John Cox Eyewitness Account

• Place: Oldham
• Role:
• Occupation: Medical Practitioner

Physician who conducted post-mortem on the body of John Lees who was injured at Peterloo. Doubted arm injury as causing death but was unclear if other body trauma may have contributed.

Account

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Name: John Cox

Occupation: Medical Practitioner / Physician

Home: (N/K)

Date: 25 September 1819

Source: Lees Inquest 26 − 32

Summary: Conducting Post−Mortem examination of John Lees, Cox submits a detailed clinical assessment of his findings, doubting that he died of his injuries.
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Mr. JOHN COX called in by the Constable, and sworn.
The CORONER—Did you attend the deceased before his death?
A. No, I did not.
Q. When did you view the body, and by whose order?
A. On Thursday afternoon, by order of the constables.
Q. Tell us, Sir. what observations you made?
WITNESS—May I refer to notes?
Q. Yes. if you took them at-the time.
A. I took them very shortly at first, and wrote them out after¬wards.
Q. Very well, you may refer to them.
Mr. HARMER—(to the Coroner)—I submit, Sir, that unless they are the original notes the witness is not entitled to refresh his me¬mory with them, if those he first took can be produced; but I make no objection to this gentleman making use of the memoran-dums he now has here.

Examination resumed by the CORONER.

Q. Were there any wounds in the body?
A. There was a transverse cut across the large bone of the lower arm.
Q. What was the description and size of that cut?
A. I took my box-measure to measure it accurately.
Q. Yes, Sir.—What then was the length of the cut?
A. It was an inch and a half long, and was open about an inch at the widest part.
Q. Tell us, Sir, what was its depth?
A. It was about an inch deep; but I can't say exactly how deep it had entered the joint. It had taken the extreme point of the bone away. It was a little oblique, as if it were done by a sword, while the man's arm was raised over his head. I took out a small piece of bone with my thumb and finger, which was partially loose.
Q. What do you suppose was the size of the bone you took out?
A. It was not larger than a sixpence, and like a shell. The wound had not been closed, and there was some grit, or small pieces of bone, in the wound. The lips of the wounds had no marks of inflammation to any degree or mortification.
Q. If you had seen it while he was living, what should you suppose would have been the state of it?
A. I cannot tell exactly, as the wound was clear from pus, or blood, when I saw it; and I suppose it had been washed clean.
Q. Do you think the man had been properly treated?
A. I do not know; there were some pieces of bone left in the wound.
Q. What other marks of external violence did you discover?
A. On the left loin there was a bruised space as large as my hand; this was over the short ribs, and from the feel of it, I considered the part had been inflamed, and that there had been some exudation; that is, some air infused into the cellular mem¬brane. There was neither putrefaction nor mortification, but an approach to putrefaction after his death.
Q. Were there marks of any other bruises?
A. There was one on the right side of the back, but not so vio¬lent. The discolouration was as large as my extended hand; it was something similar to the other, but not so violent. There were two marks over the hips; the cuticle was cut, and the marks were in a state of ulceration; there was a blackness and a purple colour on them, and they appeared to have been produced by vio¬lence. From the two bruises on the loins, to the back of the neck, there were no bruises of any consequence; indeed, I think I may say none.
Q. Did you observe any wound on his shoulder?
A. I examined both his shoulders, and there was no breaking of the skin, or any wound, that I could discover. The clothes, I was told, were cut over the shoulder; but if it was done by a sword, it must have been with the flat side, because the skin was not penetrated.
Q. Were any other parts of the body discoloured?
A. The neck and throat were inflamed and livid.
Q. What do you suppose was the cause of this discolouration in the throat?
A. I should suppose from external violence.
Q. Have you ever seen the same discolouration in the throat of a person where there had been no violence?
A. I don't recollect.
Q. Was the discolouration deeper than in cases of death, where no violence had been committed?
A. Yes, it was.
Q. How far did it extend?
A. All round the neck.
Q. From what kind of violence, think you, did it proceed—a blow, or what?
A. Strangulation might have done that in front of the neck, but not at the back. If violence was the cause, it must have been occasioned by more than one blow.
Q. How do you think the injury was produced?
A. I can form no opinion how it was done. It was tumoured, but the skin was not broken.
Q. Would not the appearances of violence and blackness have been perceivable when he was alive?
A. Certainly, the throat would have been tumefied and red, during life.
Q. Were there any other marks that you observed? Did you see any thing the matter with his legs?
A. No; I did not examine the legs. The people were waiting to bury him; and, as his stockings were on, I did not think it ne¬cessary for them to be taken off.
Q. Can you account for the deceased losing the use of his limbs?
A. The paralysis might have been occasioned by the injury on the neck. I put my hand very carefully all over the head, and saw no injury done to it; and there was no external injury on
the breast.
Q. Was there any injury on the spine, as you saw?
A. I could discover no appearance of any, and I should think there was no injury done to it.
Q. Were any of the ribs broken?
A. No.
Q. Was any injury done to the abdomen?
A. None.
Q. You opened the body?
A. I did, and observed the omentum.
A. JUROR (to the Witness)—Pray, Sir, speak out; we do not hear a word you say, and do not understand you.

