A simple effective treatmentused successfully in thousands of cases that may help solve America’s most serious health problem!
一种简单有效的治疗方法，已成功应用于数千例，可能有助于解决美国最严重的健康问题！

Digitized by the Internet Archive in 2010
2010 年由互联网档案馆数字化

is heart disease. It is now responsible for 50 percent of all deaths, with over a million Americans dying each year, and approximately 25,000 children born annually with abnormal hearts.
是心脏病。它现在占所有死亡的 50%，每年有超过一百万美国人死亡，约有 25,000 名儿童每年出生时心脏异常。

In clear language for the laymen to understandand the physician to use-Dr. Shute describes diagnostic symptoms and the sometimes astonishing results of treatment with vitamin E . He also describes other conditions in which vitamin E has been helpful-diabetes, high blood pressure, severe burns, miscarriages, and more. He discusses preventive care, perhaps most important of all.
用通俗易懂的语言让普通人理解，供医生使用——Shute 博士描述了诊断症状以及维生素 E 治疗时有时令人惊讶的效果。他还介绍了维生素 E 在其他疾病中的帮助——糖尿病、高血压、严重烧伤、流产等。他讨论了预防护理，或许这是最重要的。

Here is a basic book for anyone interested in his own health and the health of his children!
这是一本适合任何关心自己和孩子健康的人阅读的基础书籍！

A wide selection of fine books on Nu trition; Natural Healing Methods; Organic Foods; Vegełarian, Macrobiotic, Reducing, and other Special Diets; Ecology; Exercise & Fitness; Yoga, and many other health-oriented subjects is on sale at the store where you bought this book.
在您购买本书的商店，有大量关于营养、自然疗法、有机食品、素食、长寿饮食、减肥及其他特殊饮食、生态学、锻炼与健身、瑜伽以及许多其他健康主题的优质书籍出售。

A giant 32-page “Health Books Catalog” listing over 2,500 of these books is available to you absolutely free. Just Write:
一本巨大的 32 页“健康书籍目录”，列出了 2500 多本此类书籍，现免费提供给您。只需写信：

by  由
WILFRID E. SHUTE, B.A., M.D.
威尔弗里德·E·舒特，文学士，医学博士

“Any sale, lease, transfer or circulation of this book by way of trade or in quantities of more than one copy, without the original cover bound thereon, will be construed by the Publisher as evidence that the parties to such transaction have illegal possession of the book, and will subject them to claim by the Publisher and prosecution under law.”
“任何以贸易方式或超过一份数量出售、租赁、转让或流通本书，且未附有原装封面，出版商将视为交易双方非法持有本书的证据，并将对其提出索赔并依法起诉。”

A PYRAMID BOOK  金字塔图书

Secand printing December, 1972
1972 年 12 月第二次印刷

Copyright © 1969 by Wilfrid E. Shute with Harold J. Taub All rights reserved. No part of this book may be used or reproduced in any manner whatsoever without the written permission of the publishers, with the exception of brief quotations embodied in critical articles or reviews.
版权所有 © 1969，Wilfrid E. Shute 与 Harold J. Taub 保留所有权利。未经出版商书面许可，本书任何部分不得以任何方式使用或复制，批评文章或评论中包含的简短引用除外。

Library of Congress Catalog Card Number: 71-104177
国会图书馆目录卡号：71-104177

Printed in the United States of America
美国印刷

Pyramid Books are published by Pyramid Communications, Inc. Its trademarks, consisting of the word “pyramid” and the portrayal of a pyramid, are registered in the United States Patent Office.
Pyramid Books 由 Pyramid Communications, Inc.出版。其商标，包括“pyramid”一词及金字塔的图案，均在美国专利局注册。

PYRAMID COMMUNICATIONS, INC.
919 Third Avenue  919 第三大道
New York, New York 10022, U.S.A.
美国纽约州纽约市，邮编 10022

Introduction: Why Vitamin E? … 7
介绍：为什么选择维生素 E？……7

people a year dying of heart disease in the United States alone, you will not be surprised to read that coronary thrombosis - the major cause of heart attack death - is the greatest single killer in the world today. What you may find very surprising, however, is that coronary thrombosis was unknown as a disease entity in 1900 and apparently hardly existed at that time. Indeed, three cases were reported by Dr. George Dock in 1896, (1) but his reported findings of clots in coronary arteries were not corroborated by other investigators. It was not until 1912 that Herrick (2) in Chicago reported six cases and medical practitioners began to be aware of coronary thrombosis as a possibility.
仅在美国，每年死于心脏病的人数众多，你不会感到惊讶地读到冠状动脉血栓形成——心脏病发作死亡的主要原因——是当今世界上最大的单一杀手。然而，你可能会非常惊讶的是，冠状动脉血栓形成在 1900 年作为一种疾病实体尚未被认识，显然当时几乎不存在。事实上，1896 年乔治·多克医生报道了三例病例，（1）但他关于冠状动脉血栓的发现并未被其他研究者证实。直到 1912 年，芝加哥的赫里克（2）报道了六例病例，医学从业者才开始意识到冠状动脉血栓形成的可能性。

Dr. Paul Dudley White writes: (3) ". . . when I graduated from medical school in 1911, I had never heard of coronary thrombosis, which is one of the chief threats to life in the United States and Canada today-an astonishing development in one’s own lifetime! There can be no doubt but that coronary heart disease has reached epidemic proportions in the United States, where it is now responsible for more than 50 per cent of all deaths. . . .
保罗·达德利·怀特博士写道：（3）“……当我在 1911 年医学院毕业时，我从未听说过冠状动脉血栓形成，这在今天的美国和加拿大是生命的主要威胁之一——这是一个令人震惊的发展，发生在一个人的有生之年！毫无疑问，冠心病在美国已达到流行病规模，现在它占所有死亡人数的 50%以上……”
“The truth is, an ever-increasing number of young men are being struck down before the age of 40 (including a large number of physicians) at the time when they are most needed by their families and when they are prepared to make their greatest contribution to society.”
事实是，越来越多的年轻男性在 40 岁之前倒下（包括大量医生），正值他们家庭最需要他们、他们准备为社会做出最大贡献的时候。

Is there even a remote possibility that the physicians of 50 years ago were both so ignorant and incurious as to be
50 年前的医生竟然既无知又缺乏好奇心，这种可能性有多大呢？
utterly unaware of tens or hundreds of thousands of coronary thromboses occurring before their eyes? Of all possibilities that would seem to be the least likely. In fact some of the most acute and observant pathologists in American medical history were active at this time! It is by far more reasonable to assume that 50 years ago, or any time before then, coronary thrombosis simply was not occurring often enough to constitute any kind of observable disease entity.
完全没有意识到成千上万的冠状动脉血栓正在他们眼前发生？在所有可能性中，这似乎是最不可能的。事实上，美国医学史上一些最敏锐和最有洞察力的病理学家当时正活跃着！更合理的假设是，50 年前，或更早之前，冠状动脉血栓的发生频率根本不足以构成任何可观察的疾病实体。

We must then ask ourselves, in the light of what we know about this major killer, what changes have occurred in the general conditions of life. What has so recently made people, formerly immune to clots in the coronary arteries, now so very susceptible?
那么，我们必须根据我们对这一主要杀手的了解，问问自己，生活的一般条件发生了哪些变化。是什么最近使得那些以前对冠状动脉血栓免疫的人，现在变得如此易感？

There are many theories, of course. No other disease except cancer has ever provoked so many somewhat plausible, contradictory and unhelpful ideas about causation and prevention. Heart attacks have been blamed on stress and strain, on overexertion, on the fast pace of modern living, on soft drinking water, on hard drinking water, and, of course, on diets rich in animal fats. Among the prominent and more widely held theories, each of these ideas has its own kind of plausibility. Yet with each and every one it can be shown that the same condition was present in the lives of all or many people prior to 1900 , but did not cause coronary thrombosis.
当然，有许多理论。除了癌症，没有其他疾病像心脏病那样引发过如此多多少少看似合理、相互矛盾且无助于预防的因果关系和预防观点。心脏病发作被归咎于压力和紧张、过度劳累、现代生活的快节奏、软饮用水、硬饮用水，当然还有富含动物脂肪的饮食。在众多较为流行的理论中，这些观点各自都有一定的合理性。然而，可以证明，在 1900 年之前，所有或许多人的生活中都存在这些条件，但并未导致冠状动脉血栓形成。

Without attempting any complicated statistical proofs, let us simply consider what is obvious about these theories.
不做任何复杂的统计证明，我们仅仅考虑这些理论中显而易见的部分。

While we tend to think of modern living as being conducted at a faster pace, the speed is really more an attribute of our machines than it is of our own lives. We can drive 60 miles an hour, but the stress and strain of traveling 60 miles is infinitely less in driving a car than it was in traveling the same distance in a jolting stage coach threatened by robbers and hostile Indians, or than traveling the same distance on horseback or on foot along bad roads with danger threatening from behind every tree. Before the turn of the century there was more stress involved in caring for larger families on lower earnings; an employee was unprotected before the whims of his boss and knew that if he lost a job it might
虽然我们倾向于认为现代生活节奏更快，但这种速度更多是我们机器的属性，而非我们自身生活的属性。我们可以以每小时 60 英里的速度行驶，但驾驶汽车行驶 60 英里的压力和劳累远远小于乘坐颠簸的马车，途中还要提防强盗和敌对的印第安人，或者骑马或步行在崎岖不平的道路上行进，背后随时可能有危险。在世纪之交之前，抚养大家庭的压力更大，收入更低；员工在老板的任性面前没有保护，知道如果失去工作可能会面临困境。
take months, years, or forever to find another. Even savings were relatively unsafe in banks that failed without warning. Actually, there are very few stresses today that were not present in prethrombotic times.
可能需要几个月、几年，甚至永远才能找到另一个。即使是储蓄，在那些无预警倒闭的银行中也相对不安全。实际上，今天几乎没有什么压力是前血栓形成时代不存在的。

Dr. Howard B. Sprague of Boston, a former president of the American Heart Association, has stated that “one man’s stress is just another man’s challenge” and probably has little to do with heart disease.
波士顿的霍华德·B·斯普拉格博士，美国心脏协会前任主席，曾表示“一个人的压力只是另一个人的挑战”，并且可能与心脏病关系不大。

If our ancestors could live on isolated farms threatened by Indian raids and not get coronaries, stress can hardly be bad for the heart.
如果我们的祖先能够在受到印第安人袭击威胁的孤立农场上生活而不患冠状动脉疾病，那么压力对心脏几乎不可能有害。

Overexertion, like shoveling snow after a blizzard, would be a joke to our forebears, who wrestled horse-drawn plows or worked 12 hard hours a day in factories. True, men do have heart attacks while shoveling snow, but for the causation, except the immediate provocation, we must look elsewhere.
过度劳累，比如暴风雪后铲雪，对我们的祖先来说简直是笑话，他们曾经驾驭马拉犁或在工厂里每天辛苦工作 12 小时。确实，人们在铲雪时会发生心脏病发作，但除了直接诱因外，原因还得另寻他处。

Soft water and hard water, of course, have not changed appreciably. There is no doubt that 50 years ago, 80 or 100 years ago or as far back as you want to go, some people drank hard water and some drank soft, and none of them developed a coronary thrombosis.
软水和硬水当然没有明显变化。毫无疑问，50 年前、80 年前、100 年前，甚至更早，有些人喝硬水，有些人喝软水，但他们中没有人患上冠状动脉血栓。

Even when it comes to the animal-fat theory, whose adherents are world-wide and whose numbers are legion, there are obvious weaknesses that only need pointing out.
即使是关于动物脂肪理论，其支持者遍布全球且数量众多，也存在明显的弱点，只需指出即可。

In the American diet it can be shown that the number of foods containing animal or saturated fats has increased greatly, but it can also be shown that in times past people ate all the animal fat available to them. They did not trim their meats. They ate more fried foods than are eaten today. Billions of people subsisted for their entire lives on types of meat with names like “fatback” - and they were not affected with coronary thrombosis. Actually, the intake of animal fat in the American diet has, over the past 15 years, been reduced to approximately one-third of what it was, while, far from decreasing, the coronary rate has gone up every year. During this same period, the intake of animal fats in Canada was relatively unchanged. Yet, although the average Canadian ate three times as much as his American counter-
在美国饮食中，可以看出含有动物脂肪或饱和脂肪的食物数量大大增加，但也可以看出过去人们吃掉了所有可获得的动物脂肪。他们不会修剪肉类。他们吃的油炸食品比现在还多。数十亿人一生都靠名为“fatback”的肉类维生，而他们并未患上冠状动脉血栓症。实际上，在过去 15 年里，美国饮食中的动物脂肪摄入量已减少到原来的约三分之一，而冠状动脉疾病的发病率非但没有下降，反而每年都在上升。在同一时期，加拿大的动物脂肪摄入量相对保持不变。然而，尽管加拿大人的平均摄入量是美国人的三倍，...
part, the incidence of coronary thrombosis in Canada leveled off, came to a halt, and began to decrease during that same period.
在同一时期，加拿大冠状动脉血栓形成的发病率趋于平稳，停止上升，并开始下降。

An interesting study of myocardial infarction (heart attack caused by shutting off of the blood supply to the heart by a coronary artery obstruction and consequent death of heart muscle tissue) was reported by Dr. S. L. Malhotra (4) of Bombay, India. He made an illuminating comparison between natives of North India (the Punjab) and those of the South. Natives of the Punjab, he showed, have a fat intake that is largely of animal origin and is eight to 19 times as great as that of the Southerners. But the prevalence of myocardial infarction in Southern India is seven times greater than in the Punjab.
印度孟买的 S. L. Malhotra 博士（4）报道了一项关于心肌梗死（由冠状动脉阻塞导致心脏供血中断及心肌组织死亡引起的心脏病发作）的有趣研究。他对印度北部（旁遮普）和南部的土著居民进行了富有启发性的比较。他指出，旁遮普土著的脂肪摄入主要来自动物性，且是南方人的 8 到 19 倍。但南印度心肌梗死的发病率却是旁遮普的七倍。

There is much evidence to suggest that there is no relationship between dietary fat and coronary artery disease, although the theory still has its adherents. Similarly, the commonly held relationship between arteriosclerosis and coronary thrombosis may have no validity. Indeed, Morris (5) in England in 1951 demonstrated that in the year 1910 there was more coronary artery atherosclerosis than there is now. Yet, there was little or no coronary thrombosis at that time.
有大量证据表明膳食脂肪与冠状动脉疾病之间没有关系，尽管这一理论仍有支持者。同样，动脉硬化与冠状动脉血栓形成之间普遍认为的关系可能并不成立。事实上，1951 年英国的 Morris（5）证明，1910 年冠状动脉粥样硬化比现在更多。然而，当时几乎没有冠状动脉血栓形成。

For a very good specific example let us consider the chairman of the Diet-Heart Committee of the American Medical Association, who was scheduled to present to the annual A.M.A. meeting in June, 1967, his recommendation for a very expensive long-term evaluation of the restriction of animal fats in the diet. He, himself, had followed his own recommended low fat regimen for years, had kept slim and exercised frequently, and in all ways followed his own “authoritative” advice on how to prevent heart attacks. He was unable to attend that June, 1967 meeting because he was in hospital recovering from a coronary thrombosis!
举一个非常具体的例子，让我们考虑美国医学会饮食与心脏委员会的主席，他原定于 1967 年 6 月在年度 A.M.A.会议上提出关于限制饮食中动物脂肪的非常昂贵的长期评估的建议。他本人多年来一直遵循自己推荐的低脂饮食方案，保持身材苗条，经常锻炼，并在各方面都遵循自己关于如何预防心脏病发作的“权威”建议。1967 年 6 月的会议他未能出席，因为他正在医院康复，原因是冠状动脉血栓形成！

Of course, coronary thrombosis as such is not the only form of heart disease. Atherosclerotic changes causing the coronary artery to narrow bring a decrease in blood supply to the heart muscle, which, in turn, leads to gradual changes in the heart. Eventually, there is decreased tolerance to
当然，冠状动脉血栓形成并不是唯一的心脏病形式。动脉粥样硬化引起冠状动脉狭窄，导致心肌供血减少，进而引起心脏的逐渐变化。最终，耐受能力下降。
stress or to exertion or excitement, leading to pain in the chest, shortness of breath, or both.
压力、劳累或兴奋，导致胸痛、呼吸急促或两者兼有。

Elevated blood pressure leads to increased strain on the walls of blood vessels, to an accelerated rate of tissue damage, and to an increased possibility of cerebral artery, coronary artery, or peripheral artery insufficiency. The advent of new and effective antihypertensive drugs has ${}^{\ast }$${}^{\ast }$^(**){ }^{*} brought about a marked improvement in the life expectancy of such patients in the last 15 years. Acute rheumatic fever, which is often preventable by antibiotic treatment of the preceding tonsillitis or pharyngitis, is actually on the decrease.
高血压会导致血管壁负担加重，组织损伤加速，并增加脑动脉、冠状动脉或周围动脉功能不全的可能性。新型有效的降压药物的出现，在过去 15 年中显著改善了这类患者的预期寿命。急性风湿热通常可以通过抗生素治疗前期的扁桃体炎或咽炎来预防，实际上其发病率正在下降。

The fact remains that heart-disease deaths have doubled since 1945, far outstripping the growth in population and amounting today to more than one million deaths a year in the United States alone. By far the major cause of such deaths is coronary thrombosis, which occurs frequently even when there is no atherosclerosis.
事实仍然是，自 1945 年以来，心脏病死亡人数翻了一番，远远超过了人口增长，仅在美国，每年就有超过一百万人因此死亡。迄今为止，这些死亡的主要原因是冠状动脉血栓形成，即使没有动脉粥样硬化，这种情况也经常发生。

Is there, then, a more rational explanation than the animal fat-atherosclerosis theory to explain why a disease entity that did not occur prior to 1910 has become a greater ravager of human life than any plague recorded in history?
那么，是否有比动物脂肪-动脉粥样硬化理论更合理的解释，来说明为什么一种在 1910 年之前不存在的疾病，已经成为比历史上任何瘟疫都更严重的人类生命杀手？

There is an explanation so simple that it would automatically be suspect had its truth not already been demonstrated in clinical practice of more than 20 years involving many thousands of patients. I have found in my own practice that alpha tocopherol (vitamin E) is, in addition to its other properties, which will be described herein, a superb antithrombin in the bloodstream. Not only will vitamin E dissolve clots, but circulating in the blood of a healthy individual will prevent thrombi from forming.
有一个解释非常简单，如果其真实性没有在超过 20 年的临床实践中对数千名患者的验证，就会自动被怀疑。我在自己的实践中发现，α-生育酚（维生素 E）除了其将在本文中描述的其他特性外，还是血液中的一种极佳的抗凝血酶。不仅维生素 E 能溶解血栓，而且在健康个体的血液中循环时还能防止血栓形成。

Historically, it is irrefutable that when new and more efficient milling methods were introduced into the manufacture of wheat flour, those methods permitting for the first time the complete stripping away of the highly perishable wheat germ, the diet of Western man lost its only significant source of vitamin E. Flour milling underwent this great change around the turn of the century, and it became general around 1910. The amount of vitamin E in the diet
历史上，毫无疑问，当引入新的更高效的磨粉方法用于小麦面粉的生产时，这些方法首次允许完全去除极易腐败的小麦胚芽，西方人的饮食失去了唯一重要的维生素 E 来源。面粉磨制在世纪之交经历了这一重大变化，并在 1910 年左右普及。饮食中的维生素 E 含量
was greatly reduced, and with the loss of this natural antithrombin, coronary thrombosis appeared on the scene.
大大减少了，随着这种天然抗凝血酶的丧失，冠状动脉血栓形成开始出现。

The result of the removal of our major, naturally occurring, circulating antithrombin then explains our present predicament quite fully. The failure of all other methods is apparent from the following statistics of the Metropolitan Life Insurance Company. A “slight increase” was recorded yet again for 1968 in “diseases of the heart, which currently account for nearly two-fifths of all deaths in the United States. The mortality rate for the ischemic type of heart disease, mainly coronary, increased by about three per cent.”
去除我们体内主要的、自然存在的循环抗凝血酶的结果，充分解释了我们目前的困境。其他所有方法的失败从大都会人寿保险公司的以下统计数据中显而易见。1968 年“心脏疾病”再次出现“轻微增加”，目前心脏疾病占美国所有死亡的近五分之二。缺血性心脏病，主要是冠状动脉病的死亡率增加了约百分之三。

Other methods having failed, the time has come when the medical profession must adopt a method of proven success, basically sound, scientifically and abundantly verified by surgeons, physicians, and scientists the world over. As will be apparent in succeeding chapters, this process has already begun in many medical centers.
其他方法均已失败，医学界必须采用一种经过验证的成功方法，这种方法在基本原理上是可靠的，已被全球的外科医生、内科医生和科学家科学地充分验证。正如后续章节所示，这一进程已在许多医疗中心开始。

This book will enable any physician willing to find a better treatment for his cardiac cases to use alpha tocopherol therapy in the ways I have found most successful in my own practice and to learn for himself what vitamin E can or cannot do for the human heart.
本书将使任何愿意为其心脏病患者寻找更好治疗方法的医生能够使用我在自己的实践中发现最成功的α-生育酚疗法，并亲自了解维生素 E 对人类心脏能做什么或不能做什么。

What is tragic is that the medical profession, while feeling a distaste for quack use of the vitamin and properly trying to explode the mythology growing up around it, lost sight of the legitimate need for the vitamin and that, ballyhoo aside, it might be put to valuable therapeutic use. It is probably too much to expect of human beings, but had doctors been able simultaneously to condemn the fakery and accept the growing body of scientific evidence of what vitamin E is good for and how it can be used, literally millions of premature deaths could have been avoided in the period between 1922, when alpha tocopherol was first isolated by Evans and Bishop (6) and also by Sure (7), and the present day.
悲剧在于，医学界虽然对维生素的江湖使用感到反感，并且正确地试图揭穿围绕它形成的神话，但却忽视了对维生素的合法需求，忽视了除去炒作之外，它可能被用于有价值的治疗用途。对人类来说这或许要求过高，但如果医生们能够同时谴责伪科学，同时接受越来越多的关于维生素 E 的科学证据，了解它的益处及使用方法，那么从 1922 年埃文斯和毕晓普（6）以及苏尔（7）首次分离出α-生育酚到现在这段时间里，实际上可以避免数百万的过早死亡。

Clearly and unmistakably alpha tocopherol is a highly effective antithrombin in the bloodstream, yet one which does not induce hemorrhage, suffers from none of the drawbacks of the anticoagulants that are commonly used, and consequently may be used indefinitely without danger. As
显然且无可置疑，α-生育酚是血液中一种高效的抗血栓剂，但它不会引起出血，也没有常用抗凝剂的任何缺点，因此可以无限期安全使用。正如
such, it should be known to every doctor who ever has to treat any type of thrombosis.
因此，每位需要治疗任何类型血栓的医生都应该知道这一点。

Alpha tocopherol has other qualities as well, but it is its antithrombin activity that distinguishes it from six other associated tocopherols in the foods containing the vitamin. Since 1945 when it was established that in the vitamin E complex only the alpha tocopherol is biologically active as an antithrombin, the strength of vitamin E preparations has been rated pharmacologically in terms of their alpha tocopherol content. One milligram of alpha tocopherol is equal to one international unit of vitamin E activity. To most scientists today, vitamin E and alpha tocopherol are the same substance, even though the other tocopherols of the vitamin E complex are not entirely inactive, but do possess antioxidant properties. Pure alpha tocopherol was synthesized 1938 by Karrer (8) and has been widely available for use since 1941.
α-生育酚还有其他特性，但正是其抗血栓活性使其区别于含有该维生素的食物中另外六种相关的生育酚。自 1945 年确定在维生素 E 复合物中只有α-生育酚具有生物学上的抗血栓活性以来，维生素 E 制剂的效力一直以其α-生育酚含量来进行药理学评定。1 毫克α-生育酚等于 1 国际单位的维生素 E 活性。对大多数科学家来说，维生素 E 和α-生育酚是同一种物质，尽管维生素 E 复合物中的其他生育酚并非完全无活性，但它们确实具有抗氧化特性。纯α-生育酚由 Karrer 于 1938 年合成（8），并自 1941 年以来广泛用于应用。

Our interest in vitamin E really began in 1933 with the evaluation and extension of an empirical treatment for the menstrual difficulties dysmenorrhea and menorrhagia devised by our father, Dr. R. James Shute, of Windsor, Ontario, Canada. Our father’s use of thyroid extract, a treatment he originated that is now widely used, showed a certain similarity in its clinical effect to the then known properties of vitamin E with which Dr. Evan Shute had recently been working. This led to a research project, under a grant from the Banting Institute, which in turn led to a chemical method for qualitative and rough quantitative determination of the estrogen level in the circulating blood. This in turn led to evidence that both thyroid extract and vitamin E were antagonists to estrogen, though the mode of action of the antagonism was different in the two substances.
我们对维生素 E 的兴趣实际上始于 1933 年，当时我们评估并推广了由我们父亲、加拿大安大略省温莎市的 R. James Shute 博士设计的一种针对经期困难——痛经和月经过多的经验性治疗。我们父亲使用的甲状腺提取物治疗方法是他首创的，现在已被广泛应用，其临床效果与当时已知的维生素 E 特性有一定相似之处，而维生素 E 是 Evan Shute 博士最近开始研究的。这促成了一个由 Banting Institute 资助的研究项目，进而开发出一种用于定性和粗略定量测定循环血液中雌激素水平的化学方法。进一步的研究表明，甲状腺提取物和维生素 E 都是雌激素的拮抗剂，尽管两者的拮抗作用机制不同。

