Mr. Hall: I move to strike out what Mr. Sullivan’s wife told Dr. Williams.
Dr. Williams (continuing) That is characteristic; that a patient does not know of this attack unless
they have wetted the bed or there is blood on the pillow or unless he is told by people in the room. It is a very common characteristic.
Q. Is it necessary or not, doctor, for there to have been some blow to the head to have produced this traumatic epilepsy? Answer – I do not know whether it is necessary or not. I think it very likely because we know that it does produce that.
Q. If Mr. Sullivan did not have a blow on his head at the time of the accident, do you think that he could have gotton this traumatic epilepsy? Answer – He might; as he dislocated his shoulder there was considerable violence that could cause a wrench in the cranium and although there may have been no external blow visible there may have been a blow capable of producing hemorrhage, or what we call contrecoup – by the transmission of this shock.
Q. When you examined Mr. Sullivan did you find any evidence of injury at all? Answer – I do not think I recall it.
Mr. Hall: Subject to the right that I reserve to further cross examine Dr. Williams at his
convenience, I have no further questions to ask him at this time.
Mr. Patterson: We want the record to show, in view of the fact Dr. Williams expects to leave the
city not later than Sunday, April 2nd, that such cross examination will have to be before that time.
By Mr. Mackey:
Q. You were asked by Mr. Hall about the case of an epileptic mentioned by you in an article written by you which appeared in several medical journals. Was there any indication of trauma or blow in that case. Answer – No.
Q. What kind of epilepsy was that case to which you referred in the article? Answer – That is an entirely different condition produced by traumatism or a blow?
Q. Apparently so, it is a different agent. There is a different agency in question.
Q. is it necessary in order to suffer concussion of the brain or injury to the brain that the blow which causes it should be delivered directly, or could it occur from indirect injury or blows? Answer – It could occur from indirect violence. There is a very well known case we had here of concussion caused by a man hitting with a baseball bat and rupturing an artery. The man hit a two-bagger and ruptured a blood vessel. The man hit the ball and ran to second and fell down. He got up again and ran home, and fell down again. He later died.
Q. Although he was not struck by the bat? Answer – No, he was not struck by the bat. The energy used in hitting the ball ruptured a blood vessel in the brain. The jerk of the head ruptured a blood vessel of the brain. A post – mortem was held and found a ruptured blood vessel in the brain. It was in the very heart of the brain in the fifth ventrical. That is a very remarkable case.
Mr. Hall: Doctor, was there any evidence at all of a trauma when Mr. Sullivan was presented to
you for examination? Answer – I do not know. I did not see any. I have left the question of the physical examination of the man’s exterior to the other physicians. I did not find any evidence of destruction of the brain tissue. It was my chief object to see whether this was real epilepsy or not and the cause of it. I did not make the complete examination I would have made had I been the only physician in the case.
Mr. Hall: To what extent did you examine him physically?
Dr. Williams: I examined all his nervous system.
Mr. Hall: Nervous system alone?
Dr. Williams: I did not examine him in the way a surgeon examines him to see if the shoulder
was still dislocated. That was not my object.
Mr. Hall: In your examination of his nervous system outside of the history of these attacks that he
gave you, what other evidence did you find of an abnormal condition?
Dr. Williams: No other except the congestion of the face and the high nervousness.
Dr. Williams: A very high degree of blood pressure might.
Mr. Hall: What are some of the commoner causes that produce congestion?
Dr. Williams: Usually damming back of the circulation in the back of the skull.
Mr. Hall: Over eating would be a common cause?
Dr. Williams: Many people over-eat who have not congested faces. Plethora they call it.
Mr. Hall: What do you mean by congested?
Dr. Williams: The face was full and red and looked puffy and the eyelids were discolored and
stuck out, due to damming of the blood in those blood vessels indicating some pressure on the inside of the brain.
Mr. Mackey: Doctor, in your professional career, how many persons have you examined for
epilepsy and how many have you seen?
