Originally published in Eleusis, n. 6, December 1996, pp. 40-41

Abstract - In 1996, in a magazine of mycology, two French Authors reported a case of fatal poisoning due to ingestion of Liberty Caps (Psilocybe semilanceata) which have well-known "hallucinogenic" properties. The case would have occurred in France in 1993. Following a careful analysis of the data reported by the two French Authors their work appears to be invalidated by numerous methodological deficiencies and contradictions and their conclusion (that the Liberty caps were the direct cause of the fatality) is to be considered unacceptable for this reason.

In an article published recently in a French magazine of mycology, two researchers reported a case of death after consumption of psychoactive mushrooms of the Psilocybe semilanceata species. The victim was a young man of Finistère (France) (Gerault & Picart, 1996)¹.

After a careful reading of the report of the two French researchers the data referred seem to be imprecise and contradictory and the Authors' conclusion hastened and rather questionable.

The case occurred on the 29th of September of the now far 1993. The young man, M.A., aged 22, spent the afternoon picking psilos (Liberty Caps) in the surroundings of his village. In the evening, back from a huge picking, he met some friends, to whom he proposed a collective "trip" with the mushrooms he had just picked. Four of them accepted.

According to what his friends reported later, the young man had already consumed an undetermined number of Liberty Caps on the place of the picking and when he met his friends, at around 8 p.m., he felt dizzy, suffered from abdominal cramps, he had difficulties in breathing, he was pale and sweated abundantly. Nevertheless he ate a dozen more mushrooms before his friends. At 8.30 p.m. with his friends, he drank a tea obtained from the boiling of 20-40 specimens of the same mushrooms. Towards 10 p.m. the young man felt sleepy and he lay down. His breath was irregular. His friends started to worry around midnight only, when, after some convulsions and spasms he no longer reacted to their calls and went into a coma. He was sent to hospital, however uselessly, as there was no emergency department. At 2.30 a.m. the young man was brought back home. When a doctor at last arrived he could not do anything but ascertain the death of the young man. The consequence was, among other things, the intervention of the police and the opening of a judicial enquiry.

The article by Gerault and Picart goes on to set out the post-mortem toxicological analysis. A quantity of 4 nmg/ml of psilocybin was found in the blood, while only traces were found in the gastric contents. It was not possible to determine the quantity present in the kidneys and in the liver, because of a substance which interfered with psilocin. The analysis did not produce evidence of the presence of any other toxin, or severe diseases or organic causes which could be connected with the death.

The mycological study of the gastric contents, through microscopic observation of the spores and of some basydia (no fragment of mushroom bigger than 200 micrometers was found) resulted in the determination of the mushroom present in the stomach of the victim: Psilocybe semilanceata (Fr.) Quél.

From all this the two French Authors infer that "an overdose of the indolic hallucinogenic compounds psilocybin and psilocin may have been the cause of the fatality". This fact would represent an unique case not only in the survey of the tens of thousands experiences with psilocybinic mushrooms currently gone through by western culture young people, but probably in the whole history of the relationship of man with these vegetables.

Since the acknowledgement of P. semilanceata as psilocybinic and therefore psychoactive mushroom (Hofmann et al., 1963; Heim, 1967 and 1971; Mantle and Waigh, 1969), in England and Norway thousands of young people have used this species as main psilocybinic mushroom, with no case of death nor remarkable hazards for the health (Francis et al., 1973; Gart, 1966). For example, from the evaluation of the epidemiological and clinical implications on over 400 cases of recourse to hospital following ingestion of psychotropic mushrooms, in particular P. semilanceata, recorded in northern Europe during the 80s, the lack of lethal exitus and the positive and complete resolution of all cases were recorded (Samorini & Festi, 1989).

During the 80s and 90s, in northern Italy the use of funghetti (popular name given mainly to P. semilanceata) became widespread, which so far does not appear to have caused any recorded case of recourse to the emergency departments or problems of juridical and social kind (Samorini, 1989 and 1993; Pagani, 1993).

Very careful epidemiological researches showed that this mostly experimental use of mushrooms with its objectively mild side-effects, if any, will not cause a significant danger to the society (Siegel, 1985; Francis et al., 1983; Gartz, 1996; Thompson, 1985). In this case we should not mix objective symptoms with the feeling of death of some mushroom users during a strong psychological reaction. During the last two years an open selling of fresh and dried mushrooms (P. cubensis, P. cyanescens, and P. semilanceata) mainly from Great Britain, developed in Holland in over 40 "coffee shops". So far thousands of mostly young Dutch people used these species without any fatality. The Dutch Department of Health also, as well as the Dutch Minister of Justice, thinks that fresh and dried mushrooms are legal (Rikkelman, 1995).

It is known that since the 60s in Australia thousands of people have used psilocybinic mushroom without fatalities (Southcott, 1974).