Further investigation led to successes in the treatment of threatened abortion, the prevention of abruptio placenta, a cause of miscarriage in pregnancy, and prevention of the toxemias of late pregnancy, as well as other difficult conditions found in a specialist’s practice in obstetrics and gynecology. In much of this work, Dr. Evan Shute was joined by his father, Dr. James Shute, and later by the author.
进一步的研究取得了在治疗流产威胁、预防胎盘早剥（一种导致妊娠流产的原因）以及预防晚期妊娠毒血症等方面的成功，还包括妇产科专家实践中遇到的其他复杂情况。在这项工作的大部分过程中，Evan Shute 博士得到了他的父亲 James Shute 博士的协助，后来还有作者的加入。

During the early days of our experience with vitamin E , we were able to obtain a potent wheat-germ-oil product and to maintain its potency for some weeks by refrigeration. Using this product, Dr. Evan Shute obtained complete relief of severe angina pectoris in one patient. We now know that this one patient was unique in that he responded to an unusually low concentration of the alpha tocopherol. Fortunately, also, he was one of the few people who could tolerate, without nausea, the taste of this product in large quantity. An attempt on the part of the author to duplicate this accomplishment on similar patients failed, and we discontinued all efforts in this direction for some time.
在我们早期使用维生素 E 的经验中，我们能够获得一种有效的小麦胚芽油产品，并通过冷藏保持其效力数周。使用该产品，Evan Shute 博士使一名患者的严重心绞痛完全缓解。我们现在知道，这名患者是独特的，因为他对异常低浓度的α-生育酚有反应。幸运的是，他也是少数能够大量耐受该产品味道而不感恶心的人之一。作者试图在类似患者身上复制这一成就未果，因此我们暂停了这方面的所有努力一段时间。

Meanwhile, research on the use of vitamin E was continued in other fields with considerable success until some nine years later when, as a result of the research grant to a university student for summer work, our interest in the use of the vitamin for cardiovascular treatment was reawakened. This student, now Dr. Floyd Skelton, was casting about for a suitable research project and approached Dr. Evan Shute for suggestions. As a result, a project was initiated using estrogen to induce thrombocytopenic purpura in dogs and, thereafter, curing and preventing the same hemorrhagic disease with vitamin E. The design of the study was a logical extension of my brother’s original findings that the two substances, estrogen and vitamin E, are antagonists.
与此同时，维生素 E 的研究在其他领域也取得了相当的成功，直到大约九年后，由于一项资助大学生暑期工作的研究经费，我们对维生素用于心血管治疗的兴趣重新被唤起。这位学生，现在的 Floyd Skelton 博士，正在寻找合适的研究项目，并向 Evan Shute 博士寻求建议。结果，启动了一个项目，使用雌激素诱导犬的血小板减少性紫癜，随后用维生素 E 治疗和预防这种出血性疾病。该研究设计是对我兄弟最初发现的两种物质——雌激素和维生素 E——相互拮抗的逻辑延伸。

The experiments demonstrated conclusively that easy bruising and prolonged bleeding, with low platelet count, in the dog could be induced by estrogen and cured by vitamin E. Similarly, dogs protected by vitamin E could not be made purpuric by estrogen.
实验明确表明，雌激素可以引起狗易瘀伤和出血时间延长以及血小板计数低，而维生素 E 可以治愈这种情况。同样，服用维生素 E 保护的狗不会因雌激素而出现紫癜。

The real turning point in the discovery of the value of vitamin E in heart disease was the direct result of the application of the knowledge gained by Skelton with these dogs. The first human case of severe thrombocytopenic purpura on which it was tried was that of a man in deep congestive heart failure. His condition was the only reason he was considered a fit subject for the trial. Again, unusual luck accompanied the venture, since he also responded rap-
维生素 E 在心脏病价值发现的真正转折点，是斯凯尔顿通过这些狗获得的知识应用的直接结果。第一个接受试验的严重血小板减少性紫癜的人类病例，是一名深度充血性心力衰竭的男性。他的状况是他被认为适合参加试验的唯一原因。同样，这次尝试也伴随着非凡的运气，因为他也迅速做出了反应——
idly and completely to what we now consider a threshold, or often inadequate, level of the drug, namely 200 units. His congestive failure cleared up before the purpura disappeared. This established two characteristics of vitamin E treatment: one, that the dosage level, as calculated from Skelton’s experience with dogs, was 20 to 50 times that suggested for the substance up to that time, and two, that it was the alpha fraction of vitamin $E$$E$EE which was the active portion.
完全无意识地接受了我们现在认为的阈值，或者说通常不足的药物剂量，即 200 单位。他的充血性心力衰竭在紫癜消失之前就得到了缓解。这确立了维生素 E 治疗的两个特点：一是根据 Skelton 对狗的经验计算的剂量水平，是当时建议剂量的 20 到 50 倍；二是维生素 E 的α部分是活性成分。

Many months later, when because of the excessive cost of this synthetic alpha tocopherol, we switched to the natural form as manufactured by Distillation Products Industries in Rochester, New York, the clinical results were exactly comparable when only the alpha fraction of the oil was equated to that of the synthetic alpha tocopherol product.
许多个月后，由于这种合成α-生育酚的成本过高，我们改用了由纽约罗切斯特的 Distillation Products Industries 生产的天然形式，当仅将油中的α部分与合成α-生育酚产品相等时，临床结果完全相当。

The fact that this first patient was a cardiac cripple being treated by Dr. Arthur Vogelsang and that Dr. Evan Shute, being an obstetrician and gynecologist, had few, if any, cardiac-patients, brought the author into the project of further investigation of the effect of vitamin E in cardiac disease.
这位第一位患者是由 Arthur Vogelsang 医生治疗的心脏病残疾患者，而 Evan Shute 医生作为一名产科和妇科医生，几乎没有心脏病患者，这使作者参与了进一步研究维生素 E 对心脏病影响的项目。

The first patients were maintained on their previous regimens with the one exception that now 300 units of alpha tocopherol daily were added. Improvement, when obtained, could then be attributed only to the one substance.
最初的患者继续使用他们之前的治疗方案，唯一的例外是每天增加了 300 单位的α-生育酚。由此获得的改善只能归因于这一种物质。

In all this investigative work, with the exception of the one patient successfully treated in 1936, Dr. Evan Shute served as guide and co-ordinator. He has continued his very successful obstetrical and gynecological work, while taking time to assist with its extension to such peripheral bloodvessel problems as arteriosclerotic changes in the extremities, failing circulation and gangrene of Buerger’s Disease, diabetic gangrene, etc. Cardiac treatment became the province of Drs. Vogelsang and the author. Separately and together the cardiovascular aspect, in all its variations and ramifications, was investigated and for nearly 25 years has been the exclusive interest and occupation of the author.
在所有这些调查工作中，除了 1936 年成功治疗的那位患者外，Evan Shute 博士一直担任指导和协调者。他继续从事非常成功的产科和妇科工作，同时抽出时间协助将其推广到周围血管问题，如四肢动脉硬化性变化、血液循环衰竭和 Buerger 病的坏疽、糖尿病性坏疽等。心脏治疗则成为 Vogelsang 博士和作者的职责。无论是单独还是共同，心血管方面的各种变化和分支都得到了研究，近 25 年来一直是作者唯一的兴趣和工作领域。

The number of patients whose treatment I have supervised personally or through other doctors working at The Shute
我亲自或通过在 The Shute 工作的其他医生监督治疗的患者人数

Institute now exceeds 30,000 . This is somewhere in the realm of five times as many cardiovascular patients as seen by any other living doctor.
该研究所现已超过 30,000 人。这大约是任何其他在世医生所见心血管患者人数的五倍。

This work, widely published in medical journals since 1945, has stimulated investigators in our own and other countries, and there is now, as will be shown later, a very large bibliography available for those interested in its clinical application - the purpose of this book.
自 1945 年以来，这项工作在医学期刊上广泛发表，激发了我们国家及其他国家的研究人员，正如后文将展示的那样，现在已有大量文献供对其临床应用感兴趣的人参考——这正是本书的目的。

By now it is possible to say with complete assurance that alpha tocopherol is a thoroughly tried and tested therapeutic agent, unusually successful in its results and with its effects so well defined that it can be used with precision by any competent physician.
现在可以完全肯定地说，α-生育酚是一种经过充分试验和验证的治疗剂，效果异常显著，其作用机制明确，任何有能力的医生都能精确使用。

Given carefully produced alpha tocopherol of known potency in terms of international units, it is a simple matter to prove its effectiveness in combatting cardiovascular disease. This can be demonstrated in 48 to 96 hours in a case of acute inflammation of the kidney (nephritis), acute rheumatic fever, or acute thrombophlebitis. Such cases, treated as soon as the diagnosis can be established, will be, by all criteria, laboratory and clinical, completely cured in two to four days! Such a potent drug, if it had no other value than in the treatment of such cases, is an absolute necessity in the armamentarium of every doctor whatever his specialty or type of practice.
在已知国际单位效力的精制α-生育酚（维生素 E）的情况下，证明其在对抗心血管疾病中的有效性是一件简单的事。这可以在急性肾炎（肾小球肾炎）、急性风湿热或急性血栓性静脉炎的病例中，在 48 到 96 小时内得到证明。此类病例一经确诊并立即治疗，按照所有标准，包括实验室和临床标准，均可在两到四天内完全治愈！这样一种强效药物，即使仅在治疗此类病例中有价值，也应成为每位医生无论其专业或执业类型的必备武器。

The action of alpha tocopherol has been extensively investigated and its chemical use extensively confirmed. Up to 1961 there were 391 articles supporting the use of alpha tocopherol in cardiovascular-renal diseases in the medical literature written by 668 clinicians and investigators from 35 countries. The volume of papers published since has more than doubled, and this substantiates the statement made above that the effectiveness of alpha tocopherol in this field of medicine has now been thoroughly established. All that remains is to have every doctor use it whenever indicated.
α-生育酚的作用已被广泛研究，其化学用途也得到了充分确认。截止到 1961 年，医学文献中已有 391 篇文章支持在心血管-肾脏疾病中使用α-生育酚，这些文章由来自 35 个国家的 668 名临床医生和研究人员撰写。此后发表的论文数量已增加了一倍多，这证实了上述关于α-生育酚在该医学领域效果已被彻底确立的说法。剩下的就是让每位医生在适当情况下都使用它。

Like all useful therapy, it requires a thorough knowledge of its modes of application. Given a good product, the dosage must be adequate to control the specific condition. For
像所有有效的治疗方法一样，它需要对其应用方式有透彻的了解。在产品质量良好的前提下，剂量必须足够以控制特定的病症。对于
example, in treating coronary disease, the dosage range is around 600 to 800 units daily or more. If patients with chronic rheumatic heart disease are given this same dosage, the majority will become dramatically and rapidly much improved, but will then worsen; if this dosage level is continued the majority will develop rapid cardiac decompensation with failure and death. On the other hand, a relatively low initial dose gradually increased will usually lead to very worthwhile improvement not obtainable in any other way.
例如，在治疗冠心病时，剂量范围大约是每天 600 到 800 单位或更多。如果慢性风湿性心脏病患者给予相同剂量，大多数人会迅速且显著改善，但随后会恶化；如果继续维持此剂量水平，大多数人会迅速出现心脏功能失代偿，导致衰竭和死亡。另一方面，较低的初始剂量逐渐增加，通常会带来非常有价值的改善，这是其他方法无法获得的。

Just as the physician can adequately control the sugar in the diabetic only when he matches the dosage of insulin to the individual patient’s needs, so the doctor using alpha tocopherol must know the dosage range and then tailor it to his patient’s requirement.
正如医生只有将胰岛素剂量与糖尿病患者的个体需求相匹配，才能有效控制血糖一样，使用α-生育酚的医生也必须了解剂量范围，然后根据患者的需求进行调整。

Fortunately, in practice alpha tocopherol can be effectively combined with any other known treatment. There are virtually only three known, commonly used drugs with which alpha tocopherol is incompatible - inorganic iron, mineral oil, and female sex hormone. Iron leaches it out, and if iron must be given for anemia, for example, it must be kept from coming in direct contact with it. This can be done therapeutically by having the patient take all his alpha tocopherol in one dose and all his iron eight to 12 hours later.
幸运的是，在实际应用中，α-生育酚可以有效地与任何其他已知治疗方法结合使用。实际上，只有三种已知的常用药物与α-生育酚不兼容——无机铁、矿物油和女性性激素。铁会使其流失，例如，如果必须为贫血而服用铁，则必须避免铁与α-生育酚直接接触。这可以通过让患者一次性服用所有α-生育酚，然后在八到十二小时后服用所有铁剂来实现治疗效果。

Vegetable oils dissolve alpha tocopherol but readily release it in the body, while mineral oil dissolves it but does not readily release it.
植物油能溶解α-生育酚，但在体内容易释放，而矿物油能溶解它但不易释放。

Estrogen is an antagonist to alpha tocopherol, is very rarely necessary in cardiovascular cases, and should be avoided whenever possible. Its use makes it very difficult to estimate the amount of alpha tocopherol the patient is using. Alpha tocopherol has an action similar to that of digitalis on the hypoxic (oxygen deficient) heart. For this reason any digitalis given is more effective in the patient on alpha tocopherol than in one without alpha tocopherol. In most cases, the dosage of digitalis used should be no more than a half of the usual therapeutic dose and may be much less.
雌激素是α-生育酚的拮抗剂，在心血管病例中极少必要，应尽可能避免使用。其使用会使估计患者使用的α-生育酚量变得非常困难。α-生育酚对缺氧（缺氧）心脏的作用类似于地高辛。因此，服用α-生育酚的患者所用的地高辛比未服用α-生育酚的患者更有效。在大多数情况下，地高辛的剂量不应超过通常治疗剂量的一半，甚至可能更少。

With these exceptions any other indicated drug may be
除这些例外，任何其他指定的药物都可以使用
used along with alpha tocopherol. Nitroglycerine, the antihypertensive drugs, and the diuretics can safely be used as adjunct therapy, for example, and indeed seem to be more effective because of the simultaneous use of alpha tocopherol.
与α-生育酚一起使用。硝酸甘油、降压药和利尿剂可以安全地作为辅助治疗使用，例如，实际上由于同时使用α-生育酚，它们似乎更有效。

The original work on the use of alpha tocopherol in cardiovascular disease was carried out by Dr. Floyd Skelton, then a medical student, and three doctors, Evan Shute, Arthur Vogelsang, and the author. The work of Ochsner and the definitive work of Zierler, et al (9) was done later. The product originally used was synthetic, and the results were excellent. Later, when the natural product became available, we were again fortunate that the product selected was properly assayed and labeled. The results were completely comparable, one international unit of the synthetic equal to one international unit of the natural product, irrespective of how much or how little of the other tocopherols were present in the capsule. However, studies made by biochemists at Distillation Products Industries have found about 30 per cent greater biological activity in natural alpha tocopherol.
关于α-生育酚在心血管疾病中应用的最初研究是由当时还是医学生的 Floyd Skelton 博士以及三位医生 Evan Shute、Arthur Vogelsang 和作者共同完成的。Ochsner 的工作以及 Zierler 等人（9）的权威研究是在之后进行的。最初使用的产品是合成的，效果非常好。后来，当天然产品问世时，我们又很幸运地选用了经过正确检测和标记的产品。结果完全可比，合成品的一国际单位等于天然产品的一国际单位，无论胶囊中含有多少其他生育酚。然而，Distillation Products Industries 的生物化学家进行的研究发现，天然α-生育酚的生物活性约高出 30%。

There is now such a very large number of scientific reports on the efficacy of alpha tocopherol in the treatment of cardiovascular and renal diseases that there should be no longer any hesitancy about its use. The only ones qualified to discuss its properties are those who have used it. There are, of course, no other such safe and potent forms of treatment available.
现在关于α-生育酚在治疗心血管和肾脏疾病方面疗效的科学报告数量非常多，因此不应再对其使用有所犹豫。唯一有资格讨论其特性的，是那些使用过它的人。当然，没有其他如此安全且有效的治疗方法可用。

Unfortunately, the original papers dealing with the use of anticoagulants were widely circulated, and that treatment was rapidly and universally adopted. It is remarkable that it took nearly 12 years and many thousands of cases before it was discovered that the drug was probably useless and, of course, highly dangerous. By this time hospital labs had trained technicians to do the necessary blood analyses, and it is hard now to abandon the treatment. The same applies to the cholesterol theory and, of course, to “bed rest.” As early as 1952 Dr. Samuel Levine was able to lower the death rate of acute coronary thrombosis cases from approximately 40 to 60 to 9.9 per cent, merely by taking the patient
不幸的是，关于使用抗凝剂的原始论文被广泛传播，这种治疗方法迅速且普遍被采用。值得注意的是，花了近 12 年和成千上万的病例后才发现这种药物可能无效，当然，也极其危险。到那时，医院实验室已经培训了技术人员进行必要的血液分析，现在很难放弃这种治疗方法。胆固醇理论当然也是如此，“卧床休息”也是一样。早在 1952 年，Samuel Levine 医生仅通过让患者采取措施，就能将急性冠状动脉血栓病例的死亡率从大约 40%到 60%降低到 9.9%。
out of bed as soon as his pain had subsided and putting him in a comfortable chair with arms and a seat which supported the buttocks and thighs evenly. Yet for years after the inefficacy of the regimen had been irrefutably demonstrated, bed rest, abstention from exertion and excitement, retirement, and an afternoon nap were advocated for patients who had survived their initial attack.
一旦他的疼痛减轻，就让他起床，安置在一把带扶手且座位能均匀支撑臀部和大腿的舒适椅子上。然而，在多年之后，当该方案的无效性已被无可辩驳地证明，仍然有人主张卧床休息、避免劳累和激动、退休以及午睡，作为幸存初次发作患者的建议。

There has been a similar lag between knowledge of the effectiveness of alpha tocopherol and its use.
关于α-生育酚有效性的认识与其实际应用之间也存在类似的滞后。

Following recovery from a coronary occlusion, the patient usually, but by no means always, develops the intense chest pain known as angina pectoris. In many cases, angina pectoris has preceded the onset of the so-called attack.
冠状动脉闭塞恢复后，患者通常（但并非总是）会出现被称为心绞痛的剧烈胸痛。在许多情况下，心绞痛早于所谓发作的开始。

Similarly, in patients in whom there has been no history of occlusion and no clinical or electrocardiographic evidence of such an episode, angina pectoris develops gradually due to narrowing of the coronary arteries and the consequent diminution of blood supply to the heart muscle - the myocardium.
同样，在那些没有闭塞病史且无临床或心电图证据表明发生过此类事件的患者中，心绞痛是由于冠状动脉逐渐狭窄，导致心肌供血减少而逐渐发展起来的。

Commonly in diabetes mellitus of some years’ duration, narrowing of the interior channel-the lumen of arteries in brain, eye, heart, kidney, or the extremities, occurs. There is always in the diabetic female, and nearly always in the male, such narrowing to a degree greater than that expected for that age group.
在患有多年糖尿病的情况下，大脑、眼睛、心脏、肾脏或四肢的动脉内腔常常发生狭窄。糖尿病女性中总是存在这种狭窄，男性中几乎总是存在，且狭窄程度超过该年龄组的正常预期。

Narrowing of the arteries in the legs occurs in many older people and also occurs along with episodes of spasm and thrombosis in those with Buerger’s Disease.
许多老年人腿部动脉会发生狭窄，患有布尔格病的人则伴有痉挛和血栓形成的发作。

In all such cases the action of alpha tocopherol, which diminishes or relieves these symptoms, depends upon its power to decrease the oxygen need of the involved tissues. In most cases, this decrease will be marked; in many, very much worthwhile; in a few, not sufficient to warrant its further use for this purpose - the relief of pain. Of course, many factors are involved. A few are:
在所有这些情况下，α-生育酚的作用——减轻或缓解这些症状——取决于其降低相关组织氧气需求的能力。在大多数情况下，这种降低是显著的；在许多情况下，非常有价值；在少数情况下，不足以支持其为此目的——缓解疼痛——的进一步使用。当然，涉及许多因素。以下是其中几个：

This ability of alpha tocopherol to reduce oxygen need, and thereby increase exercise tolerance has been demonstrated in normal animals, racing greyhounds, race horses, and in humans in baseball, hockey, figure skating, and swimming.
α-生育酚减少氧气需求、从而提高运动耐力的能力已在正常动物、赛跑灵缇犬、赛马以及棒球、曲棍球、花样滑冰和游泳运动员中得到证明。

At least part of this demonstrable effect derives from the well-established fact that vitamin E is a biological antioxidant. By preventing premature and undesirable oxidation of lipids in the bloodstream, it keeps available to the tissues a higher proportion of the oxygen taken into the blood.
这种明显效果的至少一部分源于维生素 E 作为生物抗氧化剂的公认事实。通过防止血液中脂质的过早和不良氧化，它使组织能够利用更多进入血液的氧气。

The second action of alpha tocopherol of major importance
α-生育酚的第二个重要作用
in cardiovascular disease has been mentioned previously its ability to dissolve fresh thrombi and to prevent the occurrence of thrombosis. The patient suffering from the results of a previous thrombosis in coronary artery, vein, or peripheral vessel will thus be almost, though not quite completely, protected from a recurrence.
之前已经提到过其在心血管疾病中的作用，即能够溶解新鲜血栓并预防血栓形成。因此，患有冠状动脉、静脉或周围血管先前血栓后遗症的患者，将几乎（虽然不完全）免受复发的影响。

The results of these two major actions of alpha tocopherol, therefore, lead to marked clinical improvement in:
因此，α-生育酚这两大作用的结果导致以下方面的显著临床改善：

In acute, early stages of rheumatic fever the ability of alpha tocopherol to return abnormal capillary permeability to normal, as well as its oxygen-sparing characteristic, seems to prevent specific damage to the tissues concerned. An acutely ill patient may be in every detectable sense normal in 48 to 96 hours and will not develop sequelae.
在急性早期风湿热阶段，α-生育酚恢复异常毛细血管通透性至正常的能力，以及其节氧特性，似乎能防止相关组织的特定损伤。急性病患者在 48 至 96 小时内在所有可检测的方面可能恢复正常，并且不会发展为后遗症。

It is this same action of the restoration of normal capillary permeability that saves the kidney from irreparable damage in fresh acute nephritis. The edema of the kidney, with the resulting swelling inside the inelastic capsule and the pressure on the glomeruli characteristic of the disease, is prevented or decreased, thus preserving the glomeruli until the other actions of alpha tocopherol overcome the disease. An acute nephritis will characteristically be cured by all
正是这种恢复正常毛细血管通透性的作用，挽救了肾脏免受新发急性肾炎的不可修复损伤。肾脏的水肿，以及由此导致的无弹性囊内肿胀和疾病特有的肾小球受压，得以预防或减轻，从而保护肾小球，直到α-生育酚的其他作用战胜疾病。急性肾炎通常会被全部治愈。
available tests in 48 to 96 hours. This is why immediate treatment with alpha tocopherol of rheumatic fever and nephritis must be initiated at the first definite signs of the disease.
可在 48 至 96 小时内进行检测。这就是为什么风湿热和肾炎一旦出现明确症状，必须立即开始使用α-生育酚进行治疗的原因。

Alpha tocopherol increases the extent and the speed of the opening up of collateral circulation, and this is of great importance in the treatment of intermittent claudication and of chronic thrombophlebitis, indeed of any condition involving the peripheral circulation, venous or arterial. Since the collateral circulation in the brain and heart is poorly developed by contrast to the peripheral circulation, its action in this respect is much less obvious and is slow to appear, as well as hard to evaluate.
α-生育酚增加侧支循环的范围和速度，这在治疗间歇性跛行和慢性血栓性静脉炎，实际上在任何涉及外周循环（静脉或动脉）的疾病中都具有重要意义。由于与外周循环相比，大脑和心脏的侧支循环发育较差，其在这方面的作用不太明显，出现较慢且难以评估。

Finally, the effect of alpha tocopherol on scar tissue is of utmost importance in wounds and burns. Wide areas of burned tissue will heal and become epithelialized without the inevitable contraction. The scars following alpha tocopherol topically and orally administered are like no other scars ever seen. In many cases skin grafting need no longer be indicated, and in other cases the amount of skin grafting can be greatly reduced.
最后，α-生育酚对瘢痕组织的影响在伤口和烧伤中极为重要。大面积的烧伤组织将愈合并上皮化，而不会出现不可避免的收缩。局部和口服使用α-生育酚后形成的瘢痕与以往见过的任何瘢痕都不同。在许多情况下，不再需要进行皮肤移植，而在其他情况下，皮肤移植的数量可以大大减少。

in 1967, I was called to attend a neighbor who had suffered a severe heart attack.
1967 年，我被叫去照顾一位遭受严重心脏病发作的邻居。

On a clear, cold day he had been out with his son playing ice hockey, a popular sport in Canada. While playing he suddenly experienced severe pain in the mid-sternal region of the chest. He knew something serious was happening, called his son away from the game, removed his skates, and assisted by the boy made his way to their car to drive home.
在一个晴朗寒冷的日子里，他和儿子一起去打冰球，这是一项在加拿大很受欢迎的运动。比赛时，他突然感到胸骨中部剧烈疼痛。他知道情况严重，叫儿子离开比赛，脱下冰鞋，在儿子的帮助下走向他们的车，准备开车回家。

They lived only a few blocks away, but before they reached home he had to stop the car to vomit and was barely able to drive the last block to his house.
他们住的地方只有几个街区远，但在到家之前，他不得不停下车呕吐，几乎无法开车完成最后一个街区的路程。

