_fresh_ extracted by glycerine and alcohol, it does not appear that
there is any great loss of the toxicity by drying as is shown by the
following: Lethal dose of dried in Experiment 31 was .085 gram. per kilo
of body weight; in Experiment 55, .033 gram. per kilo caused _early_
death, while .223 gram. of dried per kilo and .120 gram. per kilo caused
death from _late_ effects (Exps. 32 and 57). The lethal doses of the
_fresh_ were .91 gram. per kilo (Exp. 29) and 1.055 gram. per kilo (Exp.
36) when a glycerine extract of the fresh growth was used, while 1.222
gram. per kilo (Exp. 16) made from an alcoholic extract failed to kill.
It may be well to introduce here the results of an experiment which
shows there is no highly poisonous volatile material given off from the
A. phalloides. This is rather an important fact to determine, as the
opinion is held by some that there is a volatile poison, and most of my
experiments were made with the dried fungus. A 1 per cent. solution of
fresh A. phalloides was distilled until three-fourths of the fluid had
passed over as distillate. The latter was injected into the vein of a
dog and found not at all toxic. The opportunity has not been afforded me
of repeating this experiment personally, but Dr. J.P. Arnold has kindly
repeated it for me, injecting the distillate into rabbits and frogs and
failed to find it toxic. Certainly if there is any volatile poison in
the A. phalloides it must be either in very minute quantity or very
slightly toxic.
ANTIDOTAL VALUE OF ATROPINE.
In arriving at any conclusion we must bear in mind the variation of
different animals in their susceptibility to poisons. Thus, to give the
greatest difference observed, .085 gram. dried Amanita muscaria per kilo
of body weight killed one dog in an hour, while in another dog .223
grams. of the same preparation per kilo only killed after 24 hours, the
cardiac inhibition having disappeared one-half hour after the poison was
injected. However, an average of six (6) experiments on cats and dogs
with dried A. muscaria in which no antidote was given shows the lethal
dose to be .103 gram. per kilo of body weight. The average of four (4)
experiments, in which the fungus, dried in the same way, was used but
_atropine was given as an antidote_, gives the lethal dose of .335 gram.
per kilo and death only occurred _late_ in each case. There can be no
doubt, therefore, of the antidotal value of atropine for poisoning by
Amanita muscaria.
It should be borne in mind, however, that it is not an infallible
antidote even when given early, and that it does not prevent death from
the _late effects_ in severe cases, although given in large doses. In
some experiments atropine was administered at the same time the poison
was given and in others before it.
The important practical lesson is that too much reliance should not be
placed upon atropine. It will be shown later that it has little value as
an antidote to A. verna and A. phalloides. Probably these fungi contain
less muscarine than A. muscaria. Although there is no drug so
antagonistic in its physiological action to the poison of the A.
muscaria as atropine, the use of other remedies should not be neglected.
The symptoms have to be treated as they arise. Strychnia, alcohol in
moderate amounts and suprarenal extract could all be used to advantage
in restoring the circulation, especially late in the poisoning. Atropine
merely removes the inhibition of the heart which occurs as an early
symptom.
External heat should be applied if the body temperature is subnormal.
The treatment of gastro-intestinal symptoms will depend upon the
conditions of each individual case. The injection of a large amount of
warm physiological salt solution (.6-.7 per cent. sodium chloride) into
the subcutaneous tissues should also be tried in severe cases seen late
in the poisoning.
POISONING BY AMANITA VERNA OR A. BULBOSUS VERNA BULL.
The symptoms appear from six to fifteen hours after the ingestion of the
poison and may be largely choleraic in nature, _i. e._, vomiting and
purging, the discharges from the bowel being watery with small flakes
suspended and sometimes containing blood.
The disturbance of the circulation is somewhat similar to that caused by
A. muscaria, viz., slow, strong pulse early, but rapid and weak later.
Dizziness and faintness may be early symptoms. Sometimes the skin is
pale and covered with cold, clammy sweat; at others there is great
cyanosis. The body temperature is subnormal, unless nervous symptoms are
very severe. Very prominent among the symptoms are tetanic convulsions,
which may appear comparatively early and persist until the end.
