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MUSHROOM POISONING
Lieutenant-Colonel E. E. VELLA
B.Sc., M.D.(Malta), D.T.M. & H., D.C.P., R.A.M.C.
Colonel W. O. MACFIE
M.B., M.R.C.P.(Edin.), late R.A.M.C.
Military Hospital, Tidworth, Hampshire
Introduction
IT is often said that mushrooms are ediple, fleshy fungi of an umbrella shape while
toadstools are poisonous ones. The Encyclopa!dia Britannica (1947) under the definition of mushroom states" ... Some people use the term mushroom only for the edible
members of this great group and call those which are not edible toadstools. Although
botanists recognize the word toadstool, they regard it as synonymous with mushroom
and write at times 'edible toadstool' or 'poisonous mushroom.' In general they
avoid the term toadstool." These fungi form a vast assemblage of organisms which
differ from plants in the essential absence of chlorophyll, thus having to obtain their
organic material requirements already prepared.
'
.
Since Greek and Roman times, edible fungi have been regarded as a delicacy.
The earliest account of accidental poisoning by fungi was made by Euripides (480406 B.C.) when on a visit to learus, a woman and her family gathered fungi and were
"strangled by eating of them." The monks too in the medieval ages made good use
of them both to replace meats during the fasting seasons, of the year and as an alternative in areas where fish was not readily available. The culinary value of mushrooms
lies not so much in their nutritive value, which is doubtful, but in their taste value.
They are the only vegetable which can conjure up on the tongu~ the illusion of a meat
dish having besides an excellent taste when well prepared. In soups and gravy, mushrooms are most valuable as seasoning. During war-time the possibility of using fungi
to eke out the food ration always arises. Thus in World War T, the German forces
in East Africa, dodging through the forests to escape the Allied forces were often
compelled to exist almost entirely on the fungi they collected; in World War II there
was a ready market for mushrooms in England as seen by the steady increase in price
from half-a-crown a pound in 1939 to 16 shillings per pound in 1943. It is widely believed that edible fungi are uncommon and that poisonous fungi are numerous; this
is not so. Contrary to popular belief there are hundreds of edible fungi and only few
can be really regarded as dangerous. Nevertheless, it is wise to exercise discretion in
this respect and keep in mind the saying, "there are old mushrooms eaters, and there
are bold mushrooms eaters, but there are no old and bold mushroom eaters" (Kowalski, 1962).
1963 Outbreak
"It must also be remembered that as each case of poisoning enlarges our knowledge .
of mushrooms and especially of poisonous mushrooms, a report of each case of poisoning should be given to experts who then will use the experience thus gained- for the
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E. E. Vella and W. G. Macfie
23
use of all." (Pilat and Usak 1957). We would therefore like to record a small epidemic
of mushroom poisoning which occurred on Salisbury Plain.
On Sunday, 23rd June, 1963, 23 Gurkha soldiers and one non-commissioned
officer were admitted to this military hospital with the presumptive diagnosis of
mushroom poisoning. Earlier in the afternoon two of the Gurkha soldiers had collected
a quantity of mushrooms which was subsequently cooked some two hours later and
served in a rice dish. Thirty to forty-five minutes after eating this early evening supper,
the first soldier was brought in to the hospital, complaining of profuse sweating,
generalized coarse body tremors, dizziness, blurred vision, abdominal colic, vomiting;
he was followed immediately afterwards by two more soldiers who complained of
sweating, abdominal colic, vomiting but no muscular tremors.
An alarm was quickly raised, and all personnel who had eaten the same supper
were admitted to the hospital for immediate prophylactic treatment in case of delayed
symptoms occurring.
The treatment given may be summarized as follows:
(a) Thorough gastric lavage which cleared the still undigested rice and mushrooms.
(b) Atropine sulphate 1 mg. given by subcutaneous injection.
(c) Sodium sulphate 30 g. in 250 ml. of water given as a cathartic draught.
The patients settled down quite comfortably with this treatment; the. one patient complaining of gastric pain was given a morphine t gr. with good effect.
Identification of the Fungus Species'
More fungi were collected from the same area where the original crop had been
found and uncooked remnants of the mushrooms were salvaged from the unit's cookhouse. The specimens were identified and reported upon as follows:
Royal Botanic Gardens,
Kew, Richmond, Surrey.
" ... The fungus in question is Inocybe patouillardii Bres., also known as the redstaining Inocybe. This species, which grows on calcareous soil, is known to be toxic
and there is a semi-popular account of some of the cases of poisoning caused by this
toadstool in 'Poisonous Fungi' by J. Ramsbottom in the King Penguin Series. In
this account the author notes that 1. patouillardil has caused occasional deaths. There
was one fatality in Surrey in 1937; others who partook of the fungus in a more reasonable manner had giddiness, then profuse sweats and vomiting. Some soldiers who ate
what was probably this fungus in 1925 had the same symptoms although not all
suffered ill effects. The poisoning is of the Amanita muscaria type."