He was able to make his way into the split-level house and up a small flight of stairs, but the attack became so severe he collapsed before he could negotiate the final 15 feet to his bed.
他能够进入那座分层住宅并爬上一小段楼梯，但攻击变得如此严重，以至于他在走完最后 15 英尺到床边之前就倒下了。

I tried to relieve his pain as he lay there and moved him to the hospital by ambulance as soon as possible. In spite of several doses of morphine administered subcutaneously and intravenous dilators, he remained in pain for nearly 24 hours. Vitamin E (alpha tocopherol), 1,600 units daily, was started immediately with the full dosage given the evening of admission. Experience has shown that when treatment is started immediately after the attack, the recovery is more rapid and more complete and the electrocardiogram returns to or toward normal more rapidly than when it is begun later. There is, therefore, no time to waste.
我试图缓解他躺在那里时的疼痛，并尽快用救护车将他送往医院。尽管给予了几次皮下注射和静脉扩血管剂的吗啡，他仍然疼痛持续了近 24 小时。立即开始服用维生素 E（α-生育酚），每日 1600 单位，入院当晚即给予全剂量。经验表明，当治疗在发作后立即开始时，恢复更快且更完全，心电图恢复到正常或接近正常的速度也比晚开始治疗时更快。因此，时间不容浪费。

This man’s electrocardiogram showed the usual changes of an anterior myocardial infarction involving all precordial
这名男子的心电图显示出涉及所有前胸导联的前壁心肌梗死的典型变化
leads and, therefore, presumably due to a thrombus in a major branch of the left anterior descending coronary or the artery itself.
导联，因此，推测是由于左前降支冠状动脉的一个主要分支或该动脉本身的血栓所致。

I am reporting this case in some detail for two reasons. The first is to point out the incompleteness and the consequent inadequacy of any advice on how to prevent heart attacks, no matter how well-intentioned or how professional, that does not include vitamin E . When he was well on the road to recovery, this patient and neighbor, while recuperating in the hospital, watching television, reading newspapers and paperback novels, one day expressed himself vehemently to me on the subject of the “clean life.” This was one patient who had not neglected himself, at least not deliberately. He had for years carefully watched his weight and diet, retaining a trim figure free of any hint of obesity. He had made it a point to exercise daily. Regardless of the weather, which can get prohibitively severe in Ontario, he had taken a two- to three-mile walk every night. Even more remarkable, this man had never smoked, did not drink alcohol, and made it a point to go to bed early and sleep eight hours every night. Even when he went to business conventions, he never stayed at the convention hotel but always got separate accommodations so that he could avoid involvement in the late hours and carousing typical of such meetings. And the net result, he told me bitterly, was that he had a heart attack anyway. I explained to my patient that while I cannot dispute the strong opinions of many important cardiologists that such a regimen has good preventive value, none of these measures can prevent thrombosis if the bloodstream is deficient in the antithrombin content that should naturally be there. As soon as his antithrombin level dropped below the critical level, I told him, a coronary thrombosis was imminent no matter how sensibly he lived. And that, I explained, was why I was treating him with alpha tocopherol, which is the chief and, perhaps, the only natural antithrombin in the human body as Zierler et al (10) have pointed out.
我详细报告这个病例有两个原因。首先是为了指出任何关于如何预防心脏病发作的建议，无论多么善意或专业，如果不包括维生素 E，都是不完整且不足的。当这位患者兼邻居在医院康复期间，观看电视、阅读报纸和平装小说时，有一天他激烈地向我表达了对“清洁生活”这一话题的看法。这位患者至少没有故意忽视自己。他多年来一直仔细控制体重和饮食，保持苗条的身材，没有任何肥胖的迹象。他坚持每天锻炼。无论天气如何严酷——安大略的天气有时极为恶劣——他每晚都会步行两到三英里。更值得注意的是，这个人从未吸烟，不喝酒，并且坚持早睡，每晚睡足八小时。 即使他去参加商业会议，他也从不住在会议酒店，而总是另找住处，以避免卷入那些会议上典型的深夜狂欢。结果，他痛苦地告诉我，他还是心脏病发作了。我向我的病人解释，虽然我不能否认许多重要心脏病专家坚信这种生活方式具有良好的预防价值，但如果血液中缺乏本应自然存在的抗凝血酶含量，这些措施都无法预防血栓形成。我告诉他，一旦他的抗凝血酶水平降到临界值以下，无论他生活多么合理，冠状动脉血栓形成都是不可避免的。我还解释说，这就是我用α-生育酚治疗他的原因，正如 Zierler 等人（10）指出的那样，α-生育酚是人体内主要且可能是唯一的天然抗凝血酶。

My second reason for describing this particular case history is another conversation I had with this patient during
我描述这个具体病例的第二个原因是我与这位患者进行的另一段对话
the three weeks he was in hospital. He asked me how often I heard good things about myself in the hospital and told me that, during his time there, three nurses on his floor, none of them on his case, had come to tell him that he was lucky to have me for his doctor. Each of them said to him that my treatment was totally different from what any other doctors in the hospital used - but that my patients live!
他在医院的三周时间里。他问我在医院里多久听到别人对我有好评，并告诉我，在他住院期间，他所在楼层的三位护士，虽然都不是负责他的，都来告诉他，他很幸运有我做他的医生。她们每个人都对他说，我的治疗方法与医院里其他医生使用的完全不同——但我的病人都活了下来！

There can be no question about the superb antithrombin activity of alpha tocopherol or that an antithrombin, without side effects and particularly that will not induce hemorrhaging, is of importance beyond measure in the treatment of coronary occlusion. As accepted an authority and as respected a surgeon as Alton Ochsner, M.D., has demonstrated that neither roughening nor damage of the lining of a blood vessel is necessary for the formation of a thrombus, as occurs in the veins of the leg after surgery or childbirth. Ochsner also has found through a long career as a surgeon that alpha tocopherol is the best prophylaxis, as well as treatment, for this condition. Twenty full years ago, in 1949, Ochsner reported the ability of alpha tocopherol to dissolve and harmlessly remove freshly formed thrombi in the large veins of the legs. In 1964 (July 23) he reported in the New England Journal of Medicine that he had been using alpha tocopherol routinely to prevent venous thrombosis; and four years later in 1968 he reported again that, because of this routine prophylaxis, he had no trouble with pulmonary emboli, the breaking loose in the veins of clots which are then carried through the heart and into the vessels of the lungs.
毫无疑问，α-生育酚具有卓越的抗凝血酶活性，而一种无副作用、尤其是不引起出血的抗凝血酶，在冠状动脉闭塞的治疗中具有无可估量的重要性。作为公认的权威和备受尊敬的外科医生，Alton Ochsner 博士已经证明，血管内膜的粗糙或损伤并非形成血栓的必要条件，这种情况常见于手术或分娩后腿部静脉。Ochsner 在其漫长的外科生涯中还发现，α-生育酚是预防和治疗这种情况的最佳方法。早在二十年前的 1949 年，Ochsner 就报告了α-生育酚能够溶解并安全清除腿部大静脉中新形成的血栓的能力。 1964 年（7 月 23 日），他在《新英格兰医学杂志》上报告说，他一直常规使用α-生育酚来预防静脉血栓；四年后的 1968 年，他再次报告说，由于这种常规预防措施，他没有出现肺栓塞的问题，即静脉中的血块脱落后通过心脏进入肺部血管。

It may well be asked, if both the antithrombin properties and lack of danger of alpha tocopherol are well known and established, why is it not more widely used?
如果α-生育酚的抗凝血酶特性和无危险性都已广为人知并得到确认，那么为什么它没有被更广泛地使用呢？

One answer to that question is an unreasonably prolonged natural lag which seems to occur in medical practice between the announcement of important discoveries and their general adoption. A typical example is the enormously important discovery by Dr. Samuel Levine (12), of Boston, that he could greatly increase the recovery rate among his
对这个问题的一个回答是，在医学实践中，重要发现的公布与其被广泛采用之间似乎存在一个不合理地长的自然滞后期。一个典型的例子是波士顿的 Samuel Levine 博士（12）发现的极其重要的事实，即他能够大大提高患者的康复率。
heart attack patients by abandoning the concept of bed rest and preferentially, as soon as possible, getting his patients out of bed and seating them upright in a chair. It is a simple enough change in treatment. Dr. Levine is recognized as a leader among cardiologists. Yet 16 years after he had reported his improved technique, I was still the only doctor in Toronto to employ it. Small wonder that the nurses, at least, have noticed that my methods are different from those of my immediate colleagues.
心脏病发作患者不再采用卧床休息的概念，而是尽早让患者起床，坐在椅子上。这是一个相当简单的治疗改变。Levine 医生被公认为心脏病学领域的领导者。然而，在他报告改进技术 16 年后，我仍然是多伦多唯一采用该方法的医生。难怪护士们至少注意到我的方法与我身边的同事不同。

In the case of the particular patient I have described, as soon as he was out of pain, 24 hours after his admission to the hospital, he was placed in a comfortable armchair with a comfortable seat which did not put undue pressure across the backs of his legs at the front of the seat, a precaution that should be carefully observed. Like all other patients so treated, he was left there until he complained of fatigue, all day if possible. He was allowed to go to the bathroom from the second day of hospitalization.
对于我所描述的这位特定患者，在他入院 24 小时后一旦不再疼痛，就被安置在一把舒适的扶手椅上，椅子座位舒适，不会在座位前部对他腿背部施加过大压力，这是一项应当仔细遵守的预防措施。像所有接受此类治疗的患者一样，他被留在那里，直到他感到疲劳，尽可能整天如此。从住院第二天起，他被允许去洗手间。

With this treatment, patients do not feel ill, do not lose strength, and are saved a great deal of mental anguish and depression. They are not aware that you may still be fighting for their lives, and even this psychic advantage can be a great one. This particular patient was discharged from hospital in three weeks. During the next three weeks at home he gradually resumed normal activities, worked at some paper work from his office, and eight weeks after his occlusion was able to return to work.
通过这种治疗，患者不会感到不适，不会失去体力，并且避免了大量的精神痛苦和抑郁。他们并不知道你可能仍在为他们的生命而战，这种心理优势甚至可能非常重要。这位患者在三周后出院。在接下来的三周里，他在家中逐渐恢复正常活动，处理了一些办公室的文书工作，闭塞发生八周后能够重返工作岗位。

There is an interesting postscript to this case. This man is a highly placed executive in one of the largest tire manufacturing companies. The company has just been sold a package deal by an enterprising medical group and has arranged for a complete check-up of all its senior executives. This patient, 16 months after his acute coronary occlusion, has just had exhaustive tests of every kind, a multitude of X-rays, intravenous dyes and, finally, a most thorough heart check-up. His resting electrocardiogram and his several electrocardiograms taken after the Master Step Test are all completely normal. He was the only one of that company’s executives able to do the complete test!
这个案例还有一个有趣的补充。这名男子是某大型轮胎制造公司的一位高层主管。该公司刚刚被一个有进取心的医疗团队以套餐形式出售服务，并安排对所有高级管理人员进行全面体检。这位患者在急性冠状动脉阻塞 16 个月后，刚刚接受了各种详尽的检查，包括大量 X 光、静脉注射造影剂，最后进行了非常彻底的心脏检查。他的静息心电图以及多次在 Master Step Test 后进行的心电图均完全正常。他是该公司所有高管中唯一能够完成全部测试的人！

I have now initiated this treatment in three hospitals. In each of them, at first, there was extreme apprehension and alarm among the nursing staff and a great reluctance to carry out my instructions. It was only by invoking the great name and reputation of Dr. Samuel Levine that I was able to get the nurses to cooperate. Yet the improvement is so much faster and so marked that each time, on about the fifth to tenth day of treatment, one or more graduate nurses has suggested that the patient couldn’t possibly have had a heart attack or he would not be so well so fast. Since so treating the first two or three patients in each hospital, I have had the most complete cooperation from the nurses.
我现在已经在三家医院开始了这种治疗。在每家医院，起初护理人员都极度担忧和惊慌，非常不愿意执行我的指示。只有借助 Dr. Samuel Levine 这个伟大名字和声誉，我才能让护士们配合。然而，病情的改善速度如此之快且明显，以至于每次在治疗的第五到第十天左右，一位或多位毕业护士都会提出，患者不可能真的心脏病发作过，否则不会恢复得这么快。自从在每家医院治疗了最初的两三名患者后，我得到了护士们最完全的配合。

In a practice of cardiology that has probably been the most extensive in the Western Hemisphere, I have become completely convinced that the combination of Levine’s armchair treatment and the earliest possible initiation of alpha tocopherol therapy make up a regimen that salvages more patients than any other currently available treatment by far while greatly reducing the extent of damage to the heart.
在西半球可能最广泛的心脏病学实践中，我已经完全确信，Levine 的椅子治疗法与尽早开始的α-生育酚疗法相结合，构成了一种方案，远远比目前任何其他治疗方法挽救更多患者，同时大大减少了心脏的损伤程度。

It is probably well to make it clear at this point that during the past 22 years the author has been called on to treat or supervise the treatment of more than 30,000 cardiovascular patients and may be presumed at this point, to have acquired some knowledge that is more than theoretical. These patients have come from every state in the U.S., every province of Canada, England, Ireland, Australia, New Zealand, Switzerland, India, and the Isle of Capri. They have all received conventional treatment for their cardiac conditions and obviously have all had residual symptoms and reason to fear another attack, or they would not have made their long journeys to Ontario to seek a better treatment. Many of these patients have themselves been physicians. In most cases they have been physicians who have recognized the logic of alpha tocopherol treatment yet have lacked the courage to administer this reasonable therapy to their own patients because of what they consider rightly or wrongly an oppressive and censorial professional climate in which they practice.
此时有必要明确指出，在过去的 22 年里，作者曾被要求治疗或监督治疗超过 30,000 名心血管患者，可以推测他已经获得了超出理论的某些知识。这些患者来自美国的每个州、加拿大的每个省、英格兰、爱尔兰、澳大利亚、新西兰、瑞士、印度以及卡普里岛。他们都接受了常规的心脏病治疗，显然都存在残留症状并担心再次发作，否则他们不会长途跋涉来到安大略寻求更好的治疗。其中许多患者本身就是医生。在大多数情况下，这些医生认识到α-生育酚治疗的逻辑，但由于他们所处的职业环境被认为是压抑和审查的，无论这种看法是对是错，他们都缺乏勇气将这种合理的疗法应用于自己的患者。

Such doctors have been pleased and, in some cases,
这样的医生感到满意，在某些情况下，
amazed at the effectiveness of the basically simple treatment they have received. Thus the reader should be aware that, whether it is generally admitted or not, alpha tocopherol therapy is not merely the province of a small group of physicians working in isolation in a Canadian province, but has been put to the test under the most severe and practical conditions by thousands of physicians and has been found highly effective.
对他们所接受的基本简单治疗的有效性感到惊讶。因此，读者应当意识到，无论是否被普遍承认，α-生育酚疗法不仅仅是加拿大某省一小部分孤立工作的医生的专利，而是在最严苛和实际的条件下由成千上万的医生进行了测试，并被发现非常有效。

Since so many of my patients come from distant places and must clearly be able to travel before coming to me, it is apparent that most of them who have had coronary occlusions are seen weeks or months after treatment elsewhere. Not having been seen in the acute stage, they cannot be said to represent a cross-section of coronary cases. They are nevertheless a better than usual sampling in that they have all been first diagnosed and treated as coronaries by other perfectly competent doctors, usually unknown to me, and then have been diagnostically confirmed by me. The possibility of diagnostic error is thus reduced virtually to zero.
由于我的许多病人来自远方，且显然必须能够旅行才能来找我，因此大多数曾经发生冠状动脉闭塞的病人都是在其他地方治疗数周或数月后才被我看到的。由于未在急性期被诊治，不能说他们代表了冠状动脉病例的一个横截面。然而，他们仍然是一个比平常更好的样本，因为他们都曾被其他完全有能力的医生首次诊断和治疗为冠心病患者，这些医生通常我并不认识，随后又由我进行了诊断确认。因此，诊断错误的可能性几乎降为零。

In some of the patients there is evidence of congestive failure or peripheral edema. Some are frankly in the last stages of circulatory failure. Most of them present simply the usual symptoms of angina pectoris (severe chest pain occurring in sudden, acute attacks because of insufficient blood supply to the heart) or dsypnea (difficulty in breathing) or both, brought on episodically by exertion or excitement. No patient, no matter how difficult or hopeless the case may seem, is ever refused treatment. Substantial and worthwhile relief is obtained by 80 to 85 percent of them.
在一些患者中，有充血性心力衰竭或周围水肿的迹象。有些患者明显处于循环衰竭的晚期阶段。他们中的大多数仅表现出心绞痛（因心脏供血不足而突然急性发作的剧烈胸痛）或呼吸困难（呼吸困难）或两者的常见症状，这些症状由劳累或兴奋引发。无论病例多么困难或无望，患者从不被拒绝治疗。80%到 85%的患者获得了实质性且有价值的缓解。

Coronary occlusion is a general term describing various forms of disease involving the coronary artery which lead to complete blockage of the arterial passage - in effect, obliteration of the lumen. The commonest form of occlusion by far is the formation of a thrombus-a clot-in the artery itself. On occasion, a calcified plaque that has formed in the arterial wall will tear loose at its upper edge and block off the passage of blood, completely obliterating the lumen. It is also presumably possible for a small clot, or a portion
冠状动脉闭塞是一个总称，描述涉及冠状动脉的各种疾病形式，这些疾病导致动脉通道完全阻塞——实际上是腔道的消失。最常见的闭塞形式是动脉内形成血栓——即血块。有时，动脉壁中形成的钙化斑块会在其上缘撕裂并阻塞血液通道，完全堵塞腔道。理论上，小血块或一部分也可能导致堵塞。
broken off from the larger thrombus in the left ventricle of the heart, to find its way into the coronary artery at its point of origin just behind the cusps of the aortic valve and, upon being carried into a small branch of the artery, close it off. Finally atheromatous plaques - the formations on arterial walls that constitute the disease entity known as atherosclerosis - may be so large and situated in such a way that; by their developing growth, they reach a point in which the lumen is completely closed off.
从心脏左心室较大的血栓中脱落，进入冠状动脉起始点，正好位于主动脉瓣瓣叶后方，并被带入动脉的一条小分支，堵塞该分支。最后，动脉粥样硬化斑块——构成动脉粥样硬化这一疾病实体的动脉壁上的形成物——可能体积庞大且位置特殊，随着其不断生长，达到完全封闭血管腔的程度。

Whichever the cause, the sudden occlusion is usually though not always - a catastrophe. By the total closing off of a coronary artery or even a branch of a coronary artery, an area of heart muscle is completely deprived of blood and thus receives no oxygen. The tissue that is so affected dies. The area of myocardium that dies in this way for lack of oxygen is called a myocardial infarct, just as the condition is known as a myocardial infarction.
无论原因如何，突然的闭塞通常——但并非总是——是一场灾难。由于冠状动脉或冠状动脉分支的完全闭塞，心肌的某个区域完全失去血液供应，因此无法获得氧气。受影响的组织会死亡。因缺氧而死亡的心肌区域称为心肌梗死，这种情况被称为心肌梗塞。

The heart and brain are the two organs susceptible to this type of sudden disaster. Except in the heart and brain, there are extensive networks of communicating vessels joining larger vessels to still larger vessels, very much the way a tree branches with each branch putting out its own network of still smaller branches. Thus in the area of most organs, even large blood vessels can be completely tied off, without serious jeopardy to the life of the tissues that are mainly supplied by the large vessels, if the other smaller vessels in the area are relatively normal.
心脏和大脑是两种容易发生这种突发灾难的器官。除了心脏和大脑外，其他器官区域都有广泛的血管网络，将较大的血管连接到更大的血管，就像树枝一样，每个枝条又分出自己的更小的枝条网络。因此，在大多数器官区域，即使较大的血管完全被绑闭，如果该区域的其他较小血管相对正常，主要由这些大血管供血的组织生命也不会受到严重威胁。

In the heart and brain, however, the collateral circulation is relatively poor. As a result, the blocking off of a large coronary artery or large branch will always lead to complete deprivation of blood supply to some area of heart muscle. Whether the result is complete or only partial disaster depends very much on the location of the thrombus and how large an area of the myocardium is affected by it. Of great importance also is the integrity of the heart muscle elsewhere in the heart, and this depends on how adequate the coronary blood flow to the balance of the heart is at the moment of occlusion. Obviously, there are many factors involved.
然而，在心脏和大脑中，侧支循环相对较差。因此，大冠状动脉或其大分支的阻塞总会导致某一部分心肌完全失去血液供应。结果是完全还是部分灾难，很大程度上取决于血栓的位置以及受影响的心肌区域大小。心脏其他部位心肌的完整性也非常重要，这取决于阻塞时冠状动脉对心脏其余部分的血流供应是否充足。显然，涉及的因素很多。

If the insult to the heart is severe, the patient will die instantly as he walks or sits or sleeps. If it is less severe, he may survive to leave the hospital with a degree of damage varying widely in different cases.
如果对心脏的损伤很严重，患者会在行走、坐着或睡觉时立即死亡。如果损伤较轻，他可能存活下来出院，但不同病例中的损伤程度差异很大。

The chief symptom of a sudden coronary occlusion, of course, is severe chest pain-usually in the center of the chest anteriorly - and this may be very severe indeed, feeling like a ton weight or often described as if a tight band encircled the chest. However, frank myocardial infarction can occur without involving the chest pain.
突发冠状动脉闭塞的主要症状当然是剧烈的胸痛——通常位于胸部前方中央——这种疼痛可能非常剧烈，感觉像一吨重物压着，或常被描述为一条紧绷的带子环绕胸部。然而，明显的心肌梗死也可能发生而不伴有胸痛。
“Estimates of the incidence of painless myocardial infarction have varied from 0 to 61 per cent depending upon the author,” the Framingham group reported. Twenty-one per cent were considered to be completely free from pain. A man may well die of an acute coronary occlusion without any chest pain.
“无痛性心肌梗死的发生率估计因作者不同而从 0%到 61%不等，”弗雷明翰小组报告说。21%被认为完全没有疼痛。一个人完全可能在没有任何胸痛的情况下死于急性冠状动脉闭塞。

Often the difference between life and death lies in the amount of collateral circulation to the heart that has been developed. It is only through exercise that the heart gains such an auxiliary blood and oxygen supply.
生命与死亡的区别往往取决于心脏已发展出的侧支循环的数量。只有通过锻炼，心脏才能获得这种辅助的血液和氧气供应。

In the 1930’s, stress and strain or physical exertion were thought to be causal in the occurrence of this relatively rare disease of old men, and treatment consisted solely of morphine to allay apprehension and as nearly absolute as possible rest in bed for six weeks or longer. All this has been changed recently, since exertion and excitement have been shown to be unrelated except in a casual way to the onset of this condition. It has been shown that the man who remains physically active has a diminished chance of developing a coronary occlusion, that when he does it is likely to be less severe, and that resumption of physical activity following recovery from the acute phase is probably desirable.
在 1930 年代，压力和紧张或体力劳动被认为是这种相对罕见的老年男性疾病发生的原因，治疗仅限于使用吗啡以缓解焦虑，并尽可能绝对卧床休息六周或更长时间。最近这一切都发生了变化，因为已经证明体力劳动和兴奋与该病的发作除了偶然关系外无关。研究表明，保持身体活跃的人发生冠状动脉阻塞的几率较低，且一旦发生，病情可能较轻，急性期恢复后恢复体力活动可能是有益的。

However, it remained for Samuel Levine, who along with Paul Dudley White was one of the first two physicians in the U.S. to specialize in cardiology, to demonstrate conclusively that bed rest was undesirable. In 1952 he published a paper (12) in the Journal of the American Medical Association with the unscientific title “The Myth of Bed Rest in the Treatment of Coronary Thrombosis.” He described
然而，正是塞缪尔·莱文（Samuel Levine）——他与保罗·达德利·怀特（Paul Dudley White）一起，是美国最早专攻心脏病学的两位医生之一——最终明确证明了卧床休息是不利的。1952 年，他在《美国医学会杂志》上发表了一篇论文（12），题为《冠状动脉血栓治疗中卧床休息的迷思》，这一标题缺乏科学依据。他在文中描述道
the treatment of acute cases by hospitalization in an arm chair for three weeks - the treatment to begin as soon as the initial chest pain was relieved. By this simple method, he was able to demonstrate the reduction of the initial death rate to 9.9 per cent instead of the expected 40 to 60 per cent. In other words, four out of five who would have died with intensive care and absolute bed rest lived in the arm-chair treatment.
急性病例的治疗是在扶手椅上住院三周——治疗应在最初胸痛缓解后立即开始。通过这种简单的方法，他能够证明初始死亡率降低到 9.9%，而不是预期的 40%到 60%。换句话说，五个中有四个在接受强化护理和绝对卧床休息时会死亡的人，在扶手椅治疗中存活下来。

