Toadstools, mushrooms, fungi, edible and poisonous; one thousand American fungi / How to select and cook the edible; how to distinguish and avoid the poisonous, with full botanic descriptions. Toadstool poisons and their treatment, instructions to students, recipes for cooking, etc., etc.

by Charles McIlvaine; Robert K. Macadam

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.