This section is from the book "Materia Medica And Therapeutics - Vegetable Kingdom", by Charles D. F. Phillips. Also available from Amazon: Materia Medica And Therapeutics: Vegetable Kingdom.
In Spasmodic and Convulsive Disorders, coniine, though apparently so suited by its physiological action to their treatment, has not yet established any settled rank, notwithstanding the strong statements that have been made in its favor.
In chorea, for example, Dr. Harley has found the succus of remarkable value; he gives it in increasing doses until he discovers the dose necessary to produce the characteristic slighter physiological symptoms above described. One, at least, of Dr. Harley's cases is beyond criticism: for the chorea was of old date, and the boy (aet. six) had also suffered from morbid restlessness from his very birth. It was not till very large doses were given that any decided improvement was observed. He took 104 fl. oz. in twelve weeks; and under this treatment not merely did he lose his chorea, but his congenital restlessness disappeared, and he also gained flesh and strength remarkably.
On the other hand, many practitioners have given patient trial to co-nium in chorea, and have either had no success at all or else very capricious and uncertain results. Ringer, for instance, speaks of the improvement under conium as apparently only temporary, and adds: "It has yet to be shown that conium will shorten the course of this disease." I have heard many practitioners express a similar view, and many, who at first believed that they had found in conium a specific remedy for chorea, have afterwards lost all faith in it. We cannot, however, lose sight of such cases as are recorded by Harley; and on the whole the reasonable conclusion seems to be that there are cases over which it has a very powerful influence, and other cases for which it does nothing. What may be the pathological difference that causes this varying result, we unfortunately do not know. Dr. Anstie remarks that he has never once seen conium do good in the severe choreas of commencing sexual development; while, on the other hand, it has sometimes appeared strikingly beneficial to young children.
In Tetanus the high anticipations of success from conium which once prevailed have not been sustained. Experimentally, Guttmann found that frogs which were tetanized with strychnia were not at all benefited even by paralyzing doses of coniine; and the cases, if apparently successful, recorded by some authors, must be received with much suspicion. Thus, Mr. Corry's case1 was treated with the extract, in 5-grain doses, and as there is every reason to believe that this is a perfectly inert remedy, the recovery was probably spontaneous. And the cases published by Professor Johnson, of Maryland, are, as Ringer points out, most unsatisfactory, for in both of them other powerful remedies were simultaneously employed. Nor does it seem probable, from the best knowledge we can get of the physiological action of the drug, that conium could antagonize either pathological or strychnia tetanus, notwithstanding Dr. Harley's arguments to the contrary.
1 Dublin Quarterly Journal of Medicine, Nov., 1860.
In Epilepsy I regret to say that I have obtained no confirmation of Dr. Harley's favorable statements. Dr. Harley limited his commendation of conium in epilepsy to those cases in which self-abuse has been the apparent cause; but even in this special relation I have not found that the drug is effective. It is probable that self-abuse is never more than the exciting cause acting upon a system predisposed to the disease. Consequently, we could hardly expect efficient remedial action from any treatment, except one which should either remove the exciting cause, or should deeply modify the nutrition of the nervous centres; and there is little hope that conium will prove adequate for either of these purposes. Whatever can be done in the way of lowering the susceptibility to peripheral excitement can probably be much more completely effected by bromide of potassium; while the slower, but more radical, benefit which may be hoped for from improvement in central nervous nutrition, is certainly more likely to be obtained by nutritive tonics, such as cod-liver oil.
In Mental and other Cerebral Diseases there seems much more probability that conium will prove efficacious. The practical authority of Dr. Crichton Browne1 is strongly in favor of its use in acute mania; and Dr. J. Wilkie Burman2 has published some remarkable results of the combined subcutaneous injection of conium and morphine in the same disease. Dr. Burman experimentally confirmed J. Harley's statement that the union of morphia and conia heightens the effect of each, and that the combined influence is tranquillizing both to the mental and the motor centres. Dr. Burman's estimate of this treatment, if correct, is very important: the question ought to be settled by extensive experiments in our large asylums; and this could very speedily be done. 1 am bound to state that I have heard of instances where the treatment has been patiently and carefully tried, in apparently suitable cases, without any good effect; but no general decision ought to be arrived at until thousands of well-conducted trials have been made.
In Delirium Tremens, according to Harley, conium is most useful, especially in combination with opium, the action of which it supplements in a very useful way. It may here be remarked that, should it prove true that conium has a direct influence over two varieties of delirium tremens, we might be led to think that it possesses special affinities for the brain-cortex; and further, remembering the interesting discoveries of Professor Ferrier, we might reasonably suspect that if conium influences affections of the motor system at all through the brain, it must be through Ferrier's motor centres in the gray matter, and not through the corpus striatum or the optic thalamus.
Preparations And Dose. - Extractum Conii Fructus Fluidum, mv. - xxx. (.30 - 2.); Extractum Conii Alcoholicum; Tinctura Conii, Extractum Conii, Succus Conii. The last four of these are so utterly unreliable that no doses can be assigned. Conia (G. Ph.), gr. 1/300 - 1/60 (.0002 - .001, Binz).
1 Lancet, Feb. 3d, 10th, and 17th, 1872. 2 Practitioner, Dec, 1872.