Endomyocardial Fibrosis in Britain.

Fibrosis of the endocardium and myocardium, in the absence of disease of the coronary arteries, still receives scant attention in the standard medical textbooks. It has been recognized for many years as a comparatively uncommon complication of collagen diseases, infiltrative diseases (amyloid, haemochromatosis, von Gierke's disease), beriberi, Friedreich's ataxia and the muscular dystrophies, and alcoholism. The whole subject was well reviewed by Brigden (1957) in the St. Cyres Lecture of 1957. Its existence, in the absence of such associated diseases, was first recognized as a cause of heart failure in East Africans when Bedford and Konstam (1946) described the condition. Following this publication further series were contributed from South and Central Africa (Becker et al., 1953; O'Brien, 1954; Davies and Ball, 1955), and were thought to delineate a disease process peculiar to the African continent. Pathologically these cases were characterized by a fibrosis of the endocardium and myocardium with a reasonably constant distribution, and occasionally associated with a cellular infiltrate or a fibrinoid change in the smaller coronary arteries. However, these last two features were by no means a con-