South African cases of hypersensitivity to the inhalation of castor bean dust are descriptionbed. They are similar to cases already reported overseas in that they are characterized clinically mainly by coryza and bronchial asthma. Castor bean sensitivity may be associated with workers in castor oil mills and fertilizer factories or in persons living in the vicinity. In addition, farmers, merchants and others handling the castor bean cake may develop sensitivity thereto as well as laboratory workers handling the bean for botanical studies or for chemical analysis. The dangerous nature of castor bean as an allergen is emphasized and a warning is given with regard to the use of the extract when skin-testing persons suspected of being sensitive to the bean. The question of desensitizing castor bean sensitive patients is discussed and it is suggested that whenever possible the patient should be advised to avoid contact with the castor bean rather than be subjected to the risk of severe reactions associated with the injection of so potent an allergen.
Primary amyloidosis differs from secondary amyloidosis mainly in that there is no primary pathology to account for the condition, and the amyloid is deposited in the heart, lungs, skin and striated muscle rather than in liver, spleen and kidney. A case is presented of primary systemic amyloidosis characterized clinically by congestive cardiac failure of unknown etiology not responding to intensive therapy. At autopsy, the heart was grossly enlarged due to amyloid deposition in the myocardium. Myloid was also found in the small arteries and arterioles, alveolar walls of the lung, muscle of the gastric wall and uterus, and round the fat cells in the omentum and subpericardial connective tissues. Primary amyloidosis should be considered more frequently in cardiac failure of unknown etiology in the older age groups especially where there is no response to adequate treatment.