The toxic and deadly effects of certain mushroom poisons, as already
described, have been known since ancient times; and the prolonged
intoxicating debauches to-day prevalent among the Amanita dipsomaniacs
of Northern Russia and Kamchatka, consequent upon the allurements of
the decoction of the fly-agaric, are well-known matters of history.
The true chemical character of this poison, however, was not discovered
until 1868, when it was successfully isolated by chemical analyses
of Drs. Vigier, Schmiedeberg, Currie, and Koppe, and ascertained to
be an alkaloid principle, to which was given originally the name of
bulbosine, since variously known as muscarine, and finally and most
appropriately amanitine.
[Sidenote: =Mr. Palmer's discovery=]
The poison thus identified, it was reserved to an American authority on
edible fungi, Mr. Julius A. Palmer, of Boston, to discover the fact of
its confinement to but one fungus family--the Amanita.
In the year 1879, in an article contributed by him to the _Moniteur
Scientifique_, of Paris, he states:
"Mushrooms are unfit for food by decay or other cause, producing simply
a disagreement with the system by containing some bitter, acrid,
or slimy element, _or by the presence of a wonderful and dangerous
alkaloid which is absorbed in the intestinal canal_. This alkaloid, so
far as known, is _found only in the Amanita family_."
To Mr. Palmer, then, is due the chemical segregation of the Amanita
group as the only repository of this deadly toxic.
[Sidenote: =Lesser poisoning=]
It has not been discerned in other species of fungi, whose so-called
"poisonous" effects are more often traceable to mere indigestibility,
the selection of "over-ripe" specimens, or to idiosyncrasy, rather than
to their distinctly poisonous properties.
Many mushrooms of other families which _do_ possess ingredients
chemically at war with the human system--as the _Russula emetica_ and
certain _Lactarii_, for instance--at least give a fair warning, either
by taste or odor, of their dark intentions.
[Sidenote: =Antidote for Amanita=]
[Sidenote: =First authentic application=]
Owing to the numerous deaths every year consequent upon
mushroom-eating, and nearly always directly traceable to the Amanita,
the discovery of an antidote to this poison has been the quest of many
noted chemists--several supposed antidotes having been experimented
with upon dogs and other animals without desired results. These
included atropine, the deadly crystalline alkaloid from the _Atropa
belladonna_. The earlier experiments upon animals with this drug
in Paris, as described by Dr. Gautier in 1884, while encouraging,
were not considered conclusive, but were sufficient to warrant the
suggestion that the treatment upon man might be effective. In a résumé
of the subject in the Philadelphia _Medical and Surgical Reporter_,
December, 1885, for the benefit of the medical practitioners who are
so frequently called upon to attend cases of mushroom poisoning,
Captain Charles McIlvaine recommended the administration of a dose of
atropine of from 0.05 to 0.0002 milligramme, and it was later reserved
for the same gentleman to witness the first authentic instance of the
application of this remedy in antagonism with the Amanita poison in the
human system. The report of this experience was afterwards published
(see Bibliography, No. 6), embodying also a complete and authentic
account of the symptoms and treatment of the cases by the attending
physician, Dr. J. E. Shadle, of Shenandoah, Pa., which account I
feel is appropriately included here, being in full sympathy with the
solicitous spirit of my pages. I therefore quote the statement of Dr.
Shadle for the benefit of those interested.
SHENANDOAH, PA., October 26, 1885.
Mr. CHAS. MCILVAINE:
MY DEAR SIR,--In compliance with your request, I
take pleasure in submitting to your consideration the
following report of five cases of toadstool-poisoning
which recently came under my observation and treatment:
[Sidenote: =Amanita poisoning symptoms=]
On Monday, August 31, at 10 A.M., I was hastily called
to see a family, consisting of Mr. F., his wife, his
mother-in-law, Mrs. R., and his brother-in-law, Thomas
R., who, the messenger stated, were having "cramps in
the bowels."
Promptly responding to the call, I found them
suffering from intense abdominal pains, nausea,
vomiting, boneache, and feelings of distress in the
_præcordial_ region.
Mr. F., twenty-nine years of age, was a miner by
occupation, and had led an intemperate life. Mrs. F.,
twenty-two years of age, was a brunette, possessing
a delicate body, and bearing a decided _neurotic_
tendency. Mrs. R., forty-five years of age, was a small
_nervo-bilious_ woman. Thomas R., thirteen years of age,
was a youth well developed.
While I was examining these patients, Mrs. B., forty
years of age, a neighbor of the family, presented
herself, manifesting in a milder degree the same
symptoms. She was a tall, spare woman. Previous to their
present attack of illness their general health was good;
in none could signs of disease be traced.
Picture to your mind five persons suffering from
cholera morbus in its most aggravated form, and you
will be enabled to form a pretty correct idea of what I
beheld in the Faris residence on Monday morning, August
31.
That five individuals, four being members of one
household, should be attacked simultaneously by a
similar train of symptoms, naturally gave rise in my
mind to a suspicion that something poisonous had been
eaten. Upon close inquiry I obtained the following
history:
On the afternoon of Sunday, August 30, Mr. F. and
Thomas R. were walking through a wood not far distant
from their home, and, in wandering from place to place,
found clusters of very beautiful toadstools growing
abundantly under trees, among which the chestnut
predominated.
