Maternity and myocardial failure in African women.

In this paper, under the name of peri-partum myocardial failure, 23 cases of idiopathic heart failure linked with maternity are described. We appraise the nature of this link. Priority in describing a syndrome of heart failure connected with childbearing may be given to the independent reports of Gouley et al., and of Hull and Hafkesbring, both in 1937, despite the claims made for Virchow (1870), Porak (1880), and Vaquez and Millet (1898). The majority of cases have come from the Southern states of the U.S.A., but there have been several reports from other parts of North America, from Holland and England, from China and from Brazil (Jensen, 1938; Hull and Hidden, 1938; Musser et al., 1938; von Bonsdorff, 1939; Vilter and McKee, 1943; Freeman, 1947; Melvin, 1948; Mackinnon and Mackeen, 1949; Lindeboom, 1950; Chang, 1952; Woolford, 1952; Bashour and Winchell, 1954; Marcus, 1955; Meadows, 1957; Silber and Saphir, 1957; Brigden, 1957; Rosen, 1959; Benchimol et al., 1959.) The condition has not previously been reported from Africa. All the patients in this study were African negro women, living in and around Johannesburg: 2 were discovered in a clinic practice and 20 in Baragwanath Hospital over the last three years and one patient suffered two episodes, giving a total of 23 cases. All have been observed and followed personally in hospital, clinic, and home and examined by radiology and electrocardiograph. Their nutritional histories have been taken and they have had urine and blood tests. In order to diminish bias in the selection of follow-up material, one of us (H.S.) has made a clinical survey of all surviving patients. We have rejected a large number of similar cases because of incomplete investigation or because of complications that might have contributed to heart failure, such as puerperal sepsis, hwmorrhage, white leg, or a hint of rheumatic fever. The cases were collected over the years 1953 to 1957.