THE POISONOUS ALKALOID
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.
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.
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.
Antidote for Amanita
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:
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.
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.
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.
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.
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.
2. That it destroys life by a process of asthenia.
3. That in atropine we have an antidote, and it should be pushed heroically from the earliest inception of the action of the poison.
I have the honor to remain
Yours very respectfully,
J. E. Shadle, M.D.
In reply to the queries, Was atropine administered in all the cases? and What was the total amount administered to each? Dr. Shadle responded as follows:
Shenandoah, Pa., October 29, 1885.
My dear Mr. McIlvaine:
Yours of the 27th I have received. The two questions you ask me therein I see are very important, and they should be answered as fully as possible. I am sorry I overlooked the matter in my report.
Amanitine and atropine
Before attempting an answer, it is well for me to note right here that Mrs. B., the neighbor, did not eat very much of the toadstool stew; Mrs. R. and Mr. F. each ate about the same quantity—from one and one-half to two platefuls. This is according to Faris's statement. But the two fatal cases—Thomas R. and Mrs. F.—tried to see which could eat the most, and consequently got their full share of the poison. The cat mentioned before had about a tablespoonful of the broth, and they tell me she was very sick. Whether or not she died is not known.
Now as to the treatment by atropine, I think I can approximate a pretty correct statement in reply to your queries. Not knowing that atropine was considered an antidote, I began its employment in the treatment of these cases from the physiological knowledge I had of the drug relative to its action in other diseases in which there was heart-failure and embarrassed respiration.
When I saw the U. S. Dispensatory suggested it, I of course felt it my duty to use it, as I could find nowhere anything else mentioned as an antidote. I feel convinced that it was by means of the atropine that I saved three of the five patients. Why do I think so? Because whenever I would administer the remedy the patient rallied, the pulse returned at the wrist, the heart-sounds became stronger, and the respiration increased in strength and fulness. What more conclusive evidence do I want than this to show as to how the agent was acting?
Administration of antidote
When I first saw the patients—twelve hours after the ingestion of the poison—their symptoms were alike, one suffering as much as the other (August 31). I began the use of the alkaloid in the evening of the same day, when I saw the powers of life giving way, the heart failing, and the respiration becoming shallow. It was used in all the cases as follows:
Mrs. B., 1/180, 1/90, 1/90, or 5/180, or 1/36 gr.
Mr. F., 1/180, 1/90, 1/90, 1/90, or 7/180 gr.
Mrs. R., 1/180, 1/90, 1/90, 1/90, or 7/180 gr.
Thos. R., 1/180, 1/90, 1/90, 1/90, 1/90, or 9/180, or 1/20 gr.
Mrs. F., 1/180, 1/90, 1/90, 1/90, 1/90, or 9/180, or 1/20 gr.
In accordance with the above formulæ the drug was administered. I visited the patients at intervals of six or eight hours, and at each visitation they received an injection in the doses above mentioned. From this we see that in all Mrs. B. received gr. 1/36 of atropine; Mr. F. received gr. 7/180 of atropine; Mrs. R. received gr. 7/180 of atropine; Thos R. (fatal) received gr. 1/20 of atropine; Mrs. F. (fatal) received gr. 1/20 of atropine.
The alkaloid failing to save the two that died I think can be attributed to one of two causes, or probably both:
1. That the use of atropine was begun too late and not used heroically enough.
2. That so much of the poison was taken up by the system in these cases that it became too virulent to counteract.
From the history of the cases I know they ate by far the largest quantity. My opinion leans towards the first probable cause I have mentioned.
Another fact worth stating here is that the pupils never became affected by the administration of these doses.
Hoping this will make the matter satisfactory, I remain
Yours truly, J. E. Shadle.
The interval between the ingestion and the symptoms is, therefore, a most important aid in the diagnosis of a case of mushroom poisoning; and in the event of an Amanita, heretofore absolutely fatal, it is presumably under the control of medical science, now that the deadly toxic principle has at last found its enemy in the neutralizing properties of the equally deadly atropine.
It would seem, moreover, from the severe personal experience of Mr. Julius A. Palmer, that the poison of the Amanita is quite capable of mischief without being taken into the digestive organs. So volatile is this dangerous alkaloid that it may produce violent effects upon the system either through its odor alone, or by simple contact with the skin and consequent absorption.
Mr. Palmer, in his before-mentioned article in the Moniteur Scientifique, Paris, relates the following experiences:
Poisons by contact and odor
"Once while perspiring from a long walk I undertook to bring in a large bunch of the Amanita for an artist. Seated in a close car, holding them in my warm hand, although protected by a paper wrapper, a fearful nausea overcame me. The toadstool was not at first suspected, yet I had all the symptoms of a sea-sick person, and was only relieved by a wide distance between myself and the exciting cause.
"While writing this article," he continues, "a friend sent me two very elegant specimens of the Amanita tribe. They were in a confined box. On opening it I smelled of them a few times, and allowed the box to lie near my desk while I wrote to a medical gentleman anxious to procure such for chemical experiment. Having sent them away the matter was dismissed from my mind for three hours after, when, by an attack of vomiting and oppression at the stomach, they were enforced upon my attention. The whites of my eyes became livid, and even until noon the day following the leaden color of my face was noticed by more than one person."