It is also well-known that in the United States approximately over one million people have used mushrooms without fatalities (Siegel, 1985; Thomson et al., 1985; Gartz, 1996). In this case it should be pointed out that P. semilanceata is the most common species in use in the Pacific Northwest USA (Weil, 1975 and 1977; Gartz, 1996). Furthermore, it is interesting to observe that the Drug Abuse Warning Network (DAWN), which collects data from all over the United States, documented only 31 cases of clinical interventions for usage of psilocybin-containing mushrooms in 1982. In some of these cases, the mushrooms were used in combination with other substances, confusing the pharmacological picture (Thompson et al., 1985; Gartz, 1995 and 1996). It is interesting to observe that, during the same year 1982, DAWN reported 498 clinical interventions for LSD use. By the early 80s prominent experts in the field estimated that the number of mushrooms users in the United States outnumbered LSD users for the first time. The danger of clinical interventions related to the use of psilocybinic mushrooms appears therefore to be much smaller than that related to the use of LSD.

A more precise evaluation should also take into consideration that such cases of recourse to hospitals concern only a small fraction of the users of these drugs and the percentage of "bad trips" (usually responsible for the recourse to hospital treatment) is even smaller in comparison with the total number of experiences.

A single accidental convulsive case is reported and discussed in the literature. The victim was a 5 year old child. The exit was lethal and ascribed to the American species P. baeocystis (Badham, 1981; Young at al., 1982) and obviously reported in confirmation of the thesis proposed in the French article.

However, Paul Stamets recently stated more precise details on this case of fatality, too often used and abused to demonstrate what a long history of the relationship of man with the psilocybinic mushrooms does not demonstrate. Stamets reports that « the child died after three days of hospitalisation, subsequent to running a 106°F fever. An autopsy showed cerebral edema, a symptom I note that is consistent with Galerina and Amanita poisonings. Examination of the photographs of the alleged toxic species clearly shows mushrooms resembling Psilocybe cyanescens, not P. baeocystis. In conversations I had with the identifying mycologist, Alexander Smith, and upon being confronted with the apparent discrepancy of the photographs - which he had never seen - he retracted his identification on the spot. Furthermore, he said, mushrooms other than Psilocybes were present in the yard of the fatal child, but were not kept. The Psilocybe, instead, was picked. In this case, Dr. Smith told me he suspected that several species were involved. The record needs to be emended, as P. baeocystis is erroneously attributed to this report» (Stamets, 1966: 97-98).

Therefore, it is no longer possible to use this American case as evidence that the psilocybinic mushrooms may be fatal; if anything, on the contrary, it may be used as an example of a myco-toxicological study carried out with superficiality, if not even obscured by scientifically unacceptable prejudices.

A case is left to be discussed. It occurred at the beginning of the 70s in Japan, probably caused by the ingestion of P. subcaerulipes Hongo, discussed by the two French Authors, too. The symptoms of the poisoning - paralysis of the lower limbs, convulsions and hyper-diaphoresis - are not so exceptional and severe as they are presented in the French article. Yokohama himself reports these symptoms in the description of positive self-experimentations with Japanese psilocybinic mushrooms with no need of a recourse to emergency departments nor much influence on the pleasure of the visionary state of the experimenter (Gartz, 1996:94). The Japanese case of poisoning with P. subcaerulipes, which, on the other hand, resolved positively, might represent one of the not infrequent cases of somatic reactions to the psilocybinic experience which generally are self-resolved during the experience itself. It is well known that during the action of psilocybin mushrooms some symptoms are not pleasant and they may cause panic reaction, but there is no somatic danger despite the belief of the mushroom user in that state of consciousness (Badham, 1984; Francis et al., 1983; Gartz, 1966; Leuner, 1981; Pagani, 1994).

In the French article there are other inaccuracies and misrepresentations in the reported data.

For example, it is reported that the content of psilocin and norbaeocystin in P. semilanceata is 0-0.6% and 0-0.4% dry weight, respectively. Actually, there are only traces of psilocin in this species, and no biochemical essays have been reported about the determination of exact amounts of norbaecocystin in this mushroom. Biochemical analysis by one of us (J. G.) developed over several hundreds of fruiting bodies of P. semilanceata from Germany, Switzerland, Austria and the Pacific Northwest USA, always showed only traces of this substance in the mushrooms; a behaviour very similar to that of many other species from all over the world. (Gartz, 1985, 1986, 1996).

It is also not true that "some varieties of P. semilanceata have more potent or toxic effects" than others, as reported in the French article. This fact is not mentioned in scientific literature, while, in an important paper forgotten - together with many others - by the French Authors, it is reported that Liberty Cap has the most constant alkaloidal content. (Beug et al., 1982). It is now well-known from various studies around Europe and the Pacific Northwest USA that the average of psilocybin content in P. semilanceata is 1% dry weight (Gartz, 1996).