(Mr. Harmer had also frequently complained that the witness sat so close to the Coroner, and gave his evidence in such a whis¬pering tone, that he could not hear him.)

A. Well, I will explain. The omentum is that part which co¬vers the intestines, which is generally called the caul. This was in a high state of inflammation; that part lying near the bruise was most inflamed. The small bowels were also inflamed. On moving the body, much blood gushed from the mouth and nostrils. On opening the larynx, or windpipe, it was full of blood. The right lobe of the lungs was full of blood. The right cavity of the thorax contained much blood, which might have been occasioned by ac¬cident, as I was using the knife, when raising the breast. I could not see how else it could have come there. The mediastine was slightly inflamed, and the right inner membrane of the pericardium was inflamed also.
Q. Would these inflammations have arisen naturally after death?
A. I cannot say that. The heart appeared sound and healthy. There was no organic effusion appeared of a nature sufficient to be fatal, except in the right lobe of the lungs.
Q. What, in your judgment, was the cause of his death?
A. It is my opinion, without the least doubt, that he could not have died of the wound on the elbow. I am also of opinion, that if he lived till the 22d day after the injury (which he did), that if he had received proper surgical and medical assistance—(I mean no reflection on any one)—but if copious quantities of blood had been taken from him, as I should have done, the injury might have been checked.
Q. Were there any appearances of his having been properly bled?
A. No, there were not.
Q. If copious bleeding had been resorted to, do you think he would have recovered?
A. It is very probable he might.
Q. Had he been bled at all that you saw?
A. There were no appearances of his having been bled in the arms or neck, which are the usual places for bleeding.
Q. Do you think the appearances on the back were sufficient to cause death?
A. I think the bruise on the loins communicated the inflamma¬tion to the omentum; and thus the inflammation proceeded through the bowels, which might have been checked by bleeding.
Q. Could you have discovered this from external observation?
A. No. I did not discover it until I opened the body.
Q. From general appearances external and internal, what do you consider was the cause of his death?
A. According to my opinion, the immediate cause was the suf¬fusion of blood into the lungs, which I do not think was caused by the bruise on the thorax.
Q. How do you account for it then?
A. I could not account for it.

Q. Was there any external violence on the lungs?
A. There was not.
Q. Was his death occasioned by mortification?
A. It was not, I saw no mortification.
Q. If the injuries were not so severe as to cause death in less than twenty-two days, was there not time for medical aid to have checked these effects?
A. There was.
Q. Can you positively say that his death was occasioned by ex¬ternal violence?
A. I cannot distinctly say it was.
Q. Can you undertake to say that the internal state of the body was occasioned by external violence?
A. I cannot decidedly say it was occasioned; although ex¬ternal violence might have increased it.
Q. To what cause can you attribute the blood in the lungs?
A. If he had had a disposition to inflammation in his breast, the inflammation occasioned by the external bruises might have increased it, so as to cause the rupture of a blood vessel, and thus occasion the suffusion of blood that appeared in the lungs.
Q. Could you form any idea of what means or weapons the bruises on the back were produced?
A. No, I could not.
Q. Could you perceive by the lungs whether he had had any cough?
A. No, I could not.
Q. Can you account for the internal appearances?
A. I cannot; but I think the external marks would not have appeared from the internal inflammation.
Q. Is it possible that the internal appearances might have ex¬isted without external violence?
A. It is possible they might; but that is only conjecture; the inflammation might have existed without violence, but, I think the appearances of the abdomen was produced by external violence. I think the injury done to the thorax might have occasioned para¬lysis, especially as the tumour in the neck was inflamed. But if I had attended the deceased during his illness, I could have ex¬plained many circumstances more satisfactorily than I can now.
Q. What do you think caused the appearances in the breast?
A. The rupture of a blood-vessel.
Q. If his death was occasioned by external violence, at what time should you think that violence had been inflicted?
A. I think, if it were occasioned by external violence, that it was done rather on the sixteenth of August than earlier.
Q. Do you know what medicines he had taken?
A. No, I do not; the smell of Palm oil, which is used with marsh mallows, was very predominant, and indeed more so than that of putrefaction.
Q. Can you tell what caused the pains in his legs and about his shoulder?