[Sidenote: =Amanita poisoning symptoms=]
Attracted by their appearance, and supposing them to
be edible, they gathered a large quantity, with the
anticipation of having a delicious dish for their Sunday
evening meal.
Various other kinds were growing in the same locality,
but this particular variety impressed them as being the
most inviting. A correct specimen of the _fungus_ they
had collected having been sent you, I will leave its
botanical description to your pen.
At about nine o'clock, five hours after gathering
them, Mrs. F. cooked three pints of the toadstools,
stewing them in milk, and seasoning with butter, pepper,
and salt.
They had dinner at a very early hour on this day, and
by the time they had supper all felt exceedingly hungry,
in consequence of which they ate quite heartily. Mrs. F.
and her brother vied with each other as to the quantity
they could eat. In addition to this dish, bread and
butter and coffee were served.
Soon after supper the family retired. None experienced
the least discomfort until towards daybreak, when
considerable distress in the abdominal organs and
cerebral disturbance manifested themselves. Prominent
among the initial symptoms were foul breath, coated
tongue, pain in the stomach, nausea, and a peculiar
sickening sensation in the epigastrium. These symptoms
gradually increased in severity, and in twelve hours
after the ingestion of the poison, when I made my first
visit, the condition of the victims involved great
danger. Intense vomiting was present in four, while in
Mrs. R.'s case a violent retching seemed to persist.
Gastro-intestinal irritation, followed by a relaxed
condition of the bowels, showed itself in about thirty
hours after the onset of the more active symptoms. With
the appearance of this trouble an insufferable tenesmus
developed, producing paroxysms of severe agony. This
was particularly true in the case of Mrs. R., whose
suffering was so great that it became a formidable
symptom to combat. Upon the subsidence of the more
severe symptoms, the patients fell into a state of
extreme prostration, accompanied by stupor and cold
extremities. In the mother, son, and daughter this was
profoundly marked. They were completely indifferent to
persons and things around them, as well as to their own
suffering.
[Sidenote: =Amanita poisoning symptoms=]
As the symptoms increased in violence, Thos. R.
advanced into a state of coma, and Mrs. F. into coma
vigil, and remained so for about twelve hours prior to
death. The face had a shrunken and wrinkled appearance,
the eyes were sunken, the skin was dusky, and the
surface of the body was dry and cold to the touch. The
pulse, a number of hours before death, was imperceptible
at the wrist, and the heart-sounds were scarcely
perceived by auscultation.
The pulse in all cases was notably affected, ranging
from 120 to 140 per minute. In character it was soft and
compressible; intermittent at intervals.
There was a distinct rise of temperature; the
thermometer in the axilla registered as much as 140° F.
A mild form of delirium was an occasional event. In
the case of Mrs. F. it formed an important element.
Respecting the special senses, it is well to mention
that sight was peculiarly affected. Notwithstanding the
fact that the pupils responded kindly to the action
of the light, an unpleasant sensation of blindness
frequently appeared, and continued for a few minutes.
In spite of all that was done to counteract its
ravages, the effects of the poison were so extremely
deadly that a fatal issue was the result in two cases.
Thomas R. died in fifty-six and Mrs. F. in sixty-three
hours after the ingestion of the toadstools.
_Treatment._--The treatment instituted was mainly
symptomatic.
[Sidenote: =Amanita poisoning treatment=]
Fearing that undigested particles of toadstools
might still be lying in the gastro-intestinal tract,
to Mrs. R., who had not freely vomited, an emetic was
administered, and to the rest a mild purge.
An intense thirst and a burning sensation being
present in the mouth, throat, and stomach, small pieces
of cracked ice were freely used with a view to allaying
it.
For the gastro-intestinal irritation I prescribed with
satisfactory results the following:
℞ Bismuth subnit., ʒv;
Creosote, gtt. xv;
Mucil. acaciæ, f℥i;
Aq. menth. pip., q.s. ad f℥iii. M.
Sig.--Teaspoonful every one or two hours.
1/8 grain of morph. sulph. was administered
hypodermically to alleviate as much as possible the
abdominal suffering.
The impending exhaustion and the failing heart's
action I endeavored to combat with a free administration
of alcoholic stimulants in combination with moderate
doses of tincture of digitalis both by the mouth and
under the skin.
In order to invite the circulation of the blood to the
ice-cold surface of the body, heated bricks and bottles
filled with hot water were placed in bed around the
patients.
[Sidenote: =Diagnosis=]
Analyzing each symptom as it arose, and carefully
observing the effects of the poison on the system, I
formed the opinion that the toxic element contained in
the noxious fungus eaten by these people was narcotic
in its nature and spent its force on the nerve centres,
especially selecting the one governing the function of
respiration and the action of the heart.
Acting upon this conclusion, I began, in the early
part of my treatment, subcutaneous injections of
sulphate of atropine in frequently-repeated doses,
ranging from 1/180 to 1/90 grain. The injections
invariably were followed by a perceptible improvement
in the patient; the heart's action became stronger,
the pulse returned at the wrist, and the respiration
increased in depth and fulness.
Through the agency of this remedy, supported by the
other measures adopted, three (or sixty per cent.) of
the patients recovered.
The lessons I draw from this experience are:
1. The poisoning produced by this variety of toadstool
is slow in manifesting its effects.