Furthermore, there is no reason to think that baeocystin is more toxic than psilocybin. P. semilanceata contains a quantity of baeocystin greater than that contained in P. semilanceata and, in spite of this, the American users think that P. semilanceata is a mushroom with "better qualities" and smaller somatic side-effects than P. baeocystis (Weil, 1975) or P. cubensis which contains only traces of baeocystin (Gartz, 1985). On the other hand, 3-10 mgs of baeocystin have caused symptoms identical to those caused by psilocybin, yet without somatic symptoms or also further risks (Gartz, 1996).

The French Authors wrongly reported that one dried mushroom of P. semilanceata weighs about 200 mgs. Actually, the dry weight of one of those tiny mushrooms is 20-60 mgs and the smaller ones contain more alkaloids (Gartz, 1996). This means that the dry weight of 50 mushrooms is about 2 gs, with relatively low alkaloid content of 20 mgs psilocybin and 6 mgs baeocystin (Gartz, 1986). Cases of consumption of higher amounts of alkaloids and mushrooms without any somatic hazard have been reported in controlled experiments (Leuner, 1981; Gartz, 1996) and there are reports about a "standard dose" of 100 fresh mushrooms! (Gartz 1996). From experimental data of animal toxicity Ott & Badham speculated that adults would need to eat their own body weight in fresh mushrooms in order to finally reach the lethal dose (Badham, 1984; Gartz, 1996).

It is significant to note, in this context, how the first pharmacological studies on pure psilocybin (Cerletti, 1958, 1959; Weidmann et al., 1958) reported for the mouse a DL50 "surely higher than 250/mg/kg body weight". Such statement ensued from the impossibility of reaching a measurable lethal dose at 50%, with the available quantities of active principle, which is an evident sign of extremely low toxicity.

The French Authors do not mention at all muscarin as a toxin which may cause a similar hyper-diaphoresis and lead to a state of coma. The extraction procedures adopted by them as a starting point for subsequent analyses, are unable to isolate this unstable chemical substance. On the other hand, the contradiction is evident in their statements that the post-mortem analysis did not show the presence of toxins other than psilocin, and that it was not possible to determine its content in the kidneys and liver of the victim because of a substance which interfered with it.

It is to be noted that in the liver and in the suprarenal glands a significant quantity of psilocin can be detected 48 hours from intake, while it tends towards minimum of null values in the other organs already 24 hours after ingestion (Kalberer et al., 1962). Even without considering the issue connected to the unidentified interfering substance, which is inexplicably not taken into consideration in the discussion, such methodological deficiency still remains. A more objective evalutation of the data by the Authors could have provided more precise information about the actual quantity of psilocybin in the organism of the victim.

Also the mycological analysis is rather doubtful: there are no reference samples for the case of poisoning and only some spores and basydia were identified.

It is true that, in the discussion, a reference is made to an attempt of differential analysis in comparison with other species (toxic Amanites, toxic Hypholoma, Cortinarius - belonging to the group of C. orellanus - and Dermocybe), however no reference is made to the possibility of intoxication with muscarinic species, such as, for example, some Inocybes.

The few reported data concerning the victim are insufficient to exclude other possible causes of the fatality. The texts on pharmacology and toxicology of psilocybinic mushrooms (Cerletti, 1958, 1959; Delay et al., 1958a, 1958b; Festi, 1985; Hollister, 1961, 1982; Weidmann et al., 1958, to mention just a few) - many of which thoughtlessly "forgotten" by the Authors - report a great number of possible vegetative and neurological symptoms resulting from the administration of psilocin or psilocybin. It is true that among these there also are those briefly mentioned by the friends of the victim (abdominal pains, abundant diaphoresis, difficulties in breathing, etc.), however it is important to note that they are absolutely aspecific and can also be noticed in a number of other toxicological syndromes, both caused by mushrooms and not. In any case, the same emergency treatments of "poisonings" caused by psilocybinic mushrooms (cf. for example Beck & Dale, 1982; Seymour & Smith, 1987) emphasise the benignity and the spontaneous resolution of such symptoms, instead drawing the attention on the psychological aspects of the experience and on the possible psychopathological complications which are the true danger for fragile personalities or borderline situations.

We do not know anything about the previous state of health of the victim. The two French Authors report that he used to smoke cannabis and drink alcohol, besides eating psilocybinic mushrooms. The subsequent judiciary investigation was unable to give information about what the young man had done during the hours preceding his death. We remind that when his friends met him he already was in a state of confusion, he was pale, damp with sweat and complained of abdominal cramps and difficulty in breathing. The fact that he had already eaten an indefinite number of psilos (and only these) on the place of the picking was reported by his friends later on and there are no direct testimonies nor, therefore, absolute certainty for it.

