18 
TI1B LARGER FUNGI 
becoming like rice water. There is an intense thirst, the urine is suppressed, 
and there is perspiration and sleeplessness, with great nervous restlessness and 
weakness. Muscular spasms may cause severe pain. The urine does not become 
tinged with the colouring matter of the blood. Within a few days jaundice and 
blueness, and coldness of the extremities, are followed by profound unconscious- 
ness and death. Towards the end there may be eye-symptoms, the pupils varying 
in size, and convulsions may occur, though rarely. Death may take place within 
48 hours if large quantities have been eaten, or if they have not been thoroughly 
cooked. The usual course of the disease is from 4 to (i days in children, and from 
s to III in adults. No antidote is known. Kinetics, the stomach tube and purga- 
tions should be employed as soon as danger is suspected to get rid of as much 
of the unabsorbed fungus as possible. Milk (raw or boiled) should be 
given. Normal salt solution (about a teaspoonful of salt to a pint of water) 
may be given by the bowel to relieve the thirst. Strong coffee and hot dry 
applications, with digitalis and camphor suhcutnueously, may all be of service. 
The pain may have to be relieved as well as the cramps. Cyanosis may call for 
oxygen inhalation. Transfusion of blood has been suggested. 
The nature of the poisonous substance is uncertain. There would appear to 
be two constituents — one is a haemolytic agent and is capable of dissolving out 
the haemoglobin from the red cells of various mammals. This haemolytic agent, 
apparently a glucoside, is very sensitive to heat, to small traces of acid, and to 
the digestive ferment in the stomach, and therefore probably plays no part in 
tin' poisoning of man. The essential poison, the Amanila toxin, will resist heat, 
drying, and the digestive juices. It apparently is not a glucoside or an alkaloid. 
Poisoning by Amanita muscaria. — Poisoning by the fly agaric is quite distinct 
from that due to A maiiitit pholhndcs. This toadstool lias a bright scarlet cap covered 
with broad white warts, and cannot be readily mistaken for one of the edible 
kinds, and certainly in no wav resembles the common mushroom. ThetrP is 
usually only a short interval, half to one hour, or perhaps a little longer, before 
the symptoms develop. If the specimens are small, live or six hours may elapse. 
There is excessive salivation and perspiration, a flow of tears, the throat feels 
constricted, and there are nausea, retching, vomiting, and watery diarrhoea. 
The pulse is usually slow and irregular, the pupils small. The patients become 
dyspnoeic. the bronchi, being filled with mucus. There is usually some giddiness, 
with confusion id' ideas, and occasionally hallucinations. Delirium, violent con- 
vulsions, and loss of consciousness may follow. When recovery takes place it 
does so rapidly in two or three days. 
The active principle is known as mm'Carin. it is probably a, complex ammonia 
derivative and not an alkaloid as was at first thought. In the symptoms it 
produces it is almost the direct antithesis of atropine and consequently this 
drug is an antidote. The ticatmcnt is to get rid of the peccant material as 
quickly as possible hr means of emetics, or washing out the stomach; the 
vomiting ami diarrhoea themselves, of course, readily aid this. In spite, how- 
ever, of the vomiting and diarrhoea both emetics and purgatives should be 
given, as fragments of the fungus are often found in the alimentary canal 
even though there has been profuse vomiting. 11 is necessary to sustain the 
patient's strength as far as possible and supply warmth. Atropine is not 
medically indicated in every ease. 
Other Species. — There are a number of other instances of poisoning by various 
kinds of toadstools with a good deal of variation in the symptoms. In Australia 
very few records of cases exist. In 1869 a child is said to have been poisoned at 
Newcastle by a toadstool the size of a crown piece, but no details arc furnished, 
and death may have been due to some other cause. Dr. P. M. Johnston ( Inter • 
colonial Medical Journal, ]907, p. 399) has recorded a fatal case of “mush- 
room'’ poisoning. A hoy aged six, together with four other members of the 
family, had eaten a number of mushrooms gathered in Albert Park, Melbourne, 
between 10 and 11 one morning. They were eaten at 9 o'clock the next morning. 
An hour and a half afterwards this boy began vomiting, which continued off 
and on during the day. Early next morning his relatives were roused by his 
noisy breathing. Dr. Johnston, when called in shortly afterwards, found him 
lying mi his back, breathing noisily but not stertorously. He was comatose, 
the eyes were open, the pupils contracted, and the corneal conjunctiva was 
insensitive. There was no squint. The face was pallid and dusky; the lips 
blackish. Clonic convulsions occurred in the limbs; the arms were strongly 
adducted, the forearm supinated, the wrist flexed, and the lower limbs rigidly 