Yours faithfully,
C. E. Hubbard
for Sir George Taylor,
Director.
Discussion
Mushroom poisoning should never be regarded lightly. The patient must be taken
to a hospital at once. Even before a doctor arrives on the scene, the patient must be
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24
Mushroom Poisoning
given emetics and purgatives in order that the rest of the poisonous mushrooms may be
expelled as quickly as possible from the body.
The classification of poisonous fungi according to their clinical effect may be
brielly and simply summarized as follows:
(a) Those causing toxic degeneration 0/ body cells, principally the deadly Amanita plwlloides
(the Death Cap) (Fig. I); Amanita vcmo (Fool's Mushroom) and Amallita l'irosa(Destroying
Angel).
Deaths due to poisonous fungi are almost invariably in this group.
Thus A. pludloides is responsible for over 90 per cent ortlle recorded de<tlhs by fungus poisoning. Death is due to the very poi sonous heat-sta ble amanita toxin (amanitin), first isolated in
a crystalline state by Wieland in 194 [ ; this toxin causes in experimental animals the majority
of lesions described in human post-mortem examinations. There is a delay in the appearance
of symptoms ror ten to 12 hours, which is a valuable diagnostic clue. Then there occurs
intense abdominal pain, vomiting, diarrhrea and intense thirst. Symptoms usually abate but
recur after a few days and finally, io more than 50 per cent of cases, delirium, collapse and
death. The treatment of a patient (a Carlisle fanner) who presented in hospital as a C.1se of
hepato-renal failure is vividly descri ~-d by Elliott et al (1961) .
(b) Those affecting (he nervous system, such as Amanita fIluscaria (the fly agaric) and blOcybe
patouilfardii (the red-staining Inocybe) (Fig. 2).
A. l1Iuscar;a is the well-known toadstool seen in nursery pictures and serving as a model for
children's toys. This fWlguS broken up in milk has been used in time."i past 10 kill llies, hence
the epithet nlllscaria. Three alkaloid'! have been isolated from these species, namely muscarine,
Figure I. Amanita phalloides (the Dr>ath Cop).
Note the cJwl"acleristic ring {l1lt/I 'o/m, at the lOp
alld base of tire stem respecfil'ei),.
Figure 2. Inocybe palouillardii (the Red-Stainjng
IlIo cyhe.
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E. E. Vella and W. G. Macfie
25
muscaridine and choline. Muscarine occurs also in many species of the genus lnocybe, thuscausing in these species that type of poisoning. Though not all species of this large genus are
poisonous, yet because numerous species are very similar and can hardly be distinguished
without a microscope, an emphatic warning must be given against the eating of lnocybe.
I. patouillardii contains 120-380 times as much muscarine as A. muscaria (Buck 1961).
(c) Those causing hf£molysis oired blood cells, such as Gyromitra esculenta (False morel).
The fungi of this group contain helvellic acid, which lyses red blood cells; fortunately, however.
this poison can be removed by washing and is destroyed by cooking or drying.
(d) Those with a purging action, such as Po!yporus officinalis (the white or purging agaric).
P. officinalis, as its name implies, has been used therapeutically as a purgative.
Claudine Loup (1938) studied in detail 33 Inocybe species, and found that they all
contained muscarine, the toxicity varying with the amount of muscarine in the different
species. Muscarine causes a strong irritation of the parasympathetic system and is
similar to poisoning by pilocarpine and physostigmine. The main symptoms are
marked secretion of sweat, tears, and saliva; secretions of nose, bronchi and P'lncreatic gland; increase of intestinal movements, vomiting, diarrhrea and stomach ache;
a slowing down of the heart, peripheral vasodilatation, lowering of blood pressure,
the extremities growing cold and a tendency to collapse. These symptoms are accompanied by a disturbance of vision, and death, although occurring rarely, is brought
about by weakening of the heart muscle. 1. patouillardii Bres. contains about 6 to
8 per cent of muscarine, and is one of the most poisonous of the Inocybe species. The
fatal dose for man is reckoned as 40 to 50 g. of the mushroom weighed when fresh,
so that it is not surprising that a number of fatal poisonings by this species are known.
