Investigators from the New York City Health Department have found that certain cases of alleged "ptomain poisoning" were really due to "sour-grass soup."[21] This soup is prepared from the leaves of a species of sorrel rich in oxalic acid. In one restaurant it was found that the soup contained as much as ten grains of oxalic acid per pint!
Fig. 3.—Fly Amanita (poisonous). (Amanita muscaria L.) (After Marshall, The Mushroom Book, by courtesy of Doubleday, Page & Company.)
By far the best-known example of that form of poisoning which results from confounding poisonous with edible foods is that due to poisonous mushrooms.[22] There is reason to believe that mushroom (or "toadstool") intoxication in the United States has occurred with greater frequency of late years, partly on account of the generally increasing use of mushrooms as food and the consequently greater liability to mistake, and partly on account of the growth of immigration from the mushroom-eating communities of Southern Europe. Many instances have come to light in which immigrants have mistaken poisonous varieties in this country for edible ones with which they were familiar at home. In the vicinity of New York City there were twenty-two deaths from mushroom poisoning in one ten-day period (September, 1911) following heavy rains. The "fly Amanita"[23] (Amanita muscaria) in this country has been apparently often mistaken for the European variety of "royal Amanita" (A. caesaria).[24] Such a mistake seems to have been the cause of death of the Count de Vecchi in Washington, D.C., in 1897.
The Count, an attaché of the Italian legation, a cultivated gentleman of nearly sixty years of age, considered something of an expert upon mycology, purchased, near one of the markets in Washington, a quantity of fungi recognized by him as an edible mushroom. The plants were collected in Virginia about seven miles from the city of Washington. The following Sunday morning the count and his physician, a warm personal friend, breakfasted together upon these mushrooms, commenting upon their agreeable and even delicious flavor. Breakfast was concluded at half after eight and within fifteen minutes the count felt symptoms of serious illness. So rapid was the onset that by nine o'clock he was found prostrate on his bed, oppressed by the sense of impending doom. He rapidly developed blindness, trismus, difficulty in swallowing, and shortly lost consciousness. Terrific convulsions then supervened, so violent in character as to break the bed upon which he was placed. Despite rigorous treatment and the administration of morphine and atropine, the count never recovered consciousness and died on the day following the accident. The count's physician on returning to his office was also attacked, dizziness and ocular symptoms warning him of the nature of the trouble. Energetic treatment with apomorphine and atropine was at once instituted by his colleagues and for a period of five hours he lay in a state of coma with occasional periods of lucidity. The grave symptoms were ameliorated and recovery set in somewhere near seven o'clock in the evening. His convalescence was uneventful, his restoration to health complete, and he is, I believe, still living. On this instance the count probably identified the fungi as caesaria or aurantiaca. From the symptoms and termination the species eaten must have been muscaria.
A. muscaria contains an alkaloidal substance which has a characteristic effect upon the nerve centers and to which the name muscarin and the provisional chemical formula C5H15NO3 has been given. The drug atropin is a more or less perfect physiological antidote for muscarin and has been administered with success in cases of muscarin poisoning. It is said that the peasants in the Caucasus are in the habit of preparing from the fly Amanita a beverage which they use for producing orgies of intoxication. Deaths are stated to occur frequently from excessive use of this beverage.[25]
The deadly Amanita or death-cup (A. phalloides) is probably responsible for the majority of cases of mushroom poisoning. Ford estimates that from twelve to fifteen deaths occur annually in this country from this species alone. This fungus is usually eaten through sheer ignorance by persons who have gathered and eaten whatever they chanced to find in the woods. A few of these poisonous mushrooms mixed with edible varieties may be sufficient to cause the death of a family. Ford thus describes the symptoms of poisoning with A. phalloides:
Following the consumption of the fungi there is a period of six to fifteen hours during which no symptoms of poisoning are shown by the victims. This corresponds to the period of incubation of other intoxications or infections. The first sign of trouble is sudden pain of the greatest intensity localized in the abdomen, accompanied by vomiting, thirst, and choleraic diarrhoea with mucous and bloody stools. The latter symptom is by no means constant. The pain continues in paroxysms often so severe as to cause the peculiar Hippocratic facies, la face vultueuse of the French, and though sometimes ameliorated in character, it usually recurs with greater severity. The patients rapidly lose strength and flesh, their complexion assuming a peculiar yellow tone. After three to four days in children and six to eight in adults the victims sink into a profound coma from which they cannot be roused and death soon ends the fearful and useless tragedy. Convulsions rarely if ever occur and when present indicate, I am inclined to believe, a mixed intoxication, specimens of Amanita muscaria being eaten with the phalloides. The majority of individuals poisoned by the "deadly Amanita" die, the mortality varying from 60 to 100 per cent in various accidents, but recovery is not impossible when small amounts of the fungus are eaten, especially if the stomach be very promptly emptied, either naturally or artificially.
A number of other closely related species of Amanita (e.g., A. verna, the "destroying angel," probably a small form of A. phalloides) have a poisonous action similar to that of A. phalloides. All are different from muscarin.