placed. Despite rigorous treatment and the administration of morphine and atropine, the count never recovered consciousness and died on the day following the accident. The count's physician on returning to his office was also attacked, dizziness and ocular symptoms warning him of the nature of the trouble. Energetic treatment with apomorphine and atropine was at once instituted by his colleagues and for a period of five hours he lay in a state of coma with occasional periods of lucidity. The grave symptoms were ameliorated and recovery set in somewhere near seven o'clock in the evening. His convalescence was uneventful, his restoration to health complete, and he is, I believe, still living. On this instance the count probably identified the fungi as caesaria or aurantiaca. From the symptoms and termination the species eaten must have been muscaria.

A. muscaria contains an alkaloidal substance which has a characteristic effect upon the nerve centers and to which the name muscarin and the provisional chemical formula C₅H₁₅NO₃ has been given. The drug atropin is a more or less perfect physiological antidote for muscarin and has been administered with success in cases of muscarin poisoning. It is said that the peasants in the Caucasus are in the habit of preparing from the fly Amanita a beverage which they use for producing orgies of intoxication. Deaths are stated to occur frequently from excessive use of this beverage.[25]

The deadly Amanita or death-cup (A. phalloides) is probably responsible for the majority of cases of mushroom poisoning. Ford estimates that from twelve to fifteen deaths occur annually in this country from this species alone. This fungus is usually eaten through sheer ignorance by persons who have gathered and eaten whatever they chanced to find in the woods. A few of these poisonous mushrooms mixed with edible varieties may be sufficient to cause the death of a family. Ford thus describes the symptoms of poisoning with A. phalloides:

Following the consumption of the fungi there is a period of six to fifteen hours during which no symptoms of poisoning are shown by the victims. This corresponds to the period of incubation of other intoxications or infections. The first sign of trouble is sudden pain of the greatest intensity localized in the abdomen, accompanied by vomiting, thirst, and choleraic diarrhoea with mucous and bloody stools. The latter symptom is by no means constant. The pain continues in paroxysms often so severe as to cause the peculiar Hippocratic facies, la face vultueuse of the French, and though sometimes ameliorated in character, it usually recurs with greater severity. The patients rapidly lose strength and flesh, their complexion assuming a peculiar yellow tone. After three to four days in children and six to eight in adults the victims sink into a profound coma from which they cannot be roused and death soon ends the fearful and useless tragedy. Convulsions rarely if ever occur and when present indicate, I am inclined to believe, a mixed intoxication, specimens of Amanita muscaria being eaten with the phalloides. The majority of individuals poisoned by the "deadly Amanita" die, the mortality varying from 60 to 100 per cent in various accidents, but recovery is not impossible when small amounts of the fungus are eaten, especially if the stomach be very promptly emptied, either naturally or artificially.

A number of other closely related species of Amanita (e.g., A. verna, the "destroying angel," probably a small form of A. phalloides) have a poisonous action similar to that of A. phalloides. All are different from muscarin.

Fig. 4.—Death-cup; destroying angel (Amanita phalloides Fries); reduced; natural size: cap, 3¹/₂ inches; stem, 7¹/₂ inches. (After Marshall, The Mushroom Book, by courtesy of Doubleday, Page & Company.)

The character of the poison was first carefully investigated by Kobert, who showed that the Amanita extract has the power of laking or dissolving out the coloring matter from red blood corpuscles. This hemolytic action is so powerful that it is exerted upon the red cells of ox blood even in a dilution of 1:125,000. Ford[26] has since shown that in addition to the hemolytic substance another substance much more toxic is present in this species of Amanita and he concludes that the poisonous effect of the fungus is primarily due to the latter ("Amanita toxin"). The juice of the cooked Amanita is devoid of hemolytic power, but is poisonous for animals in small doses, a fact that agrees with the observation that these mushrooms, after cooking, remain intensely poisonous for man. Extensive fatty degeneration in liver, kidney, and heart muscle is produced by the true Amanita toxin. In the Baltimore cases studied by Clark, Marshall, and Rowntree[27] the kidney rather than the liver was the seat of the most interesting functional changes. These authors conclude that the nervous and mental symptoms, instead of being due to some peculiar "neurotoxin," are probably uremic in character. No successful method of treatment is known. An antibody for the hemolysin has been produced, but an antitoxin for the other poisonous substance seems to be formed in very small amount. Attempts to immunize small animals with Amanita toxin succeed only to a limited degree.[28]

POISONOUS ANIMALS

While the muscles or internal organs of many animals are not palatable on account of unpleasant flavor or toughness, there do not seem to be many instances in which normal animal tissues are poisonous when eaten. As pointed out elsewhere (chapter vi), the majority of outbreaks of meat and fish poisoning must be attributed to the presence of pathogenic bacteria or to poisons formed after the death of the animal. This has been found especially true of many of the outbreaks of poisoning ascribed to oysters and other shellfish; in most, if not all, cases the inculpated mollusks have been derived from water polluted with human wastes and are either infected or partially decomposed.

In some animals, however, notably certain fish, the living and healthy organs are definitely poisonous. The family of Tetrodontidae (puffers, balloon-fish, globe-fish) comprises a number of poisonous species, including the famous Japanese Fugu, which has many hundred deaths scored