Dr. Williams: I could not tell you. I have seen hundreds of them in institutions. Since I have been
in practice, not very many since then, perhaps a hundred or so.
Mr. Hall: In your opinion, doctor, would a physician having seen only three or four cases of
epilepsy be competent to determine whether or not Sullivan had epilepsy, if he had before him only such facts as were presented to you by Sullivan?
Dr. Williams: You mean not having seen Sullivan in a convulsion?
Mr. Hall: I am first taking the proposition as I stated it.
Dr. Williams: I do not know. It depends on the man and how he studied his case.
Mr. Hall: Assuming that this physician had only met these three or four cases of epilepsy in his
general practice as a family physician over a practice of ten years?
Dr. Williams: It depends on the man, whether or not his judgment is worth anything. If you have
once seen an epileptic convulsion and examined it properly it is enough.
Mr. Hall: But, of course, one epileptic convulsion does not mean that a man is an epileptic?
Dr. Williams: It may not mean it.
Mr. Hall: He might have eclempsio?
Mr. Mackey: Assuming that the physician was a physician and surgeon of experience and had
treated the patient for several years and saw him in a condition which this physician pronounced to be epilepsy with epileptiform seizures, would he be competent in your opinion to properly diagnose the case?
Dr. Williams: If he was a good observer and knew epilepsy when he saw it.
Further deponent saith not.
(signed) Tom A, Williams M. D.
Subscribed and sworn to before me this 25th day of March, A. D. 1916
Thereupon the taking of depositions was adjourned.
“Interrogatory No. 1 by plaintiff’s attorneys:
Please state your name, age, residence and occupation? Also where you studied medicine and surgery and how long you have practiced your profession? Answer – to Interrogatory No. 1: Dr. Robert B. Bacon, 43 years, Washington, D. C., physician. College of Physicians and Surgeons at Baltimore, twenty-two years practice.
“Interrogatory No. 2 by plaintiff’s attorneys:
Are you acquainted with William j. Sullivan of Washington, D. C., the plaintiff in this cause? Answer – to Interrogatory No. 2: Yes, sir.
“Interrogatory No. 3 by plaintiff’s attorneys:
If you answer “Yes” to the last interrogatory, please state how long you have known the said William J. Sullivan, and whether you have ever treated him in your capacity as a physician? Answer – to Interrogatory No. 3: I have known him about one and one-half years. I have treated him.
“Interrogatory No. 4 by plaintiff’s attorneys:
If you answer that you have treated the said William J. Sullivan professionally, please state if you have treated him during the present year; when such treatment, during the present year, was begun, and for how long a time it was continued? Answer – to Interrogatory No. 4: I have treated him during the present year. It began February 28th, 1915, and it continued until the latter part of June.
“Interrogatory No. 5 by plaintiff’s attorneys:
For what did you treat the said William J. Sullivan; what was his condition and what symptoms did you observe when he first came under your observation? Also state what his condition thereafter? Answer fully and in detail, please. Answer – to Interrogatory No. 5: I found that he had contusion of the shoulder and contusion of the back of the scalp, back of the head, and a few minor bruises. He had great pain in the shoulder and great pain about the cranium; his mind appeared to be confused and he was in a very irritable state of mind; he had some vertigo. The symptoms indicated a form of concussion. At the time I first saw him I was unable to decide whether or not there was a fracture of the skull; he seemed to be suffering from great shaking up of nerve centers; could find no evidence of depression in the skull, as a matter of fact, there was a swelling on the scalp. I saw him again the next day, March 1st, at Sibley Hospital; his symptoms then were about the same as the evening before; the shoulder joint appeared to be bruised and sprained then; there had been a history of dislocation at the time of the accident but March 1st there was no indication of dislocation but considerable swelling about the shoulder joint; his irritable state of mind was quite pronounced on March 1st, not delirious but just seemed to be in a sort of half-stupor. There was no paralysis. He was not satisfied to remain in bed; after my departure from the hospital that day he demanded his clothes and left the hospital and I saw him about the 14th or 15th