A. I should think they proceeded from the internal state of the body.
The CORONER (to the Jury)—Would the Jury wish to ask any questions of the witness?
A JUROR (to the witness)—Do you think all danger might have been removed by bleeding?
A. I saw nothing the matter with him but what might have been remedied by bleeding.
JUROR—Do you consider his death to have been occasioned by neglecting copious bleeding?
A. I think if he had been copiously bled, he might have reco¬vered.
JUROR—Was the disorder which caused his death occasioned by external bruises?
A. I think the bruise occasioned an inflammation, which extended slightly to the bowels.
JUROR—What do you suppose to be the immediate cause of his death?
A. The most skilful anatomists are often at a loss to find the real cause of death. I think the immediate cause was the suffusion of blood on the lungs; but I am confident it did not proceed from the wound on the elbow.
The CORONER (to Mr. Harmer)—Would Mr; Harmer wish to put any question?

The Witness examined by Mr. HARMER.

Q. When did you first see the body of the deceased?
A. On Thursday afternoon.
Q. That, I believe, was after the Jury had seen it.
A. Yes, I believe it was.
Q. Did you not learn that Mr. Earnshaw the Surgeon had at¬tended the deceased during his illness?
A. Yes, I did.
Q. Is it not the usual courtesy with gentlemen of your profes¬sion, when called in as you were, to require the presence and as¬sistance of the gentleman who has attended the patient?
A. It may be.
Q. Is it not the constant course?
A. I believe it may be.
Q. What may be, is no answer to my question. Do you not know it to be uniformly the practice?
A. It is.
Q. Then I ask you, Sir, did you send for Mr. Earnshaw?
A. No, I did not.*

* ”One cannot help regretting that the course which is usually proceeded in, I believe, by medical gentlemen, was not adopted on the present occasion; and that this gentleman had not desired to meet the former practitioner in consultation, to ascertain what had been done; what had proved ineffectual; and in short, to be fully apprised of the previous state and treatment of the deceased."—Vide Mr. Baron Garrow's charge in Fairchild v. Graham. Essex Summer Assizes, 59 Geo. III. Dowling's Nisi Prius Cases.

Q. Was it not material, to enable you to form a correct judg¬ment, that you should learn from Mr. Earnshaw the symptoms of his patient, and the treatment he had adopted?
A. Yes, and if Mr. Earnshaw had been a regular practitioner, I should have desired his attendance; but, as he was not, I sent to another professional gentleman in this town to accompany me to open the body; but he was from home.
Q. Do l understand you to say, that you are of opinion that the external bruises were the cause of his death? -
A. It may be, he might not have died, but for them.
Q. Do you mean to say there were not sufficient external appear¬ances to account for the state of the lungs?
A. I do.
Q. Can you undertake to swear that the rupture was not occa¬sioned by external violence?
A. No, I cannot.
Q. Have you ever seen a body in such a state internally, with¬out external violence?
A. I think I have.
Q. Do you mean to say that you ever saw a body in a state pre¬cisely similar?
A. No, I cannot say I ever did.
Q. Might not the external injuries be the primary cause which led to the inflammation internally, and thus bring on the rupture of the blood vessel?
A. I cannot say that.
Q. Can you undertake to say that the external injuries were not the primary and ultimate cause of his death?
A. No, I cannot, I do not know why he died.
Mr. HARMER,—Then, Sir, I will ask you no more questions.
The Witness re-examined by the CORONER-
Q. If the state of the lungs had been occasioned by bruises on the 16th of August, could he have gone to Middleton?
A. No, he could not.
Q. If his injuries had been so serious as to lead to his death, would he not have been likely to complain?
A. Yes. But I understood he was afraid of complaining to his father on account of the circumstances under which he received the injury.
Q. How do you know that?
A. By the conversation of the people in the neighbourhood, who knew the family.
Q. Had he any other complaint?
A. I saw no appearance of any other about him.
Q. If the lungs had been injured before the 16th, would he not have had a difficulty of breathing?
A. He would, and perhaps a cough.

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