A man, his wife, and three children, ate to dinner carp stewed by mistake with the Amanita citrina. The wife, the servant, and one of the children had vomiting, followed by deep sopor; but they recovered. The husband had true and violent cholera, but recovered also. The two other children became profoundly lethargic and comatose, emetics had no effect, and death soon ensued without any other remarkable symptom. The individuals who recovered were not completely well till three weeks after the fatal repast.[[2432]] This set of cases shows the tendency of the poisonous fungi to cause in one person pure irritation, and in another pure narcotism.
The last set of cases to be mentioned were produced by the Hypophyllum sanguineum, a small conical fungus of a mouse colour, well known to children in Scotland by the name of puddock-stool. This species seems to cause convulsions as well as sopor. A family of six persons, four of whom were children, ate about two pounds of it dressed with butter. The incipient symptoms were pain in the pit of the stomach, a sense of impending suffocation, and violent efforts to vomit; which symptoms did not commence in any of them till about twelve hours after the poisonous meal, in one not till twenty hours, and in another not till nearly thirty hours. One of the children, seven years of age, had acute pain of the belly, which soon swelled enormously; afterwards he fell into a state of lethargic sleep, but continued to cry; about twenty-four hours after eating the fungi the limbs became affected with permanent spasms and convulsive fits; and in no long time he expired in a tetanic paroxysm. Another of the children, ten years old, perished nearly in the same manner, but with convulsions of greater violence. The mother had frequent bloody stools and vomiting; the skin became yellow; the muscles of the abdomen were contracted spasmodically, so that the navel was drawn towards the spine; profound lethargy and general coldness supervened; and she too died about thirty-six hours after eating the fungus. A third child, after slight symptoms of amendment had shown themselves, became worse again, and died on the third day with trembling, delirium, and convulsions. This patient, who had taken very little of the poison, was not attacked till about thirty hours after the meal. The fourth child, after precursory symptoms like those of the rest, became delirious, and had an attack of colic and inflammation of the bowels, without diarrhœa; but he eventually recovered. The father had a severe attack of dysentery for three days, and remained five days speechless. For a long time afterwards he had occasional bloody diarrhœa; and, although he eventually recovered, his health continued to suffer for an entire year.[[2433]] The cases now mentioned illustrate clearly the simultaneous occurrence of narcotic and irritant symptoms in the same individuals.
A striking circumstance in respect to the symptoms of poisoning with the fungi, is the great difference in the interval which elapses before they begin. In the first case the symptoms appear to have commenced in a few minutes; but, on the contrary, an interval of twelve hours is common; and Gmelin has quoted a set of cases, seventeen in number, in which, as in one of those related by Picco, the interval is said to have been a day and a half.[[2434]] The tardiness of the approach of the symptoms is owing to the indigestibility of most of the fungi. Their indigestibility is in fact so great, that portions of them have been discharged by vomiting so late as fifty-two hours after they were swallowed.[[2435]]
Another circumstance, worthy of particular notice, is the great durability of the symptoms. Even the purely narcotic effects of some fungi have been known to last above two days. In the instance just alluded to, the vomiting of the poison was the first thing that interrupted a state of deep lethargy, which had prevailed for fifty-two hours. The symptoms of irritation, after their violence has been mitigated, might continue, as in the instance quoted from Orfila, for about three weeks.
It was stated above, that some people are apt to suffer unpleasant effects from eating even the best and safest of the esculent mushrooms. These effects, which depend on idiosyncrasy, are confined chiefly to an attack of vomiting and purging, followed by more or less indigestion. Some persons have been similarly affected, even by the small portion of mushroom-juice which is contained in an ordinary ketchup seasoning. This accident, however, may very well be often unconnected with idiosyncrasy; as I have seen those who gather mushrooms near Edinburgh, for the purpose of making ketchup, picking up every fungus that came in their way.