of March again; then the condition of his shoulder was better and much less pain; no trouble with the shoulder injury to any extent, but his head symptoms were very pronounced, pain, vertigo and confusion of mind. Then he had history of convulsive seizures. I saw him about every day then for a week and on one of my visits the latter part of the week I saw him when he had an attack of convulsions; he appeared restless before the attack came on, just moved about the room, he went into the next room and fell, he was unconscious; he had a rigid condition of all the muscles of the neck, face and limbs. That lasted about a minute, then he had clonic convulsions; they were severe and were general, involved the muscles of the neck, limbs and face. That lasted about two minutes then his body became relaxed; he sat up on the floor and appeared dazed, in a stupor, exhausted; he got on his feet without assistance, staggered about the kitchen, walked out into the yard for a moment and went up stairs and fell on the bed in a semi-conscious condition and went off in a sterterous slumber; that lasted for sometime. When this attack first came on him his face was pale, his pulse rapid; after the first rigid spasm occurred his face became congested; his eyes were open and his pupils dilated. I saw him the next morning and his condition was pretty satisfactory; he complained of head-ache but was able to move about; he had to fight for steadiness on his feet. The history of the case disclosed that he had had the convulsive seizures for about a week prior to the time I saw him in one and that they occurred about every day or second day. After seeing Mr. Sullivan in the convulsion and studying the history of the case I diagnosed the seizure as epileptic seizure caused by the head injuries that he sustained at the time of the railway accident. With the convulsions he had frothing about the mouth, no blood.
“Interrogatory No. 6 by plaintiff’s attorneys.
Please state whether during the time the said William J. Sullivan was being treated by you, you ever saw him have any convulsions? Also state if you discovered any symptoms indicating that he suffered from convulsions? Answer – to Interrogatory No. 6: Answered fully in answer to Interrogatory No. 5.
“Interrogatory No. 7 by plaintiff’s attorneys.
If you answer that you did see the said William J. Sullivan have a convulsion or convulsions, please state the nature and kind of convulsion it was? Answer – to Interrogatory No. 7. answered fully in answer to interrogatory No. 5
“Interrogatory No. 8 by plaintiff’s attorneys.
Have you ever treated the said William J. Sullivan or his family previous to the time referred to in the foregoing questions and answers? If so, during what period of time? Answer – to Interrogatory No. 8: Yes, about a year prior to the time of the accident.
“Interrogatory No. 9 by plaintiff’s attorneys.
State if you know whether the said William J. Sullivan had ever had, or was subject to convulsions before the time herein indicated?
Mr. Hall: Doctor, will you please confine your answer to matters witin your own knowledge.
Answer to Interrogatory No. 9: I have no knowledge of Mr. Sullivan having convulsions during the time that I was the family physician or prior to that time.
“Interrogatory No. 10 by plaintiff’s attorneys.
If in answer to any of the foregoing questions you state that the said William J. Sullivan suffered from epileptic convulsions during the time you treated him this year, and such convulsions still continue, taking these facts in connection with your knowledge of this patient and the history of his case, what is your prognosis of his case, with special reference to whether he will continue to be an epileptic, either for a period of time or for life? Also whether his condition will improve or become worse? Answer – to interrogatory No. 10: I am of the opinion that he will continue to be an epileptic for life, unless since the time I last saw him he should have developed localizing systems which might indicate a location of a lesion that might be removed by an operation.
“Interrogatory No. 11 by plaintiff’s attorneys.
Please state, as accurately as you can, when you last saw the said William J. Sullivan? Also when your observation of his condition ceased, together with your reason for not observing him thereafter? Answer – to interrogatory No. 11. Sometime in June, 1915; I have not the data here,. At the same time. The main reason was the fact that I was preparing to leave on account of sickness and Mr. Sullivan failed to come to the office.
