 
nation, made this admission: “ I did not undertake to dissolve 
that white cloud with tartaric acid; in one of Dr. Aikin’s ex- 
periments he dissolved the white cloud with tartaric acid; the 
white cloud thrown down by antimony dissolves in tartaric 
acid”; and again “it is a characteristic test to dissolve an an- 
timonial in tartaric acid.”* 
Professor Reese, when examined in reference to the same 
omission, testified :f “ I did not dissolve the white cloud from 
gelseminum in tartaric acid ; that is one of the tests for anti- 
mony. I do not know why it was not done.” I saw these ex- 
periments proceed up to the white cloud.” 
The Attorney-General here asked, “Why did you stop 
there?” to which the witness replied, “ I do not know; you will 
have to put Professor McCulloch on the stand in regard to that.” 
But this was hardly necessary; for it is difficult to conceive a 
more complete abandonment of a position than is shown by 
Professor McCulloch’s testimony upon this point. After starting 
out with the bold assertion that the tests used by Professor 
Aikin were not sufficient to establish the presence of antimony, 
he was obliged, under a stringent cross-examination, to acknowl- 
edge that Professor Aikin had applied the proper test, and had 
gotten a result characteristic of that metal. In other words, 
his testimony on this point confirmed the State’s position. 
The question left by Professors McCulloch and Reese at a 
critical moment in an interesting state of uncertainty, was sub- 
sequently settled by Prolessor Aikin, who, when called as a re- 
butting witness, testified, “ that the white cloud when it was ob- 
tained from the contents of the stomach, and treated with tar- 
taric acid, totally dissolved; the white cloud from chloral and 
gelseminum would not dissolve at all when treated with tartaric 
acid.” 
The conclusion reached by Professor Aikin was corroborated 
by Dr. Craig, the chemist in charge of the laboratory of the 
Surgeon-General’s office in Washington, who testified in regard 
* See Report in “ Baltimore American,” 
f Report in “Baltimore American.” 19 
to Professor Aikin’s written report, “ no other substance known 
to science except antimony would, under the tests here de- 
scribed, have given the result.” 
At the second exhumation of the body, undertaken by direc- 
tion of the law-officers of the State, the liver was obtained for 
the purpose of ascertaining whether the antimony had been ab- 
sorbed. It was examined by Professor Tonry, who applied 
Marsh’s test in the earlier part of his analysis, and obtained 
spots indicative of either antimony or arsenic. Farther analy- 
sis proved them to be antimony. The amount was small, for in 
consequence of the ready solubility of antimony its elimination 
from the system is rapid, as shown by Orfila and other chemists. 
For this reason, authorities who urge the importance of pro- 
ducing arsenic in the metallic form, do not make the same re- 
quirement in regard to antimony. The spots, however, were 
produced, and it was necessary to explain their production. 
A certain Dr. Caius once asked the natural question: “What 
shall the honest man do in my closet?” With similar perti- 
nency the question might be put, How did these spots happen 
to be formed ? 
The chemists for the defence found a happy solution of the 
difficulty by referring them to impurities in the materials em- 
ployed in the analysis; and thus tried to vindicate their honest 
presence. To our apprehension, their correspondence with pre- 
vious chemical results obtained by the use of other materials, 
is far too striking to admit of any such explanation. 
The final stage of Professor Tonry’s analysis, which resulted 
in the reduction of metallic antimony, was not completed in 
time to be allowed as evidence. Inasmuch, however, as it was 
openly announced, though in the absence of the jury, and thus 
became a part of the scientific record of the case, we have no 
hesitation in stating that the metal was brought into court, and 
held ready for exhibition to the jury and to the experts for the 
defence. We mention this fact for whatever additional weight 
it may give to chemical results already conclusive. 
In the former part of this article the opinion ascribing the 20 
death to poison was stated to have been founded on medical 
reasoning. This opinion was confirmed by the results of chem- 
ical investigation, which, as has been seen, showed unmistakably 
the presence of antimony in the stomach and liver of the 
deceased. 
Professor Reese, in his comment upon the trial, remarks :* 
u All we desire to insist upon here is the very strong presump- 
tion that the medical testimony of the State was materially 
influenced by the assumption of the actual discovery of tartar- 
emetic in the body of Gen. Ivetchum by the chemical analysis.” 
Now, it is clear from the evidence that this presumption is 
unfounded, because the medical opinion formed, as already 
stated, suggested in the first instance the necessity for a chemi- 
cal examination. Professor Reese is in error, both logically 
and chronologically—logically, in confounding a cause with an 
effect; and chronologically, in not remembering that the expres- 
sion of the medical opinion antedates the chemical analysis. 
An examination of the testimony would have prevented him 
from falling into this latter error, and from intimating that the 
idea of poison “ entered the mind of Dr. Williams in conse- 
quence of his being shown a tumbler containing a suspicious 
looking sediment.” 
We would remark here that there was nothing very suspi- 
cious in the look, but something exceedingly suspicious in the 
acrid taste of that sediment. Whether or not this gave just 
cause for suspicion, it is certain from the evidence that Dr. 