In animals the effect of this toadstool is entirely different from that
of A. muscaria. Perhaps the most striking difference is the frequency
with which convulsions appear. Convulsions occurred repeatedly in
mammals and in nearly every frog to which the toadstool was given. This
fungus seems to contain some poison that acts upon the spinal cord very
much as strychnia does, though less powerfully, of course.
The circulatory conditions are also different. The inhibition of the
heart may be pronounced as an early condition, but the pressure does not
return to the normal after this disappears, either from giving atropine
or from cutting the pneumogastric nerves. Section of these nerves
removes the cardiac inhibition much more completely than after poisoning
by the A. muscaria. There is often a fall of pressure without cardiac
inhibition. In other words, there is a much greater permanent fall of
blood-pressure due to paralysis of the nerve center controlling the
blood vessels (vaso-motor center). This condition will last a long time
and does not show the same tendency to disappear as after A. muscaria.
Moreover it is produced by comparatively small amounts of the A. verna.
The respirations are very slow. The blood is poorly oxygenated and this
probably causes the cyanosis sometimes observed in men poisoned by this
fungus.
Bloody fluid is sometimes vomited or comes from the nose. It may also
occur in the discharge from the bowel.
Retching and purging occurred more frequently as early symptoms than in
animals poisoned by A. muscaria.
Coma appeared early and continued until death. The administration of
atropine soon after giving the poison when cardiac inhibition was
present, caused a slight temporary rise of blood pressure but did not
affect the dilated condition of the blood vessels. The pressure
continued low notwithstanding the atropine. Although the experiments
with this fungus were not as numerous as with the A. muscaria because of
difficulty in obtaining it, yet it seems clear that atropine is of very
little value as an antidote. Death very rarely resulted from the cardiac
inhibition occurring early but usually came on late after that condition
had disappeared. The lethal dose was no larger when atropine was given
than when no antidote was used.
Amanita verna is very much more toxic than A. muscaria, the average of
four experiments in which the former was given without an antidote being
.034 gram. (dried) per kilo of body weight, while .103 gram. (dried) per
kilo, was the average for the latter fungus.
POISONING BY AMANITA PHALLOIDES.
The symptoms described in man are very similar to those caused by the A.
verna, except that the convulsions are less constant and cyanosis is not
mentioned. In some cases vomiting and purging are prominent symptoms.
There is dizziness and fainting, extreme ashy pallor, cold skin covered
with sweat, subnormal temperature, muscular twitchings and occasional
convulsions and somnolence which deepens into coma and lasts until
death, which usually occurs two or three days after eating the poison.
Sometimes the gastro-intestinal symptoms are less severe or may be
absent, though they are usually present; in that case the nervous
symptoms are more prominent, particularly the convulsions and
circulatory disturbance.
In experiments upon animals the convulsions were not observed so
constantly as with the A. verna. Out of twenty-five dogs poisoned by the
Amanita phalloides, convulsions only occurred twice, while twelve frogs
injected with different preparations (dried toadstool and glycerine and
alcoholic extracts of the fresh) failed to show a convulsive seizure in
a single instance. It seems to be difficult for mycologists to draw a
sharp line between the A. verna and the A. phalloides and say to which
of these two certain fungi belong. This may explain why convulsions are
recorded more frequently in persons poisoned by this toadstool than in
animals poisoned by it. Frogs are very susceptible to poisons acting
upon the spinal cord, and all of those poisoned by lethal doses of A.
verna had convulsions, while none of those poisoned by the A. phalloides
had any. It would therefore appear from this striking difference in the
physiological actions that the two are separate and distinct.
The circulatory and gastro-intestinal symptoms were quite similar to
those caused by the A. verna.
A. phalloides is less toxic than the A. verna, but more so than the A.
muscaria, the average lethal dose of the dried fungus (eight
experiments) for dogs, where no antidote was used, being .117 gram. per
kilo.
The antidotal value of atropine is very slight, if indeed it has any
action other than removing the temporary cardiac inhibition. The animals
very seldom died from this, but mostly from the late effects after the
inhibition had disappeared. In four experiments on dogs in which
atropine was given either at the same time as the poison or before it,
the average lethal dose was .198 gram. of the dried fungus per kilo. Two
dogs were killed by .1 gram. per kilo without atropine; another was
given the same amount and was given atropine hypodermatically a number
of times and recovered, though very ill for two days.