It has been made apparent in the previous chapter that there is also some chance of reducing the amount of damage to the heart muscle by dissolution of the clot itself, restoring circulation to the necrotic area, and by preventing any extension or recurrence. Obviously, the sooner this patient starts to take and absorb alpha tocopherol, the better. In the original paper by Dr. Alton Ochsner, on alpha tocopherol as an antithrombin, he stated that in the prevention of clots in the veins of the legs, a dosage of 600 units of alpha tocopherol was effective. This is probably an adequate dosage for most patients. However, some need more, and since there is no laboratory test as yet to determine each patient’s exact requirements, we take no chances but start the patient immediately on 1,600 international units a day. Except in special circumstances to be described later, there is no danger-not even any discomfort-in surplus dosage. The only danger lies in using too little.
在前一章中已经明确指出，通过溶解血栓本身、恢复坏死区域的循环以及防止任何扩展或复发，有可能减少对心肌的损伤。显然，患者越早开始摄取和吸收α-生育酚（alpha tocopherol），效果越好。在 Alton Ochsner 博士关于α-生育酚作为抗血栓剂的原始论文中，他指出在预防腿部静脉血栓时，600 单位的α-生育酚剂量是有效的。这对于大多数患者来说可能是足够的剂量。然而，有些患者需要更多，由于目前尚无实验室检测能确定每位患者的确切需求，我们不冒险，立即让患者每天服用 1600 国际单位。除非后文将描述的特殊情况外，过量服用没有危险，甚至不会引起任何不适。唯一的危险是剂量过少。

We treat the initial shock and pain by sufficient morphine and by intravenous, inhalation and oral vasodilators for the quickest possible restoration of circulation. The patient sits up as soon as possible, that point being marked by the cessation of severe pain.
我们通过足量的吗啡以及静脉注射、吸入和口服血管扩张剂来治疗最初的休克和疼痛，以尽快恢复血液循环。患者应尽早坐起，坐起的时间点以剧烈疼痛停止为标志。

Alpha tocopherol is the keystone of the treatment. During the early explorations of its unique value, the first three cardiac patients we treated were in frank failure, all three seriously ill. When alpha tocopherol and alpha tocopherol
α-生育酚是治疗的基石。在早期探索其独特价值的过程中，我们治疗的前三位心脏病患者均处于明显衰竭状态，三人均病情严重。当使用α-生育酚和α-生育酚时
alone was added to their treatment, all three experienced a marked diuresis, all three lost all or nearly all of their failure, and all three returned to normal activity.
仅添加这一项治疗，三人均出现明显利尿，三人全部或几乎全部消除了衰竭，三人均恢复正常活动。

Many thousands of patients later, nearly all my cardiac patients are routinely started on 800 I.U. of alpha tocopherol a day and raised by 200 to 400 I.U. a day at six-week intervals if necessary.
经过数千名患者的实践，几乎我所有的心脏病患者都常规开始每天服用 800 国际单位的α-生育酚，并在必要时每六周增加 200 到 400 国际单位。

Patients will usually show no effects of treatment for the first five to ten days. Most of them, however, will be free of symptoms of angina pectoris or dyspnea in four to six weeks of treatment. Since alpha tocopherol is apparently an “all or none” substance, the patient either responds in four to six weeks, or he doesn’t. If he doesn’t the dosage level is raised for the next six weeks, or at six-week intervals until he either responds or is obviously not going to respond. There will be no doubt in the mind of patient or physician in either case, since the effect of the drug is so obvious.
患者通常在治疗的最初五到十天内不会表现出任何效果。然而，大多数患者在四到六周的治疗后将不再出现心绞痛或呼吸困难的症状。由于α-生育酚显然是一种“全有或全无”的物质，患者要么在四到六周内有反应，要么没有反应。如果没有反应，剂量将在接下来的六周内或每六周间隔增加，直到患者有反应或明显不会有反应。无论哪种情况，患者和医生心中都不会有疑问，因为药物的效果非常明显。

Since there is no toxicity with alpha tocopherol treatment, in the typical cardiac case the only problem is to use enough. It is a peculiarity of this and many drugs that half a dose does not accomplish half a result.
由于α-生育酚治疗没有毒性，在典型的心脏病例中，唯一的问题是使用足够的剂量。这种药物及许多其他药物的一个特点是，半剂量并不会产生一半的效果。

However, although alpha tocopherol is the basic treatment, we now make use of all other available useful drugs to hasten in all possible ways the recovery of patients and to obtain as complete a result as possible. We use diuretics freely as needed, as long as they are needed, hoping that after six to eight weeks they will no longer be necessary. We control the apical rate in auricular fibrillation with digitalis, remembering that diuretics on the one hand and alpha tocopherol on the other potentiate the action of digitalis preparations. We use very little digitalis in the absence of auricular fibrillation-usually none.
然而，尽管α-生育酚是基本治疗方法，我们现在利用所有其他可用的有效药物，以尽可能多的方式加速患者的康复，并尽可能获得完整的治疗效果。我们根据需要自由使用利尿剂，只要需要就用，希望六到八周后不再需要。我们用地高辛控制心房颤动时的心尖率，记住利尿剂一方面和α-生育酚另一方面都会增强地高辛制剂的作用。在没有心房颤动的情况下，我们几乎不使用地高辛——通常不使用。

A word is needed about hypertension in its relation to coronary occlusion. There are five factors, chiefly, maintaining blood pressure: the volume of the blood, its viscosity, the beating action of the heart, the elasticity of the vessel wall, - and the peripheral resistance. Many of the cardiac patients seen have or have had an elevation of blood pressure. Alpha tocopherol in a large dose increases the tone of heart muscle
需要谈一下高血压与冠状动脉闭塞的关系。维持血压主要有五个因素：血液容量、血液粘度、心脏的搏动作用、血管壁的弹性以及外周阻力。许多心脏病患者现在或曾经都有血压升高的情况。大剂量的α-生育酚可以增强心肌的张力。
and so tends to increase the blood pressure in those who have had or still do have hypertension. On the other hand, small doses of alpha tocopherol have been shown to decrease the peripheral resistance and so to lower blood pressure. Therefore, in such cases we are careful to control the blood pressure with the modern antihypertensive drugs and usually begin treatment of such patients with a lower dosage level of tocopherol.
因此，它倾向于增加那些曾经或仍然患有高血压者的血压。另一方面，少量的α-生育酚已被证明可以降低外周阻力，从而降低血压。因此，在这种情况下，我们会小心使用现代降压药控制血压，通常从较低剂量的生育酚开始治疗此类患者。

This precaution is not necessary in the acute case, since blood pressure falls with the occlusion and the tendency of alpha tocopherol to raise it is a beneficial effect.
在急性情况下不需要采取此预防措施，因为血压在阻塞时会下降，而α-生育酚使血压升高的倾向是一种有益的效果。

In treating the hypertensive patient, if the pressure begins to rise, the drug should be stopped for a day or a day and a half and resumed at a lower level. All the effect of alpha tocopherol is lost in as little as three days, so one must never withdraw it for longer than one or two days once it has achieved the desired result.
在治疗高血压患者时，如果血压开始升高，应停药一天或一天半，然后以较低剂量恢复使用。α-生育酚的所有效果在短短三天内就会消失，因此一旦达到预期效果，绝不能停用超过一两天。

Fortunately if the patient does respond, his improvement will continue for months and even years, and his electrocardiogram will often show progressive slow improvement, probably due to the development of increased collateral circulation, for months or years.
幸运的是，如果患者有反应，他的改善将持续数月甚至数年，他的心电图通常会显示出逐渐缓慢的改善，这可能是由于侧支循环的增加发展所致，持续数月或数年。

There have been so many of these patients treated in the last 22 years. Results, of course, have been quite varied in individual cases. Many patients have survived many years after one or even more occlusions, and there are hundreds who have survived ten to 20 years, some even longer. This, of course, is one of the most gratifying experiences a doctor can have.
在过去的 22 年里，已经治疗了许多这样的患者。当然，个别病例的结果各不相同。许多患者在一次甚至多次血管堵塞后存活了多年，有数百人存活了十到二十年，甚至更长时间。当然，这对医生来说是最令人欣慰的经历之一。

Several cases will illustrate the extent of improvement that can be obtained. These are among those who have secured the maximum oxygen-sparing faculty of the drug.
几个案例将说明所能获得的改善程度。这些案例属于那些已经获得药物最大节氧能力的人群。

One man, aged 47, following his occlusion was unable to walk a block in the city without severe angina pectoris. After five weeks treatment he rejoined the 48 Highlanders and went on a route march. He was able to walk at a military pace up and down hills without pain.
一名 47 岁的男子在发生闭塞后，无法在城市中步行一个街区而不出现严重的心绞痛。经过五周的治疗后，他重新加入了 48 高地兵团，并进行了徒步行军。他能够以军用步伐上下山丘而无痛感。

Another, aged 56, was a farmer. He was completely incapacitated following a coronary occlusion, and a nephew
另一位，56 岁，是一名农民。冠状动脉阻塞后他完全丧失了行动能力，他的一个侄子
was looking after the farm. About five weeks after beginning treatment, he thought he could help the nephew a little around the barn so one morning harnessed up the team of horses and began to hitch them to a wagon. One of the team, a young horse, became frightened and, with the other one, bolted and began to run away. The patient dug his heels into the ground, see-sawed the reins, and pulled the team to a halt just as they reached the gate. Then he realized what he had done!
正在照看农场。开始治疗大约五周后，他觉得自己可以帮侄子在谷仓周围做点事，于是一天早上给马匹套上缰绳，开始把它们拴到一辆马车上。其中一匹年轻的马受惊了，和另一匹马一起惊跑了起来。病人用脚后跟踩地，来回拉扯缰绳，终于在马匹快到大门口时把它们拉停了。然后他意识到自己做了什么！

At this writing a 61 -year-old man and his wife are on a trip around the world.
在撰写本文时，一位 61 岁的男子和他的妻子正在环游世界。

Twenty years ago this man had a coronary occlusion and apparently was dead on arrival at the hospital. He was brought there by ambulance, given oxygen from the moment the ambulance reached the home. One of the ambulance attendants wanted to practice the use of the oxygen equipment and, since the tank was nearly empty anyway, continued to administer oxygen. The patient began to breathe and survived the attack. A year later he had a second occlusion, was very seriously ill, but refused to go to a hospital. He survived this attack also, but was left a cardiac cripple. A very restless, always active man, he chafed under enforced idleness and came to The Shute Institute for help. This man’s recovery is unbelievable in that he not only lives a normal life but delights in building complicated summer cottage structures, stairways over huge rocks, sea-walls of stone and cement, fountains, etc. He has been carrying two pails of cement at a time, all day long, all this past summer, up slopes and stairs to reach places inaccessible by wheelbarrow. He runs a machine shop, operates a small bulldozer, and has no angina pectoris or dyspnea at all.
二十年前，这名男子发生了冠状动脉阻塞，抵达医院时显然已经死亡。救护车将他送到医院，从救护车到达家中那一刻起就开始供氧。救护车上的一名工作人员想练习使用氧气设备，既然氧气罐几乎空了，就继续给他供氧。患者开始呼吸，成功度过了这次发作。一年后，他又发生了第二次阻塞，病情非常严重，但拒绝去医院。他也挺过了这次发作，但成了心脏残疾者。这是一个非常好动、总是忙碌的人，他无法忍受被迫的闲置生活，来到 Shute 研究所寻求帮助。这名男子的康复令人难以置信，他不仅过着正常的生活，还乐于建造复杂的夏季别墅结构、巨石上的楼梯、石头和水泥的海堤、喷泉等。整个夏天，他一直背着两桶水泥，上坡和爬楼梯，去那些手推车无法到达的地方。他经营着一家机械车间，操作一台小型推土机，完全没有心绞痛或呼吸困难的症状。

Of course, these are exceptional cases, though there are many like them. Some patients do not seem to obtain any worthwhile benefits, although in such cases we still recommend continuation of treatment for protection against the recurrence of attack-something of real importance to all such patients.
当然，这些是特殊情况，尽管有许多类似的病例。有些患者似乎没有获得任何显著的益处，尽管在这种情况下，我们仍然建议继续治疗，以防止复发——这对所有此类患者来说都是非常重要的。

Here are more case histories: One 65-year-old man was first seen at his cabin overlooking Rabbit Bay in one of the
这里有更多的病例历史：一位 65 岁的男子首次在他俯瞰兔湾的小屋中被看到，地点位于其中一个
most beautiful lakes of the Canadian North. He had been brought there so he might look out over his favorite section of the North woods as he died. He was sitting up in bed gasping for breath in the last stages of congestive failure, with an abdomen enormously distended with huge liver and what must have been nearly maximum ascites (effusion of serous fluid). His legs were as big as tree trunks.
加拿大北部最美丽的湖泊。他被带到那里，是为了在临终时能眺望他最喜欢的北方森林区域。他坐在床上，喘着气，处于充血性心力衰竭的最后阶段，腹部极度膨胀，肝脏巨大，腹水（浆液性积液）几乎达到最大量。他的双腿像树干一样粗壮。

This man was one of the original settlers in the area, had trapped and sold furs, had lumbered his land, and had been a good neighbor. He was a gregarious and generous Irishman, much beloved by many friends. One of these, a lumber baron and patient of mine, had sought me out at a holiday camp and insisted I see the patient.
这个人是该地区的最初定居者之一，曾经捕猎并出售皮毛，开采过自己的土地，并且是个好邻居。他是一个爱社交且慷慨的爱尔兰人，深受许多朋友的喜爱。其中一位是木材大亨，也是我的病人，他在一个假日营地找到我，坚持让我去看望这位病人。

He had had two coronary occlusions and after the second one gradually developed congestive failure and was hospitalized in the nearest Northern hospital. Because his condition worsened, he was sent to a large university hospital in Toronto where he spent several weeks. He was returned to the Northern hospital still in congestive failure, and finally his doctor, who knew him well and had cared for his large family for years, suggested that he be taken carefully to his cottage on this beautiful lake with the large picture window overlooking the bay-where $I$$I$II, at the end of a holiday, was brought to him.
他曾两次冠状动脉闭塞，第二次后逐渐发展为充血性心力衰竭，并被送往最近的 Northern 医院住院。由于病情恶化，他被送往多伦多的一所大型大学医院，在那里住了几周。后来他被送回 Northern 医院，仍处于充血性心力衰竭状态，最终他的医生——一位了解他并多年来照顾他大家庭的医生——建议小心地将他带到他位于这个美丽湖泊边的小屋，那里有一扇大落地窗俯瞰海湾——假期结束时， $I$$I$II 被带到了他身边。

Obviously, he was much too ill to move, and I had only three more days left before having to return to my office. Also, I had purposely not brought the tools of my trade with me and had no blood pressure cuff or stethoscope with me. So I explained that the situation was hopeless, that he would need a lot of emergency care, with diuretics, punctures to drain off serum, etc., and that I could not remain to give care to him. His daughter told me she was the office nurse of the family doctor and that she and the rest of the family would do anything for their father. So against my better judgment, we drove 25 miles into town and obtained a blood pressure cuff and stethoscope from the doctor’s office, went to the hospital for mercurial diuretics, only to find they had none, then to the various drug stores, all of which but one were closed for the Thursday half-holiday.
显然，他病得太重，无法动弹，而我只剩三天时间就得回办公室了。此外，我故意没有带上我的工作工具，没有带血压计或听诊器。所以我解释说情况无望，他需要大量紧急护理，如利尿剂、穿刺放出血清等，我无法留下来照顾他。他的女儿告诉我，她是家庭医生的办公室护士，她和家人会为父亲做任何事。于是违背我的判断，我们驱车 25 英里进城，从医生办公室拿到了血压计和听诊器，去了医院想要水银利尿剂，却发现没有，然后去了几家药店，除了一个，其他都因周四半天假期而关门了。

My indefatigable lumber baron started to throw his weight around and bullied half the druggists to open up and search for the needed drugs. One had some vitamin E, but no diuretics. Finally, we located a doctor who had three vials samples - of a pre-World War I mercurial diuretic, and we returned to the cottage to begin treatment.
我那不知疲倦的伐木大王开始施展他的权势，逼迫一半的药剂师开门寻找所需的药物。有人有一些维生素 E，但没有利尿剂。最后，我们找到了一位医生，他有三瓶样品——一种第一次世界大战前的汞制利尿剂，我们便回到小屋开始治疗。

By shipping up supplies after I returned to practice and by almost daily telephone consultations with the daughter, this patient was successfully treated. Within two weeks, he was out of bed. That fall he cut a road into the bush and supervised cutting and logging operations. The following summer I visited him, and they had to call him in from the lake where he was canoeing. He insisted on paddling us around the bay and insisted on presenting us with our choice of lots from among his 2,000 feet of shoreline. Three years later he built us a cottage on that lot.
在我回到诊所后通过运送补给品，并几乎每天与患者的女儿电话咨询，这位患者得到了成功治疗。两周内，他就能下床了。那个秋天，他开辟了一条通往丛林的道路，并监督砍伐和伐木作业。第二年夏天我去看望他时，他们不得不从他划独木舟的湖上叫他回来。他坚持要划船带我们绕湾一圈，并坚持让我们从他拥有的 2000 英尺海岸线中选择地块。三年后，他在那块地上为我们建了一座小屋。

I hesitate to add this footnote, but it may interest my profession and highlight our interesting experiences of the early days of vitamin E. Although they attended the same church and frequently met on the steps, his own doctor refused to acknowledge his existence or to speak to him. He had dared to get better!
我犹豫是否添加这个脚注，但它可能会引起我的同行的兴趣，并突出我们在维生素 E 早期的有趣经历。尽管他们参加同一个教堂，经常在台阶上相遇，他自己的医生却拒绝承认他的存在，也不与他说话。他竟然敢好起来！

Female - aged 50 when first seen.
女性——初次就诊时 50 岁。
This highly educated, short, obese colored woman was first seen April 13, 1949.
这位受过高等教育、矮胖的有色人种女性于 1949 年 4 月 13 日首次就诊。

She had suffered an acute coronary occlusion with an anterior myocardial infarct in February of 1948. For the six months before the actual attack she had had considerable angina. She was kept in bed until June of 1948 - a period of four months - so severe was the attack.
她在 1948 年 2 月经历了一次急性冠状动脉闭塞，伴有前壁心肌梗死。在实际发作前的六个月里，她有相当严重的心绞痛。由于发作严重，她一直卧床休息直到 1948 年 6 月——长达四个月的时间。

When first seen she had angina and dyspnea on exertion, such as climbing stairs, but could slowly walk about six blocks in the city.
初次就诊时，她在运动时如爬楼梯时有心绞痛和呼吸困难，但能慢慢走大约六个街区。

On 600 units of alpha tocopherol she lost all angina and dyspnea and returned to her work as a teacher of languages in high school. She retired from teaching in June of 1958 when 68 years old.
服用 600 单位的α-生育酚后，她所有的心绞痛和呼吸困难都消失了，恢复了作为高中语言教师的工作。1958 年 6 月，她 68 岁时退休。

Now aged 79, she returns for her annual check-up again
现年 79 岁，她再次回来进行年度体检
this summer, some 21 and one-half years after her coronary occlusion.
今年夏天，大约在她冠状动脉闭塞发生 21 年半之后。

Male - aged 58, first seen July 6, 1951.
男性，58 岁，首次就诊于 1951 年 7 月 6 日。
This man had a coronary occlusion proven by electrocardiograms which showed a posterior infarction, January 10, 1951. He had always been very athletic but had had attacks of paroxysmal auricular fibrillation since he was very young. He was kept in hospital for two weeks and hadn’t been able to work since six months.
这名男子于 1951 年 1 月 10 日通过心电图确诊为冠状动脉阻塞，显示后壁梗死。他一直非常爱好运动，但从很年轻时起就有阵发性心房颤动发作。他在医院住了两周，且六个月来一直无法工作。

He was started on 800 units of alpha tocopherol a day, and by September 18, 1951 he was “swell” - had no symptoms and was back to work. He remained well until June, 1968 ( 17 years!) when one evening after dinner he went out to mow the lawn. He collapsed and was taken to the hospital with auricular fibrillation. With rest and oxygen, the attack soon passed over and normal rhythm was established again. Following his release, an electrocardiogram showed no further damage, and he has been perfectly well since. He is now 76 .
他开始每天服用 800 单位的α-生育酚，到 1951 年 9 月 18 日时，他“状况良好”——没有症状，已经恢复工作。他一直健康直到 1968 年 6 月（17 年！），那天晚饭后他出去割草，突然倒下，被送往医院，诊断为心房颤动。经过休息和吸氧，发作很快过去，心律恢复正常。出院后，心电图显示没有进一步损伤，此后他一直非常健康。他现在 76 岁。

Male - aged 40, first seen April 8, 1949.
男性，40 岁，首次就诊于 1949 年 4 月 8 日。
This man had a coronary occlusion in December, 1948, confirmed by several electrocardiograms. After recovery from the acute attack, he developed some angina on exertion.
这名男子于 1948 年 12 月发生冠状动脉闭塞，经过多次心电图确认。急性发作恢复后，他在运动时出现了一些心绞痛。

After his being on 600 units of alpha tocopherol, these symptoms disappeared completely in four weeks. This patient, a druggist, has been perfectly well since. He owns saddle-bred, three-gaited horses and trains, rides, and shows them in the ring. He survived a severe accident with broken ribs and internal hemorrhaging in 1967 and is still active with the horses - some 20 years after his coronary occlusion.
在服用 600 单位的α-生育酚后，这些症状在四周内完全消失。这位患者是一名药剂师，自那以后一直身体健康。他拥有马鞍赛马和三步马，训练、骑乘并在赛场上展示它们。1967 年他经历了一次严重的事故，肋骨骨折并内出血，但他依然活跃于马术活动——这距他冠状动脉阻塞已有约 20 年。

Male-aged 51, first seen October 24, 1957.
男性，51 岁，首次就诊于 1957 年 10 月 24 日。
This man was first seen after three coronary occlusions December, 1951, 1954 and October, 1956. He had angina and dyspnea and could only walk slowly three blocks. His blood pressure and pulse were normal.
此人首次就诊是在经历了三次冠状动脉闭塞后，分别于 1951 年 12 月、1954 年和 1956 年 10 月。他有心绞痛和呼吸困难，步行速度缓慢，仅能走三条街区。他的血压和脉搏正常。

This man had no further attacks in the 12 years since we
自那以后，这个人在 12 年内没有再发作过
first saw him. He very seldom has angina pectoris, has no dyspnea, lives normally, and enjoys it. He is now 63 years old.
第一次见到他时。他很少有心绞痛，没有呼吸困难，生活正常，并且享受生活。他现在 63 岁。

Female - aged 56, first seen September 18, 1954.
女性，56 岁，首次就诊于 1954 年 9 月 18 日。
This patient suffered a coronary occlusion in March, 1953, and her blood pressure at this time was 220 systolic. She was unable to work in her profession, that of a school teacher, until March, 1954.
这位患者于 1953 年 3 月发生冠状动脉闭塞，当时她的收缩压为 220。她直到 1954 年 3 月才能够恢复从事她的职业——学校教师的工作。

After two months on 800 units of alpha tocopherol, she was able to resume her teaching, which she continued until retirement. Now, aged 71, she lives normally, has a large vegetable garden, which she tends by herself, and walks daily to the post office and back, a distance of half a mile, without distress of any kind.
服用 800 单位的α-生育酚两个月后，她能够恢复教学工作，并一直坚持到退休。现在，她 71 岁，生活正常，有一个大菜园，由她自己打理，每天步行往返邮局，距离半英里，毫无任何不适。

Male - aged 45, April 3, 1950.
男性 - 45 岁，1950 年 4 月 3 日。
This man had a coronary occlusion in February of 1950. He was kept in bed three weeks and resting for four weeks. Apparently, some cardiologists even in 1950 were abbreviating the traditional “six weeks in bed” routine. Blood pressure and pulse rate were normal, and he was started immediately on 375 units of alpha tocopherol. Six weeks later he started back to work part time and then to full-time work as a sales executive. He was playing golf and living normally.
这名男子于 1950 年 2 月发生冠状动脉闭塞。他卧床三周，休息四周。显然，即使在 1950 年，一些心脏病专家也在缩短传统的“卧床六周”疗程。血压和脉搏正常，他立即开始服用 375 单位的α-生育酚。六周后，他开始兼职工作，随后全职担任销售主管。他打高尔夫球，生活正常。

In 1959 he began to have a noise in the ears with some diminution of hearing, and for this reason his intake of alpha tocopherol was raised to 800 units; and 50,000 units of vitamin A were added. He remained perfectly well, except for his ear problem, which an excellent otologist considered a circulatory problem. On 1,600 units of alpha tocopherol, 50,000 units of vitamin A, and the Arlidin prescribed for him by the aforementioned otologist, there has been no deterioration in his hearing in the last ten years, but also no improvement. He can carry on his business, but must listen carefully.
1959 年，他开始出现耳鸣和听力轻微下降，因此他的α-生育酚摄入量提高到 800 单位；并增加了 5 万单位的维生素 A。他除了耳朵问题外，身体一直非常健康，一位优秀的耳科医生认为这是循环系统问题。在服用 1600 单位的α-生育酚、5 万单位的维生素 A 以及上述耳科医生开具的 Arlidin 后，过去十年他的听力没有恶化，但也没有改善。他可以继续做生意，但必须仔细听。

He has curled (a Scottish and Canadian sport) every winter, sweeping in his turn, and plays golf regularly. He
他每年冬天都会打冰壶（一种苏格兰和加拿大的运动），轮流扫冰，并且定期打高尔夫球。他
is officially retired, but working harder than ever helping a former associate to run a new firm in the same business category.
正式退休了，但比以往任何时候都更努力地帮助一位前同事经营一家同类新公司。

Irish woman doctor - diabetic, hypertensive, coronary thrombosis.
爱尔兰女医生——糖尿病、高血压、冠状动脉血栓形成患者。

