Symmetrical Gangrene Occurring in a Female African Affected with Endomyocardial Fibrosis
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Endomyocardial fibrosis was first described in Africans in 1946 by Bedford and Konstam, who recognised it in West African soldiers, and two years later Davies gave a fuller account of it from Uganda. Since then several important and confirmatory papers from Uganda, the Union and elsewhere in Africa have appeared. We now possess a fairly good conception of its pathology and clinical course. Briefly, it is characterised by an endomyocardial fibrosis of varying extent, especially marked at the apex of the left ventricle. Almost always a thrombus is seen on the damaged endocardium or a large one forms in the appendage of one or other of the auricular appendages. The fibrosis may be patchy or diffuse, involving the whole of the ventricle. The layer may be several millimetres thick, extending on to the epicardium, and in rare instances may be so pronounced that an obliterative effect from the fibrosis is produced, reducing considerably the capacity of the right ventricle (Ball, Williams and Davies, 1954). The site of election is in the apex of the left ventricle.