iuttctstool Poisoning and its Treatment 



taneous 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 poison- 

 ing 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 witJi 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 ; respira- 

 tion stertorous; pulse 28 per minute and so feeble that it was almost 

 imperceptible. Two full doses of atropine were given hypodermatically 



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