Extracted from the American Journal of the Medical Sciences for October, 1880. 
FATAL POISONING BY MUSHROOMS. 
BY 
ADOLPH KESSLER, M. D., 
OF NEW YORK CITY. [Extracted from the American Journal of the Medical Sciences for October, 1880.] 
FATAL POISONING BY MUSHROOMS. 
By ADOLPH KESSLER/^.ir, 
OF NEW YORK CITY 
The comparatively rare occurrence of fatal poisoning by mushrooms and 
its somewhat obscure pathology and symptomatology induce me to publish 
a report of the following two cases which happened simultaneously in the 
same family. Not having been able to obtain from the physician in at- 
tendance until my arrival an account of the earlier history, I am obliged 
to give it in the words of the surviving patient, a highly intelligent college 
student residing in Stamford, Conn., where the cases occurred. 
Case I—Mr. H. w'rites as follows: “On the 31st of August (1879), 
in the evening I started out to get some mushrooms for tea. I had had 
some the day before for dinner, and they tasted very nicely and had done 
me no harm. I picked about two dozen on the lawn, and as I returned 
with them my cousin proposed to go out to one of the pasture fields to get 
some more, which we did accordingly. 
“ The number of plants gathered amounted to about three dozen of all 
sizes; as to their name I am in ignorance. We supposed them to be the 
common edible mushrooms. In colour they were for the most part of a 
bright and clear white ; some few of those we gathered later had a brownish 
tinge on the top. They were partly full-grown, that is, the cap or top 
(pileus) had spread itself out, and the peculiar formation of the plant was 
strongly marked on the under side ; partly they consisted of the small un- 
developed buttons growing near the ground. We applied the test of peal- 
ing the cap to all that appeared suspicious. The mushrooms were fried or 
boiled and brought on the table that evening. My cousin ate a good 
many, as he was very fond of them, my mother just tasted one, and I par- 
took of them liberally. 
“ After tea we walked down to the village, and partook of some ice-cream 
and sat down on the veranda of the hotel smoking. That same night my 
cousin was taken sick with violent nausea and pain in the stomach ; I did 
not feel any ill effects the next morning, and drove down town to summon 
a physician. He came and prescribed an opium powder to be taken every 
hour, thinking that the sickness resulted from overloading the stomach. 
Towards noon I also felt ill, but did not take any of the powders, while 
my cousin took them regularly. I vomited once or twice during the after- 
noon, and oftener in the evening. Next morning the doctor, gave each of 
us a hypodermic injection of morphia; we vomited before that very fre- 
quently, though we had little or nothing on our stomach. I was also at- 
tacked with very severe diarrhoea, but this symptom did not manifest it- 
self in the case of my cousin. The doctor further prescribed some large 2 
white pills (T think bismuth) of which I took a couple. After the hypo- 
dermic injection the vomiting and looseness of the bowels disappeared for 
the time, and I was thrown into a kind of stupor, which lasted till the 
afternoon when the former symptoms reappeared. We suffered greatly 
from nausea, vomiting, burning thirst, headache, and I from diarrhoea, 
which probably had been checked in my cousin’s case by the quantity of 
opium taken the day before. That evening, I think, you were called in.” 
In obedience to a summons by telegram, I went to Stamford and I 
found Mr. II. just recovering from the effects of the last hypodermic in- 
jection, and greatly annoyed by an incessant nausea and tenesmus. lie 
piteously implored me to relieve him and to administer another subcutaneous 
injection of morphia, but believing that all of the materia peccans had not 
been removed from the intestinal tract, and finding the patient possessed 
with a fair amount of strength, and with a pretty good pulse, I firmly re- 
fused to comply with his request, but, on the contrary, considered it my 
duty to aid nature in her efforts to eliminate the poisonous substances, 
which were still retained and kept up the gastro-intestinal irritation, by 
administering hot drinks and purgative enemata carried high up—which 
kept the patient almost all night vomiting and especially purging. With 
the thorough removal of the mushrooms the symptoms of gastro-intestinal 
irritation entirely and at once abated, and towards morning the patient 
was not only free from all danger and the distressing pains of the last two 
days, but bright and cheerful. The stomach having speedily regained its 
normal functions I was enabled to adopt an appropriate course of treat- 
ment, which resulted in the patient’s rapid recovery of his previous health 
and strength. 
Case II—Far different, however, was the condition of the other patient, 
Mr. C., aged 24 years, a student of divinity, who was shortly to be ordained. 
My first impression upon seeing him was that he appeared to be doomed, 
alarming symptoms of collapse being apparent, such as I had frequently 
had occasion to observe in fatal cases of Asiatic cholera. 
