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.
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. |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. |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. |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.