The action of conine is, primarily and chiefly, on the end-organs of the motor nerves; the nerve-trunks next lose their excitability, and by an extension of the paralysis the spinal cord is at last involved. The muscular irritability remains unaffected. According to M. Verigo, the paralysis proceeds from the spinal cord, outwardly, to the terminal filaments of the motor nerves. But it is probable that this experimenter operated with a preparation of conine containing methylconium, which has been shown, by Crum Brown and Fraser, to affect first the motor columns of the spinal cord.

No constant and characteristic post-mortem appearances seem to be produced by conine. The left cavities of the heart are found empty, and the right distended, but these are products of the mode of dying, and are not directly due to the action of the poison. The blood is generally fluid, and the coagula are soft.

Elimination takes place by various channels, chiefly by the kidneys. Conine has been found in considerable quantity in the liver, lungs, and spleen.

That the conium of our time was employed by the ancients, can hardly be doubted by any one who will read the account of the death of Socrates from the Athenian state poison. This remarkable story, which has descended to us in Plato, bears all the indications of verisimilitude, and its delineation of the effects, as the symptoms successively manifested themselves, are just as we see them now, in the action of conium on animals, and, as Harley has described them, as occurring in his own person. Socrates continued his sublime discourse after the poison had been swallowed, thus showing that his mental powers had not been clouded—not certainly till near the end, when, as we now know, carbonic-acid narcosis comes on. Plato described the slowly-developing paralysis, beginning below and ascending—the mental powers of Socrates remaining unimpaired until near the end, when his commands were laid on his disciples to sacrifice a cock to AEsculapius, which was a return to the superstitions of the age, after having condemned them in the course of his ethical disquisitions before the youth of Athens, for which he now underwent the extreme penalty of the law.

Therapy

Formerly the preparations of conium were much used for a supposed discutient or resolvent action in glandular enlargements, and in certain kinds of tumors. But, since it has been shown that the preparation chiefly employed for this purpose (the extract) is practically inert, the supposed cures effected in this way are justly regarded as examples of the post hoc. Influenced by the same considerations, conium was supposed to have an alterant and anodyne action in cancer. But, since, in the progress of physiological research, it has been shown that conium affects the motor and not the sensory nerves, it is no longer employed to relieve the pains, or to arrest the growth and diffusion, of cancer. It is right to add, however, that able practitioners hold that the discutient and resolvent powers of conium are well established in clinical experience (Stillé).

The true uses of conium are those deduced from a consideration of its physiological actions. As it lowers the functional activity of the motor nervous system, it is indicated in those cases of disease in which motor activity is in excess. Very valuable results have been obtained by the use of conine in mania, administered with the view of subduing excessive motor excitement. Its real utility consists in quieting muscular agitation, and thus preventing emaciation and maniacal exhaustion. It is considered to be most suitable to the treatment of acute mania, without organic brain-lesion (Burman). The dose required for this purpose is τη ss—τη iij, or subcutaneously, commencing with one tenth of a minim, and gradually increasing it until some characteristic physiological effects are produced.

The succus conii has been used by Harley and others with success in chorea. The special object for which it is used in this malady is to quiet the excessive muscular agitation; but, in order to accomplish this result, a sufficient quantity must be administered to produce distinct physiological effects. To quiet muscular agitation is not alone sufficient to cure chorea; a suitable hygiene, proper alimentation, and restorative agents, are indispensable. Some cases of paralysis agitans are remarkably benefited by conium, but it is of little avail in cases of sclerosis, or when important structural alterations have occurred. Conine is certainly indicated in tetanus, hydrophobia, and strychnine-poisoning, but hitherto it has not succeeded, probably because inert preparations were employed. The author has ascertained that in animals conine rather hastens than retards the lethal effects of strychnine.

In whooping-cough, asthma, and laryngismus stridulus, good effects have been obtained by the use of conium, carried to the point of inducing its characteristic physiological effects. A priori, the best results might be expected from the use of conium in epilepsy, but it is by no means comparable to the bromides. According to Echeverria, conium is serviceable in those cases of epilepsy "attended by cerebral derangement and vertigo."

The state of blepharospasm, which accompanies strumous ophthalmia, is relieved by considerable doses of conium. It is necessary in the treatment of this, as of other motor disorders, to give a sufficient quantity of conium to produce sensible physiological effects.

The subcutaneous injection of conine may be practiced instead of the stomach administration, in all of the forms of disease for which this remedy is prescribed. By Burman this mode of administration has been practiced with much success in the treatment of acute mania; by Pletzer, in asthma; by Erlenmeyer, in emphysema and angina pectoris; by Lorent, in pneumonia and pleuritis; and by Eulenburg, in blepharospasm. A marked decrease in the pulse-rate, and in the temperature, has been observed to follow the hypodermatic injection of conine in these diseases. The rational indication for the use of conine in pneumonia and pleuritis is, to give the organs physiological rest by inducing a paretic state of the respiratory muscles.

A solution of bromhydrate of conine is greatly preferable to any form of the alkaloid, for all purposes, but especially for subcutaneous injection. The following will prove useful: Rx Conine bromhydratis, gr. viij; aquae, vel aquae chloroformi, oz j. M. Sig.: Ten minims contain one sixth of a grain. As Tiryakian and also Tuloup have shown, the effects of this agent decline by repetition, and hence the dose must be increased every few days. Two doses every twenty-four hours will usually be sufficient to maintain a constant effect. By the authors above mentioned, by Dujardin-Beaumetz, Prevost, Rochefontaine, and others, it is asserted to be very effective in spasmodic affections, especially of the respiratory organs—in whooping-cough, asthma, dyspnoea, laryngismus stridulus, spasm of the glottis, hiccough, etc. It has been used with success in tetanus by Chisolm and by Cory.

Conine and Morphine

The effects of conine are in every way heightened by morphine. These agents have been very successfully employed in acute mania, conjointly administered subcutaneously. "Conine acting on the purely motor centers, in a sedative manner, and morphine acting in a similar way on the sensori-motor and ideo-motor centers, it follows, as a fair corollary, that the combination of the two, in subcutaneous injection, should lead to effects directly antagonistic to the condition of maniacal excitement; and, such being in fact the case, they may be thus used together with very great success in the treatment of mania." When nerve-pain and muscular spasm coexist, the best results may be expected from the combined administration of morphine and conine.

Authorities referred to:

Burman, Dr. J. Wilkie. West Riding Lunatic Asylum Reports, vol. ii, p. 1. Curtis, Dr. Edward. The Medical Record, Nos. ccxxxvii, ccxxxviii, 1875. Erlenmeyer, Dr. A. Die subcutanen Injectionen, p. 74. Eulenburg, Dr. A. Die hypodermatische Injectionen, p. 239. Fluckiger and Hanbury. Pharmacographia, p. 266. Harley, Dr. John. Old Vegetable Neurotics, English edition, etc. Husemann, Dr. Theodor. Handbuch der gesammten Arzneimittellehre, zweiter Band, p. 925.

Husemann, Drs. Theod. und Aug. Die Pflanzenstoffe.

Kolliker, Prof. Dr. A. Virchow's Archiv, Band x, p. 228.

Lorent, Dr. E. Die hypodermatischen Injectionen, p. 42.

Pelyet et Damourette. Archives Générales, sixiéme série, tome vi, p 87.

Peltzer, M. Quoted by Eulenburg, supra.

Taylor, Dr. A. S. On Poisons, third edition, p. 731.

Von Praag, L. Schmidt's Jahrbücher der gesammten Medicix..

Verigo, M. The Practitioner, vol. vii, p. 58.