The face and entire surface of the body were bathed with a cold clammy 
sweat, the extremities were cold, the eyes deeply sunk in their sockets, 
the colour of the countenance ashy pale with livid contours around the 
lips and nose, the features pinched and shrunken, the pulse exceedingly 
weak and at times scarcely perceptible, the impulse of the heart faint, ir- 
regular, and intermitting, the respiration shallow, short, and oppressed, 
the intellect apathetic and obtuse, and the whole aspect of the patient that 
of a deep sopor from which he was occasionally roused by complaints of an 
excruciating pain in the epigastrium and an insatiable thirst. 
The first indication to be fulfilled was, of course, the vital one to sustain 
the life that was fast ebbing away; I, therefore, injected at once subcu- 
taneously large quantities of camphor, ether, musk, and alcohol, applied 
artificial heat and rubefacients and excited the cutaneous surface by stimu- 
lating frictions, persevering in that course until a favourable reaction began 
to set in, and pulse, temperature, colour, countenance, and the mental com- 
plexion showed visible signs of improvement. 
The imminent danger of fatal collapse having passed for the time, I 
turned my attention next to the neutralization and elimination of the poi- 
son. But my efforts in that direction were unfortunately rendered futile 
by the extremely irritable and intolerant condition of the stomach which 
caused the almost immediate rejection of even a teaspoonful of iced water 
or champagne. 3 
The internal administration of tannic acid as a partially efficacious 
chemical antidote and of cathartics for the speedy removal of the poisonous 
matter from the alimentary canal being thus rendered impossible, I had 
to resort to rectal medication and purgative enemata, but met here also 
with considerable difficulty. For although making use of a long tube and 
carrying it high up into the colon the injected fluid passed off almost im- 
mediately, neither the medicated, nor the purgative and nutritive clysters 
were retained and the discharge of fecal matter was quite scanty. The 
bowels lutd not once spontaneously moved since the patient was taken ill, 
and all efforts of freeing the system from the poison by active purgation 
threatened to fail. Feeding and medication by the rectum were further- 
more aggravated by the patient’s exhaustion, as any long-continued change 
of position or brisk movements were apt to induce syncope and slight col- 
lapse accompanied with severe and painful vomiting. 
In this emergency while nervous prostration, gastric inflammation and 
intestinal torpor stubbornly combined against the pursuance of a rational 
and radical mode of treatment, I resolved as my last resort to employ 
atropia subcutaneously. Although left in ignorance of the true character 
of the ingested mushrooms—whether merely bad and partly decayed or 
truly poisonous—and although the patients were in no condition to throw 
any light upon the matter, I had reason to suspect from the symptoms 
that presented themselves the ingestion of a fungus-poison. The purely 
gastro-intestinal disturbances of Mr. H. seemed to be due merely to un- 
sound mushrooms, whereas, the predominant nervous symptoms in the 
case of Mr. C., with the alarming signs of coma and collapse pointed with 
almost positive certainty to the presence of a noxious poison affecting alike 
the central nervous system and the organs of circulation and respiration. 
Another marked and positive symptom of seemingly great importance, 
because common in cases of poisoning by fungi, was the considerable pupil- 
lary contraction, but that might also have been due to the large amount 
of opium taken internally and hypodermically before I saw the patient. 
Under all the circumstances, however, I was justified in suspecting the 
presence of a specific fungus-poison, and as all direct methods of treatment 
for the purpose of neutralizing and eliminating the same failed, I deter- 
mined to test the efficacy of atropia as an antidote. 
Schmiedeberg and Koppe had succeeded in obtaining from amanita mus- 
caria a poisonous alkaloid—muscarine—closely resembling if not wholly 
identical in its toxic effects with the alkaloids gained from other fungi— 
such as bulbosine from amanita plmlloides or agaricus bulbosus, the alka- 
loid obtained from boletus luridus, and others—and they further estab- 
lished by experiments upon animals the fact that atropia acted as a true 
antidote in cases of poisoning by muscarine. 