This woman, aged 55, cabled for an appointment from Ireland. Since her history illustrates the effect of alpha tocopherol on diabetes mellitus, angina pectoris, hypertension, and coronary thrombosis, it is worth recording in detail. The professional aspects are also worth reporting.
这位 55 岁的女性从爱尔兰发电报预约。由于她的病史展示了α-生育酚对糖尿病、心绞痛、高血压和冠状动脉血栓形成的影响，值得详细记录。其专业方面也值得报告。

She was a graduate in medicine from an English university, married an Irishman, and practiced, therefore, in Ireland. She first developed diabetes mellitus and went to England for consultation on this condition. She was hospitalized and her diabetes controlled and a regime mapped out for her. On return to Ireland she found that she could not carry on her practice on the diet prescribed, so she modified her treatment to allow her good control but enough strength to allow full-time work.
她毕业于一所英国大学的医学专业，嫁给了一位爱尔兰人，因此在爱尔兰执业。她首先患上了糖尿病，随后前往英国就此病情咨询。她住院治疗，糖尿病得到控制，并为她制定了一个方案。回到爱尔兰后，她发现无法按照规定的饮食继续执业，于是她调整了治疗方案，以便既能良好控制病情，又有足够的体力进行全职工作。

As is the rule with female diabetics, vascular changes began to occur, and she developed a moderate to severe hypertension. This was followed by angina pectoris, which gradually became more severe. After some months of angina, she suffered a severe coronary thrombosis with myocardial infarction.
正如女性糖尿病患者的常见情况一样，血管开始发生变化，她发展为中度至重度高血压。随后出现了心绞痛，且逐渐加重。几个月的心绞痛后，她发生了严重的冠状动脉血栓形成并伴有心肌梗死。

After release from hospital she journeyed to the London Heart Institute for evaluation and suggested therapy. Of course, this consisted of decreased activity and nitroglycerin for angina. In spite of this, she just wasn’t able to practice and retired to the country.
出院后，她前往伦敦心脏研究所进行评估和建议的治疗。当然，治疗包括减少活动和使用硝酸甘油缓解心绞痛。尽管如此，她仍然无法继续工作，只好退休回乡。

In her country retreat she was accompanied by one of her Great Dane dogs, a champion female. Twice this dog routed out intruders, and when the dog became older and somewhat feeble, the doctor was anxious to keep her alive and well so she sought the help of Dr. Lambert, at that time president of the Irish Veterinary Association. Dr. Lambert examined the dog, suggested treatment, but then said to the doctor, “however, I can help you a lot better than I can
在她的乡间别墅里，她带着她的一只大丹犬，这是一只冠军母犬。这只狗两次驱赶了入侵者，当狗变老且有些虚弱时，医生非常希望她能健康长寿，于是她寻求了当时爱尔兰兽医协会主席兰伯特医生的帮助。兰伯特医生检查了这只狗，提出了治疗建议，但随后对医生说：“不过，我能帮你的远比我能帮这只狗的多。”
your dog.” He prescribed a useful daily intake of vitamin E (alpha tocopherol).
你的狗。” 他开出了每日摄入维生素 E（α-生育酚）的有益剂量。

The patient responded slowly to the alpha tocopherol. First, she noted a decrease in her insulin requirement, then her angina pectoris lessened and eventually disappeared, and she discovered that her blood pressure had returned to normal.
患者对α-生育酚反应缓慢。起初，她注意到胰岛素需求减少，随后心绞痛减轻并最终消失，她发现自己的血压已恢复正常。

The reader, if he has read this book to this point, will realize that the doctor was unusually lucky in many ways. First of all, the dose of alpha tocopherol suggested by Dr. Lambert was exactly right. Secondly, she was one of the lucky one-third whose pressure falls on alpha tocopherol therapy. One-third stay at approximately the same level and one-third rise - often to tremendous heights. Thirdly, she was one of the lucky one-third of the victims of diabetes mellitus whose insulin requirement drops. Finally, her angina pectoris was completely relieved.
读者如果读到这里，会意识到这位医生在许多方面都非常幸运。首先，Lambert 博士建议的α-生育酚剂量恰到好处。其次，她是幸运的三分之一中血压在α-生育酚治疗下下降的患者之一。三分之一的血压保持在大致相同水平，三分之一则上升——往往升得非常高。第三，她是幸运的三分之一糖尿病患者中胰岛素需求减少的那部分。最后，她的心绞痛得到了完全缓解。

She returned to practice; and she felt that she could safely travel to Canada to see her elder son, his Canadian wife, and her first grandchild. She had never seen the latter two. She combined this trip with an appointment with me.
她恢复了工作；她觉得自己可以安全地前往加拿大，去看望她的大儿子、他的加拿大妻子以及她的第一个孙子。她从未见过后两者。她将这次旅行与与我约见结合在一起。

I had nothing to suggest but a continuation of the same treatment and was both interested and amused when this very professional and polite Irish woman doctor, with a delightful Irish accent, asked me two questions: the first to explain the mode of action of alpha tocopherol and then diffidently, “Why do I, who know every important doctor in England, have to be cured of my disease by my veterinarian?”
我无可建议，只能继续相同的治疗，当这位非常专业且彬彬有礼的爱尔兰女医生用她那迷人的爱尔兰口音问我两个问题时，我既感兴趣又觉得好笑：第一个是解释α-生育酚的作用机制，接着她有些胆怯地问：“为什么我这个认识英格兰所有重要医生的人，必须由我的兽医来治愈我的疾病？”

Dr. Lambert alertly picked up our original short paragraph announcement in Nature of our use of alpha tocopherol in cardiac disease and applied it to his veterinary practice with spectacular results, which he then published in both the English and American Veterinary Journals.
兰伯特博士敏锐地注意到我们在《自然》杂志上关于使用α-生育酚治疗心脏病的简短原始公告，并将其应用于他的兽医实践，取得了显著成果，随后他在英国和美国的兽医期刊上发表了相关论文。

He is not the only veterinarian who has successfully treated human patients with coronary artery disease. Dr. Egan in Detroit, now unfortunately deceased, and two other veterinarians in Canada that I personally know, have more human patients in their areas than I have!
他并不是唯一一位成功治疗冠状动脉疾病人类患者的兽医。底特律的 Egan 医生（现已去世）以及我个人认识的加拿大另外两位兽医，在他们所在地区的人类患者比我还多！

pectoris is described by the patient as a sensation of pressure, tightness, or heaviness behind the breastbone. It may become crushing in nature like a closing vise and may be very severe indeed. It can come on so suddenly that it seems instantaneous, with the victim suddenly subjected to unbearable pain that renders him unable even to walk. The attack can end quickly or can continue until it is treated. The pain has a tendency to radiate, usually to the left shoulder and arm all the way down to the fingers. It is often accompanied by great anxiety and a fear of impending death. A mild attack, however, may occur simply as a sensation of pressure within the chest.
心绞痛患者描述为胸骨后方的压迫感、紧绷感或沉重感。它可能变得像闭合的钳子一样压迫性极强，甚至非常剧烈。发作可能突然发生，似乎瞬间出现，患者突然遭受难以忍受的疼痛，甚至无法行走。发作可以迅速结束，也可以持续直到得到治疗。疼痛往往会放射，通常向左肩和手臂一直延伸到手指。常伴有极度焦虑和对即将死亡的恐惧。然而，轻微的发作可能仅表现为胸内的压迫感。

Yet unless there is definite electrocardiographic evidence of coronary insufficiency - s-t segment and T wave changes can sometimes be elicited by taking electrocardiographic tracings immediately following or during sufficient exercise to elicit the pain - it is only by the most thorough and painstaking examination that the physician can be sure he is indeed dealing with cardiac anoxia and not with referred pain from some other disease. Since the electrocardiogram will usually show no abnormality, I have come to rely on extremely detailed case histories and an exercise trial. It is the best way I have found to distinguish true angina from its most frequent mimic, intercostal neuralgia or inflammation of one or more of the nerves between the ribs.
然而，除非有明确的心电图证据表明冠状动脉功能不全——通过在足够运动以引发疼痛后或期间立即进行心电图记录，有时可以诱发 ST 段和 T 波的变化——否则只有通过最彻底和细致的检查，医生才能确定确实是在处理心脏缺氧，而不是其他疾病引起的牵涉痛。由于心电图通常不会显示异常，我开始依赖极其详细的病史和运动试验。这是我发现区分真正心绞痛与其最常见的模拟症——肋间神经痛或一条或多条肋间神经的炎症——的最佳方法。

Characteristically, true angina pectoris is elicited when the oxygen demand is increased, which can occur because
典型地，真正的心绞痛是在氧气需求增加时引发的，这可能是因为
of excitement, exertion, or even after the eating of a heavy meal. However, intercostal pain may also be elicited by exertion, since an increased rate of respiration and greater movement of the chest may irritate the affected nerve, but it can also result from any change in position and frequently occurs while the patient is sitting in a chair or lying in bed, whereas true angina does not occur when the patient is at rest.
兴奋、用力，甚至在吃了一顿丰盛的饭后都会出现。然而，肋间痛也可能因用力而引发，因为呼吸频率增加和胸部运动加剧可能刺激受影响的神经，但它也可能由任何体位变化引起，且常发生在患者坐在椅子上或躺在床上时，而真正的心绞痛在患者休息时不会发生。

Although it had long been supposed, because angina attacks are so frequently brought on by exercise, that the syndrome resulted from insufficient oxygen supply to the heart, it was first demonstrated in 1964 when Dr. Lawrence S. Cohen of Harvard Medical School and Peter Bent Brigham Hospital found an excess of lactic acid in the heart muscle during angina attacks. Since the consistently high quantities of lactate could only have been produced in the absence of oxygen, the findings represented a remarkably clean and uncomplicated demonstration of hypoxia, as reported to the Thirteenth Annual Convention of the American College of Cardiology in New Orleans.
尽管长期以来人们认为，由于心绞痛发作常常由运动引发，该综合症是由于心脏供氧不足所致，但直到 1964 年，哈佛医学院和 Peter Bent Brigham 医院的 Lawrence S. Cohen 博士首次证明了这一点。他发现心绞痛发作时心肌中乳酸过多。由于持续高量的乳酸只能在缺氧的情况下产生，这一发现成为了缺氧的一个极其清晰且简单的证明，并在新奥尔良举行的第十三届美国心脏病学会年会上进行了报告。

Since then it has gone almost unquestioned that angina is caused by oxygen lack, which knowledge should have provided the key to a treatment that would be more than palliative. The characteristics of such a treatment had become obvious. For example, it was possible for a paper in the New England Journal of Medicine (December 14, 1967, page 1,278 ) to commence with, “Because angina pectoris is a consequence of inadequate myocardial oxygenation, ideal therapy for this incapacitating symptom would be directed toward both increasing coronary blood flow and decreasing myocardial oxygen requirements.”
从那时起，几乎无人质疑心绞痛是由缺氧引起的，这一认识本应为一种不仅仅是缓解症状的治疗方法提供关键。这样治疗方法的特征已经变得显而易见。例如，《新英格兰医学杂志》（1967 年 12 月 14 日，第 1278 页）的一篇论文开头写道：“由于心绞痛是心肌供氧不足的结果，理想的治疗方法应同时着眼于增加冠状动脉血流量和减少心肌的氧气需求，以缓解这一使人丧失能力的症状。”

The authors, Dr. Braunwald, Epstein, Glick, Wechsler, and Braunwald, might just as well have gone on to name alpha tocopherol as their ideal therapy if these National Heart Insitute doctors had only known it.
作者们，布劳恩瓦尔德博士、爱泼斯坦、格里克、韦克斯勒和布劳恩瓦尔德，如果这些国家心脏研究所的医生们早知道的话，完全可以继续将α-生育酚命名为他们的理想疗法。

It has already been pointed out in the chapter on coronary occlusion that alpha tocopherol simultaneously is a powerful fibrinolytic agent, with an action that causes arterial blood clots to disintegrate, and a vasodilator that will increase the blood supply to the heart by widening the arterial lumen.
在冠状动脉闭塞一章中已经指出，α-生育酚同时是一种强效的纤溶剂，能够使动脉血栓分解，并且是一种血管扩张剂，通过扩张动脉腔来增加心脏的血液供应。

It also plays a third and equally significant role in its function, well known to food technicians everywhere, as an antioxidant.
它还在其功能中扮演第三个同样重要的角色，作为抗氧化剂，这一点为全球食品技术人员所熟知。

When it is pointed out that the consumption of polyunsaturated fats reduces the serum level of vitamin E and increases the likelihood of vitamin E deficiency, that is an expression of the consequence of vitamin E’s antioxidant activity. Ordinarily the essential fatty acids released into the bloodstream by polyunsaturates are highly vulnerable to per-oxidation-linking their molecules one for one with molecules of oxygen. Vitamin E in the bloodstream, however, preferentially bonds with the fatty acids and prevents their oxidation. The vitamin E is destroyed in the course of this activity, which is why polyunsaturates in the diet in -any quantity create a need for proportionately more of the vitamin. But by this antioxidant activity, the vitamin prevents oxygen from being converted into toxic peroxides, leaving the red cells of the blood more fully supplied with pure oxygen that the blood carries to the heart as well as all other organs.
当指出多不饱和脂肪的摄入会降低血清中维生素 E 的水平并增加维生素 E 缺乏的可能性时，这实际上是在说明维生素 E 抗氧化活性的结果。通常，多不饱和脂肪释放到血液中的必需脂肪酸极易发生过氧化反应——它们的分子与氧分子一一结合。然而，血液中的维生素 E 优先与这些脂肪酸结合，防止它们被氧化。维生素 E 在这一过程中被消耗，这就是为什么饮食中摄入任何数量的多不饱和脂肪都会相应增加对维生素 E 的需求。但通过这种抗氧化作用，维生素 E 防止氧气转化为有毒的过氧化物，使血液中的红细胞能够携带更多纯净的氧气，输送到心脏及其他所有器官。

By all these properties already existing in one drug - and that drug virtually without side effects except through overdosage in very special cases - surely this drug, alpha tocopherol, is as well tailored to be the ideal therapy for angina as any material could possibly be.
凭借一种药物已经具备的所有这些特性——而且这种药物几乎没有副作用，除非在极特殊情况下过量服用——毫无疑问，这种药物α-生育酚，是治疗心绞痛的理想疗法，几乎没有任何物质能比它更合适。

Unfortunately, alpha tocopherol remains largely unknown to the medical profession, and as a consequence the profession has wasted a frantic 20 years of search for a drug that already exists. Untold time and money have been spent in the development of amyl Nitrite, erythrityl tetranitrate, pentaerythritol Tetranitrate, and others in a long list of nitrates and nitrites, Iproniazid, and other monoamine-oxidase inhibitors. The result is usually a short-lived fad and a quick return to nitroglycerin, which has no therapeutic effect whatsoever, but is remarkably fast and effective in relieving an attack of angina.
不幸的是，α-生育酚在医学界仍然 largely unknown，因此医学界浪费了疯狂的 20 年时间去寻找一种已经存在的药物。大量时间和金钱被投入到开发亚硝酸异戊酯、四硝酸红霉素、四硝酸季戊四醇等一长串硝酸盐和亚硝酸盐，以及异丙肼和其他单胺氧化酶抑制剂上。结果通常是短暂的流行，随后迅速回归使用硝酸甘油，硝酸甘油本身没有任何治疗效果，但在缓解心绞痛发作时速度快且效果显著。

So after years and years of search for a drug that would treat angina, the choice available to today’s doctor is still whether to use the brown nitroglycerin tablets that have a
经过多年寻找治疗心绞痛的药物，今天的医生仍然只能选择使用棕色硝酸甘油片剂，后者具有..
chocolate base or the white tablets with a sugar base.
巧克力基底或糖基底的白色片剂。
To the patient accustomed to walking around with a pocket full of nitroglycerin tablets and perhaps taking as many as 20 to 30 tablets a day, it could in no way represent a burden to take a few vitamin E capsules daily, thus preventing the recurrence of angina attacks in most cases, and to be able to throw away the nitroglycerin.
对于习惯随身携带一袋硝酸甘油片，甚至每天服用多达 20 到 30 片的患者来说，每天服用几粒维生素 E 胶囊绝不会成为负担，这样在大多数情况下可以预防心绞痛发作的复发，并且能够丢弃硝酸甘油片。

The complete or nearly complete prevention of angina attacks is the usual and expected result of treatment with alpha tocopherol. Angina patients are treated exactly like those who suffer the same symptoms upon recovery from a coronary occlusion. The results are comparable in every way, except that I have a vague impression that, on the whole, patients who have had a frank coronary occlusion respond somewhat better. I don’t know why.
用α-生育酚治疗通常能完全或几乎完全预防心绞痛发作。心绞痛患者的治疗方法与那些冠状动脉闭塞恢复后出现相同症状的患者完全相同。结果在各方面都相当，唯一的区别是我隐约感觉总体上经历过明显冠状动脉闭塞的患者反应稍好一些。我不知道原因。

It is essential to recall that two investigators, after years of careful study of the available material and evidence, stated that in their opinion all patients who had developed angina pectoris had had a coronary occlusion, though usually of a small vessel so that the electrocardiographic changes were not diagnostic or were easily missed. If this is so, and I consider it probable, then angina represents a specific indication for preventive measures against the possibility of thrombosis.
必须记住，两位研究人员经过多年的细致研究现有资料和证据后表示，他们认为所有患有心绞痛的患者都曾发生过冠状动脉闭塞，尽管通常是小血管闭塞，因此心电图变化不具诊断性或容易被忽视。如果情况确实如此，我认为这是很可能的，那么心绞痛就代表了预防血栓形成可能性的特定指征。

Unless there is some contraindication, such as hypertension, an angina patient is routinely started by me on 800 international units of alpha tocopherol a day and seen at intervals of six weeks for reassessment. If no result has been obtained within six weeks, the dosage is increased by 200 to 400 international units for the next six weeks. When we reach the dose on which their symptoms are relieved, it is continued permanently.
除非有某些禁忌症，如高血压，我通常会给心绞痛患者每天服用 800 国际单位的α-生育酚，并每六周复查一次。如果六周内没有效果，剂量将在接下来的六周内增加 200 到 400 国际单位。当达到缓解症状的剂量时，将永久维持该剂量。

Although the protection from a coronary thrombosis in these patients is very nearly universal, it sometimes happens that, after some years, the symptoms of angina recur. In such a case, it is necessary once again to increase the dose gradually and keep increasing it until the condition is relieved.
尽管这些患者几乎都能得到冠状动脉血栓形成的保护，但有时几年后，心绞痛的症状会复发。在这种情况下，有必要再次逐渐增加剂量，并持续增加，直到症状缓解。

In discussing the successful treatment for angina, how-
在讨论心绞痛的成功治疗时，如何—
ever, it must be re-emphasized that a misdiagnosis can easily be made.
然而，必须再次强调，误诊很容易发生。

There is one type of pain which is very common in middleaged or older people which is very commonly mistaken for angina pectoris. It has been given many different names, by many different authors, although recognized as a definite entity for years. Also, the site of the responsible lesion has been identified in different locations - the sterno-costal joint, the intercostal nerve itself, or the nerve root. To make matters more confusing, it can be on either side at any level, and so the pain can be ascribed to referred pain from several different organs. The most common name for this condition is intercostal neuralgia or intercostal neuritis, and so the inference is that it is a definite lesion of the intercostal nerve. It is often referred to as a radiculitis, signifying a lesion in the nerve root. It has been called the rib syndrome. It has been often misdiagnosec as breast tumor, cholecystitis, etc.
有一种疼痛在中年或老年人中非常常见，且常被误认为是心绞痛。许多不同的作者给它起过许多不同的名字，尽管多年来它被公认为一种明确的疾病。此外，病变部位也被确定在不同的位置——胸骨肋骨关节、肋间神经本身或神经根。更令人困惑的是，它可以出现在任一侧的任何水平，因此疼痛可能被归因于来自多个不同器官的牵涉痛。这种情况最常见的名称是肋间神经痛或肋间神经炎，因此推断它是肋间神经的明确病变。它常被称为神经根炎，表示神经根的病变。它也被称为肋骨综合症。它常被误诊为乳腺肿瘤、胆囊炎等。

This pain nearly always occurs in the left upper chest in front in right-handed people and in the upper right chest in front in left-handed people. In fact, this is so usually the location and so typically right or left sided, that once the patient has described it you can confidently tell him whether he is right or left handed. Characteristic of this pain is that it occurs toward the front of the chest; but it is accompanied by marked tenderness between the ribs, and this tenderness can be followed all the way around in the intercostal space right to the lateral aspects of the spine. The patient may not be aware of the tenderness until the doctor puts pressure on the area.
这种疼痛几乎总是发生在惯用右手者的左上胸前部，而惯用左手者则发生在右上胸前部。事实上，这种疼痛的位置通常如此典型地位于右侧或左侧，以至于一旦患者描述了疼痛，你就可以自信地判断他是惯用右手还是左手。这种疼痛的特点是发生在胸部前方；但伴随着肋间明显的压痛，这种压痛可以沿着肋间隙一直延伸到脊柱的侧面。患者可能直到医生按压该区域时才会察觉到压痛。

The author has seen hundreds of such cases, many of which have had the condition for years. There has been no very effective medical treatment available for this condition, and the author has developed his own theories and method of treatment which are very effective in nearly all - but not all - cases.
作者见过数百例此类病例，其中许多患者患病多年。对于这种情况，尚无非常有效的医疗治疗方法，作者发展了自己的理论和治疗方法，这些方法在几乎所有——但并非全部——病例中都非常有效。

The doctor of medicine has been taught for years that minor dislocations of joints or their immobilization in an abnormal part of their range of movement cannot occur.
医学博士多年来被教导，关节的轻微脱位或其在异常活动范围内的固定是不可能发生的。

Therefore, the chiropractic and osteopathic approach to pain was considered necessarily based on incorrect theory and manipulation of no greater benefit than heat and massage. All this, too, has changed, and the president of the American College of Surgeons and, now, many others have attested to the value of correct manipulation in treating many joint lesions. The author has known this for 24 years. He discovered three osteopaths who could relieve chest pain of this type in most patients, often very dramatically. In one such case a man who couldn’t walk 20 yards, without pain, after manipulation walked for miles up and down hill and through college grounds and climaxed it by running upstairs, where he arrived breathless and perspiring, but free of pain.
因此，脊椎指压疗法和整骨疗法对疼痛的处理被认为必然基于错误的理论，其操作效果不比热敷和按摩更好。所有这些情况也发生了变化，美国外科医师学会的主席以及现在的许多其他人都证明了正确操作在治疗许多关节病变中的价值。作者对此已知晓 24 年。他发现三位整骨医生能够缓解大多数患者的此类胸痛，且效果常常非常显著。在一个案例中，一名患者在操作前无法无痛行走 20 码，操作后却能在大学校园内上下坡走数英里，最后还跑上楼梯，虽然气喘吁吁、满头大汗，但已无疼痛感。

However, again by chance, a most effective medical treatment for this condition was discovered. While investigating the possible usefulness of vitamin E ointment ( 30 I.U. alpha tocopherol per gram of petroleum jelly), Burgess and Pritchard of the Montreal General Hospital had demonstrated its usefulness in hastening the healing of indolent ulcers and in so doing had shown that the alpha tocopherol in the ointment was absorbed by the tissues under the skin right down to the periosteum of bone. It literally walks right through the skin as if it weren’t there. Now we treat all such patients by the inunction of vitamin E ointment into the skin over the nerve root for ten minutes, followed by heat for another ten minutes to drive in still more alpha tocopherol. This works miracles in one to three nights. If it doesn’t work within this three-day interval, we send the patient to the osteopath - not just any osteopath, of course - and if this doesn’t get the desired result, we use vitamin B, hypodermically and by mouth, but with little hope that it will be successful.
然而，偶然间，一种对这种病症极为有效的医疗方法被发现了。在研究维生素 E 软膏（每克凡士林含 30 国际单位α-生育酚）可能的用途时，蒙特利尔综合医院的 Burgess 和 Pritchard 证明了其在加速难愈性溃疡愈合方面的有效性，并由此显示出软膏中的α-生育酚能够被皮肤下的组织吸收，直达骨膜。它实际上能穿透皮肤，就像皮肤不存在一样。现在，我们通过将维生素 E 软膏涂抹在神经根部位的皮肤上，按摩十分钟，然后再用热敷十分钟以促进更多α-生育酚的吸收，来治疗所有此类患者。这种方法在一到三晚内能产生奇迹般的效果。如果在这三天内无效，我们会将患者送去看整骨医生——当然不是随便哪个整骨医生——如果这仍未达到预期效果，我们会使用维生素 B，通过皮下注射和口服，但成功的希望不大。

Having excluded referred pain from organs and having excluded intercostal nerve pain, presumably pain that occurs in the chest on exertion or excitement (especially after a heavy meal or soon after the oxygen reserve in the heart muscle has been used up during sleep or after exertion just before elicitation of pain) is due to coronary artery narrowing and resulting myocardial anoxia.
排除了器官转移痛和肋间神经痛后，推测在胸部因用力或兴奋（尤其是在大餐后或心肌中的氧储备在睡眠期间或运动后刚被耗尽、疼痛刚出现之前）而发生的疼痛，是由于冠状动脉狭窄及由此引起的心肌缺氧所致。

