170 
Mycologia 
ish color is rarely seen. Amanita phalloides usually grows in the 
woods but this rule is by no means univeral. Occasionally, plants 
are to be found out in the open pastures near the margin of dense 
forests or in the grassy spots in the roads leading to and from 
them. 
Clinical aspects 
In poisoning by Amanita phalloides the clinical symptoms are 
practically always the same. After a prodromal stage of six to 
fifteen hours in which no discomfort is felt, the victims are sud- 
denly seized by severe abdominal pain, cramp-like in character, 
and accompanied by vomiting and diarrhoea. Vomitus and stools 
consist of undigested food with much blood and mucus. Anuria is 
usually present and rarely constipation develops. Hemoglobinuria 
does not occur. Paroxysms of pain and vomiting alternate with 
periods of remission, the extreme suffering producing the Hippo- 
cratic facies described by the French as “la face vulteuse.” The 
loss of strength is rapid and excessive. Jaundice, cyanosis, and 
coldness of the skin develop within a few days, followed by pro- 
found coma from which the patient does not rally. There is no 
fever. Convulsions are absent in the early stages and when pres- 
ent in the late stages are usually a terminal event. Ocular symp- 
toms also do not usually occur. The course of the disease lasts 
four to six days in children and eight to ten in adults but if large 
quantities of the fungus are eaten a very profound intoxication 
develops and death may occur within 48 hours. The mortality in 
“ phalloides ” intoxication is extremely high, varying from 60 to 
100 per cent., and is dependent somewhat upon the amount of the 
poisonous material ingested and probably somewhat upon the treat- 
ment. It requires surprisingly small quantities, however, to bring 
on fatal consequences and there are numerous deaths on record 
from eating one or two good-sized specimens. Plowright 14 has 
reported the death of a child of ten years from the consumption 
of about a third of the top of a small plant eaten raw. Recovery 
after ingestion of any quantity of Amanita phalloides may be re- 
garded as extremely rare but not impossible. There is no diffi- 
culty in distinguishing between a poisoning due to this fungus 
from one due to other species such as Amanita muscaria since 
the entire clinical course of the disease is different. 