Acting upon their suggestion, I injected in the first night, subcuta- 
neously, one-fiftieth of a grain of the sulphate of atropia, and the effect of 
that dose seemed to be remarkable. Not only did the pupils speedily 
respond to the action of the drug, but the brain and stomach symptoms 
greatly improved, and the heart, lungs, and arteries exhibited more force 
and regularity in their functions. It is scarcely necessary to say that I, 
profiting by this experience, followed up this treatment during the next 
three days, and the very great improvement which took place within that 
time appeared in a large measure to be due to the atropia. The bowels 
and bladder, that had been absolutely torpid heretofore, acted now with 
greater force, rectal feeding and medication could be regularly conducted, 4 
the mind assumed a brighter and more cheerful complexion, the intellect 
regained its former clearness and vigour, and, apart from the gastric 
trouble, the patient did not complain of pain or distress. His weak and 
anaemic condition forbidding the application of leeches to the epigastrium, 
I had, almost immediately after taking charge of the case, commenced 
treating the acute gastritis with a large fly-blister, the ice-bladder, and 
absolute stomachal rest. No food or drink whatsoever, not even a small 
piece of ice, much as the patient begged and yearned for it, was allowed 
by the mouth ; and that absolute prohibition of stomachal alimentation, 
perhaps more than the remedial measures employed, conquered not only 
all pain and nausea, but restored to the organ, after three days, so much 
of its strength and tone that small quantities of milk, gruel, champagne, 
and wine jelly were easily and painlessly retained. On the fourth day ot 
my attendance, the 6th of September, after having spent three successive 
nights with the patient, he was able to sit up in bed, change his position, 
and even walk to a lounge without feeling any faintness, pain, and nausea ; 
he did, in fact, so well that I could conscientiously suspend my visits alto- 
gether for a day or two, owing to urgent professional engagements in the 
city, and leave him in charge of a local practitioner. During my absence 
he got up several times, sat in an easy chair, ate with appetite, talked 
cheerfully, and even went down stairs upon the piazza—which was con- 
trary to my strict orders—but, before he could reach his room again, was 
seized with nausea and pains in the epigastrium. These symptoms, how- 
ever, were of short duration, and passed away under the careful observance 
of rest, a horizontal posture, and the treatment and regimen which I had 
prescribed. 
On the 9th of September, the ninth day of the illness, I received a 
telegram hastily summoning me to the patient’s bedside. In the morning 
he had been taken with a very severe chill, together with nausea and 
vomiting; and, when I saw him a few hours later, he was feverish, and 
partially delirious—temperature 105° F., pulse 135, and respirations 36. 
The breathing was short, rapid, and oppressed; and pressure upon the 
epigastrium, back, hips, and loins quite painful—so much so that the 
patient, although not perfectly conscious, moaned and cried while under 
examination. There was neither cough nor expectoration present, yet 
percussion and auscultation revealed beyond doubt the existence ol a 
pneumonic infiltration of the lower and middle lobe of the right lung; and 
the suspicion of a complicating acute Bright’s disease—croupous nephritis— 
first raised by the peculiar and characteristic pain in the region of the 
kidneys, aggravated upon pressure, was confirmed by an examination of 
the scanty, dark-coloured urine, which was of high specific gravity, and 
contained more than seventy-five per centum of albumen. 
It is not my purpose to enter into a detailed report of the case as it pro- 
gressed from day to day, and to reproduce the notes which I took, inter- 
esting and instructive as they might prove in connection with the first 
morbific cause; I shall, therefore, confine myself to a brief summary of 
the principal symptoms. With the advent of the pulmonary and renal 
troubles the acute gastric symptoms, which had greatly abated, gathered 
new force, and although not quite reaching their former intensity, the 
patient was only capable of taking and retaining very small quantities of 
food in solution, and in consequence of this disability of swallowing and 
digesting, the chief alimentation and medication had to be conducted by 
the rectum. The very high temperature prevalent on the first day of the 5 
relapse, yielded readily to large and repeated doses of quinia and digitalis; 
which remedies exercised, however, no other beneficial effect. Although 
the physical signs on percussion showed marked dulness, and the absence 
of the normal respiratory murmur, with slight crepitant and mucous rales, 
the local and usually obvious pulmonary symptoms were almost entirely 
masked—owing, no doubt, to the great depression and mental apathy of 
the patient. The disorder assumed the decided type of a typhoid pneu- 
monia ; the feverish flush of the face, so plainly marked in the beginning, 
making room to a livid and dusky hue, the skin being most of the time 
cold and clammy, and partially covered with petechiae, the tongue coated 
with a dry, brownish-black fur; the gums, lips, and teeth incrusted with 
black sordes, the pulse growing steadily weaker, smaller, and more com- 
pressible, and the mental state more apathetic and obtuse. The liver and 
spleen were found to be abnormally enlarged. In spite of the frequent 
desire of micturition, the secretion of the urine was nearly suppressed, and 
as the bladder was wholly inactive, the water had to be drawn off by the 
catheter, and remained throughout scanty, dark-coloured, albuminous, and 
of a high specific gravity. The bowels also persisted in their torpid con- 
dition, and no defecation was obtainable without laborious and frequently 
repeated clysters. The most marked and distressing symptoms, however, 
were confined to the nervous system. I refer more particularly to a con- 
tinual restlessness and insomnia, which baffled all treatment. Morphia, 
atropia, hyoscyamia, and chloral were employed singly and in combina- 
tion, but produced no lasting and refreshing sleep ; and the patient, while 
apparently and for a short time under the effect of a narcotic, would rest- 
lessly toss about and sigh, moan and mutter, as if in agony or under the 
dread influence of horrible dreams. 
