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began to take the prescription given, he must observe the effect, and stop the remedy the instant he noticed any effect on his muscles, stomach, or head, or elsewhere; I concur in the testimony of Dr. Webster; I have not had favorable experiences in the use of this remedy in similar cases; it is not a common case, but is known to the profession; this was a remarkable case; I have had him sit talking with me half an hour, during which time his face would be drawn in all directions, closing his eyes tightly and contorting his features, pursing them up; I consider the case as extraordinary and distressing, justifying the use of extraordinary remedies under scientific direction ; he was a man of brains, and of much training, and so remarkable a man that I approved of intrusting the patient with the administration of the medicine by himself, with the caution that was given; it is difficult to account for his proceeding with the medicine, but in the absence of positive knowledge, I should suppose he wanted the fullest effect; I presume from the circumstances that he had full knowledge of the effects; I have no doubt that he had full knowledge of the drug; Socrates dictated to his disciples his symptoms to the last moment, in the same way that Mr. Walker did ; I wondered how he could have repeated the dose; the second and third doses were directly in the face of the most positive orders. The extract used at my office by Dr. Webster was the extract of the leaves of conium, so stated to be by the chemist—the apothecary—who filled the prescription. Harley says that the test of the value of a given specimen of conium is its physiological effect; the maximum dose varies with the individual; 260 drops have been known to be taken at a dose, producing its effect and the patient recovering.
Mrs. ALIDA R. WALKER testified that she was the widow of the late Frederick W. Walker; on Saturday afternoon last Mr. Walker came home and said that he had just come from Dr. C. R. Agnew's office; he had been taking conium, he added, but it had had no effect upon him; Dr. Webster, Dr. Agnew's assistant, had advised him to go to Dr. Squibb's factory and get a more trustworthy preparation of the drug; he had got the preparation, and said that he was going to take it immediately ; Mrs. Walker asked her husband whether he had better not take some nourishment; he replied that he thought he had better not, because he believed that the medicine would have a better effect upon an empty stomach; he was to take 50 minims each half hour, until the results expected were obtained ; Mrs. Walker gave her husband the first 50 minims at 4.10 P. M., and then, at his direction, took paper and pencil and wrote, at his dictation, the feelings he experienced; he told me that Dr. Agnew had requested him to do this; the memorandum read as follows: 4.10 P. M. took 50 minims Squibb’s fluid extract of conium (bemlock); 4.40 P. M. effect very decided in dizziness, re. laxation of muscles and limbs; 50 minims more then taken ; difficulty of walking immediately, and want of power to control movements; forced to lie down, but no mitigation of spasm; limbs and legs weak, unable to hold up head, speech thickening some, pain and heaviness in top and back part of head; pulse 56.
5.15 P. M., took 50 minims; some nausea, some tremor at base of clavicle and in muscles across the chest, just above the sternum; no diminution of spasms about eyes, nor of photophobia.
5.25 P. M., drowsiness, inclined to sleep.
5.40 P. M., eyes difficult to open, speech difficult, fulness in throat, prostration nearly complete, diplopia (double sight) vastly in. creased.
6.10 P. M., nausea, twitchings on right side, unable to articulate, eyes closed, fulness almost to suffocation in throat, pulse about 60. At 8 minutes past
Mr. Walker felt his own pulse to ascertain the number of beats a minute, and his wife marked the time for him. After he became unable to articulate, he made signs that he wished to have his collar loosened. He also signified that he was thirsty. A cup of coffee was brought, but he was unable to drink it—he could not swallow. Mr. Walker's son came in soon afterward, and Mr. Walker signified that he wished to have electricity applied. He bad used electricity a great deal for the paralysis of the facial muscles, and had made a business of applying it to others. He was asked whether he would have galvanism or the Faradaic current. He signified that he would have the Faradaic. The battery was taken up to him, and he indicated that he wished one pole to be applied to the back of his neck. One of the electrodes was placed as desired, and he attempted to take the other in his hand, but dropped it, being unable to hold it. Mrs. Walker then raised him in her arms. He made an attempt to say something, and fell back suddenly, dead. I don't believe that he had the least idea that he was about to die. He did not suggest taking another dose of the preparation at 5.40 P. M., half an hour after he had taken the last previous dose. He complained then of feeling great nausea. He said that he received the instructions for taking
the medicine from Dr. Squibb. In answer to a question by Dr. Bell, Mrs. Walker said that her late husband had been considerably afflicted with rheumatism. She had never known of his having palpitation of the heart, or being troubled with shortness of breath on going up stairs.
Dr. J. C. SHAW testified that he had made a post-mortem examination of the body in the presence of the coroner, Drs. Bell, Segur, and others. In the brain was a good deal of venous congestion. Falx cerebri slightly thickened and opaque on its anterior portion. Arachnoid and pia mater very much thickened and vascular, but turning readily from brain substance. Cruræ cerebri slightly soft. Right crus tore in removing the brain, owing to its softness, and presented a discolored appearance. Right vertebral artery much larger than normal, and had undergone atheromatous degeneration. Left vertebral artery smaller than normal, and had also undergone atheromatous degeneration. Basilar artery larger than normal, and also atheromatous; and so, too, the post-cerebral and middle cerebral arteries. These changes extended into the smaller divi. sions. A small foreign growth (about as large as a grain of coffee) was found on the pia mater, just in the fork at the commencement of the cruræ cerebri. Puncta vasculosa not more than nominal. Choroid plexus very vascular and thickened, otherwise brain apparently healthy. Weight of brain 57 ounces.