By Mr. Hall:
Q. Doctor, are you a specialist? Answer – No.
Q. General practitioner? Answer – Yes.
Q. Can you state how many cases of epilepsy have you treated in your life? Answer – No.
Q. Infrequent? Answer – Yes, infrequent.
Q. Have you ever really closely observed anyone except the plaintiff in this connection Answer – Yes
Q. Have there been one, two, three or more cases? Answer – Yes, more than three case
Q. For what complaint did Sullivan first come to you, doctor, after February 23, 1915? Answer – He came to me to be treated for injuries received from a railway accident about February 23, 1915?
Q. Now was he suffering about that time from hemorrhoids? Answer – No.
Q. You never treated him for hemorrhoids then? Answer – Never did.
Q. I understood you to say he was first examined by you on February 28, 1915? Answer – Yes.
Q. And the next day you saw him at Sibley Hospital? Answer – Yes.
Q. Dr. Jacks was there? Answer – Yes.
Q. Were you and Dr. Jacks called together to examine the plaintiff? Answer – I called Dr. Jacks.
Q. When did the plaintiff first talk to you about the accident? Answer – The night of February 28th
Q. Did he tell you he had received a blow on the head? Answer – Yes.
Q. On which side? Answer – Back of the head.
Q. Where did he tell you he was at the time of this accident? Answer – On a passenger car on the railroad.
Q. Sitting down or standing up? Answer – He didn’t state.
Q. Was he holding his baby in his left arm? Answer – No. I have not the detailed notes here in Saranac Lake, but, to the best of my recollection, Mr. Sullivan was not holding his baby in his arm.
Q. Was his wife on the same seat with him? Answer – No, to the best of my recollection his wife was not.
Q. What did he tell you happened to him when the accident occurred? Answer – His description of what happened to him was very vague. In his confused state of mind he had an idea that a heavy piece of timber or piece of iron had struck him on the back of the head.
Q. Was his wife and baby injured at the same time? Answer – I understood from his conversation that they were not injured.
Q. Did you find any scalp wound when you examined him? Answer – No laceration of the scalp; no abrasion of the skin.
Q. Did he claim to you he had been knocked unconscious? Answer – Yes.
Q. Did he say he had been pinned under the wreckage? Answer – From his conversation, I was led to believe that he was mixed up with the wreckage; he had rather a hazy idea.
Q. Could you recall what he did say about the wreckage? Answer – I was led to believe from his description that some heavy metal or board from this train or the train that was in collision with this train struck him about the head and shoulders.
Q. I believe you testified in answer to one of the plaintiff’s interrogatories that you did not find any symptom of concussion at that time? Answer – No, I did not.
Q. Was there any evidence of paralysis on either side? Answer – There was not.
Q. When did you last examine him? Answer – Sometime in June, 1915
Q. Did you make a thorough physical examination at that time? Answer – Not as thorough as the one I made earlier in the case.
Q. Did you then test him for one-sided weakness? Answer – No.
Q. Did you test his reflexes? Answer – I tested his reflexes.
Q. With what effect? Answer – They were normal.
Q. Do you recollect the plaintiff’s description to you of his first convulsive attack? Answer – He didn’t seem to know exactly what had happened to him; his confusion of mind was such that he could’t give me any kind of a fair description of his sensations that he had prior to the seizures.
Q. I understood you to say that he first described these attacks to you on March 14th or 15th ? Answer – He first mentioned the fact then; it was mentioned by the nurses and others that he had had them. I didn’t see him have one at that time.
Q. Where was the plaintiff from February 28th to March 15th ? Answer – I am of the opinion it was Virginia
Q. He was not in the hospital? Answer – Not in Sibley Hospital.
Q. How long did he stay in the hospital? Answer – One day, March 1st . At the time Dr. Jacks and I examined him.
Q. On March 14th when you saw him, did you know he had made up his mind to sue the railway company? Answer – No, I did not.