Transfusion of physiological salt solution (.6 per cent. table salt) was
practiced in three dogs. Although death occurred in all of these and the
lethal dose was not unusually high, the pressure was restored for a time
at least. It should be employed in treating poisoning in man, and not be
depended upon as the _only_ procedure, but used in conjunction with
other remedies. This will be referred to again in describing treatment.
It will be seen from the above that poisoning by the A. verna and A.
phalloides present symptoms in the lower animals which are quite
different from those caused by the A. muscaria, and that in either case
poisoning is far more serious than by the latter fungus. This is not
only because they are so much more toxic, but also because there is no
decidedly antagonistic action by atropine, and hence its value as an
antidote is much less.
In treating a case of poisoning by either A. verna or A. phalloides the
only thing that can be done is to meet the indications in the individual
case. If the heart is beating slowly, atropine should be given in
liberal doses. This will not overcome the chief disturbance of the
circulation, viz., the tremendous dilation of the blood vessels.
Strychnia will do this to a certain extent, but its use may be
contra-indicated by twitchings or convulsions from the toadstools. If it
can be used it is exceedingly valuable, as it stimulates not only the
vaso-motor center but the respiration and heart as well. Caffein or
strong coffee may also be used to this end if the stomach will retain
it. Suprarenal extract should also be given hypodermatically, as it will
restore the blood pressure more nearly to normal than any other drug,
according to our experiments. It has the advantage of not increasing the
excitability of the spinal cord as strychnia does, and hence would not
be contra-indicated by nervous symptoms.
Perhaps the most rational treatment to meet the most serious condition
of the poisoning by these toadstools is the transfusion of normal saline
solution (.6-.7 per cent. solution of table salt) into the subcutaneous
tissues. This should, of course, only be given by a physician, as great
care is required in sterilizing the syringe. It can be given with a
fountain syringe and aspirating needle beneath the skin of the thigh.
Large quantities should be used—at least a quart (1000 cc.) or more. The
fluid is rapidly absorbed by the lymphatics and gets into the blood
vessels. It restores the blood pressure by increasing the fluid in the
vessels and also doubtless aids the organs of excretion in eliminating
the poison; at the same time it would relieve the intense thirst
patients complain of. Clinicians who have observed cases of poisoning by
the A. phalloides in man have suggested this procedure as the most
rational one to meet the symptoms presented. From the condition produced
in animals poisoned by this toadstool the writer was led to the same
conclusion. In two experiments upon dogs, when transfusion of warm
physiological salt solution was made directly into the vein after
poisoning by the A. phalloides, death occurred in both cases and the
lethal dose was not unusually large, although the amount transferred was
equal to the estimated volume of the blood of the animal in one case and
half that amount in another. In another animal atropine was given before
the poison and the pressure had been reduced by the latter to one-fifth
of the normal, the transfusion of an amount of normal salt solution
equivalent to two-thirds of the bulk of blood restored the pressure to
three-fourths of normal in about 15 minutes, but further injection of
the poison caused late death.
Although the rise of pressure is not so great from transfusion as from
suprarenal extract in large doses, it is more _permanent_. Transfusion
(or transfusion into the subcutaneous tissues by hypodermoclysis which
amounts to the same thing) has the additional advantage of increasing
the flow of urine, which is often suppressed in these cases. Even if it
does no good it can do no harm if done antiseptically and should be
tried but _always in conjunction with other remedies_.
A remarkable case of recovery after the injection of a large amount of
normal saline solution has been reported by Delobel (Presse medicale
September 30, 1899). A man aged fifty-two ate some A. phalloides; he was
seen four hours afterward. The skin was covered with cold, clammy sweat;
body temperature was sub-normal; shivering and tremors present; had not
vomited or purged; urine suppressed; respiration stertorous; pulse 28
per minute and so feeble that it was almost imperceptible. Two full
doses of atropine were given hypodermatically as well as 10 cc. of ether
and 200 cc. of strong coffee with 20 cc. of rum were given by the mouth
and hot bottles applied externally. In spite of all this the symptoms
became worse and the patient sank into a condition of profound collapse,
the pulse dropping to 24 per minute and the tremors ceased. One liter (1
quart) of normal saline solution was injected hypodermatically and
improvement began in 15 minutes after the injection. The respiration
lost the Cheyne-Stokes character; the pulse improved in tension and in
an hour was 60 per minute; the skin improved and the temperature
returned to normal and the patient went to work next day.
