Treatment of Mushroom Poisoning

To the Editor.—  The survey on mushroom poisoning by Hanrahan and Gordon¹ published in The Journal covered four types of toxic mushrooms, each illustrated by a clinical case. However, the section on amatoxin poisoning (caused by either Amanita phalloides, Amanita virosa, or Amanita verna) contains inaccuracies and fails to inform the reader about advances in therapy.The statement that the mortality of amatoxin poisoning was until recently 50% to 90% is misleading and likely to falsify the interpretation of therapeutic results. In a large study including 288 cases of Amanita ("death cap") intoxications observed between 1919 and 1958 in Switzerland, the mortality rate was 30%.² In much smaller series of patients, a higher mortality may be occasionally recorded, but it is clear that large series are mandatory to assess the mortality rate correctly. In a newer series of 205 cases of Amanita intoxications that occurred in Europe from