This section is from the book "Studies of American Fungi: Mushrooms, Edible, Poisonous, Etc.", by George Francis Atkinson. Also available from Amazon: Studies of American Fungi: Mushrooms, Edible, Poisonous, Etc..
This is the most important because the most dangerous alkaloid found in the mushrooms. It is most abundant in Amanita muscaria, it is also found in considerable quantity in Amanita pantherina, and to a lesser, but still very dangerous extent in Boletus luridus and Russula emetica. It is quite probably identical with bul-bosine, isolated from Amanita phalloides by Boudier. Muscarine is an extremely violent poison, .003 to .005 of a gram (.06 grain) being a very dangerous dose for a man. Like other constituents of mushrooms, the amount of muscarine present varies very greatly with varying conditions of soil and climate. This, indeed, may account for the fact that Boletus luridus is regarded as an edible mushroom in certain parts of Europe, the environment being such that little or no muscarine is developed.
According to Kobert, Amanita muscaria contains, besides choline and muscarine, a third alkaloid, pilz-atropin. This alkaloid, like ordinary atropin, neutralizes to a greater or less extent the muscarine. The amount of pilz-atropin present varies, as other constituents of mushrooms vary, with varying conditions of soil, climate, etc., and it may be that in those localities where the Amanita muscaria is used for food the conditions are favorable for a large production of pilz-atropin which neutralizes the muscarine, thus making the plant harmless. Be this as it may, Amanita muscaria, so deadly as ordinarily found, is undoubtedly used quite largely as food in parts of France and Russia, and it has been eaten repeatedly in certain localities in this country without harm.
Fortunately muscarine has a very unpleasant taste. It is interesting in this connection to note that the Amanita muscaria is said to be used by the inhabitants of Northern Russia - particularly the Koraks - as a means of inducing intoxication. To overcome the extremely unpleasant taste of the plant they swallow pieces of the dried cap without chewing them, or boil them in water and drink the decoction with other substances which disguise the taste.
The symptoms of poisoning with muscarine are not at once evident, as is the case with several of the less virulent poisons. They usually appear in from one-half to two hours. For the symptoms in detail we shall quote from Mr. V. K. Chestnut, Dept. of Agr., Washington (Circular No. 13, Div. of Bot.): "Vomiting and diarrhoea almost always occur, with a pronounced flow of saliva, suppression of the urine, and various cerebral phenomena beginning with giddiness, loss of confidence in one's ability to make ordinary movements, and derangements of vision. This is succeeded by stupor, cold sweats, and a very marked weakening of the heart's action. In case of rapid recovery the stupor is short and usually marked with mild delirium. In fatal cases the stupor continues from one to two or three days, and death at last ensues from the gradual weakening and final stoppage of the heart's action."
The treatment for poisoning by muscarine consists primarily in removing the unabsorbed portion of the mushroom from the alimentary canal and in counteracting the effect of muscarine on the heart. The action of this organ should be fortified at once by the subcutaneous injection, by a physician, of atropine in doses of from one one-hundredth to one-fiftieth of a grain. The strongest emetics, such as sulphate of zinc or apomorphine, should be used, though in case of profound stupor even these may not produce the desired action. Freshly ignited charcoal or two grains of a one per cent. alkaline solution of permanganate of potash may then be administered, in order, in the case of the former substance, to absorb the poison, or, in the case of the latter, to decompose it. This should be followed by oils or oleaginous purgatives, and the intestines should be cleaned and washed out with an enema of warm water and turpentine.
Experiments on animals poisoned by Amanita muscaria and with pure muscarine show very clearly that when the heart has nearly ceased to beat it may be stimulated to strong action almost instantly by the use of atropine. Its use as thus demonstrated has been the means of saving numerous lives. We have in this alkaloid an almost perfect physiological antidote for muscarine, and therefore in such cases of poisoning its use should be pushed as heroically as the symptoms of the case will warrant. The presence of phallin in Amanita muscaria is possible, and its symptoms should be looked for in the red color of the blood serum discharged from the intestines.