A word is necessary about status anginosis, a condition of nearly continuous angina pectoris even at rest. In 30,000 cases, I’ve never seen one. I’ve seen patients in such deep failure that they couldn’t move about at all - but no status anginosis. Early in our London, Ontario, days a patient of my brother’s, an obstetrician, was seen in consultation while in the hospital at her daughter’s request. She was there because of the diagnosis of status anginosis made by the internist to whom she had been sent by her family physician. My brother elicited the typical intercostal tenderness in the appropriate segment and suggested vitamin E ointment and heat as described in this chapter. She was completely cured of her status anginosis overnight.
关于持续性心绞痛（status anginosis）需要说明一下，这是一种即使在休息时也几乎持续出现心绞痛的状况。在 3 万例病例中，我从未见过一例。我见过病情极为严重、完全无法活动的患者——但没有持续性心绞痛。早年在加拿大安大略省伦敦市，我兄弟的一位产科患者在其女儿的请求下住院期间接受了会诊。她之所以住院，是因为内科医生诊断她患有持续性心绞痛，而这位内科医生是她的家庭医生转诊的。我的兄弟在相应的肋间段发现了典型的肋间压痛，并建议使用本章所述的维生素 E 软膏和热敷。她的持续性心绞痛一夜之间完全治愈了。

Like all our coronary patients, angina patients are urged to lead normal lives, as far as this is possible. We restrict them in only two ways. We ask that they don’t try to show anyone how much they. can lift or how fast they can run. Many patients have returned to hard manual laboring on farms and in factories without subsequent trouble.
像我们所有的冠心病患者一样，心绞痛患者也被鼓励尽可能过正常的生活。我们只在两方面对他们有所限制。我们要求他们不要试图向任何人展示自己能举多重的东西或跑多快。许多患者已经恢复了在农场和工厂的繁重体力劳动，且没有出现后续问题。

There is even a distinct possibility that such hard work does them good - as long as they are protected against sudden insufficiency by vitamin E saturation. It was reported by Doctors Smith and Kidera in Aerospace Medicine (38: 742, July, 1967) that physical stress is beneficial in some cases of angina, because it helps the development of collateral circulation. A gradually extended exercise program leading up to an objective of jogging a mile in 20 minutes showed excellent results in 15 cases and poor results in six.
甚至有一种明确的可能性认为，这种艰苦的锻炼对他们有益——只要他们通过维生素 E 的饱和得到保护，避免突发的功能不足。Smith 医生和 Kidera 医生在《航空医学》（38: 742，1967 年 7 月）中报道，身体压力在某些心绞痛病例中是有益的，因为它有助于侧支循环的发展。一个逐渐延长的锻炼计划，目标是在 20 分钟内慢跑一英里，在 15 个病例中显示出优异的效果，而在 6 个病例中效果较差。

The poor results, of course, were in dyspnea and early congestive failure. They could have been avoided.
当然，糟糕的结果表现为呼吸困难和早期充血性心力衰竭。这本可以避免。

to atherosclerosis is the clinical term for the very common entity whose chief symptom is angina pectoris, which literally means “pain of the chest.”
动脉粥样硬化是临床术语，指的是一种非常常见的疾病，其主要症状是心绞痛，字面意思是“胸痛”。

The diagnosis of coronary heart disease is based on evidence of recent or old myocardial infarction (tissue destruction in the heart) or of angina pectoris in a patient with no evidence of syphilis or disease of the heart valves. Angina pectoris can also occur in a case of syphilitic aortitis, because the disease causes narrowing of the ostea of the coronary arteries at their origins behind cusps of the aortic valve.
冠心病的诊断基于近期或既往心肌梗死（心脏组织破坏）的证据，或在无梅毒或心脏瓣膜疾病证据的患者中出现心绞痛。心绞痛也可能发生在梅毒性主动脉炎病例中，因为该疾病导致冠状动脉起始部位（位于主动脉瓣瓣叶后方）的开口狭窄。

This can cut down the blood able to get into the coronary arteries and so lead to oxygen deficiency of the heart muscle and the production of angina pectoris. In our day this is rarely seen, however.
这会减少进入冠状动脉的血液量，从而导致心肌缺氧和心绞痛的产生。然而，在我们这个时代，这种情况很少见。

Angina pectoris, as we know it today, can occur with aortic stenosis, or narrowing of the aorta, and less frequently also with aortic regurgitation. Also angina pectotis does occur less frequently with mitral stenosis and congestive heart disease of noncoronary origin.
我们今天所知的心绞痛，可以发生在主动脉狭窄或主动脉缩窄的情况下，较少见于主动脉返流。心绞痛也较少见于二尖瓣狭窄和非冠状动脉起源的充血性心脏病。

However, a definitive diagnosis of Coronary Heart Disease depends upon an unequivocal history of distinctive cardiac pain or of electrocardiographic changes denoting acute or healed myocardial infarction. Occasionally, but not often there are other manifestations that might suggest coronary heart disease, such as acute pulmonary edema, chronic congestive heart failure, systematic arterial embolization, or
然而，冠心病的明确诊断依赖于具有特征性心脏疼痛的明确病史或显示急性或愈合性心肌梗死的心电图变化。偶尔，但不常见，还有其他表现可能提示冠心病，如急性肺水肿、慢性充血性心力衰竭、系统性动脉栓塞，或
the onset of the Stokes-Adams syndrome. Angina remains the primary symptom.
斯托克斯-亚当斯综合征的发作。心绞痛仍然是主要症状。

It is necessary to point out that when patients first develop the disease, there are usually no physical signs of the condition and that the electrocardiogram is ordinarily normal.
有必要指出的是，当患者初次发病时，通常没有身体上的症状，心电图通常也是正常的。

Angina occurs when the lumen of the artery is diminished to about one-third of its normal size, either in a small area or in a more diffuse change. The pain is typically behind the breastbone (sternum) or across the chest. It is commonly described as a tight band across the chest or like a heavy weight over the sternum. It may be referred to either shoulder, though usually the left, and may extend down into the hand on the little finger side. The pain may extend into the jaw or teeth instead of into the shoulder or arm region. The symptom is brought on by exertion, usually walking outdoors, by emotion, commonly after ingestion of a heavy meal, by tachycardia in the susceptible, and by cold, especially by walking in the cold.
心绞痛发生在动脉腔缩小到正常大小的大约三分之一时，可能是局部狭窄，也可能是更广泛的变化。疼痛通常位于胸骨后方或胸部横跨处。常被描述为胸部一条紧绷的带子，或像胸骨上压着一块重物。疼痛可能放射到任一肩膀，通常是左肩，并可能延伸到小指一侧的手部。疼痛也可能扩散到下颌或牙齿，而不是肩膀或手臂区域。该症状通常由劳累引发，通常是户外行走，由情绪引起，常见于进食丰盛餐后，由易感者的心动过速引起，以及由寒冷引发，尤其是寒冷中行走时。

Angina, as a symptom following coronary occlusion, has been fully discussed in the chapter dealing with that subject. What we are dealing with now is a condition with no clinical or electrocardiographic signs. However, there is a general acceptance of the definitive work of Blumgart and Schlesinger, who showed that at autopsy the hearts of subjects who had suffered angina during life contained at least one and usually two scars of previous coronary occlusions.
心绞痛作为冠状动脉闭塞后的症状，已在相关章节中详细讨论。我们现在讨论的是一种没有临床或心电图表现的情况。然而，Blumgart 和 Schlesinger 的权威研究得到了普遍认可，他们在尸检中发现，生前曾患心绞痛的患者心脏至少有一个，通常有两个以前冠状动脉闭塞留下的疤痕。

Present statistics indicate that the average length of life after the onset of angina pectoris is about ten years and that myocardial infarction or congestive heart failure are the usual causes of death in such patients.
目前的统计数据显示，心绞痛发作后平均寿命约为十年，心肌梗死或充血性心力衰竭是此类患者的常见死因。

One of the curious situations that we are faced with time after time is the frank delight of the patient who has been very ill with heart disease and who has had a complete return to apparently normal health. His secondary reaction so often is a bewildered question: “Why have the doctors not generally adopted this treatment?” Some of these patients have become very belligerent and are hard to calm down, since they consider their own physicians have let
我们一次又一次面临的一个奇怪情况是，那些患有严重心脏病并且已经完全恢复到看似正常健康状态的患者表现出的坦率喜悦。他们的次要反应常常是困惑地问：“为什么医生们普遍没有采用这种治疗方法？”其中一些患者变得非常好斗，难以平息，因为他们认为自己的医生辜负了他们。
thein suffer needlessly and, callously and unconcernedly, let them proceed toward death.
他们无谓地受苦，冷酷而漠不关心地任其走向死亡。

We are unable to help them in this phase, since there are organizations, notably Heart Associations, which raise large sums of money and profess to be fighting heart disease. Yet they have done as near to nothing as is possible while feed-. ing large sums of money into research institutions, which promptly spend it with absolutely no results whatsoever. To make matters worse, a large number of leading cardiologists, including the man whose name is currently most famous, know that vitamin E is at least a partial answer. Why they have done nothing but ignore or oppose it must be because it is still not politically wise.
我们在这个阶段无法帮助他们，因为有一些组织，尤其是心脏协会，筹集了大量资金并声称在抗击心脏病。然而，他们几乎没有做任何实质性的事情，却将大量资金投入研究机构，而这些机构迅速花掉这些钱，却毫无任何成果。更糟糕的是，许多顶尖的心脏病专家，包括目前最著名的那位，都知道维生素 E 至少是部分解决方案。之所以他们什么也没做，只是忽视或反对，必然是因为这在政治上仍不明智。

The same situation occurs when anyone, such as an author or a drug salesman, is introduced to vitamin E and sees what it can do medically. He is originally uninterested, then becomes curious, and soon becomes an angry evangelist. To us, who have gone through this for more than 20 years, this stage has mercifully passed, and we go about our business of helping as many patients as we can who find their way to us.
当任何人，比如作者或药品推销员，被介绍给维生素 E 并看到它在医学上的作用时，情况也是如此。他们起初不感兴趣，随后变得好奇，很快就变成了愤怒的传教士。对我们这些经历了二十多年的人来说，这个阶段已经幸运地过去了，我们专注于帮助尽可能多找到我们求助的患者。

However, there is a time and place for everything, and the time has come when it should be pointed out that the average cardiologist can do nothing to help a damaged heart if he does not use vitamin $E$$E$EE - except to treat symptoms and complications.
然而，凡事都有其时机，现在应该指出的是，如果普通心脏病专家不使用维生素 $E$$E$EE ，他对受损的心脏无能为力——只能治疗症状和并发症。

Let the cardiologist tell you about it himself. For this we quote the editorial in the Texas State Journal of Medicine of January, 1951, written by George W. Parson, M.D., president of the Texas State Heart Association.
让心脏病专家亲自告诉你。为此，我们引用 1951 年 1 月《德克萨斯州医学杂志》上的一篇社论，作者是德克萨斯州心脏协会主席乔治·W·帕森医学博士。

The Challenge of Cardiovascular Disease
心血管疾病的挑战
More than 637,000 deaths annually in the United States from cardiovascular disease account for about 44 per cent of all deaths. Approximately $9,000,000$$9,000,000$9,000,0009,000,000 Americans have heart disease; of these 500,000 are elementary and high school children. An estimated 152,100,000 workdays are lost each year because of diseases of the heart and blood vessels. This is the challenge of cardiovascular disease.
美国每年因心血管疾病导致的死亡人数超过 637,000 人，占所有死亡人数的约 44%。大约有 $9,000,000$$9,000,000$9,000,0009,000,000 美国人患有心脏病；其中有 500,000 名是小学和中学学生。每年因心脏和血管疾病损失的工作日估计为 152,100,000 天。这就是心血管疾病的挑战。

Equally as challenging is the individual patient. When a physician makes a diagnosis of organic heart disease, he realizes that in the care of the patient he has begun a losing fight. In the earliest stages he offers general advice; “avoid strenuous activities; live sensibly; watch your weight; don’t worry; the heart is a wonderful organ.” Before long symptoms develop and the doctor braces the patient with digitalis or other drugs, restriction of usual activities, more rest and more encouragement. Again, before long, more urgent symptoms force a retreat. Bedrest, low sodium diet, diuretics, and other well known measures are brought to the front and the line is stabilized. But not for long. All too soon increasing pressure bends the line and retreat begins again. Now there are left no more reserves - no more in the heart and no more in the hands of the one trying to help the heart. Then only surrender remains. Not infrequently the enemy strikes suddenly with overwhelming power, and surrender occurs before the doctor can mobilize his forces.
同样具有挑战性的是个体患者。当医生诊断出器质性心脏病时，他意识到在照顾患者的过程中已经开始了一场注定失败的战斗。在最初阶段，他会提供一般建议：“避免剧烈活动；生活要有节制；注意体重；不要担心；心脏是一个奇妙的器官。”不久后，症状出现，医生用地高辛或其他药物、限制日常活动、增加休息和鼓励来支持患者。再过不久，更紧急的症状迫使医生退让。卧床休息、低钠饮食、利尿剂和其他众所周知的措施被提上日程，病情暂时稳定。但好景不长。压力不断增加，病情曲线再次下弯，退让再次开始。此时，心脏和帮助心脏的医生手中已无更多储备。唯有投降。不少情况下，敌人突然以压倒性的力量袭来，医生还未能调动力量，便已投降。

This is not to minimize our present efforts. Our forces are better trained and more efficient than they ever have been, and we are able to hold the line longer than ever before. But present day efforts are not enough. Much more education and research will be needed before the course of cardiovascular disease can be reversed or its development prevented. The control of heart disease is a great challenge to every physician and layman."
这并不是要贬低我们目前的努力。我们的力量比以往任何时候都训练有素、效率更高，我们能够比以往更长时间地坚守阵地。但现有的努力还远远不够。在扭转心血管疾病的进程或预防其发展之前，还需要更多的教育和研究。控制心脏病是每位医生和普通人面临的一大挑战。

This editorial could just as well have been written in January, 1969, since it is just as true today as it was in 1951.
这篇社论完全可以写于 1969 年 1 月，因为它今天依然和 1951 年一样真实。

I have before me a pamphlet sent out by the Florida Heart Association, a member of the American Heart Association, and I cannot think of any more pitiful literature. It certainly must depress the recipient if he reads carefully. For the sufferer from angina pectoris, it states, “Most angina pa-
我手中有一份由佛罗里达心脏协会（美国心脏协会的成员）发出的小册子，我想不到还有比这更可怜的宣传资料。如果仔细阅读，收件人肯定会感到沮丧。对于心绞痛患者，它写道：“大多数心绞痛患者——
tients can look forward to years of active living.” Reducing activity, working at a less demanding job, getting lots of rest, and the use of nitroglycerin is all there is to suggest. How could there be less?
患者可以期待多年积极的生活。”减少活动，做一份要求较低的工作，充足休息，以及使用硝酸甘油，这就是所有建议。还能有什么更少的呢？

Meanwhile, it has been established by many workers that alpha tocopherol decreases the need of oxygen in heart muscle and that it reduces the tendency to thrombosis. What more does one need than that and the published successes of hundreds of internists, surgeons, biochemists, veterinarians, etc., throughout the civilized world?
与此同时，许多研究人员已经证实，α-生育酚减少心肌对氧气的需求，并降低血栓形成的倾向。还有什么比这更重要的呢？再加上全世界众多内科医生、外科医生、生物化学家、兽医等的成功案例，这些都已被广泛报道。

One of my patients had the answer! He was the largest exporter of day-old chicks by plane to Japan and told me a parallel story of his experience. The Canadian Poultry Association holds an annual convention at which there is always a featured guest speaker, followed by open and usually rather frank discussion. Some years ago, the guest speaker came from California and outlined a completely new and very radical method of raising chicks for the commercial market. It was so new as to appear, on the face of it, quite ridiculous. He was “taken apart” by the audience, and two professors from the poultry department of our Agricultural College were most critical and advised the assembled members to have nothing to do with it, giving very logical and scientific reasons for their stand. The Californian chicken farmer kept cool and reasonable, answered their questions, but kept repeating: “Gentlemen, why don’t you try it? It works.” Then my patient told me, “You know every successful chicken farmer in Canada is now using this method and do you know who are teaching it to the upcoming poultry farmers? Those two professors from the agricultural school.” Then he said, “Dr. Shute, you should never say anything about vitamin E, except ‘Why don’t you try it? It works.’”
我的一位病人给出了答案！他是通过飞机向日本出口日龄雏鸡最多的人，并告诉我一个类似的经历。加拿大家禽协会每年都会举办一次大会，会上总有一位特邀嘉宾演讲，随后进行公开且通常相当坦率的讨论。几年前，一位来自加利福尼亚的特邀嘉宾介绍了一种全新且非常激进的商业养鸡方法。乍一看，这种方法显得相当荒谬。听众“把他拆解”了一番，我们农业学院家禽系的两位教授非常批评，建议与会成员不要采纳，给出了非常合乎逻辑和科学的理由。那位加州养鸡农保持冷静和理智，回答了他们的问题，但不断重复：“先生们，为什么不试试呢？这方法有效。”然后我的病人告诉我，“你知道加拿大所有成功的养鸡农现在都在用这种方法吗？你知道是谁在教即将成为养鸡农的人吗？就是那两位农业学院的教授。”然后他说，“博士， Shute，你永远不应该说关于维生素 E 的任何话，除了“你为什么不试试？它有效。”’”

Of course, like every other potent medication, it doesn’t work for everyone. The wide variation in its oxygen-sparing activity in different patients means that some get absolute relief as long as they take the optimum dosage while others get nearly complete relief. Some get definite help but still need occasional nitroglycerin.
当然，像所有其他强效药物一样，它并不适用于所有人。它在不同患者中的节氧活性差异很大，有些人在服用最佳剂量时能获得完全缓解，而有些人则几乎完全缓解。有些人得到明显帮助，但仍需偶尔使用硝酸甘油。

I have mentioned elsewhere, I believe, that we have had as patients three of the richest men in Canada and England. I do so only because they are obviously in a position to obtain the services of the best-known cardiologists in England, Canada, or the U.S. There must be a reason why they chose us. One of these cases will illustrate the point.
我相信我在别处提到过，我们曾接诊过加拿大和英格兰的三位最富有的人。我之所以提及此事，仅因为他们显然有能力聘请英格兰、加拿大或美国最著名的心脏病专家。一定有原因促使他们选择了我们。其中一个病例可以说明这一点。

This man, his whole family, and the chief executive of virtually each one of his numerous world-wide companies are all patients as a result of the coronary occlusion suffered by his mother-in-law.
这个人、他的整个家庭以及他几乎所有遍布全球的众多公司的首席执行官，都是因为他的岳母患有冠状动脉闭塞而成为病人。

She was at his northern Ontario camp some 50 miles north of my own. The local doctor was called to treat her. He, in turn, summoned a cardiologist from the nearest city, who in turn sent for a cardiologist from our leading Canadian university. All three, after consultation, informed the family that she had had a very extensive myocardial infarction, that she could not be moved, and that she would certainly die and that very soon. After they left, the son-in-law called the Shute Institute in London to ask if there was any help available and was told where he might locate me, since I was in the immediate area. He failed to reach me, but three days later when I was on my way home, I was intercepted at the next village and asked to call the northern lodge.
她当时在他位于安大略北部的营地，距离我自己的营地大约 50 英里。当地医生被叫去治疗她。医生随后召来最近城市的一位心脏病专家，心脏病专家又请来了我们加拿大顶尖大学的一位心脏病专家。三人会诊后通知家属，她患了非常严重的心肌梗死，不能移动，且肯定会很快去世。医生们离开后，女婿打电话给伦敦的 Shute 研究所，询问是否有帮助，并被告知如何找到我，因为我就在附近。他没能联系上我，但三天后，当我正要回家时，在下一个村庄被拦下，并被要求给北部营地打电话。

The patient’s granddaughter, along with special nurses, was looking after the patient and was able to give me all the necessary data about her case, her blood pressure, her pulse rate, whether it showed normal sinus rhythm, or not (it did), as well as the presence or absence of congestive failure, orthopnea, dsypnea, etc. I suggested the routine we used in such patients to the daughter, who dutifully copied it down. Then, the son-in-law returned to the phone and asked me what I thought and how she would respond. He wanted to know when she could be moved, since her home was in one of the Southern states, some 1,500 miles or more away. I told him she would be better on the tenth day, could sit up out of bed in three weeks, and go south in six.
患者的孙女和专职护士一起照顾患者，能够向我提供她病例的所有必要数据，包括血压、脉搏率、是否显示正常窦性心律（是的），以及是否存在充血性心力衰竭、端坐呼吸、呼吸困难等情况。我向女儿建议了我们在此类患者中使用的常规方案，她认真地记了下来。然后，女婿回到电话旁，问我怎么看以及她会有怎样的反应。他想知道她什么时候可以转移，因为她的家在南方某州，距离有 1500 英里或更远。我告诉他，她第十天会好转，三周后可以坐起来，六周后可以南下。

She was better on the tenth day, sat out of bed after three weeks, and went to Virginia after six weeks, perfectly well.
她在第十天时情况好转，三周后能坐起床，六周后去了弗吉尼亚，完全康复。

This man said that if I could tell him she would live, could tell him the exact day she would be well, the exact day she could get out of bed, and the exact day she could safely travel, he had better come over to our side.
这个人说，如果我能告诉他她会活下来，能告诉他她康复的确切日期，能告诉他她能下床的确切日期，以及她能安全旅行的确切日期，他最好转到我们这边来。

Any physician reading this can do as well, since this was about the third year of my experience with vitamin E , some. 17 or 18 summers ago.
任何阅读此文的医生都能做到，因为这大约是我使用维生素 E 的第三年经验，约在 17 或 18 个夏天前。

A few case histories follow:
以下是几个病例记录：
Male - aged 52, seen first September 24, 1968.
男性，52 岁，首次就诊于 1968 年 9 月 24 日。
This man developed angina in March of 1968. It would begin substernally and, if it continued for any length of time, extend upward into his neck. Nitroglycerin relieved this pain. He made an appointment because the attacks were becoming more severe and more prolonged. Shortness of breath usually accompanied the pain, but might disappear just before the pain began. Palpitation usually accompanied both the pain and the dyspnea. He was able to walk two blocks to the post office, but developed the pain on returning, since it was a little “up grade.” His blood pressure was 110/70, pulse 52.
这名男子于 1968 年 3 月出现心绞痛。疼痛起初位于胸骨下方，如果持续一段时间，会向颈部上方扩展。硝酸甘油能缓解这种疼痛。他预约就诊是因为发作变得更加严重且持续时间更长。呼吸急促通常伴随疼痛，但有时在疼痛开始前会消失。心悸通常伴随疼痛和呼吸困难。他能步行两条街区到邮局，但在返回时因路稍有上坡而出现疼痛。血压为 110/70，脉搏 52。

On 1,200 units of alpha tocopherol, his angina disappeared entirely by the fourth week of treatment. Now, five months later, he has been walking regularly about two miles a day and is now jogging a little with no distress. His blood pressure is $120/70$$120/70$120//70120 / 70, pulse 56 .
服用 1200 单位的α-生育酚后，他的心绞痛在治疗第四周完全消失。现在，五个月过去了，他每天规律地步行约两英里，现在还能轻微慢跑，没有不适。他的血压是 $120/70$$120/70$120//70120 / 70 ，脉搏 56。

Female - aged 47 when first seen November 4, 1949.
女性 - 首次就诊时年龄 47 岁，日期为 1949 年 11 月 4 日。
This woman had developed angina pectoris slowly over the course of the previous two years. At this time we were using approximately 300 units of alpha tocopherol a day, and on this dosage she developed severe congestive failure and needed mercurial diuretics. It wasn’t until October, 1952, when her dosage was raised to 375 units that her angina disappeared and her failure came under control.
这位女性在过去两年中逐渐发展出心绞痛。当时我们每天使用大约 300 单位的α-生育酚，在这个剂量下，她出现了严重的充血性心力衰竭，需要使用汞制利尿剂。直到 1952 年 10 月，当她的剂量提高到 375 单位时，她的心绞痛才消失，心力衰竭得到了控制。

By May, 1953, she stated that “she was feeling so well, working like a hatter.” She had no pain and no dyspnea, and all her peripheral edema was gone.
到 1953 年 5 月，她表示“感觉非常好，工作得像个制帽匠一样。”她没有疼痛，也没有呼吸困难，所有的周围水肿都消失了。

In the intervening years, with much family illness and
在这期间，经历了许多家庭疾病，且
one or two broken bones, she has had several brief episodes of peripheral edema and a little congestive failure, but has carried on a perfectly normal life with perhaps more activity than most people.
她曾有一两处骨折，经历过几次短暂的周围水肿和轻微的充血性心力衰竭，但她一直过着完全正常的生活，甚至可能比大多数人更活跃。

She is now 67. For the last month she has been confined to a nursing home after a fall April 17, 1969, in which she sustained a broken hip and right arm!
她现在 67 岁。自 1969 年 4 月 17 日摔倒后，她在过去一个月一直被限制在护理院内，摔倒导致髋部和右臂骨折！

This man volunteered for the army in 1943, at the age of 37, as a commando. As the training period in Canada neared its end and just before they were scheduled to go overseas, he developed on exertion pain in the very center of his chest. Eventually, during one of the final route marches, he was unable to continue after three miles and dropped out. He was very embarrassed by his distress and by its timing and only reported it when, on this occasion, he could not carry on. He succeeded in getting the final decision on his status with the unit deferred - until, while on leave, he was able to obtain a careful examination by one of the senior Canadian cardiologists. He confirmed the diagnosis of coronary insufficiency, with angina pectoris, and stated that he couldn’t possibly continue in army service.
这名男子于 1943 年自愿参军，时年 37 岁，担任突击队员。随着在加拿大的训练期接近尾声，且就在他们计划出国前，他在用力时胸部正中央出现疼痛。最终，在一次最后的长途行军中，他在行进三英里后无法继续，只能退出。他对自己的不适及其时机感到非常尴尬，直到这次无法继续时才报告。最终，他成功推迟了部队对他身份的最终决定——直到休假期间，他得以接受一位加拿大高级心脏病专家的仔细检查。专家确认了冠状动脉功能不全并伴有心绞痛的诊断，并表示他绝不可能继续服兵役。