When the English version of the article was inserted in the Lycaeum Internet site (see note 1), one of the French Authors, dr. Gerault, got an additional comment included, which is reported integrally on note 2. By this comment probably Gerault intended to soften the conclusion proposed in the article, offering us, actually, further details about the superficiality with which the investigation was carried out. For example, he states that his present chemical analyses - on samples, mind you, taken from the body in 1993! - showed the presence of psilocybin, psilocin, baeocystin and many other unidentified derivatives and this contradicts the finding of psilocybin only in the previous analyses.

On the other hand, the reason why in the additional note of the Internet version the two French Authors take care of clarifying only that the ascertainment of death caused by an overdose of psilocybinic mushrooms was a conclusion drawn by the forensic expert and not their conclusion, is not clear (they then adopted a priori somebody else's theses, without having finished their own chemical analyses - still in progress - chemical analyses which would anyway offer partial data because, as already remarked, are developed on samples got by means of partial extractive procedures which did not detected, for example, quantities of muscarin, if any).

Although referring to (and only now) other unfavourable circumstances, such as the absolute lack of medical care (we remind that the young man, already in a state of coma, was refused by the nearby hospital) Girault goes on considering the ingestion of Liberty Caps as the main cause of the fatality. He offers us another example of distortion of the data by stating this time that the mushrooms eaten by the young man on the place of the picking were 30-50 - however it was not possible to ascertain it - and some lines below he make things worse, starting directly from number 50 and adding: "but it is probably more".

The statement that "raw mushrooms certainly increase the toxicity" is the issue of superficiality. The samples of fresh P. semilanceata contain the same quantity of alkaloids as the dried samples since psilocin, which can decompose through drying, is present only in traces in this mushroom, as we already remarked.

Speaking of Liberty caps as "natural stuff with changeable properties" Gerault reaches the limits of pure imagination, since the scientific data well showed how P. semilanceata is one of the psilocybinic mushrooms with greater constancy in the quantity of produced indolic compounds.

One may wonder whether it is accidental that the article by Gerault and Picart appears after so many years from the case of poisoning and exactly in this moment when in France Liberty Caps and their users are charged with criminality, to such a point that a song, currently in fashion among the youth, with the title Mangez moi! ("Eat me!", referring to psilos, the Liberty Caps) has been censored!

In this connection, the last sentences of the article are revealing: « The so-called innocuity of hallucinogenic mushrooms is now questioned. Apart from causing psychiatric troubles, hallucinogenic mushrooms, like any other drug, may have bad effects caused by an overdose. Therefore the forbiddance of picking, distribution and selling of hallucinogenic mushrooms is justified» (printed in Italics by us).

The one thing certain is that the work of the two French Authors is invalidated by too many methodological deficiencies and contradictions and their thesis is therefore to be considered unacceptable.

Notes

1 - An English version is present at the Internet site: http://www.lycaeum.org/drugs/plants/mushrooms/fatal-report.html

2 - Addendum by dr. Gerault present at the same Internet site:

"Gone on his own to gather mushrooms in the fields, he consumed 30 to 50 of them, raw, right in the fields, around 3:00 pm. He consumed around 10 raw mushrooms around 6:00 pm. With some friends of his, he consumed cooked mushrooms around 8:00 pm. The quantity ingested by each participants of the "shrooms party" was estimated to 5 to 10. The other participants, who had not consumed any mushrooms earlier in the day got "high" with this quantity, some of them did even feel adverse effects: cramps, drunkenness,... which proves that the P. semilanceata variety was particular potent.

Conclusion after the post-mortem examination by the forensic expert: The death is due to a collapse after an overdose. Our personal conclusions are: The death is due to a combination of unfavourable and aggravating circumstances. Three intakes of mushrooms in short intervals with cumulative effects (I have estimated the number to 50 mushrooms, but it is probably more). In this case, raw mushrooms certainly increase the toxicity. No vomiting (vomiting is common when the intake of mushrooms is too important, it is a good defensive reflex of the body which prevents from a severe poisoning. The vomiting could be caused by baeocystins). Variety of very potent P. semilanceata containing an important amount of total indolic components. According to my personal analysis psilocybin, psilocin and baeocystin are present and also many other unidentified derivatives. Studies are in progress in my laboratory. In this specific case, we can not reason in terms of psilocybin because a synergy between the different components is to be considered. Absolute lack of medical care and maybe a weak resistance of the victim - he was left several hours in the coma. Cares in hospital would certainly have saved the victim.

It is actually an unusual case about mushroom consumption (but not in toxicology where fatality or severe injuries are reported in some cases with substances that are not said to be very toxic).

I would add that the accumulation of several unfavourable circumstances is necessary. Unfortunately, all of them were gathered in this dramatic case. The nil risk does not exist, especially about natural stuff with changeable properties".

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