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Objective: This paper provides the first compilation in more than 30 years of human injuries and fatalities from envenomation by marine gastropod molluscs of the predominantly tropical family Conidae. It seeks to apply recent advances in knowledge of the physiological effects of conopeptides and molecular genetics to improve our understanding of the human responses to stings by species that normally use their venom peptides to paralyze and overcome prey such as polychaete worms, other gastropod molluscs, and fishes., Results: A database has been constructed for the 139 cases accepted as reliably reporting each human injury. It includes data on the species responsible, the time and place where the stinging occurred and the sting site on the victim's body, the time-course of clinical effects, treatment carried out, if any, and outcome. Members of the hyperdiverse genus Conus caused all the injuries, except for 2 cases involving species from the recently separated genus Conasprella. Death occurred in 36 cases, 57 cases presented with serious symptoms but recovered completely, and in 44 cases victims were only minimally affected. A few cases are listed as tentative because the information in the reports was limited or unverifiable. Many cases have undoubtedly gone unreported and been forgotten. No cases are known for the period between the date of the first reliable report in the 17th century, and the mid-19th century. Knowledge of conopeptide molecular structure and function has recently burgeoned, permitting initial exploration of relationships between the symptoms and outcomes of human injuries and modes of action of these mainly small, very toxic neuroactive peptides. These relationships are reviewed here, especially in regard to the severe and fatal cases, with the aim of making recent knowledge accessible to clinicians and others involved in treating the effects of human stings, which continue to be reported., Conclusions: Conus geographus, a specialized predator of fishes, which it paralyzes with its venom and swallows whole, is the most dangerous species to humans. It accounts for about half of the known human envenomations and almost all the fatalities. Children succumb more often to C. geographus stings than adults and stings by larger snails are lethal more often than stings from smaller snails, regardless of the victim's age. Other piscivorous Conus species have stung humans, but with nonlethal results. A few species that normally prey on other gastropods have also seriously injured humans, but most of the fatalities reported have not been confirmed. Most species of Conidae prey only on marine worms; 18 of these species are known to have stung humans, with generally mild effects. Research on the treatment of Conus stings has lagged behind that on the application of conopeptides in pharmacological research and in the development of new pharmaceuticals. However, improved communication and availability of medical aid in remote tropical areas has likely contributed to reducing the mortality rate during the last half century.