The circulatory symptoms are most prominent and demand most attention.
Vomiting and purging have to be treated according to the conditions in
the individual case and no rule can be followed. As the peripheral
vessels are dilated the body temperature is usually subnormal. This
should be overcome by applying hot bottles externally.
The suppression of urine should receive attention, and the activity of
the kidneys be stimulated as much as possible. It is probable the
suppression is largely due to the tremendous fall of blood pressure. If
the urine is secreted but retained in the bladder it should be drawn
off.
Just as there is no simple way of detecting the presence of poisonous
mushrooms in a mixture of mushrooms, so there is no simple way of
destroying or removing the poisons. Pouchet stated that boiling
destroyed the poison and Chestnut has stated the poison of A. phalloides
is a toxic albumen. If this were the case boiling would destroy it. In
our experiments, however, boiling has not diminished the toxicity at all
and it can be definitely stated that the poison is _not_ an albumen.
There is also a popular impression that vinegar will remove the poison
and numerous observers claim to have removed the poison of A. muscaria
completely by soaking the fungus in vinegar. We have not had the
opportunity of trying this with fresh A. muscaria, but in one experiment
in which the A. verna was soaked over night in vinegar it failed to get
rid of the poison—any more than would have dissolved in that amount of
water.
Toadstool poisoning differs from most poisonings in the long time
elapsing before death in fatal cases. The only inorganic poisons causing
death after such a long interval produce profound tissue changes.
Husemann believed death from poisonous mushrooms to be due to fatty
degeneration of the various organs. We have examined microscopically the
tissue of dogs and cats dying from the _late_ effects of the A. muscaria
and A. phalloides and found them to be perfectly normal.
Mr. V.K. Chestnut, in a bulletin published by the United States
Department of Agriculture (Circular No. 13, p. 23), states that death
from the A. phalloides is due to a destruction of the red-blood
corpuscles. Upon what authority this assertion is made is not stated.
The conclusion has probably been based upon the venosity of the blood in
cases of poisoning resulting from the disturbance of the respiration and
circulation. The blood corpuscles of animals poisoned by all three of
the Amanitæ studied have been counted repeatedly in our experiments and
in _none of them has there been any appreciable reduction_.
It can be positively stated that death is not due to a destruction of
the red blood cells.
Further, the coloring matter of the blood (hæmoglobin), which carries
oxygen to the tissues, has been examined with the spectroscope to see if
any new compound had been formed which would prevent it from carrying
oxygen. No such compound has been found—no alteration could be detected
in the hæmoglobin. It is quite evident that these toadstools do not kill
by their action on the blood, for in a number of experiments the blood
was examined a very short time before death.
Thinking that they might act upon the nerve cells of the brain and
spinal cord very much as certain toxins of infectious diseases do, those
structures were examined by special staining methods (silver
impregnation), but no greater variation than is normal could be detected
in any of those examined.
No statement can be made as to the cause of this late death, but it
would appear to be due to some disturbance of nutrition.
Late death occurs not only in animals, but in most of the cases of
poisoning in man recorded in medical literature.
The contrast between the early and late symptoms is not so great in
poisoning by A. phalloides and A. verna as in the case of poisoning by
A. muscaria. In the first two the serious symptoms appear early and
continue till the end; in the last the early effects of the muscarine
soon passes off or can be removed by atropine, but the late symptoms,
strikingly in contrast with the early ones, still appear, and continue
till death.
[Illustration]
RECIPES
FOR
COOKING AND PREPARING FOR THE TABLE
Preparing toadstools for the table should begin while collecting them.
Have a soft brush, a knife, half a dozen one or two-pound paper bags and
an open-topped, roomy, shallow basket. [Sidenote: Collecting.