There were occasionally brief intervals of apparent improvement, during 
which the patient was perfectly rational, and even cheerful, displaying 
interest, expressing gratitude, and considerately appealing to his friends 
not to be too much concerned about him; but these periods of ameliora- 
tion were but temporary, and not calculated to kindle any new hopes. 
Later on the obtuse condition of the intellect changed to a decided stupor, 
with low, muttering delirium. The patient was only with difficulty 
aroused, and appeared unwilling to be questioned, or in any way dis- 
turbed. Deglutition and rectal feeding and medication became almost 
impracticable, and life was chiefly sustained by hypodermic injections of 
cognac, camphor, and musk. On the 17th of September the patient was 
so greatly prostrated as to involve the probability of a speedy, fatal termi- 
nation. Shortly after noon he lapsed into unconsciousness, and after 
remaining in this condition about an hour, with occasional glimpses of 
recognition of his physician and friends, the action of the heart grew 
faint, the pulsation at the wrist ceased, and he expired without the slightest 
struggle—calmly passing away. 
Autopsy Tliirty hours after death I made the autopsy in the presence 
and with the kind assistance of Drs. Geib, Lewis It. Hurlbutt, and Hurl- 
butt, Jr. 
Rigor mortis not well marked; body greatly emaciated, and adipose 
tissue entirely wanting. The cutaneous surface presented a decided icte- 
rode hue, with large ecchymoses, especially on the posterior parts of the 
body. Both pleune were adherent throughout, but more particularly the 
right one. There was no effusion of serum. The lungs exhibited evi- 
dences of recent congestion and oedema, with softened and puriform in- 6 
farctions scattered over their surface. The lower and middle lobes of the 
right lung were the seat of a hypostatic pneumonia, which had scarcely 
passed the stage of hypersemia. The lung-parenchyma was dark, reddish- 
blue, congested, and partially gorged with blood, resembling in consistence 
and anatomical structure the spleen. There were here and there scattered 
very small, almost unrecognizable patches of red hepatization, which 
showed upon section a granular texture, and from whose alveoli oozed a 
lymphoid serum, slightly tinged by fibrinous coagula. 
Heart enlarged, pale, and flabby; its cavities, especially the left one, 
considerably dilated, but walls not markedly hypertrophied. The mitral 
valve was swelled and thickened; the other valves, however, appeared 
perfectly normal; the right auricle was dilated, and so much attenuated 
as to be almost transparent. Liver and spleen were enlarged and con- 
gested ; gall-bladder enormously distended, and filled with dark, concen- 
trated bile. The stomach contained about an ounce and a half of a dark 
fluid, strongly smelling of musk, and was covered with a puruloid mucus, 
upon the removal of which there appeared a diffused congestion of the 
entire mucous membrane, with serous infiltration of the submucous coat. 
The congestion varied from a bright-red to a dark-livid, and even blackish- 
brown colour, and in those spots where the inflammation and discoloration 
were most intense the mucous membrane was not only softened, and could 
be readily detached, but the anatomical lesions penetrated to the sub- 
mucous coats as if they had been produced by the chemical action of a 
slightly corrosive poison. Isolated ecchymoses were also apparent 
throughout the whole extent of the stomach. 
The entire intestinal tract from the duodenum to the rectum bore evi- 
dences of congestion and inflammation; the mucous membrane was 
swollen, congested, softened, here and there covered with a layer of 
fibrinous exudation, and in other places even more thoroughly disor- 
ganized. There was scarcely any fecal matter present, and no traces of 
the ingested mushrooms could be detected. 
The kidneys were abnormally large and swollen; the cortex grayish- 
white, pale, mottled with red spots, the capsule not adherent. The 
bladder was enlarged, and filled with about two ounces of a thick, milky 
fluid. 
The brain and spine wrere not examined. 
The necropsy thus fully confirmed the more or less active inflammation 
of the stomach and intestines produced by the direct toxication of the 
ingested mushrooms, and the complicating nephritis and pneumonia which 
owed their existence undoubtedly to the influence of the same noxious 
cause. That the dangerous collapse in the beginning of the patient’s ill- 
ness, together with the great prostration and exhaustion to which he 
finally succumbed, were chiefly, if not solely, due to the same materia 
peccans, seems beyond all doubt. 
Having given a somewhat detailed account of the case with all its 
salient features, it is scarcely necessary to add any remarks, and to dwell 
any further upon the various points of interest. I would only lay par- 
ticular stress upon the favourable action of atropia in such cases. To be 
sure, it did not prevent a fatal issue in this instance, because probably 
employed too late; but it nevertheless caused such a great improvement 
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