Amyloidosis; five cases of primary generalized amyloidosis and some other unusual cases.

A conception of amyloidosis as merely a complication of chronic syphilitic, tuberculous or septic disease of bones and joints or of chronic intrathoracic sepsis is no longer adequate. This older view has had to be modified as the association of amyloidosis with other diseases came to be recognized: the predisposing diseases are now known to include rheumatic and rheumatoid affections, myelomatosis, Hodgkin's disease, ulcerative colitis, pyelonephritis and a variety of other conditions. In addition, the occurrence of generalized amyloidosis in the absence of any recognized predisposing cause, that is, " primary amyloidosis," has lately attracted increasing attention. The first indisputable cases of this sort were reported by Soyka (1876) and Wild (1886), but the condition did not begin to be widely known until after Lubarsch (1929) defined certain pathological differences between this atypical form of amyloidosis and ordinary secondary amyloidosis. These differences have proved to be neither absolute nor diagnostic, although they characterize a majority of the cases: in fact, it is now known that there is no one feature which occurs exclusively in any form of amyloidosis. How far primary amyloidosis may be considered an entity remains undecided, but the present tendency is to consider all forms of amyloidosis to be closely related. Various aspects of the history, pathology, aetiology, and clinical pictures of amyloidosis, with special reference to primary amyloidosis, have been reviewed elsewhere in this issue. In thz present paper five cases of primary amyloidosis are recorded, and some cases illustrating o.her unusual manifestations and associations of amyloidosis are described briefly.