A wide berth to Amanita
The moral of this story is that the less the reader has to do with Amanita fungi the better. Let them have a wide berth, or at most an annihilating kick, lest by their alluring beauty they tempt the next unwary traveller who shall encounter them.
But you desire a specimen "to show a friend," or "to make a photograph of, or a sketch," perhaps. In such case it were well to consider further the experiences of Mr. Palmer, which will show the wisdom of keeping your gustatorial and artistic mycology in separate expeditions, or at least of providing your poison-exhaling Amanita specimen with a cage by itself. In the same article he continues:
Mushrooms inoculated by contact
"Mushrooms make the same use of the atmosphere as men, even their exhalations are accordingly vitiated with their properties. Those not deadly thus attack humanity—namely, by absorption of their essential elements by the whole system. They also inoculate each other with or without contact, so that if edible and noxious toadstools are gathered together the former will absorb the properties of the latter."
In proof of this assertion he instances a personal experience as follows: "About four years ago a number of poisonous mushrooms (not Amanitæ, but of a totally different family) were sent me with edible fungus. The two varieties had lain twelve hours in the same box. The noxious ones were rejected, and the esculent washed and eaten. In a moment my appetite was gone; violent perspiration, vertigo, and trembling were the next symptoms; then chills, nausea, purging, and tenesmus, all within thirty minutes. Now the substance could not have reached the intestines. The virus absorbed from the noxious fungus permeated the whole system through eating the harmless ones; unmixed with other food it acted upon the muscles through an empty stomach; once spent, the ailment passed off," etc.
Poison extracted by vinegar
From these and other experiences he draws the following conclusions: The poisonous principle of a fungus being absorbed by a harmless element, if the latter be eaten the venom acts more quickly. In reinforcement of this he states that "if the Amanita be cut in sections and laid in vinegar the fungus may be eaten without danger to life; but on a very small dose of the vinegar, death will follow more speedily than if the whole toadstool be eaten." Further interesting matter upon this topic is contained in the article from which I quote, and to which the reader is referred in his volume included in my bibliographical list. The work also contains numerous other collected articles of Mr. Palmer's upon this subject of fungi, to which he has devoted so much attention, and with which his name has become so popularly identified in America.
Effect of salt and heat
The allusion to vinegar as an absorbent of the poison suggests the prevalent habitual use of salt as a safeguard by many in the employment of the fungus as food, as both of these ingredients play a prominent part in a fungus cuisine. It is averred by some writers that one of the most noxious of Amanitæ—the Fly-agaric—is eaten in some countries, notably Russia, without unpleasant results, while it is confidently asserted to be harmless after, as it were, having its venom drawn by a soaking in brine previous to cooking. Boiling—both in the possible neutralizing of the poison through heat, and in the withdrawal of the same in the solution—would also be contributive to safety in such cases, provided the tainted liquid were not retained as in a stew or soup.
Epicurean perversity
On this topic it is interesting to note the epicurean perversity of a certain French author, who, in the face of the already overwhelming abundance of nature's esculent species of fungi, must needs include all the deadly Amanitæ as well, though he gives a recipe by which the poison is extracted by the copious aid of salt, vinegar, boiling water, and drawing. This process, on general principles, might invite humorous speculation as to the appetizing qualities of the residual morsel thus acquired, or as to the advisability of deliberately selecting a poisonous substance for the desideratum of the washed-out, corned, spiced, nondescript remnant which survives the process of extraction, not only of its noxious properties, but of even what nutriment it might possibly contain.
Mushrooms à la mode
Fancy a beefsteak similarly "prepared," all its nourishing ingredients extracted and thrown away; its exhausted remnant of muscular fibre now the mere absorbent vehicle for vinegar, salt, lemon-juice, butter, nutmeg, garlic, spice, cloves, and other seeming indispensables to the preparation of the Champignon à la mode!
The verdict of the extreme fungus epicure upon the delectable flavor of this or that mushroom must indeed be taken cum grano salis, the customary culinary treatment, or maltreatment, of these delicately flavored fruits having for its apparent object the elimination as far as possible of any suggestion of the true flavor of the fungus. I fancy that even the caustic, rebellious root of the Indian-turnip or the skunk-cabbage thus tamed and subdued in a smothering emollient of spiced gravy or ragoût might negatively serve a purpose as more or less indigestible pabulum.
Enough without Amanita
While, as already mentioned, a few of this genus Amanita are edible, it is well in concluding our chapter to emphasize the caution of an earlier page as to the absolute exclusion of the entire genus from the bill of fare of the amateur mycophagist. There is an abundance of wholesome, delicious fungi at our doors without them.
Many species of Amanita are to be found more or less frequently in company with the esculent varieties recommended in the chapters following. Among these the two extremes of variation from the typical form are seen in the A. muscarius in its permanent retention of the volva scales and the obscurity of its cup, and in the A. phalloides, herewith pictured about half natural size, with the frequent entire absence of these remnant scales, which wither and fall off, leaving the yellowish or greenish cap perfectly smooth.
It is to the volva or cup, then, that we must turn for the one fixed permanent character by which this genus is to be identified.
AMANITA PHALLOIDES