Chest. Lungs very much congested, perfectly full of blood. I do not mean hypostatic congestion. They were exceedingly soft, and in places tore during the removal. Heart weighed nineteen ounces. Valves perfect, not the slightest roughness on them. Walls of heart healthy. Left ventricle perhaps a trifle thicker than normal in proportion to the whole.
Coronary arteries quite free. Aorta—found only one small point of atheromatous degeneration visible and about the size of a pin's head, about half an inch from its origin. No fluid in pericardium. Abdominal viscera sound, except an undue amount of fat. In my opinion death resulted from asphyxia due to poisoning by conium.
Dr. E. R. SQUIBB was the next witness. He submitted a carefully written statement as follows: The first and only time I saw the deceased was about half past two o'clock on Saturday afternoon, April 3, 1875. He told me his name was Walker, and that he had been sent to me by Drs. Agnew and Webster, with a written prescription, and with special instructions to see me person
ally, and to trust his message to no one else. He presented the written prescription to me, and I saw that it called for one ounce of fluid extract of conium. He then told me he had been long affected with involuntary contractions about the face and eyes. Had tried unsuccessfully many plans of treatment, and that be now, at the suggestion of Drs. Agnew and Webster, wanted to try the use of conium. He said that Dr. Webster had given him a fluid extract of conium in Dr. Agnew's office so as to watch the effects, had given him four doses at intervals of about half an hour, the first three doses consisting of forty drops each, and the last dose of sixty drops, making 180 drops in all. This he told me had been taken without any sensible effect upon him in any way, and that Drs. Agnew and Webster had attributed its want of effect to bad quality in the medicine. He told me they had sent him to me to try to get some of better quality, which might be stronger, and therefore directed him to take particular instructions from me in person, as to how much to take and how often to repeat the dose, and to follow my instructions closely. I told him that I could not supply his prescription up stairs, where we then were, and asked him to return to the office with the prescription, where it would be properly put up for him; I then gave him verbally the directions to take fifty minims of this fluid extract of conium seed every half hour until he should feel some effect from it; I told him that the effect to be watched for was a kind of intoxication. That this usually commenced by dizziness and muscular weakness and relaxation, and that when he felt this or any other change in his condition after taking the medicine, he should stop taking it. In reply to his remarks regarding my own deformity of face and eyes, I said we all had our troubles of one kind or another.
The matter then passed from my mind entirely, until, on the following day, Sunday, when I was called out of church to see Dr. Webster, who told me that Mr. Walker died near seven o'clock on Saturday evening, and he gave me the few details that were then in his possession after a short visit to his distressed family. I am acquainted with the use of conium within the past ten years for overcoming muscular spasms, and considered Mr. Walker's condition to be one well adapted to realize its good effects, and was not at all surprised that Drs. Webster and Agnew wished to use it in his case; now that I know the full history of his disease, I should bave blamed them had they dismissed the case without using the remedy ; I consider that Drs. Webster and Agnew in their attempt to use this remedy, applied it in a way so cautious and so careful as to deserve commendation; and that when they failed in getting the desired effect, and sent their patient to me, the careful and minute directions they gave him, relieve them entirely of all reasonable responsibility in the unforeseen result, and transferred that responsibility to me. I might have gone home with Mr. Walker and have given him the medicine under my own personal supervi. sion, as Drs. Webster and Agnew did; and had I for a moment suspected or feared that he would have so disregarded his thrice repeated instructions, of course I should have gone with him; but if in order to avoid such accidents of mismanagement, I or any physician, was bound to follow each portion of potent medicine, and observe its effects in use until it ceased to be dangerous through mismanagement, our vocation would be at an end. I knew well that I was dealing with a potent medicine, but one which I did not then, and do not now, consider very deadly nor very dangerous.
From the fact that the deceased had taken a moderate quantity of the medicine dispensed under the same name, and which should have been of the same strength, I inferred that he was not very sensitive to the action of this drug, and attributed the want of effect to insufficiency of dose as well as to inferiority of quality.
This induced me to increase the dose from the uncertain quantity ' of forty drops to the more definite quantity of fifty minims.
Then, knowing well that the effects of this medicine are prompt and
pass off entirely within a few hours, and that a decided effect was necessary to this particular use of the drug, I adhered to the same interval of half an hour between the doses that had been adopted by Dr. Webster; I also knew that any possible effect from that which he had taken in Dr. Agnew's office must by lapse of time bave passed off before he could begin upon the new portion; bad he followed the directions I gave him, Mr. Walker would never have taken the second dose-much less the third one -although, had I been present, I should probably, or almost certainly, have given him the second one; why he ever took the second and third doses, as there was no reasonable ground for misunderstanding the directions I gave him, and as he certainly did understand them, can only be conjectured; he, however, acted as though he believed his advisers were tirnid and overcautious, and