He consulted me on March 13, 1947, and since blood pressure, pulse, and resting electrocardiogram were normal, was started on 400 units daily of alpha tocopherol. Ten days later, he felt definite improvement, and recovery was nearly complete between the third and fourth weeks of treatment and complete by the sixth week.
他于 1947 年 3 月 13 日来咨询我，由于血压、脉搏和静息心电图均正常，开始每天服用 400 单位的α-生育酚。十天后，他感觉明显好转，治疗的第三至第四周之间几乎完全康复，第六周时完全康复。

He has been called up annually by the medical board of the Veterans’ Hospital and is usually questioned at length about his treatment with vitamin E. On one occasion, just to test the reaction of his examining physician, he stated that he had stopped this treatment. The physician became fairly agitated, walked up and down for awhile, and finally said, “You’re the biggest damn fool I’ve seen today. You know what it has done for you, why did you stop it?” He then went on to say he wasn’t allowed to prescribe it in the Department of Veterans’ Affairs, but “it certainly was good.”
他每年都会被退伍军人医院的医疗委员会召唤，并且通常会被详细询问关于他使用维生素 E 的治疗情况。有一次，为了测试检查他的医生的反应，他说自己已经停止了这种治疗。医生相当激动，来回走了好一会儿，最后说：“你是我今天见过的最大的傻瓜。你知道它对你有什么好处，为什么要停用？”然后他接着说，他在退伍军人事务部不被允许开这种药，但“它确实很好”。

This man’s first symptoms began at age 37 . He is now 64, works every day, and lives a normal life. He has just survived an episode of pneumonia following an attack of the “Hong Kong flu,” a severe test of his cardiac condition.
这个人最初的症状出现在 37 岁时。他现在 64 岁，每天工作，过着正常的生活。他刚刚在经历了一次“香港流感”后患上肺炎，成功度过了这一严重考验他的心脏状况的难关。

He has had 27 years of normal health following the onset of severe coronary insufficiency, severe enough to invalid him out of the army on an army pension. Our army doesn’t pay pensions on “suspected” coronary disease!
他在严重冠状动脉功能不全发作后，已经有 27 年保持正常健康，这种严重程度足以使他退伍并领取军队养老金。我们的军队不会因为“疑似”冠状动脉疾病而支付养老金！

Here is the history of a man who retired twice, years apart, on pension.
这是一个男人两次退休、相隔多年领取养老金的故事。

This man came to us first on June 16, 1952, at the age of 48. He had severe angina pectoris on exertion and was off work.
这个人于 1952 年 6 月 16 日第一次来找我们，当时 48 岁。他在劳累时有严重的心绞痛，无法工作。

On alpha tocopherol he was free of pain by November 1, 1952, but was retired from his job as a railroad section foreman on a pension of $\mathrm{\$}50.00$$\mathrm{\$}50.00$$50.00\$ 50.00 a month.
到 1952 年 11 月 1 日，他服用α-生育酚后已经无痛，但作为铁路区段工头的工作已退休，领取每月 $\mathrm{\$}50.00$$\mathrm{\$}50.00$$50.00\$ 50.00 的养老金。

On vitamin E, he was returned to “good health” with very rare brief attacks of angina pectoris.
关于维生素 E，他恢复了“良好健康”，仅偶尔出现极少的短暂心绞痛发作。

He went back to work at a new job and has just been retired on a second pension at age 65 (compulsory retirement age).
他回去做了一份新工作，并且刚刚在 65 岁（法定退休年龄）领取第二份养老金退休。

fever is a distressing and sometimes fatal illness, usually with a variety of painful symptoms, it is the frequency with which it leads to rheumatic heart disease that, above all other considerations, demands rapid and effective treatment. Rheumatic heart disease, in turn, is the commonest form of heart disease in children and is responsible for 90 per cent of defective hearts among the young.
发烧是一种令人痛苦且有时致命的疾病，通常伴有各种疼痛症状，正是它导致风湿性心脏病的频率，使得这一点在所有其他考虑之上，要求迅速而有效的治疗。风湿性心脏病反过来是儿童中最常见的心脏病形式，并且是导致年轻人中 90%心脏缺陷的原因。

It is also the second most prevalent form of heart disease in adults, accounting for 30 per cent of crippled hearts and about 50 per cent of the deaths from heart disease that occur before 30 years of age. It is the cause of death of between 30,000 and 60,000 people in the U.S. yearly.
它也是成年人中第二常见的心脏病形式，占瘫痪心脏的 30％和 30 岁前因心脏病死亡人数的大约 50％。它是美国每年 3 万到 6 万人死亡的原因。

The average life of patients with definitive rheumatic heart disease is about 15 years after its onset. About 50 per cent live less than nine years. In adults, about 75 per cent of sufferers from rheumatic heart disease die as a direct result, mostly due to congestive heart failure, while about 10 per cent die of thrombosis or infarction, and about six per cent develop bacterial endocarditis, inflammation of membranous and connective tissues of the heart. Clearly the responsible rheumatic fever is a major medical problem.
确诊风湿性心脏病患者的平均寿命约为发病后 15 年。约有 50%的患者存活不到九年。在成人中，约 75%的风湿性心脏病患者直接死于该病，主要是由于充血性心力衰竭，约 10%死于血栓形成或梗死，约 6%发展为细菌性心内膜炎，即心脏膜状和结缔组织的炎症。显然，导致该病的风湿热是一个重大的医学问题。

There are many curious features of this disease worth mentioning here. First of all, there are no specific diagnostic features, and the patient or his family may not be aware that he is ill. On the other hand, he may have evidence of involvement of the serous (serum-producing) membranes of joints or those enveloping the brain and spinal cord of pleura or pericardium and be acutely ill with all gradations in between these two states. Involuntary jerky movements (chorea) and circular reddened areas on the skin, with elevated edges, are other important diagnostic signs. Daily or semiweekly electrocardiograms shows transitory abnormalities in more than 95 per cent of hospitalized patients, which suggests that most victims of rheumatic fever have heart damage.
这种疾病有许多值得一提的奇特特征。首先，没有特定的诊断特征，患者或其家属可能不知道他生病了。另一方面，他可能表现出关节浆液（产生浆液的）膜或包裹大脑和脊髓的膜、胸膜或心包膜受累的迹象，并且病情严重，介于这两种状态之间有各种程度。非自主的抽动性运动（舞蹈病）和皮肤上带有隆起边缘的环状红斑是其他重要的诊断标志。每日或每周两次的心电图显示，超过 95%的住院患者存在短暂的异常，这表明大多数风湿热患者都有心脏损伤。

As a result of the great variation in the initial symptoms and the lack of specific diagnostic criteria, the patient with rheumatic heart disease may be totally maware of his condition, until he develops progressive breathlessness on exertion or an attack of acute shortness of breath or the gradual appearance of peripheral edema, several years later.
由于最初症状的巨大差异和缺乏具体的诊断标准，风湿性心脏病患者可能完全不知道自己的病情，直到几年后出现运动时进行性呼吸困难、急性呼吸急促发作或逐渐出现外周水肿。

Although a specific group A hemolytic streptococcal infection precedes the rheumatic fever, treatment of the latter by the sulfonamides or penicillin is useless. Yet, the gradual decrease in the incidence of rheumatic heart disease is almost certainly due to the adequate treatment with these drugs of patients with the preceding streptococcal infection. In a word, rheumatic heart disease can be prevented by antibiotic therapy, but not treated.
虽然风湿热之前有特定的 A 群溶血性链球菌感染，但用磺胺类药物或青霉素治疗风湿热本身是无效的。然而，风湿性心脏病发病率的逐渐下降几乎可以肯定是由于对先前链球菌感染患者进行了充分的这些药物治疗。总之，风湿性心脏病可以通过抗生素治疗来预防，但不能治疗。

The reason that this subject is so important and that this chapter follows after the chapters on coronary artery disease, is that there is a most successful treatment for the acute and early stages of rheumatic heart disease. On the other hand, there is no evidence that any of the currently
这个主题之所以如此重要，并且本章紧随冠状动脉疾病章节之后，是因为对于风湿性心脏病的急性和早期阶段，有一种非常成功的治疗方法。另一方面，目前没有证据表明任何现有的治疗方法能够...
popular forms of treatment has any effect upon the progress of the disease. Rest in bed, suppression of pain and fever, etc., while making the patient more comfortable do not alter the damage to the structures or to the progress of the disease.
流行的治疗方法是否对疾病的进展有任何影响。卧床休息、缓解疼痛和发热等虽然能使患者更舒适，但并不能改变组织的损伤或疾病的进展。

Currently, the disease is usually regarded as an allergic phenomenon since it has been shown that the poison affects the whole of the cardiovascular tree with the most serious damage affecting the heart muscles and the valves of the heart. The pathologists have described a typical lesion as affecting the “ground substance” of the connective tissue, although Murphy has shown that the Aschoff nodule may result from rheumatic injury to the heart muscle cell with its eventual disintegration and replacement with scar tissue.
目前，这种疾病通常被视为一种过敏现象，因为已经证明毒素影响整个心血管系统，最严重的损害发生在心肌和心脏瓣膜。病理学家描述了一种典型的病变，影响结缔组织的“基质”，尽管 Murphy 表明 Aschoff 结节可能是风湿性损伤心肌细胞，最终导致细胞解体并被瘢痕组织取代的结果。

The initial damage done by rheumatic fever occurs in the region surrounding the blood vessels that supply the heart muscle and the serum-producing membranes. In the heart the perivascular reaction causes areas of injury with fluid accumulation and the collection of inflammatory cells. Small areas of myocardium - heart muscle - are destroyed, and the final result is a myocardium full of many, many small areas of scar tissue. The inflammation of the serous membranes lining the heart, inside and out, leads to injury, scarring, and eventually scar-tissue contraction. Since the valves are folds of endocardium, they become involved in 85 per cent of cases. The scarring and contraction lead to thickening and narrowing of the valves, with a decrease in the size of the orifice when the valve is open, or it may be so distorted as to be unable to close completely, or both.
风湿热造成的最初损伤发生在供应心肌和产生浆液的膜周围的血管区域。在心脏中，血管周围的反应导致受损区域出现液体积聚和炎症细胞的聚集。心肌——心脏肌肉——的小区域被破坏，最终结果是心肌中充满了许多小的瘢痕组织区域。覆盖心脏内外的浆膜的炎症导致损伤、瘢痕形成，最终瘢痕组织收缩。由于瓣膜是心内膜的褶皱，85%的病例中瓣膜都会受到影响。瘢痕形成和收缩导致瓣膜增厚和狭窄，瓣膜开放时口径变小，或者瓣膜变形严重以至于无法完全关闭，或者两者兼有。

These lesions attack the valves directly at the line of opposition of the opposing cusps, with thickening of the valve, eventual scarring and deformity, and shortening of the chordae tendinae.
这些病变直接攻击瓣膜，在对合瓣膜的接触线上，导致瓣膜增厚，最终形成瘢痕和变形，以及腱索缩短。

With good recovery from the acute attack of rheumatic fever, with an average degree of damage to the heart muscle and valves, there is usually a quiescent period during which the patient may be apparently perfectly well. Indeed, such a person may engage in vigorous athletics successfully for years without knowing he has heart damage. In my own
在急性风湿热发作得到良好恢复，心肌和心脏瓣膜受损程度为中等的情况下，通常会有一个静止期，患者看起来可能完全健康。事实上，这样的人可能多年成功地进行剧烈运动而不知道自己有心脏损伤。在我自己的经历中
experience, professional football and baseball athletes and Olympic skating and swimming competitors are numbered among my rheumatic heart disease cripples.
经历过的职业橄榄球和棒球运动员以及奥林匹克滑冰和游泳选手，都在我的风湿性心脏病残疾患者之列。

To summarize:  总结：
Rheumatic fever is a vicious disease, sometimes difficult to diagnose in its early stages, sometimes escaping detection during its acute phase. Whenever it attacks a patient, there is usually some damage to the heart, and no treatment currently used, except the alpha tocopherol treatment about to be described, has been shown to do anything to alter its inexorable course.
风湿热是一种恶性疾病，有时在早期阶段难以诊断，有时在急性期逃避检测。每当它侵袭患者时，通常会对心脏造成一定损害，而目前使用的任何治疗方法，除了即将描述的α-生育酚治疗外，都未被证明能改变其不可避免的进程。

Apart from the one to four per cent, who die in the acute stage, it is a chronic disease, with progessive damage to heart valves and heart muscle, leading to recurrences of the acute phase or to the final stages of chronic rheumatic heart disease.
除了 1%到 4%的患者在急性期死亡外，这是一种慢性疾病，心脏瓣膜和心肌逐渐受损，导致急性期复发或进入慢性风湿性心脏病的晚期阶段。

The actions of alpha tocopherol which affect the acute rheumatic fever and the early stages of the cardiac complications, or the similar state in a recurrent attack of rheumatic fever, are those which diminish the allergic reactions in the cardiovascular tree, those that prevent capillary thrombosis and consequent tissue destruction, and those which decrease the oxygen need of the tissue.
α-生育酚对急性风湿热及心脏并发症早期阶段，或风湿热复发时类似状态的作用，是减少心血管系统过敏反应、防止毛细血管血栓形成及随之的组织破坏，以及降低组织对氧气的需求。

Alpha tocopherol’s ability to return abnormal capillaries to normal reduces fluid accumulation within and between cells, promotes normal gas interchange across the involved cell membranes, and seems thereby to halt the disease very rapidly. Decreased oxygen need allows rapid recovery and rapid healing.
α-生育酚使异常毛细血管恢复正常的能力减少了细胞内外的液体积聚，促进了受影响细胞膜的正常气体交换，从而似乎能够非常迅速地阻止疾病的发展。氧气需求的减少使得快速恢复和快速愈合成为可能。

The effect of alpha tocopherol in acute rheumatic fever can best be illustrated by two cases, the first one ever so treated and a more recent one.
α-生育酚在急性风湿热中的效果可以通过两个病例最好地说明，第一个是曾经接受过这种治疗的病例，另一个是最近的病例。

Twenty-three years ago, I was called out to a neighboring farm to see an acutely ill boy of 15 years. When 11 years old, the lad had had an attack of acute rheumatic fever and was treated in the most famous Canadian hospital for sick children, where he was kept for seven months on the ward and was then sent to that hospital’s convalescent hospital, where he remained a patient for another 15 months before
二十三年前，我被叫到邻近的农场去看一位急性病重的 15 岁男孩。这个男孩 11 岁时曾患急性风湿热，在加拿大最著名的儿童医院接受治疗，他在那里住了七个月的病房，随后被送到该医院的康复医院，在那里又作为病人住了 15 个月，之后才...
returning home to his family’s farm. After some weeks at home, he was permitted to do minor chores that were not physically taxing, such as feeding the chickens. He gradually increased his activity until the summer of 1946, when, while riding the tractor, he developed pain in one wrist and, within 24 hours, had a definite migrating acute rheumatic fever.-
回到家族农场。回家几周后，他被允许做一些不费体力的小活儿，比如喂鸡。他逐渐增加活动量，直到 1946 年夏天，当他骑着拖拉机时，手腕一侧开始疼痛，24 小时内出现了明显的迁移性急性风湿热。

When I examined him, his temperature was 100.3 , his pulse 120, and three joints were involved. The wrist which had been acutely involved was by now almost normal again; one knee was acutely inflamed and swollen, and the other knee was beginning to be involved. The tags remaining from a tonsillectomy, which had been performed while he was in the original hospital, had become reddened and inflamed.
当我检查他时，他的体温是 100.3，脉搏 120，三个关节受累。之前急性受累的手腕现在几乎恢复正常；一只膝盖急性发炎肿胀，另一只膝盖开始受累。原先在最初医院进行的扁桃体切除术留下的疤痕变得发红和发炎。

His heart was moderately enlarged and showed the typical murmurs of mitral stenosis - narrowing of the orifice on the left side of the heart - and of mitral regurgitation, due to incomplete closure of the valve.
他的心脏中度增大，表现出典型的二尖瓣狭窄杂音——心脏左侧口径变窄——以及二尖瓣返流杂音，因瓣膜关闭不完全所致。

The only treatment I used for the boy was 200 units of alpha tocopherol daily. In three days he was apparently well, and on the sixth day he walked into my office. He was able to return to normal farm activities.
我给男孩使用的唯一治疗方法是每天服用 200 单位的α-生育酚。三天后他显得明显好转，第六天他走进了我的办公室。他能够恢复正常的农场活动。

In November of that same year, 1946, along with several other of my patients, he was examined by four eminent university staff cardiologists, who remarked on the existing cardiac enlargement and the murmurs. When they questioned him about his physical condition, however, he told them that he had just spent four days pulling turnips.
同年 11 月，1946 年，他和我的其他几位病人一起接受了四位著名大学心脏病专家的检查，他们指出了现有的心脏扩大和杂音。然而，当他们询问他的身体状况时，他告诉他们自己刚刚花了四天时间拔萝卜。

Since then, he has remained perfectly well; has grown into a tall, well-developed man; has done all sorts of manual labor, including one summer’s work harvesting grain in the Canadian west, and since then has worked in a feed mill where the labor is taxing.
从那时起，他一直保持完全健康；长成了一个高大、发育良好的男子；做过各种体力劳动，包括一个夏天在加拿大西部收割谷物的工作，此后一直在一个劳动强度大的饲料厂工作。

When I was first called to see this boy, his mother remarked that she didn’t know how she could face another 22 months of hospitalization and subsequent convalescence. He was the thirteenth child in the family, and obviously his mother had her hands full with her entire brood. I could offer no reassurance at that time, for this was the first case
当我第一次被叫去看这个男孩时，他的母亲说她不知道自己如何能面对接下来的 22 个月住院治疗和随后的康复期。他是家里的第十三个孩子，显然他的母亲已经忙不过来了，照顾着整个大家庭。那时我无法给予任何安慰，因为这是我遇到的第一个病例。
in all the world in which rheumatic fever had been treated with vitamin E. Fortunately the result obtained exceeded even my hopes. His total convalescence was six days.
在全世界所有用维生素 E 治疗风湿热的病例中，幸运的是，得到的结果甚至超出了我的预期。他的完全康复用了六天。

One day in July, 1968, a 20 -year-old neighbor, who had just finished his first year in pharmacy and who was working for the summer in the service department of a large tire manufacturing company, developed soreness of his left wrist. This was on a Friday morning. The company doctor put the joint at rest with a palmar splint, and by the following Monday the wrist was nearly pain-free, and he returned to work. Monday afternoon he developed a sore, swollen left knee, and the company doctor diagnosed acute rheumatic fever and sent him home to his family physician. Since he was the son of the patient described in the chapter on acute coronary occlusion, his mother phoned me. I had her take him to the hospital laboratory for sedimentation rate, white blood cell count, etc., and after iny afternoon office hours called on him at home. By this time his right knee was swollen and sore, he was running a fever, and was willing to admit he was in real pain. He was started immediately on 800 I.U. of alpha tocopherol and was perfectly well 48 hours later - clinically and by all known laboratory tests.
1968 年 7 月的一天，一位 20 岁的邻居刚完成药学第一年学业，暑期在一家大型轮胎制造公司的服务部门工作，左手腕开始感到酸痛。那是一个星期五的早晨。公司医生用掌侧夹板让关节休息，到下周一时，手腕几乎无痛，他便回去工作。星期一下午，他的左膝开始肿痛，公司医生诊断为急性风湿热，并让他回家找家庭医生。由于他是急性冠状动脉阻塞章节中提到患者的儿子，他的母亲给我打了电话。我让她带他去医院实验室做血沉、白细胞计数等检查，下午下班后我去他家看望他。此时，他的右膝也肿痛，发烧，并且愿意承认自己确实很痛苦。立即开始给予 800 国际单位的α-生育酚治疗，48 小时后，他的临床症状和所有已知的实验室检查均显示完全康复。

On the third day, Thursday, I surprised him, up and dressed and entertaining two of his college chums, who were trying to throw him into their back yard swimming pool. He was successfully resisting them when I came by.
第三天，星期四，我给了他一个惊喜，他已经起床穿好衣服，正在招待他的两个大学好友，他们正试图把他扔进后院的游泳池。当我经过时，他正成功地抵抗着他们。

By any other method of treatment, he would, of necessity, have been weeks or months in bed, his pain controlled by aspirin, salicylates, or cortisone, but his basic condition not one whit helped. His future might well have been altered materially since 85 per cent of such patients develop permanent cardiac damage. ${}^{\text{.}}$${}^{\text{. }}$^(". "){ }^{\text {. }}
通过任何其他治疗方法，他必然需要卧床数周或数月，疼痛由阿司匹林、水杨酸盐或可的松控制，但他的基本状况丝毫未得到改善。他的未来很可能会发生重大变化，因为 85%的此类患者会发展为永久性心脏损伤。 ${}^{\text{.}}$${}^{\text{. }}$^(". "){ }^{\text {. }}

Now, one year later, he is apparently perfectly well, and there is no detectable evidence of any cardiac damage.
现在，一年过去了，他显然完全健康，没有任何可检测到的心脏损伤迹象。

Still another early case, a boy of I2 years seen in the children’s hospital in consultation, illustrates the rapid recovery possible with alpha tocopherol and no other treatment. This lad had a typical acute rheumatic fever with evidence of severe cardiac involvement. It was when the
另一个早期病例是一名 12 岁的男孩，在儿童医院会诊时被发现，说明了仅用α-生育酚而无其他治疗即可实现的快速康复。这名男孩患有典型的急性风湿热，伴有严重心脏受累的迹象。正是在那时
family physician, and the specialist he had called in, explained the seriousness of the condition and the grave prognosis that the father asked that I be called in as a consultant. He had developed pericardial and pleural effusion in addition to his joint involvement.
家庭医生和他请来的专家解释了病情的严重性和严重的预后，父亲要求叫我作为顾问介入。他除了关节受累外，还出现了心包积液和胸腔积液。

At the time he was seen, we were cautiously using larger doses of the drug and started him on 600 units a day. His symptoms disappeared by the third day, his pericardial and pleural effusions completely by the sixth day. He was discharged from the hospital on the tenth day and has remained perfectly well since - a matter of 19 years or so.
在他被看到的时候，我们正在谨慎地使用更大剂量的药物，给他开始服用每天 600 单位。他的症状在第三天消失，心包和胸腔积液在第六天完全消失。他在第十天出院，之后一直保持完全健康——大约已经 19 年了。

Two of our earliest cases of acute rheumatic fever have interesting stories worth recounting. One, first seen in 1948 during an acute recurrence of the disease and with the characteristic murmurs of mitral stenosis, did characteristically well with alpha tocopherol treatment. In 1954, he had joined the Royal Canadian Air Force. Although he had told them his cardiac history, exhaustive examination revealed no evidence of the disease. On his first leave he came to me for a check-up, and I was also unable to find any evidence of rheumatic heart disease.
我们最早的两例急性风湿热病例都有值得一述的有趣故事。其中一例于 1948 年首次发病，当时正处于疾病的急性复发期，并伴有二尖瓣狭窄的典型杂音，经过α-生育酚治疗后表现良好。1954 年，他加入了加拿大皇家空军。尽管他向他们说明了自己的心脏病史，详尽的检查却未发现疾病的任何迹象。第一次休假时，他来找我做检查，我也未能发现风湿性心脏病的任何证据。

The second case is similar in all respects, except that he applied for enrollment in a forestry survey camp in northern Ontario. Here also the well-established murmurs, typical of rheumatic heart disease with mitral stenosis, had disappeared.
第二个病例在各方面都类似，只是他申请加入了安大略北部的一个林业调查营。在这里，典型的风湿性心脏病伴二尖瓣狭窄的明显杂音也消失了。

I was fortunate enough to examine a Royal Canadian Air Force veteran, who had been discharged from the service almost exactly two years after an initial attack of rheumatic fever. On his discharge, careful examination had revealed no murmur. Three months later I examined him for entrance into the local agricultural college under the Department of Veterans’ Affairs. At this time, he had a definite presystolic mitral murmur, although he felt perfectly well. With alpha tocopherol, it gradually lessened and had disappeared by the fourth month. When last seen, six years later, there was no evidence of heart damage.
我有幸检查了一位加拿大皇家空军退伍军人，他在首次风湿热发作后几乎整整两年才退役。退役时，仔细检查未发现杂音。三个月后，我在他申请退伍军人事务部下属的当地农业学院时对他进行了检查。此时，他有明显的收缩前二尖瓣杂音，尽管他感觉完全正常。服用α-生育酚后，杂音逐渐减轻，到第四个月时已消失。六年后最后一次见面时，没有心脏损伤的迹象。

We, of course, have many such patients who have lived normal lives and remained well after adequate treatment
我们当然有许多这样的患者，在经过充分治疗后过上了正常的生活并保持健康
in childhood of acute or recurrent acute rheumatic fever, and the response of patients seen more recently has been the same.
儿童时期急性或复发性急性风湿热的情况，最近观察到的患者反应也是相同的。

For example, one first seen May 29, 1967, at the age of nine years, will illustrate the point. He was interesting, because he was the only child of an unusual couple. The father was Japanese, a black belt jujitsu expert and teacher and the mother a white Caucasian, apt pupil of the art.
例如，一个于 1967 年 5 月 29 日首次见到的九岁男孩可以说明这一点。他很有趣，因为他是一个不同寻常的夫妇的唯一孩子。父亲是日本人，是柔术黑带专家和教师，母亲是白人高加索人，是这门艺术的优秀学生。

