Heart disease in the Zulu: especially cardiomyopathy and cardiac infarction.

Interest in African cardiology has been focused on its two main peculiarities. One is the welldocumented rarity of coronary thrombosis. The other is the prevalence of cardiomyopathies of unknown origin among indigenous Africans. While both are receiving much publicity their extent has been difficult to assess. In the relatively undeveloped areas, where their incidence might be of greatest interest, no accurate sources of information regarding morbidity and mortality exist. In the urban areas, where such statistics are more accurate, the African population at risk is to a certain extent selected since many of its members are part of a young, migrant labour force whose homes are in native reserves away from the cities. When these people are overtaken by old age or chronic illness they return to these homes. Their fates often escape recording. The fallacies of hospital morbidity statistics are obvious. Nevertheless, a hospital whose patients are broadly representative of the population at risk can probably contribute to the knowledge of disease incidence, especially where the difference in incidence of certain diseases is very large. Edendale Hospital enjoys advantages in this respect. Its scope and situation allow it to admit African and Indian patients of all classes. A random survey has revealed that about 5 per cent of its patients are resident in the city of Pietermaritzburg and larger towns. Approximately 37 per cent come from periurban townships and locations, and 58 per cent are truly rural in that they live in native reserves or on farms. Because the few surveys that have been made have been concentrated on the larger cities, and because these have shown certain discrepancies, we have made a detailed analysis of patients admitted to this hospital with heart disease.