832 THE AGARICACEAE OF MICHIGAN 



Schuerer's six cases — most thoroughly studied and reported 1 " — show- 

 ed cramps in calf of leg, arms and other muscles, the left arm es- 

 caping in one. Many days of pains in the legs persisted. Recovery 

 was more or less rapid according to age but the youngest (5) died 

 in thirty-five hours after violent convulsions and coma. If recovery 

 takes place the liver and spleen enlarge about the third day. after 

 which day, according to Maass, 12 the prognosis becomes better. "In 

 clear-cut cases the physician can diagnose the variety of toadstool 

 from the typical symptoms." 1 " 



Reports on the post mortem findings in man in fatalities due to 

 A. phalloides are not overly satisfactory. There is little to be found 

 to account for the violent paroxysms of pain, vomiting and diarrhea. 

 Schuerer found, in a child, colitis, pleural haemorrhages and 

 fatty degeneration of liver, heart and kidneys. Microscopically 

 there were "Very wide-spread and obviously severe lesions of the 

 cell elements of the central nervous system, as heretofore hardly 

 known in this form and to this extent" — regressive changes like 

 those seen in the septic deliria. Harmsen, Maass and Robert liken 

 the postmortem findings to those of phosphorous poisoning. Thus, 

 the normal liver contains from 8 to 25 per cent of fat, that of 

 phosphorus and of alcohol poisoning 50 to TO per cent and that of 

 Amanita-toxin (2 cases) 53 and 69 per cent. Death seems to be due 

 to this extreme fatty degeneration of the liver. (Ford, Schuerer.) 

 Medico-legally, such a liver, with the addition of the other findings, 

 makes the postmortem picture pathognomonic of Amanita phal- 

 loides. 10 



Treatment of Poisoning by -1. phalloides 



All authorities agree unanimously that therapeutic measures in 

 these grave emergencies are almost useless. Case histories show- 

 that often the cause is not recognized, or the gravity of the cases 

 not appreciated. There is no antidotal drug for Amanita-toxin 

 and the treatment is that of poisoning and septic intoxication 

 in general. Competent medical advice should be obtained as 

 soon as possible. Active emetics (ipecac, mustard, apomorphine), 

 assisted perhaps by the stomach-tube, purgatives (castor oil being 

 preferable to the salines) should be administered at once and 

 every effort thereby made to reduce further absorption of the poison 

 to a minimum. By the time symptoms from A. phalloides have be- 

 gun, the toxin is already in the circulation. High enemata to 

 empfy the lower bowel may be used early. Later normal saline 

 solution should be given thus, or hypodermically, or even intra- 