There is some reason for suspecting that even the best mushrooms, when taken as a principal article of food for a considerable length of time, will prove injurious, and that they then induce a peculiar depraved habit, which leads to external suppuration and gangrene. The only cases which have hitherto appeared in support of this statement, were lately published in Rust’s Journal. A family, consisting of the mother and four children, were seized with a kind of tertian fever, and the formation of abscesses, which discharged a thin, ill-conditioned pus, passed rapidly into spreading gangrene, and proved fatal to the mother and one of the children. No other cause could be discovered to account for so extraordinary a conjunction of symptoms in so many individuals, except that for two months they had lived almost entirely on mushrooms; and the probability of this being really the cause, was strengthened by the fact, that the father who slept always with his family, and who alone escaped, lived on ordinary food at a place where he worked not far off.[[2436]] In opposition, however, to the natural inference from this narrative, some have believed, that mushrooms may be safely eaten to a large amount and for a long time, provided they be used raw. A botanist of Persoon’s acquaintance, while studying the cryptogamous plants in the vicinity of Nuremberg, says he found that the peasants ate them in large quantities as their daily food; and, in imitation of their custom, he ate for several weeks nothing but bread and raw mushrooms; yet at the end he experienced an increase rather than a diminution of strength, and enjoyed perfect health. He adds that they lose their good qualities by cooking; but he has supplied no facts in support of that statement.[[2437]] It is said that eatable fungi, used for a considerable time as a principal article of food, as in Russia, cause greenness of the skin.[[2438]] There is no reason for supposing, as some have done,[[2439]] that wholesome mushrooms may produce the effects of the poisonous kinds, if eaten in large quantity.
Of the Morbid Appearances.—The morbid appearances left in the bodies of persons poisoned by this deleterious fungi have been but imperfectly collected.
The body is in general very livid, and the blood fluid; so much so sometimes, that it flows from the natural openings in the dead body.[[2440]] In general, the abdomen is distended with fetid air, which, indeed, is usually present during life. The stomach and small intestines of the four French soldiers (p. [705]), presented the appearance of inflammation passing in some places to gangrene. In two of them especially, the stomach was gangrenous in many places, and far advanced in putrefaction. The same appearances were found in Picco’s cases. In these there was also an excessive enlargement of the liver. The lungs have sometimes been found gorged or even inflamed. The vessels of the brain are also sometimes very turgid. They were particularly so in a case related by Dr. Beck, where death was occasioned in seven hours by an infusion of the Amanita muscaria in milk. The whole sinuses of the dura mater, as well as the arteries were enormously distended with blood; the arachnoid and pia mater were of a scarlet colour; the vessels of the membrane between the convolutions, together with the plexus choroides, were also excessively gorged; and the substance of the brain was red. Lastly, a clot of blood, as big as a bean, was found in the cerebellum.[[2441]]—The stomach, unless there had been vomiting or diarrhœa, will usually contain fragments of the poison, if it has not been taken in a state of minute division; and this evidence of the cause of death may be obtained, even although the individual survived two days or upwards. Sometimes fragments are found in the intestines. In one of Picco’s patients who lived twenty-four hours, there was found in the neighbourhood of the ileo-cæcal valve, which was much inflamed.[[2442]]
Of the Treatment.—The treatment of poisoning with the fungi does not call for any special observations. Emetics are of primary importance; and after the poison has been by their means dislodged, the sopor and inflammation of the bowels are to be treated in the usual way. No antidote is known. Several have at different times been a good deal confided in; but none are of any material service. Chansarel found acids useless, but thought infusion of galls advantageous.[[2443]]
In concluding the present chapter it is necessary to take notice of a variety of poisoning, not altogether unimportant in a medico-legal point of view. A person may seem to die of poisoning with the deleterious fungi, from eating esculent mushrooms intentionally drugged with some other vegetable or mineral poison. It must be confessed, that if the murderer is dexterous in the choice and mode of administering the poison, such cases might readily escape suspicion, and even when suspected might not be cleared up without difficulty. The ascertaining the species of mushroom, by finding others where it has been gathered, will not supply more than presumptive proof of the wholesomeness of that which has been eaten; because the esculent and poisonous species sometimes grow near one another, and have a mutual resemblance, so that a mistake may easily occur. The presumption may be somewhat strengthened by evidence derived from the interval which elapses before the symptoms begin, from the nature and progress of the symptoms themselves, and from the morbid appearances. Some one or other of these circumstances may establish the fact of poisoning with a deleterious fungi. It is impossible, however, that they shall ever establish satisfactorily that the fungus was naturally wholesome; and, on the whole, the only decided evidence of poisoning by some other means will be the actual discovery of another poison.