Williams, before hearing of the tumbler, and solely from obser- 
vation of the symptoms, had remarked to a bystander, “ I fear 
the General has been poisoned.” And accordingly, he testified 
that, after tasting the contents of the tumbler, he returned to 
the room with his doubts changed into a conviction that his 
patient had been poisoned. 
Yet, in the face of this testimony, Prof. Reese, endeavors 
to make it appear that the tumbler first prompted the thought 
of poison. 
* Amer. Jour. Med. Science, April, 1872, p. 352. 21 
Professor Reese alleges that Drs. Williams, Miles, and Chew, 
who made the post-mortem examination, were influenced by the 
strong suspicion of poison. To this, we reply, that it is 
undoubtedly true. Examinations of this kind are not usually 
made, we believe, except upon suspicion. Had they not sus- 
pected poison, they would not have deemed it necessary to make 
the examination; and it was in order to ascertain whether the 
opinion already formed, would be substantiated by pathology 
and chemistry, that their task was undertaken. 
Professor Reese censures these witnesses for “ impropriety in 
conducting a post-mortem examination where there is suspicion 
of death by prison .... without the presence and oversight 
of the legally constituted authority—the coroner.” 
We cannot see what possible effect the presence of the coro- 
ner could have had, except to give publicity to the! affair, when, 
in view of the possibility of negative results, a proper regard 
for all concerned prompted concealment. Had the course Prof. 
Reese deems proper been followed, it would surely have been 
censured by some as hasty and inconsiderate. The coroner, 
had he been summoned, would have been obliged to seek just 
such professional knowledge as was applied to the case without 
his offices. 
The second exhumation which occurred during the course of 
the trial, and which Professor Reese characterizes as “ a still 
more glaring departure from propriety,” was effected by the 
law officers of the State, with the understanding that whatever 
its results, they should be made known. It is perfectly obvious 
that these authorities were under no obligation to invite the 
defence to take part in a procedure which at any time could 
have been resorted to independently by the defence itself. 
When Professor Reese asserts that the examination “ was in 
the hands of those who were not entirely devoid of prejudice/' 
meaning thereby, if words mean anything, that their precon- 
ceptions would prevent correct observation, we meet the asper- 
sion with a denial of its truth. Such a charge would be 
unworthy of notice, if suggested by an advocate in the heat of 
an argument before a jury; but when deliberately propounded 22 
by a medical man against fellow-members of the Profession, it 
is so utterly unwarrantable as to cause not only surprise, but 
well-founded indignation. 
A strange inconsistency is betrayed by Professor Reese in 
charging the medical witnesses of the State with being under 
the influence of prejudice, while at the same time he asserts 
that none of them testified that tartar-emetic was the cause of 
death. How is it possible to reconcile these two statements 
with each other ? Does Professor Reese doubt that these wit- 
nesses believed tartar-emetic to be the cause of death ? If, 
then, they are under the influence of prejudice, what better way 
of manifesting their prejudice than by expressing their belief? 
If, on the other hand, believing as they assuredly did, they 
were yet reticent as to their belief and reluctant *to express it, 
then how can he allege that they were acting under the influ- 
ence of prejudice ? His positions are mutually destructive of 
each other. But if he desires to know why reference was not 
made by the State’s witnesses to tartar-emetic as the fatal agent, 
the reason is easily given, and'it is one which, in the judgment 
of all fair-minded persons, should absolutely acquit them of tl*e 
charge of partisanship or prejudice. At no time were they 
questioned by the counsel for the State as to whether they be- 
lieved the death to have been caused by tartar-emetic; and 
they held it to be no part of their duty to advance opinions 
which might injuriously affect the accused. 
We regret being compelled to allude to matters of a personal 
nature, which, as far as possible, we had determined to avoid ;. 
but a word more must be said. 
Aii intimation lurks in the pages of Professor .Reese’s review 
that certain members of the Faculty of the University of 
Maryland were influenced in giving their medical testimony by 
the fact that Professor Aitken was their colleague. This is no 
where openly stated, but it is clearly intimated. A charge of 
such a nature, however faintly suggested, however salved over 
by allusions to “ high character and standing in the Profession,” 
demands notice, that it may be repelled. Were it made openly, 
though not less injurious, it would have been more manly; but 23 
being implied and not expressed, we can but regard it as an in- 
dication of the spirit which is “ willing to wound and yet afraid 
to strike. 
It was stated at the beginning of this paper, that besides the 
questions of diagnosis suggested by the case, considerations of 
a moral nature were also involved in it. Physicians are ordi- 
narily occupied with tasks, the accomplishment of which carried 
with it a large measure of reward. But in circumstances like 
these, the application of professional knowledge which they are 
required by duty, as well as compelled by law to make, engages 
them apparently in strife, and may subject them with unmis- 
takable reality to obloquy and reproach. 
i\.gainst such reflections, however, the proper and the only 
antidote is this: that in whatever sphere medical knowledge 
may be required, there it is our duty honestly and patiently to 
work. 
The medical and chemical facts of this case, and the opinions 
founded thereon, we submit to the judgment of the Profession,