Medical Jurisprudence And Toxicology

POISOKOUS FUNGI

697

to a height of about four to six inches in woody places. It has a hollow stalk with a
prominent bulb at the base, the upper margin of which is formed into a vulva or cup.

The pileus is usually white but may vary
in colour from pale dull yellow to olive, and
has gills covered with white spores on its
under surface.

The fungus is a powerful poison and con-
tains two active principles, amanita, Tioemo-
lysin (Phallvn of Kobert) and amanita.
toxin. ^ Amanita hsemolysin is a hsemolytic
glycoside which is precipitated by alcohol
and is completely destroyed when heated to
70 °C., or when digested with pepsin as well
as pancreatin. Amanita toxin is the chief
poisonous principle which is not a glycoside
nor an alkaloid, but it is a nitrogenous sub-
stance and is dissolved by alcohol, but is not
destroyed by heat or digestive ferments.

Symptoms.— These are divided into two
groups, irritant and neurotic.

1. Irritant Symptoms. — The symptoms are
usually delayed for six to ten hours or for
thirty hours in some cases. These are con-
striction of the throat, burning pain in the
stomach, nausea, painful retchings, vomit-
ing, and diarrhoea, the stools containing
blood ; the urine may contain blood and
albumin. These are followed by cyanosis,
small pulse, laboured respirations, convul-
sions, profuse sweating, collapse and death.
Sometimes there may be anuria.

2. Neurotic Symptoms. — These are giddi-
ness, headache, mental excitement, delirium,
diplopia, contraction of the pupils, tetanic
spasms, insensibility and coma.

In some cases irritant symptoms may be

TK« top A™*«^ TVT,,*™^

Fig. 192.-Amamta Muscana. present, and in others neurotic only. The

predominance of one or the other group of
symptoms depends on the nature of the active principles present.

Fatal Dose.— Uncertain. Four grains and a half of rnuscarine administered hypo-
dermically would prove fatal to an adult. One-third of the pileus (top) of Amanita
phalloides has caused the death of a child.

Fatal Period. — Death usually occurs within twenty-four hours but may sometimes
take place in from three to eight days.

Treatment.— Evacuate the stomach by giving common salt as an emetic or by lavag-
ing it with water containing potassium permanganate or finely powdered charcoal. Give
castor oil or magnesium sulphate to clear the bowels. Atropine is considered a physio-
logical antidote to muscarine, and should be administered hypodermically. Morphine
may be administered hypodermically to relieve pain. Give stimulants and normal saline
subcutaneously. Repeated intravenous infusions of 300 to 500 cc. of 10 to 20 per cent
sugar solutions with eventual addition of calcium salts are considered very useful.
Injections of insulin combined with vitamin K and vitamin B and a ten per cent solu-
tion of calcium gluconate may be administered parenterally with advantage, Anti-
phaHinic serum should be used, if available.

Limousin and Petit55 recommend the administration, of the fresh stomach and
brain, of a rabbit in poisoning by Amanita phalloides. A family of four persons partook
of A. phalloides, and one died. The other three had serious symptoms. They were
given each three fresh rabbit stomachs mashed and some fresh brains, and a rapid
recovery ensued.

Post-mortem Appearances. — Signs of inflammation of the mucous membrane of the
alimentary canal are present, if irritant signs have been predominant. Fatty degenera-

54. Ford, Brit. Med. Jour., Dec. 1, 1906, p. 1541.

55. Bull, de V Acad. Med., May 1932, p. 24; Med. Annual, 1933, p. 500.