as though he was dissatisfied with the effects which had been described to him, and was seeking some ideal effects of his own. It is a long established and well-known characteristic of this medicine that it does not disturb the intellect, and it is plain, from his detailed account of himself while under its influence, that it did not disturb his intelligence, so that his bad judgment or bad theory in continuing the medicine against all his positive instructions, must have been a natural quality of his judgment and not the result of the action of the medicine on his brain. If his minim measure be anything like correct, the dose he took was not a large one, and the cases on record where conium has been most successful in overcoming muscular spasm have on the average been treated by doses much larger. In the cases published by Dr. John Harley, of London, who is one of the highest and best authorities on the uses of this medicine, the average dose exceeds that taken by Mr. Walker by one-half, while many of the doses, though not considered exceptionally large or at all dangerous, far exceeded the whole quantity taken by Mr. Walker in his three doses. But Dr. Harley repeats such doses only once or twice a day, though he often keeps them up for weeks, as would have been required in Mr. Walker's case. A prominent physician of this city had a case in which a woman took sixty minims or more of this same preparation every four hours, until nine or ten doses had been taken, with profound intoxication, but with safety. In another instance I knew of a man who took at least 240 minims at one dose with the same results, but with very rapid recovery. And another instance wherein a girl took 120 minims, and repeated it in an hour. This was a case of brain disease which afterward proved fatal. Doses of 60 minims are common, while larger ones are not uncommon, and are often necessary. These circumstances make it doubtful to my mind whether Mr. Walker died from the effects of conium alone. The testimony of his wife in regard to the manner of his death convinces me that he died from what is called cardiac syncope, or heart fainting; and although I have no doubt that conium caused this heart fainting, I have some doubt whether this quantity of conium could have produced heart fainting in a healthy heart in any other way than as a pure accident, which could have no more been foreseen than the accident by which he nearly lost his life when run over by a truck. Nevertheless, his heart had been examined during his treatment, without the discovery of any disease. The fluid extract of conium is not a special or peculiar preparation made by me, nor one in which I have any individual claim or interest. It is, on the contrary, an officinal preparation of the United States Pharmacopoeia, and as made by me is no better nor stronger than it is ordered to be, if as strong. The Pharmacopoeia directs all fluid extracts to be so made that each minim shall represent the strength of one grain of the drug from which it is made, and thus the physician who knows the dose of the drug in grains knows the dose of the fluid extract of that drug in minims. I only profess and try to make this and similar preparations practically as nearly up to the standard of the Pharmacopoeia as is practicable, and am more liable to fall below than to exceed the standard strength. The United States Pharmacopoeia and United States Dispensatory are not the same thing. The first is the national standard, while the Dispensatory is a commentary on this and other Pharmacopoeias, and is a private enterprise of its authors, Drs. Wood and Bache. These authors were good authority up to the time of the latest edition of their work. But this last revision is now many years old, and does not embrace the last revision of the Pharmacopoeia, and therefore cannot now be considered as recent authority. Minims and drops are not the same thing. A minim is a definite fixed measure, namely the 480th part of a fluidounce, while a drop varies in quantity with the size and shape of the mouth of the vial from which it is dropped, and with the thinness and thickness of the liquid. They never can be equivalent in quantity, except by accident, and drops can only be accidentally twice alike. Dr. Agnew informs me that the fifty drops of the fluid extract of conium used by him in Mr. Walker's case, measured about twentyfive minims, while fifty drops of the fluid extract of conium-seed which I gave to Mr. Walker, dropped from a bottle similar to the one he had, measured sixty minims. Hence physicians can never be practically accurate or safe in prescribing doses by dropping. Minim measures are not always accurate, but are commonly inaccurate, though far less so than measuring by drops. They are inaccurate for want of skill and care in making. This is a free country: people can get any kind of medicine or any kind of measure for it that they want, just as they can get any kind of doctor they want, or may doctor themselves to any extent they please, even to death, as in Mr. Walker's case. Any properly educated person can make fluid extract of conium-seed by the directions given in the Pharmacopoeia. There is no secrecy or any great difficulty about it, nor does it require much knowledge or skill. This and other medicines are so variable, less from want of skill and knowledge in making them than from want of common honesty in bringing the materials to make them of. A cheap and inefficient drug, when made into a fluid extract which shall fairly represent it in the official standard proportion of minims for grains, will only be so much the more dangerous in its liquid form, because the landmarks for judging of quantity are, as with powdered drugs, mainly removed. The witness then described the plant conium and the method of preparing the conium juice and conium extract at length, and further said: In the case of Dr. Harley, in which a child eight years old took fifty minims of the same preparations made by me, and within thirty minutes, if I remember aright (I am not certain about the number of minutes), the effect was so moderate that sixty minims more were given. The effect does not generally pass off within five or six hours. A juror asked: "As the deceased stated, after taking the second dose, he found no mitigation of spasms, whether he was not justi fied in expecting, as the desired result of the medicine, a mitigation of the spasms ?" The witness said he was not so justified by any instructions or directions from me. I did not allude in those instructions to the spasms; I told him to stop when he felt any effect, telling him that the effect would be intoxication. Under this intoxication, one will do all the things that a drunken man will do, but will not be irrational as one drunk from alcohol. The increase of diplopia spoken of in the deceased's notes was caused by the action of the medicine; I do not think that 150 minims of my extract, which Mr. Walker took, was a deadly or a dangerous dose, even if taken all at once; a prisoner in Sing Sing Prison took a tablespoonful, 240 or more minims, without serious effect; the circumstances under which Mr. Walker took the medicine, he being perhaps excited in consequence of the treatment, and taking it upon an empty stomach, would make him more susceptible to the influence of the drug than he would be ordinarily. Mr. CHAS. L. WALKER and Mr. JNo. H. WALKER, sons of the deceased, confirmed the evidence of Mrs. Walker, and stated that deceased had for twenty years or more used a family medicine chest of homoeopathic medicines, but never treated himself; he may have prescribed for trifling ailments. For about the last six months, he had advertised himself by a sign as Electrician, and was in the habit of applying it to such persons as called upon him; whenever any such persons required medicine, however, he always called in, or sent them to a practising physician. On the Wednesday before his death, he sold out a policy for $10,000 which he held on his life, thinking that he could do better with the money in his business, saying that the chances of his life were that he would live at least ten years. The jury rendered the following verdict:— That the said Frederick W. Walker came to his death April 3, 1875, at No. 300 State Street, by the medical use of the fluid extract of conium. First of the extract of the leaves 180 drops, obtained from Caswell & Hazard, New York, prescribed and administered in four doses of forty, forty, forty, and sixty drops at intervals of about half an hour, by Drs. C. R. Agnew and David Webster, without any apparent effect. Second after an interval of four hours by about 150 minims of the fluid extract of conium-seed, prescribed by the said Drs. Agnew and Webster, dispensed and directions for taking given by Dr. E. R. Squibb (of his own manufacture) in three doses of fifty minims each at intervals of about half an hour, and that the deceased suddenly died in about one hour and a half after taking the third dose. Moreover we find that, from some inappreciable cause to us, the medicine acted with extraordinary potency. In witness whereof we, the said jurors, as well as the coroner, have to this inquisition set our hands. (Signed) A. N. BELL, M.D., ALBERT VICKERS, M.D., D. D. WHITNEY, S. W. MOORE, B. A. SEGUR, M.D., WILLIAM RICHARDSON, HENRY C. SIMMS, M.D., Coroner. |