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472 deviation of the aorta, the large vessels, and inferior venacava. Of 195 deaths studied by Bachman, 116, or 59-4 per cent., were due to cardiac failure and 24 to tuberculosis. The usual symptoms are dyspnoea, due at first to pulmonary atelectasis and emphy- sema, and later to myocardial insufficiency, cyanosis, and oedema of the legs. Attacks of palpitation and pain may occur in crises. The pulse is not infrequently rapid and may be irregular. As the myocardial insufficiency progresses, dyspnoea, cyanosis, and oedema become more marked, the liver becomes enlarged, the excretion of urine is greatly diminished, and anasarca and ascites may ensue. The prognosis in patients with kyphoscoliosis depends mainly upon the reserve power of the heart. It is unfavourable when once the signs of myocardial insufficiency are established, and the end is frequently precipitated by intercurrent pulmonary affections. Dr. Boas’s patient was a woman, aged 29, in whom scoliosis was first noted at the age of 9, and had slowly and progressively become worse. For 10 years she had suffered from attacks of giddiness appearing every month, and for about five years from dyspnoea on exertion. Examina- tion showed the case to be one of paroxysmal auricular fibrillation with symptoms of myocardial insufficiency. The issue of the case is not recorded. LIFE ASSURANCE AND SYPHILIS. THE bearing of syphilis upon life assurance is discussed by Dr. W. P. S. Branson in the current number of St. Bartholomew’s Hospital Reports (vol. lvi., part 2.). Dr. Branson begins by inquiring into the incidence of syphilis among the insuring population, and comes to the conclusion that the best estimate is a figure of about 10 per cent. He then discusses the effects of syphilis as a lethal disease, and points out that it may kill as the result of (1) general paralysis of the insane, (2) aortic aneurysm, (3) gummatous disease of the cerebral vessels, (4) tabes dorsalis, (5) epithelioma of the tongue, implanted on syphilitic leucoplakia, (6) suicide. Dr. Branson admits that there are other causes-one of the most common is cardiac failure from syphilitic disease of the coronary arteries, and this probably increases the mortality amongst syphilitics to a large extent. The author next takes up the period at which syphilis produces fatal results and points out that general paralysis and aortic aneurysm cause death between 30 and 50, while tabes, when it kills, as a rule kills late in life. He is not impressed with cerebral syphilis as a cause of death, but the statistics of the American Life Offices showed that the mortality among syphilitics was very high the first six years after infection, and death was almost always due to cerebral syphilis. Dr. Branson next discusses the question as to whether treatment can cure syphilis. It is well known that syphilis has been cured by mercurial treatment as recommended by Jonathan Hutchinson, who noted the occurrence of a second primary chancre after such treatment, and cases have been described of second infections after treatment with arsenic ; but it is prob- able that in the great majority of cases once syphilis has been contracted, whatever the treatment, it is always liable to recur. This is especially true when any secondary manifestations of disease have developed. Dr. Branson does not place extravagant confidence in a negative Wassermann result. The blood test may be negative whilst the cerebro-spinal fluid is positive, and it is no uncommon event for the blood to be negative to-day and positive in six months’ time. He says, however, that he considers a positive W.R. as a bar to life insurance. While agreeing with Dr. Branson that a negative W.R. is of no value as evidence of a permanent cure of syphilis, we are not so sure that a positive W.R. should be a total bar to life assurance. In a recent case a proposer, who had been perfectly well for seven years after contracting syphilis, was found to have a positive W.R., and in his anxiety to turn it into a negative one he had no less than 20 injections of neo-salvarsan in 12 months, I the W.R. continuing positive, though he himself was in good health. Dr. Branson draws up rules as to the eligibility for insurance of lives who have had syphilis, and comes to the conclusion that those who have exhibited tertiary lesions, who have Argyll Robertson pupils, or leucoplakia of the tongue are ineligible, while increased rates must be charged for those who have had secondary manifestations and have been thoroughly treated for three years or more. He considers those who have been thoroughly treated in the primary stage and can produce evidence of negative W.R. three years or more after contracting the disease may be taken at ordinary rates. Some experienced observers would not entirely exclude cases of tertiary skin lesions, as many of these cases often live to a very considerable age. But all cases, even those giving a history of a primary sore only, should, we are convinced, be rated up. EDIBLE FUNGI. THE latest publication of the Natural History Department of the British Museum is a Handbook of the Larger British Fungi, by Mr. John Ramsbottom, M.A., F.L.S., assistant in the Department of Botany. Types have been selected for description on the ground of their economic and biological interest. In dealing with the fleshy agarics the basis of selection has been the edible or poisonous qualities of the species, the term " edible " being used simply to imply that the fungus has been eaten without ill effects. In this country only the field-mushroom (Psalliota campestris) and the horse-mushroom (P. arvensis) are commonly eaten, and for most people the cultivated variety of the field-mushroom is the only edible fungus. Mr. Ramsbottom expresses regret that this is so, for many of our common toad- stools are far more delicate in flavour than either of these. This conservatism of taste is a modern failing. Classical literature contains frequent reference to various edible and poisonous fungi, and the only way in which to know whether a fungus is edible or poisonous is by being able to distinguish it in the same way as one does other edible plants and to ascertain its record. There is, says Mr. Ramsbottom, no other way; and his handbook will serve its purpose if it popularises the safe use of a number of cheap and appetising food products. The edible fungus contains roughly 2 to 5 per cent. of protein nitrogen (of which probably not more than one-third is digestible), 5 per cent. of sugars, 1 per cent. of fat, and to 1 per cent. of mineral matter. With this composition, fungi are a complete food. a fact established by the Fuegians, who live on Cyttaria during a large part of the year. In Central Europe, where the use of fungi as food is much more widespread, coloured wall charts are posted in the elementary schools, so that children learn from an early age the distinguishing marks of the poisonous and non-poisonous varieties. VALUE IN DISINFECTION. THE Brazilian National Department of Health has reprinted an article from the Boletim Sanitario, No. 2, of 1923, with the view of impressing upon medical practitioners the futility of terminal disinfec- tion in the prophylaxis of infectious disease. The gist of this article is that chemical disinfection of premises in which infectious cases have occurred can be of little value, seeing that the micro-organisms whose destruction is desired by that procedure are in number and virulence far less dangerous than those scattered through direct human agency or by means of recently infected articles. Moreover, many of these micro-organisms escape destruction by any means of terminal disinfection, whether by forma-lin spray or by disinfectant solution. Finally, the point is made that the employment of terminal disinfection Printed by order of the Trustees and sold at the British Museum (Natural History), Cromwell-road, London, S.W.7. Pp. 222. 7s. 6d.