Q. In the absence of direct evidence of a severe blow, a scalp wound, loss of consciousness, local or general temporary paralysis, one-sided weakness or abnormal reflexes, I say in the absence of these, and with no symptom of epilepsy, except general convulsions, would you say such a case was idiopathic or traumatic epilepsy? Answer – I could not decide whether or not this case was a case of epilepsy or a variety of epilepsy when merely the only symptom present was convulsions.
Q. If they were true epileptic convulsions of a general character and with the absence of the symptoms named in the preceding question what would your opinion be? Answer – my opinion would be that it was a case of idiopathic epilepsy.
Q. What percentage of the total number of cases of epilrpsy are traumatic? Answer – A comparatively small proportion.
Q. Doctor, is the fact that a blow to the head has been sustained within a period of several years, accompanied by general convulsions, sufficient for you to diagnose the case of epilepsy as idiopathic or traumatic? Answer – No.
Q. What additional systems are necessary? Answer – To diagnose the case as a case of traumatic epilepsy there must be a history of more recent injury and an injury to the brain of rather a severe character; such a diagnosis is more likely to be correct when a patient has other head systems as headache, vertigo.
Q. I believe you stated that when you saw the plaintiff in one of these attacks you were there on a professional visit? Answer – Yes, sir.
Q. How soon after he was seized did he become unconscious? Answer – He became unconscious immediately after he was seized.
Q. There were no preliminary twitching or localized attacks? Answer – Not when the seizure occurred. He had some nervous symptoms prior to the time of the seizure.
Q. How can a person having such an attack remember and afterwards describe what he did and how he felt? Answer – He cannot.
Q. Did you ever see him in more than one attack? Answer – No, I did not.
Q. If the plaintiff never had but one fit, such as the one you then witnessed, would you diagnose that as epilepsy? Answer – I would.
Q. Having seen one fit of this character, would you accept the plaintiff’s statement as to others as definite proof that such others were epileptic? Answer – I would consider such a statement as presumptive evidence that subsequent attacks of epilepsy had occurred.
Q. If the plaintiff’s statements were supported by non medical observers, as to other fits, would their testimony be worth anything, in your opinion, as showing a case of true epilepsy? Answer – No; their testimony as to the character of the fit would not be at all convincing as to its character.
Q. Would the statements of the plaintiff himself be even presumptive evidence of epilepsy as compared with hysteria; in other words, could you from his statements say whether he had epilepsy or hysteria? Answer – It would be impossible to say from his statements whether he had epilepsy or hysteria or both.
Q. Would not the same thing be true as between epilepsy and eclampsia? Answer – The testimony of the patient would not be conclusive.
Q. Doctor, how is the brain affected by traumatic epilepsy? Answer – In cases where traumatism is not severe the brain undergoes what might be called a shaking up; even such as a slight or mild injury to the brain might produce irritation and epilepsy. Where a more severe injury to the brain is sustained there are minute hemorrhages scattered through the brain substance which may be sufficient to cause epilepsy; and where more severe injury is sustained there may be considerable hemorrhage under the skull bones or the membrane that covers the brain or brain substance and in a great many cases of traumatism inflammation of the brain or of the coverings of the brain may occur, also abscesses may be produced.
Q. As I understand you, there must be organic cerebral lesions or irritation of the tissues or abscesses of the brain in order to produce epilepsy? Answer – In traumatic epilepsy I would expect some such condition
Q. Can you state how much force or the extent of violence would be necessary to produce such a condition? Answer – It is impossible to state.
Q. You cannot even estimate it? Answer – No.
Q. Would a slight tap on the head be different? Answer – It might be.
Q. Do most writers say that severity is the most important causable element? Answer – No, they do not mention particularly that severity is the most important.
Q. Is Bailey a good authority on this? Answer – I am not familiar with him.
Q. Doctor, what is the difference between idiopathic and traumatic epilepsy. Answer – Traumatic epilepsy is epilepsy caused by injury; idiopathic epilepsy is caused independent of injury or other source of irritation.