Previous Outbreaks
About 39 years ago, almost to the very day, two small outbreaks of mushroom
poisoning due to Inocybe species were reported from this area and published in this
Journal (Young 1925). On 25th June, 1924, one corporal and six fusiliers from the
1st Battalion, the Lancashire Fusiliers, stationed at Tidworth were admitted to hospital
complaining of giddiness, blindness, cold clammy sweats, slow pulse, dilated pupils,
and subnormal temperature; recovery was rapid following treatment which consisted
of gastric lavage, atropine 1/50 gr. by injection, application of hot-water bottles, and
administration of castor oil and brandy. Two days later, on 27th June, four gunners
from Larkhill, six miles from Tidworth, became ill after breakfasting on mushrooms,
the symptoms and treatment given were the same as for the previous outbreak. The
species 'of fungus in all these cases was identified and reported as l. incarnata, because
of the reddish coloration. But up to then, l. patouillardii had not been recorded in this
country and it is therefore possible in fact that the fungus causing the 1924 outbreaks
was I. patouillardii (Rams bottom 1963).
Discussion
In the past there have been many suggestions for treating toadstools so as to make
them safe to eat. In 1851 F. Gerard published experimental results showing that,
by the method which he had devised, poisonous fungi could be made innocuous;
Gerard's method had some advocates and for a time was mentioned in the instructions
issued to French Army Officers. In this case it is fortunate that only young fit men ate
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26
Mushroom Poisoning
the mushroom supper reported here as it appears that this year 1. patouillardi has
grown very profusely in this area (Davies 1963). Moreover, if the mushrooms had been
picked some weeks later A. phalloides would probably have been collected as well.
This episode of acute poisoning emphasizes the need for every medical reception
centre and, casualty department to have at hand a "poison treatment cupboard"
(Ministry of Health Report, 1962), wherein one can lay hands at a moment's notice on:
(a) a handy reference book on toxicology with tabulated information on poisons and antidotes,
Cb) adequate equipment and drugs to treat, if need be, many patients who may require 'treatment
at the same time,
(c) the telephone numbers of the four "Poisons Information CeJ?tres" recently established in the
U.K., namely:
Leeds Infirmary
Leeds 32799
Wroughton 391
Burdrop U.S.A.F. Hospital
Guy's Hospital
HOP 7600
Fountainbridge 2477
Edinburgh Royal Infirmary
Summary
1. An outbreak of mushroom poisoning by I. patouillardi involvi1].g 24 personnel of
an Army unit stationed at Tidworth on Salisbury Plain is reported.
2. Reference is made to two previous outbreaks occurring in Army units in the same
area.
3. The toxins of poisonous fungi are briefly summarized, with special reference to
poisoning by Inocybe species.
Acknowledgments
We would like to thank Colonel J. Mackay-Dick, O.B.E., F.R.C.P.(Edin.) late R.A.M.C., for
suggesting this article and the Director of the Royal Botanic Gardens, Kew, for identification of the
mushroom species. We are grateful to the following publishers: Penguin Books, CoIlins and Hamlyn
for their kind permission to use extracts from their books, respectively Poisonous Fungi, Mushrooms
and Toadstools and Mushrooms. We are especially grateful to J. Ramsbottom, Esq., of the British
Museum (Natural History) for his advice and permission to publish correspondence; and also in like
manner toD. A. L. Davies, Esq., M.R.E. Porton.
.
REFERENCES
BUCK, R. W. (1961). New England, J. Med., 265, 681.
DAVIES, D. A. L. (1963). Personal communication.
Encyc!opredia Britannica (1947), 16, 1.
ELLIOTI, W., HALL, M., KERR, D. N. S., ROLLAND, C. F., SMART, G. A., and SWINNEY, J. (1961).
Lancet, ii, 630.
GIRARD, F. (1851). In J. Ramsbottom's Poisonous Fungi, pp. 13-14, Penguin, London.
KOWALSKl, J. M. (1962). Illinois med. J., 122,25.
UlUP CLAUDINE (1938). Contribution a 1'6tude toxico10gique de la region de Geneve. M.D. Thesis
No. 114, Geneve. In Pilat and Usak's Mushrooms, p. 62, Hamlyn, London.
MINISTRY OF HEALTH (1962). Report on "Emergency Treatment in Hospital o/Cases 0/ Acute Poisoning."
App: 1, p. 19, H.M.S.O.
PILAT, A. and USAK, O. (1957). Mushrooms, Spring Books, Hamlyn, London.
RAMSBOTIOM, J. (1945); Poisonous Fungi, King Penguin Series, Penguin, London.
(1953). Mushrooms and Toadstools, Collins, London.
(1963). Personal communication.
YOUNG, T. (1925). J. roy. Army med. Cps., 44, 52.
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Mushroom Poisoning
E. E. Vella and W. G. Macfie
J R Army Med Corps 1964 110: 22-26
doi: 10.1136/jramc-110-01-07
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