Some Aspects of Ageing in Africans 111 



amount of iron in a specimen from a siderotic liver, if sections 

 have not been properly stained, specifically for iron. 



Severe simultaneous siderosis of both hepatic epithelium and 

 reticuloendothelial cells, associated with cirrhosis, is exempli- 

 fied in Fig. 11. It seems that, at this stage of the disease, 

 three processes occur simultaneously, or at least in rapid 

 succession — namely, (1) the progressive accumulation of iron 

 in the liver cells associated with (2) the continuous movements 

 of large quantities of iron, from the diet and possibly from 

 dying liver cells into the KupfTer cells and the portal tracts, 

 the latter apparently reacting with massive fibrosis culminat- 

 ing in (3) gross architectural distortion, or cirrhosis. The 

 histological picture established in biopsy specimens in this 

 case was subsequently confirmed at postmortem (Fig. 12). 

 Interestingly enough, on admission to hospital the patient in 

 this instance, as in many others, was not initially diagnosed as 

 suffering from hepatic disease, but was considered to be in 

 congestive cardiac failure with an associated ascites. 



We have, for some time, suspected that congestive cardiac 

 failure, very common in the relatively young African, and 

 often of unknown aetiology, may be due to a basic derange- 

 ment in the metabolism of the intramyocardial iron-containing 

 enzymes, similar to that in the liver. This intracellular 

 metabolic lesion may perhaps underlie the cardiac failure, dis- 

 turbed electrocardiograms and the accumulation of iron 

 within the myocardial cells themselves — a possibility which 



PLATE III 



Fig. 12. Low power view of section from same liver as Fig. 11, but obtained at 

 postmortem. Gross siderosis (type 2 and type 3) with severe cirrhosis super- 

 imposed, confirming liver biopsy diagnosis, x 36. 



Fig. 13. Low power view of cardiac muscle from same case whose liver is 



shown in Figs. 11 and 12. Note patchy intra- myocardial siderosis with 



absence of iron from connective tissue, x 82. 



Fig. 14. High power view of same myocardium as Fig. 13, showing consider- 

 able accumulations of iron pigment, in fine granules and clumps, within 

 myocardial cells ; iron absent from connective tissue. X 820. 



Fig. 15. High power view of thyroid follicle from same case as Figs. 11-14, 



showing granules and coarse clumps of intra-epithelial iron pigment, which is 



absent from peri-follicular connective tissue. X 720. 