Q. In the two cases, is there any difference in the first seizures? Answer – No.
Q. You do agree then with writers when they say that were first convulsions are general and there is no preliminary twitching the case is idiopathic and not traumatic. Answer – The writers, in speaking of that particular variety of epilepsy, mean Jacksonian epilepsy.
Q. Where the seizures are local they are usually on the opposite side of the body to that of the affected part of the brain? Answer – Usually.
Q. What happens if the blow is in the center of the back of the head, is that general traumatism or localized traumatism? Answer – It would depend on what part of the brain was injured; the blow on the back of the head might produce injuries in a different portion of the brain from the point where the blow landed.
Q. In other words, if the blow was received on the back of the head, I understand you to say that it might injure some part of the brain on the right or left side of the head? Answer – On any part of the brain.
Q. In which case you would expect a local seizure or local traumatism? Answer – If that were the only damage that was done, I would.
Q. Epilepsy is a progressive disease? Answer – I cannot say it is.
Q. Would you say then, it would be a true case of epilepsy where the seizure or spasm occurred two or three times a week for a period of a month and then the spasms became less frequent and occurred only once a month, is that a true cause of epilepsy? Answer – Yes, A great many cases behave that way; they have periodical seizures.
Q. The periods become more or less frequent? Answer – They vary sometimes; there will be several seizures in quick succession and then a long period without any seizures.
Q. Does the mental condition remain the same or is there a sign of mental weakness as the disease progresses? Answer – As the disease progresses there are signs of mental weakness/
Q. Can you state how long a period should elapse before there would be signs of mental weakness? Answer It would depend upon the character of the attacks and frequency of the attacks.
Q. I understand you treated Mr. Sullivan’s family for a year previous to February, 1915? Answer – Yes.
Q. Did you ever treat him? Answer – Yes, I treated him for minor troubles, as colds.
Q. did he complain of his eyes? Answer – No, I treated him for minor troubles, as colds.
Q. You are not acquainted with his history, that is not the history of his earlier years? Answer – No.
Q. You do not know whether he had any severe shock or injury to his head prior to February, 1915. Answer I have no personal knowledge.
Q. You do not know from what he tells you, whether he was subject to convulsions when a baby or at a later time, prior to your treatment, do you? Answer – No.
Q. Did you find any evidence of neurosis in the plaintiff due to heredity? Answer – No.
Q. Did you find any evidence of acute alcoholism or any other form of chronic poisoning or degeneration in his system? Answer – Yes.
Q. I understood you to say that the plaintiff’s seizures was of a general character, did this indicate to you that any one portion of the plaintiff was traumatized or that the whole cerebral cortex was in a condition of latent disease? Answer – It indicated that the whole cerebral cortex was involved, but there might have been some portions more involved than others.
Q. I understood you to say in answer to interrogatory No. 9 that you did not know, of your own knowledge, whether the plaintiff had ever had or was subject to convulsions before you began to treat him? Answer – No, that is correct. I know he had no convulsions the year before I treated him.
Q. Did I understand you to testify that he had never told you he had any convulsions prior to February, 1915; was not that your direct testimony? Answer – As the family physician of the man, and being a frequent visitor to his house and attending to all the ailments of the family during that year, I am safe in assuming that I have knowledge that he had no convulsions during the year prior to February 23, 1915.
Q. Have you been paid for your services to Mr. Sullivan? Answer – Yes.
Q. What was the amount of your bill? Answer – I sent him a bill for $20.00 and he paid that.
Q. You are a lawyer, too, doctor? Answer – Yes.
Q. When were you a lawyer? Answer – In 1908.
Q. Where did you practice? Answer – Baltimore.
Q. Were you practicing medicine at the same time? Answer – Yes.
Q. You had a law office in Baltimore? Answer – I was at the time of my moving to Washington and I had this central office in Baltimore for a few months and attempted to take part in cases that involved medical and surgical points, but I stopped that entirely.”
The following deposition taken on behalf of the Southern Railway Company is read by Mr. Hall:
“In the Circuit Court, Prince William County, Virginia.