THE CONGO RED TEST FOR AMYLOIDOSIS

THE hremorrhagic lesions occurring in the course of arterial hypertension have often suggested to clinicians the possibility of foretelling such threats to a patient's safety. The importance of the capillaries not only in maintaining the circulation efficiently but also in holding out against the stealthy inroads of age has been recognized, although measure of their functional capacity is possible. to only a limited extent. The "capillary fragility test" is one of the efforts to look into the future of the hypertensive patient and to attempt a forecast of the degree of danger which may threaten his vascular system in a vital place. Louis A. Soloff and C. T. Bello have investigated this problem from two points of view, the validity of the capillary fragility test, and the connexion if any between the occurrence of retinal hremorrhages and cerebral vascular lesions.' Reports have been made of series of tests on hypertensives which seemed to show a large proportion of reactors, but other work has not confirmed this. One reason for this is apparently the lack of agreement as to the technique of the test. When the cuff of a sphygmomanometer is applied to the arm petechire may be produced below the cuff under certain conditions of pressure, and as might be expected, they appear more readily as the amount and duration of the pressure increase. The question at issue in Soloff and Bello's work is whether the pressure is above or below the diastolic level individual to the subject of the test. They also point out that subclinical scurvy has been shown to be not uncommon, and will vitiate the test for this particular purpose. Therefore in investigating a series of 50 hypertensive patients they saturated them with vitamin C for a month. Though 33 patients showed a positive result with the test when the supra-diastolic pressure was used, only two responded to the test when the infra-diastolic pressure was used. The effect of rutin was tried on the last-mentioned two patients, but no reversal of the result of the test could thereby be obtained. Further, on comparison of the patients who showed petechire in the test with those in whom retinal hremorrhages had been observed, no correlation could be found. The relationship of retinal bleeding to cerebral hremorrhage if any was now investigated. The records of hospital patients over a five-year period were examined, and those were selected for study which dealt with subjects of an established hypertension who had died or who had suffered a cerebral vascular accident, and who in addition had been observed to have retinal hremorrhages by chosen experts in ophthalmology. The figures were submitted to analysis, and although they were too small to be unassailable from the statistical point of view, the conclusions drawn appear to be justified. It seems to be clear that retinal hremorrhages cannot be regarded as prognostic guides as to the likelihood of cerebral heemorrhage. The reverse is rather true according to Soloff and Bello, who found that a hypertensive patient with retinal hremorrhages was more likely to die from cardiac or renal failure. In this study patients with retinal hsamorrhages were more commonly found among the group suffering from urremia of renal or extrarenal origin than any other. Analysis of the types of hypertension apparently prone to produce retinal lesions indicated the importance of spasm: a high degree of spasm and a welladvanced degree of sclerosts always accompanied them. The authors suggest that the occurrence of arteriolar spasm increases the burden on the heart and kidneys, and that the patient is then in danger of not living long enough to suffer a cerebral accident. The actual figures found for patients with retinal hremorrhages who had cardiac failure and cerebral hremorrhage were 77% and 29% respectively. These findings seem to coincide well