Keep to natural diseases. Did you ever know these symptoms of opisthotonos, in that shape or to that extent, arise from anything but tetanus?--Not within my own experience. I have read of epilepsy being accompanied with tetanic convulsions. Epilepsy, when it assumes that marked character, is accompanied with unconsciousness. I have read in a case of Dr. Marshall Hall’s that sometimes unconsciousness is not present. He does not mention whether death took place in this case or not. That would make all the difference. You said that gritty granules would be likely to produce convulsive diseases. What extent of development, in your judgment, must such granules reach to produce an action in the spinal marrow?--I should say there is no relation between the size of the granules and the extent of the effect produced. Would you expect when they began to get to the size that they would have any effect on the nervous system--that they would begin to show their effect more or less gradually?--No, in epilepsy I have myself observed several granules in the membrane of the brain; and any disturbing cause in the system, I think, would be likely to produce convulsions. I believe that the granules in this case were very likely to irritate the spinal cord, and an attack might very likely come on at once in a fit of epilepsy. There would be pain during the continuance of the violent spasms of the patient, not necessarily pain merely from the spasms. These granules might or might not produce arachnitis. You would expect to find inflammation in that case?--Not necessarily. Irritation, not inflammation. Granules of that description do not often exist in healthy spines. In the dissections of epilepsy in the large hospitals, these small granules have been found very frequently. The granules, in my opinion, would be likely to produce epilepsy. In my experience I have never known epilepsy unaccompanied by unconsciousness, nor have I known epilepsy producing the marked symptoms of tetanic character which occur in Mr. Cook’s case. [Sidenote: G. Robinson] Do you feel yourself warranted in giving an opinion that these granules caused epilepsy in this case?--I think I might have done so. If I put aside the hypothesis of poisoning by strychnia I would. Several of the symptoms described by Mr. Jones, the severe paroxysm, the stiffening of the body, the convulsions of all the muscles of the trunk and limbs, and the complete opisthotonos, are also common to other convulsions. The symptoms are certainly consistent with death by strychnia. They are the symptoms that you would expect after strychnia?--I think there would have been some slight premonitory symptoms. If I had no other cause to which I could ascribe the death I would ascribe it to epilepsy. But in this case you admit some of the symptoms are inconsistent with your experience of epilepsy?--Yes.