Cleansing.]As edible species are found, cut them loose well above their
attachment. Keep the spore surface down until the top is brushed clean
and every particle of dirt removed from the stem. This prevents dirt
from getting upon the spore surface, from which it is very hard to
dislodge. Never clean a toadstool over other toadstools. If the stem is
hard, tough or wormy, remove it.
Having cleaned the plant, place it in one of the paper bags, spore
surface down. Write its name on the bag. Place but one kind in the same
bag, unless species of about the same texture and flavor are found and
mixing is not objectionable. Where another species is found, give it a
bag to itself.
Select fresh, inviting plants only. Do all possible cleaning in the
field. [Sidenote: Selection]Plants keep clean, pack better, and more of
them can be carried. A careless jumble is gritty, bruised and
disappointing.
If not ready to cook the find, place the bags in the ice chest. It is
best to cook fungi as soon as possible. Cooked, they can be kept much
longer than when uncooked.
When ready to cook, wash the plants by throwing them into a deep pan of
water. [Sidenote: Washing.]Pass the fingers quietly through them upward;
let stand a moment for the dirt to settle, then gather them from the
water with the fingers as a drain. Remove any scurf or adhering dirt
with a coarse flannel or a cloth. Wash in this way through two or three
waters. Lay to drain. By experience in draining, exactly the amount of
water necessary to cook a particular species can be allowed to remain
within its spore surface, if it is a gilled species. To other kinds,
water must usually be added.
The removal of the skin of any toadstool is seldom justifiable. As with
the apple and most fruits, the largest amount of flavor is in the skin.
By the consistency of the species in hand, decide upon the best method
of cooking it and the time and medium required. If it is thin, juicy,
tender, from five to ten minutes' slow stewing will be ample; if it is
thick, dry, tough, from thirty to forty minutes will be required. After
any species is cooked tender, it may be seasoned to one’s liking and
served as one chooses.
Many species, which absolutely refuse to become tender after prolonged
stewing, quickly succumb in the frying pan and make crisp, delicate
morsels. Edible kinds which dry well, or are hard when found, often
grate or powder easily, and are excellent (after soaking) made into
soups, fritters or pâtés.
Hundreds upon hundreds of recipes for cooking the common mushroom and
the few other fungi heretofore eaten, are at hand. The simpler
methods—those which retain the natural flavor of the species cooked—are
the best.
When a species has good body, and but little flavor, it may be made
delicious by cooking with it another species of higher flavor.
The most concise instruction is: Cook in any way you can cook an oyster.
The writer’s best and long-tried recipes are here given. Mrs. Sarah
Tyson Rorer has kindly contributed some of her own choice methods; Mrs.
Emma P. Ewing, of culinary celebrity, is represented; and that every
recipe needed may be found herein, the most sensible of English and
French recipes are given.
TO COOK MUSHROOMS.
Gather mushrooms whenever they can be found. That is the best time of
the day to collect them. The gills grow darker and the flavor improves
as the spores ripen. They are in good condition up to the time the gills
begin to grow moist and to soften.
Cut off the extreme butt of the stem, holding the gills downward. Rub
off the cap and stem with a rough towel or flannel. Do not peel. Wash in
cold water. Drain well, gills downward.
The English method is to scald them, but there is more of custom than
use in it.
Mushrooms may be preserved temporarily by boiling them in salt and water
for five minutes, draining and wiping dry. A better way is to cook them,
place in ice-chest, and reheat when wanted.
_McIlvaine._
TO BROIL.—Use well-spread caps only. Use double iron broiler. Place the
caps on it, gills down, and broil two minutes, turn and broil two
minutes more. While hot, season with salt and pepper, and butter well,
especially upon the gill side. Serve upon toast.
_Mrs. S.T. Rorer._
BAKED MUSHROOMS ON TOAST.
Bake under a glass or basin, on toast along with scalded or clotted
cream or a little melted butter, and salt and pepper to taste. They take
about a quarter of an hour in a gentle oven or before a fire; when they
are taken up, do not remove glass for a few minutes; by that time the
vapor will have condensed and gone into the toast.
_Stevens._
CRUSTS OF MUSHROOMS.