The lad had an attack of acute rheumatic fever in January, 1963 and has since had a recurrent fever of 101 to 102.3 with any exertion. He suffered from epistaxis once or twice a week and perspired excessively with the slightest exertion. He was markedly short of breath on exertion. Following his attack of acute rheumatic fever, when symptoms did not subside, he was kept in bed from September, 1964 until December, 1965. He continued to show fever all the while. From December, 1965 to April of 1966 he was partially confined to bed, since he had to learn to walk all over again. His mother then took him to California for two months where she heard about vitamin E treatment, and she started to give him 50 to 100 units daily. His temperature fell to normal for the most part, and his general condition started to improve.
这名男孩于 1963 年 1 月患上急性风湿热发作，此后只要稍微活动就会反复发烧，体温在 101 到 102.3 度之间。他每周有一到两次鼻出血，稍微活动就大量出汗。活动时明显气短。在急性风湿热发作后，症状未见缓解，他从 1964 年 9 月卧床休息直到 1965 年 12 月，期间持续发烧。从 1965 年 12 月到 1966 年 4 月，他部分卧床，因为他必须重新学习走路。随后，他的母亲带他去加利福尼亚两个月，在那里她听说了维生素 E 治疗，开始每天给他服用 50 到 100 单位。他的体温大部分时间恢复正常，整体状况开始好转。

I accidentally met his mother who was standing beside a friend of mine in a large crowd at a dog show, the friend talking about my use of vitamin E. However, the boy did not come to me for examination or treatment for some months.
我偶然遇到了他的母亲，她正站在我一个朋友旁边，在一场大型犬展的人群中，那位朋友正在谈论我使用维生素 E。然而，那个男孩几个月内没有来找我检查或治疗。

On examination, there was nothing remarkable except for a faint presystolic murmur at the apex. His temperature was normal when seen in the office. I raised his dose of alpha tocopherol to 300 units a day, and he improved steadily over the next six weeks. He has been playing ball, without distress or fever, and he has remained clinically well since.
检查时，除了心尖部有轻微的收缩前杂音外，没有发现异常。他在诊所时体温正常。我将他的α-生育酚剂量提高到每天 300 单位，接下来的六周内他逐渐好转。他一直在打球，没有不适或发烧，且此后一直临床表现良好。

A 16-year-old girl, first seen on October 31, 1967, had not been well since an infection in April of 1967, the condition complicated by an allergy to grasses. She did not respond to antibiotics and in spite of treatment, developed severe pains in her left chest. X-rays showed a pleural effusion, treated by a change in antibiotics, but she was not told to
一名 16 岁的女孩，首次就诊于 1967 年 10 月 31 日，自 1967 年 4 月感染以来身体一直不适，病情因对草类过敏而复杂化。她对抗生素无反应，尽管接受了治疗，左胸部仍出现剧烈疼痛。X 光显示有胸腔积液，通过更换抗生素进行治疗，但她没有被告知去做什么。
go to bed. She became very tired, ran a chronic fever, and when she tried to run became dyspneic and cyanotic, a condition of insufficient oxygenation characterized by blueness of the skin. Her mother took her to the Cleveland Clinic at the end of August, 1967, and after exhaustive laboratory X-ray and other tests, she was diagnosed as having mitral regurgitation. She was given penicillin and released from the clinic. She showed no improvement up to the time she presented herself to me on October 31, 1967.
去睡觉。她变得非常疲惫，持续发烧，当她试图走动时出现呼吸困难和发绀，这是一种因氧气供应不足而导致皮肤发蓝的状况。她的母亲于 1967 年 8 月底带她去了克利夫兰诊所，经过详尽的实验室、X 光及其他检查后，诊断为二尖瓣返流。她接受了青霉素治疗后出院。在 1967 年 10 月 31 日她来找我时，病情没有任何改善。

Her heart was well “up to size,” her blood pressure 100/40. She was cyanotic, and she showed a definite mitral regurgitation. She was started immediately on 300 units of alpha tocopherol daily. By December 13, 1967, she was “fine,” ever so much better, free of fever, and had very little, if any, cyanosis. By February, 1968, she was active in sports with no handicaps and could swim without dyspnea.
她的心脏大小正常，血压为 100/40。她呈现发绀，且明显有二尖瓣返流。她立即开始每天服用 300 单位的α-生育酚。到 1967 年 12 月 13 日，她“状况良好”，好转很多，无发热，几乎没有发绀。到 1968 年 2 月，她能够积极参加体育运动，没有任何障碍，游泳时也无呼吸困难。

Except for acute thrombophlebitis and acute glomerulonephritis, there is nothing so dramatic in this field of medicine as the response to adequate vitamin E therapy in acute rheumatic fever.
除了急性血栓性静脉炎和急性肾小球肾炎，在医学领域中，没有什么比急性风湿热对充足维生素 E 治疗的反应更为显著的了。

the second most common form of heart disease and accounts for 30 per cent of the crippled hearts in the adult. It is the cause of death in 30,000 to 60,000 persons annually in the U.S. It accounts for virtually all heart disease deaths between the ages of five and 25 years- 50 per cent of all deaths before the age of 30 .
第二常见的心脏病类型，占成年瘫痪心脏病例的 30%。它是美国每年 3 万到 6 万人死亡的原因。它几乎占据了五岁到二十五岁之间所有心脏病死亡的全部——占三十岁以下所有死亡的 50%。

There had been no treatment available to prevent the onset of this disease until the sulfonamide and antibiotic era. However, since the general use of these drugs, the incidence of rheumatic fever and, consequently, of rheumatic heart disease, has been decreasing. This is because adequate treatment of invasion of the body by group $\dot{A}$$\dot{A}$A^(˙)\dot{A} hemolytic streptococci, usually type 12 , and its elimination prevent the allergic response of the body, some three weeks or so later, that is rheumatic fever.
在磺胺类药物和抗生素时代之前，没有可用的治疗方法来预防这种疾病的发生。然而，自从这些药物被广泛使用以来，风湿热的发病率以及随之而来的风湿性心脏病的发病率一直在下降。这是因为对由 12 型β-溶血性链球菌（通常为 12 型）侵入人体的充分治疗及其清除，防止了大约三周后身体的过敏反应，即风湿热。

Unfortunately, in this context, many doctors use the sulfonamides and penicillin as infrequently as possible, no doubt due to the emphasis that was put on the dangers of their use when first introduced, but also because of the definite evidence now that their indiscriminate use and misuse have led to the development of resistant strains of virulent streptococci and staphylococci for which no antibiotic is effective.
不幸的是，在这种情况下，许多医生尽可能少使用磺胺类药物和青霉素，这无疑是因为最初引入时强调了其使用的危险性，但也因为现在有明确证据表明，它们的滥用和误用导致了耐药性强的致病性链球菌和葡萄球菌菌株的出现，而这些菌株对任何抗生素都无效。

Consequently, many children are not treated by antibiotics for their streptococcal infections, either because they are not presented to the doctor or the doctor elects not to use an antibiotic.
因此，许多儿童的链球菌感染未接受抗生素治疗，原因要么是他们没有去看医生，要么是医生选择不使用抗生素。

Of course, there are still those individuals who had their acute attacks of rheumatic fever before the antibiotic era and so are today suffering from chronic rheumatic heart disease. Again, no accurate statistics are available, but it is believed that one to six per cent of the general population have specific rheumatic valvular defects.
当然，仍有一些人在抗生素时代之前曾患急性风湿热发作，因此今天正遭受慢性风湿性心脏病的困扰。同样，没有准确的统计数据，但据认为，普通人群中有 1%到 6%存在特定的风湿性瓣膜缺陷。

These valvular defects consist of scarring of the cusps and shortening of the chordae tendinae. The resulting loss of efficiency in the functioning of the heart valves often leads to regurgitation-the backward flow of blood that has already passed through the valve in the correct forward direction. The most commonly involved valve is the mitral - the only one of the four that has but two cusps, which may account for its increased susceptibility.
这些瓣膜缺陷包括瓣叶的瘢痕形成和腱索的缩短。由此导致心脏瓣膜功能效率的下降，常常引起返流——即已经通过瓣膜向前流动的血液反向流动。最常受影响的瓣膜是二尖瓣——四个瓣膜中唯一只有两个瓣叶的，这可能是其易受损的原因。

The aortic valve is also commonly affected, while the pulmonic valve is rarely deformed, and the tricuspid valve also usually escapes deformity. Narrowing of the mitral valve is more common than mitral regurgitation and the combination is more common than either alone. On the other hand, aortic regurgitation is five times more common than aortic stenosis. Both aortic stenosis (narrowing of the aorta) and regurgitation are often combined, and rarely is there aortic stenosis alone.
主动脉瓣也常受影响，而肺动脉瓣很少变形，三尖瓣通常也不变形。二尖瓣狭窄比二尖瓣返流更常见，且两者同时存在比单独存在更常见。另一方面，主动脉返流比主动脉狭窄的发生率高五倍。主动脉狭窄（主动脉变窄）和返流常常同时存在，单独出现主动脉狭窄的情况较少。

A recent discussion of chronic rheumatic heart disease in the British Medical Journal (May, 1968) points out the grave characteristics of the disease and, better than any recent article, implies the total lack of any accepted treatment for the condition except surgery. In fact, the author advocates surgical treatment “as soon as it is certain that the valvular defect is of serious hemodynamic significance; that is to say the degree of stenosis or incompetence is causing objective evidence of severity whether or not symptoms are present.” The italics are the author’s, not mine.
英国医学杂志（1968 年 5 月）最近关于慢性风湿性心脏病的讨论指出了该病的严重特征，并且比任何近期文章都更明确地暗示，除了手术外，完全没有公认的治疗方法。事实上，作者主张“只要确定瓣膜缺损具有严重的血流动力学意义，即狭窄或关闭不全的程度已导致客观的严重证据，无论是否有症状，就应尽早进行手术治疗。”斜体字为作者所加，而非我加。

He stresses the fact that when the surgeons found they could open the heart they found that, more often than not, the medical diagnosis and assessment of the pathological processes present were quite wrong.
他强调，当外科医生发现他们能够打开心脏时，往往发现医学诊断和对存在的病理过程的评估大多是错误的。

The author’s reason for advocating early surgery is the established fact that the disease is chronic and that it leads to progressive changes in the pulmonary circulation in the
作者主张早期手术的理由是已确立的事实，即该疾病是慢性的，并且会导致肺循环的进行性变化
right ventricle and also, if there is cardiac failure, in the lungs.
右心室，如果有心脏衰竭，也会在肺部出现。

The author admits the obvious fact that surgery does not halt the rheumatic process and that the progressive sclerosis and calcification of the valve continues.
作者承认一个显而易见的事实，即手术并不能阻止风湿性过程，瓣膜的进行性硬化和钙化仍在继续。

We have seen many hundreds of such cases over the last 20 -odd years and while it is the hardest of all the various types of heart disease to treat, it is the most satisfactory in the long run. Virtually all those with early symptoms and normal sinus rhythm respond well and continue to improve slowly for many months. The more advanced cases are, in many instances, very difficult to treat, and require patient, careful attention for many weeks, initially. Yet, some of our most advanced cases have shown unexpected magnificent improvement.
在过去的 20 多年里，我们已经见过数百例此类病例，虽然这是所有类型心脏病中最难治疗的一种，但从长远来看效果最令人满意。几乎所有早期症状且窦性心律正常的患者反应良好，并在接下来的数月中缓慢持续改善。较为严重的病例在许多情况下非常难以治疗，最初需要数周耐心而细致的关注。然而，我们一些最严重的病例也显示出了意想不到的显著改善。

I have, of course, also followed with extreme interest the course of surgical treatment of these patients in many cardiac centers, since I have not wanted to be responsible for withholding help, directly or indirectly, from any patients by the use of an inferior form of treatment. Also, I have been fortunate in having had as a clinical instructor in medical school the most brilliant surgeon Canada has ever produced. He was one of the first, perhaps the first, to attempt correction of mitral stenosis surgically. The last time I talked to him, he said he was going to abandon surgery of the rheumatic heart until it was obvious that the long-term result was worthwhile.
我当然也极其关注许多心脏中心对这些患者进行的外科治疗过程，因为我不想因使用一种较差的治疗方法而直接或间接地拒绝任何患者的帮助。此外，我很幸运在医学院时有一位临床导师，他是加拿大有史以来最杰出的外科医生之一。他是最早尝试通过手术矫正二尖瓣狭窄的人之一，甚至可能是第一个。上次与他交谈时，他说他打算放弃风湿性心脏病的手术治疗，直到明确长期效果值得为止。

While hoping that improved surgical methods may make surgery superior to alpha tocopherol, at the time of writing it is obvious that alpha tocopherol is by far the best form of treatment available to the sufferer from chronic rheumatic heart disease. Certainly the type of patient that Dr. Turner suggests should be submitted to surgery will do very well indeed with alpha tocopherol therapy and will never need surgery. The far advanced case will do better with alpha tocopherol as well.
虽然希望改进的外科手术方法可能使手术优于α-生育酚，但在撰写本文时，显然α-生育酚是目前慢性风湿性心脏病患者可获得的最好的治疗方式。确实，Turner 医生建议应接受手术的那类患者，用α-生育酚治疗效果非常好，根本不需要手术。病情非常严重的患者用α-生育酚治疗效果也会更好。

It seems very hard to me to evaluate the results of surgical treatment in a patient “whether or not symptoms are present.” On the other hand, all the patients we see have devel-
对我来说，评估一位患者“无论是否有症状”接受外科治疗的结果似乎非常困难。另一方面，我们看到的所有患者都已经发展出—
oped symptoms, and these we remove in virtually all the early cases.
出现的症状，我们几乎在所有早期病例中都能消除。

There are very special characteristics of alpha tocopherol treatment in the case of the rheumatic heart disease patient, and I want to point out at the onset that the improper use of the drug may well kill the patient, while too small a dosage will have no effect whatsoever.
在风湿性心脏病患者中，α-生育酚治疗具有非常特殊的特点，我想一开始就指出，药物使用不当可能会致患者死亡，而剂量过小则完全无效。

In general, the dosage schedule of alpha tocopherol is totally different from that used in the other forms of heart disease. Referring back to the early part of this chapter it will be obvious that in most cases the damage to the heart is more severe on one side, usually the left, than it is on the other. This is because the mitral valve, between the left auricle and the left ventricle, is the valve that is most usually affected, while the valves in the right side may be totally unaffected. In other cases, there is damage in the valve or valves as well as the myocardium on both sides and as a result the hemodynamic effect may be nearly equal.
一般来说，α-生育酚的剂量方案与用于其他类型心脏病的方案完全不同。回顾本章前面部分，可以明显看出，在大多数情况下，心脏一侧的损伤通常比另一侧更严重，通常是左侧。这是因为位于左心房和左心室之间的二尖瓣是最常受影响的瓣膜，而右侧的瓣膜可能完全未受影响。在其他情况下，瓣膜或多个瓣膜以及两侧的心肌都有损伤，因此血流动力学效应可能几乎相等。

The heart is really two organs joined together by a common central septum. The right side has less work to do than the left in that, simply stated, it takes blood brought to it by the great veins and propels it into the pulmonary tree. On the other hand, the left side takes blood from the lungs and sends it around miles of steadily narrowing blood vessels. Consequently, the muscular wall of the left ventricle is much thicker than that of the right ventricle. When one side of the heart is unable to keep up its work normally because of abnormalities of the valves, while the other side is functioning well, fluid collects in the tissues proximal to the malfunctioning side, and the two sides of the heart are “out of balance.” Give such a patient a large dose of alpha tocopherol, and the good side improves faster than the poor side, the imbalance is increased, and the congestive failure becomes rapidly worsened. Continuation of large daily doses of alpha tocopherol will lead to rapid worsening and, if not withdrawn, to the patient’s death.
心脏实际上是由两个器官通过一个共同的中央隔膜连接在一起。右侧的工作量比左侧少，简单来说，它接收由大静脉带来的血液并将其推动进入肺动脉系统。另一方面，左侧从肺部接收血液，并将其送入数英里不断变窄的血管中。因此，左心室的肌肉壁比右心室厚得多。当心脏一侧由于瓣膜异常无法正常工作，而另一侧功能良好时，液体会在靠近功能不良一侧的组织中积聚，心脏的两侧“失去平衡”。给这样的患者大量服用α-生育酚，功能良好的一侧会比功能差的一侧改善得更快，失衡加剧，充血性心力衰竭迅速恶化。持续每天大量服用α-生育酚会导致病情迅速恶化，如果不停止用药，患者将会死亡。

The object of treatment, therefore, is to help the more damaged side of the heart very gradually and to bring its efficiency up so slowly that it comes into normal balance
因此，治疗的目标是非常缓慢地帮助心脏受损较重的一侧，并使其效率逐渐提高，直到达到正常平衡
with that of the good side. Then when the effective dose level is reached, the heart acting as a single unit will begin to improve.
与良好方面的情况相比较。当达到有效剂量水平时，心脏作为一个整体将开始改善。

Again, let me emphasize this unique response of the chronic rheumatic heart when treatment with alpha tocopherol is instituted.
再次让我强调，当使用α-生育酚治疗慢性风湿性心脏病时的这种独特反应。

Since we are unable to predict which patients can tolerate a fair-sized initial dose, a slow, cautious routine is now invariably used. It nearly always leads to eventual worthwhile improvement in such cases. We tell all such patients now that they can expect improvement to a worthwhile degree in approximately three to three and one-half months but will see none at all short of that length of time. If their condition is progressively worsening, it will continue to do so for the first three months or so, and they must use all the help available in the meantime from decreased activity, digitalis, or even diuretics, if needed, to control the symptoms of their disease. If the patient responds as expected, there will be no doubt in his mind or his physicians’ that he is definitely improved. He can be confidently advised that his condition will continue to improve slowly but steadily for many months.
由于我们无法预测哪些患者能够耐受较大剂量的初始用药，因此现在通常采用缓慢而谨慎的常规方法。这几乎总能在此类病例中最终带来有价值的改善。我们现在告诉所有此类患者，他们可以预期在大约三到三个月半的时间内达到有意义的改善，但在此之前不会看到任何效果。如果他们的病情持续恶化，前三个月左右仍会如此，在此期间必须利用减少活动、地高辛，甚至利尿剂（如有需要）等所有可用的帮助来控制疾病症状。如果患者如预期那样有反应，他本人和医生都会毫无疑问地认为病情确实有所改善。可以自信地告知他，病情将在接下来的数月内缓慢但稳定地持续改善。

In a few cases, after about eight weeks there is a definite improvement, then a worsening. This is evidence that even the dosage schedule is “too much, too soon,” so the alpha tocopherol should be stopped for a day and a half, recommenced at a slightly lower dosage level, and increased more slowly.
在少数情况下，大约八周后会有明显的改善，然后又恶化。这表明即使是剂量安排也是“过多，过快”，因此应停止服用α-生育酚一天半，然后以稍低的剂量重新开始，并更慢地增加剂量。

This dosage schedule is as follows:
此剂量安排如下：
For the first four weeks, the patient takes 90 units a day; for the second four weeks, 120 units a day, and then 150 units a day. One hundred and fifty units is usually the maximum tolerated for many months and ordinarily is enough. If more is given and the patient is unable to tolerate it, there
在最初的四周内，患者每天服用 90 单位；接下来的四周每天服用 120 单位，然后每天服用 150 单位。对于许多患者来说，150 单位通常是几个月内能耐受的最大剂量，通常也足够。如果服用更多且患者无法耐受，便会出现...
will be no change for seven to ten days, a little worsening around the fourteenth day, and a rapid return of unwanted symptoms thereafter. On the other hand, a dose that can be tolerated, with no change or with improvement for six weeks, will not cause regression of the cardiac status.
七到十天内不会有变化，约在第十四天左右会有些恶化，随后不良症状会迅速恢复。另一方面，一个能够耐受的剂量，在六周内无变化或有所改善，不会导致心脏状况的倒退。

The ideal dosage for patients with rheumatic heart discase is 300 units a day if and when they can tolerate it. On 300 units a day, nothing untoward can happen to the patient. He is no longer a case for worry or concern.
风湿性心脏病患者的理想剂量是每天 300 单位，如果他们能够耐受的话。每天服用 300 单位，患者不会发生任何不良反应。他不再是需要担忧或关心的病例。

However, most patients cannot and need not be raised to this level. It is a matter for precise medical judgment and skill. However, the characteristic of alpha tocopherol therapy so important to remember in all cases is nowhere better exemplified than in these cases. If the dose is too large, the patient will show no change for seven to ten days and will gradually worsen thereafter. Deterioration, though, will be at a sufficiently slow rate so that the doctor can take his time and check carefully to make sure that the patient really is deteriorating. When it is confirmed, stopping the use of the drug will lead to its rapid excretion and a quick drop in the level, so that no real harm is done.
然而，大多数患者无法也不需要达到这个水平。这需要精确的医学判断和技巧。然而，α-生育酚治疗的一个重要特征，在所有情况下都值得记住，在这些病例中表现得尤为明显。如果剂量过大，患者在七到十天内不会有变化，之后会逐渐恶化。不过，恶化的速度足够缓慢，医生可以从容不迫地仔细检查，以确认患者确实在恶化。一旦确认，停止使用该药物将导致其迅速排出，水平迅速下降，因此不会造成真正的伤害。

This is a basic concept in alpha tocopherol treatmentthe right dose of alpha tocopherol takes five to ten days to begin to act and four to six weeks before it becomes obviously effective. When the drug is stopped, it disappears from the body nearly completely after three days. Therefore, when evaluating the condition of a patient, it is necessary to remember that his present status is due to the dosage he has been taking continuously for the last month or more, not to that which he has been taking for the last week. The above applies in cardiac cases and in most peripheral vascular cases with arterial damage. In contrast, as stated elsewhere, the effects of the drug appear in hours in the patient with acute rheumatic fever, fresh thrombophlebitis or very early glomerulorphritis.
这是α-生育酚治疗的一个基本概念——正确剂量的α-生育酚需要五到十天才能开始起效，四到六周后才会明显有效。当药物停止使用后，三天内几乎完全从体内消失。因此，在评估患者状况时，必须记住他目前的状态是由于过去一个月或更长时间持续服用的剂量，而不是过去一周服用的剂量。上述情况适用于心脏病病例和大多数伴有动脉损伤的周围血管病例。相反，如其他地方所述，药物的效果在急性风湿热、新发血栓性静脉炎或非常早期的肾小球肾炎患者中数小时内显现。

The history of my absolutely favorite patient will illustrate these principles very well. As a child, she contracted diphtheria with some weeks of soft palate paralysis, followed by rheumatic fever within weeks. She apparently made a
我最喜欢的病人的故事将很好地说明这些原则。她小时候患了白喉，软腭瘫痪持续了几周，几周后又患了风湿热。她显然康复了。
normal recovery from these conditions except for a slight residual effect of soft palate paralysis from the diphtheria. A few years later she had scarlet fever. Her recovery was apparently complete, since when 16 years old and again when 20 , she represented Canada at the Olympic Games. She was the first Canadian swimmer to break an Olympic and an American record in her specialty, the breast stroke, and was also an all-round swimmer and winner of the Gail Trophy for Ornamental Swimming.
从这些状况中正常恢复，除了白喉引起的软腭麻痹有轻微的残留影响。几年后她患了猩红热。她的恢复显然是完全的，因为在 16 岁和 20 岁时，她代表加拿大参加了奥运会。她是第一位打破奥运会和美国纪录的加拿大游泳运动员，专长蛙泳，同时也是一名全能游泳选手，曾获得盖尔奖杯的花样游泳冠军。

Nevertheless, she had sustained an important degree of cardiac damage, which showed up for the first time during her second pregnancy. She was on a small dose of vitamin E to maintain this pregnancy, and an increased dose solved the problem of her congestive failure. Without our knowledge, she was treated perfectly for her cardiac condition during her two pregnancies, both of which were initiated and maintained with great difficulty by vitamin E. However, after delivery, vitamin E was deemed unnecessary, was withdrawn, and again congestive failure ensued.
然而，她已经遭受了重要程度的心脏损伤，这在她第二次怀孕期间首次显现出来。她服用了小剂量的维生素 E 以维持这次怀孕，增加剂量解决了她的充血性心力衰竭问题。在我们不知情的情况下，她在两次怀孕期间都得到了完美的心脏病治疗，这两次怀孕都是通过维生素 E 艰难地开始和维持的。然而，分娩后，维生素 E 被认为不再必要，被停止使用，充血性心力衰竭再次发生。

On 150 units of alpha tocopherol, which was the dosage used during the last months of the second pregnancy, her congestive failure disappeared, and she was rapidly returned to apparently normal health.
在使用 150 单位的α-生育酚（这是第二次怀孕后期使用的剂量）时，她的充血性心力衰竭消失了，她迅速恢复到看似正常的健康状态。

By persistence, by trial and error really, her dosage was gradually increased as she was able to tolerate it. Many times it was necessary to stop for one and one half days and decrease it to the former level. It took nearly ten years before she could tolerate 300 units a day, but on this quantity she has been very well, swims, plays golf, and looks after all her own housework.
通过坚持，实际上是通过反复试验，她的剂量逐渐增加，随着她能够耐受。很多次需要停药一天半，然后将剂量降低到之前的水平。花了将近十年时间，她才能够耐受每天 300 单位的剂量，但在这个剂量下，她身体非常好，游泳、打高尔夫，并且自己打理所有家务。

Four years ago, because she was in her mid-fifties and needed protection if possible against the danger, however remote, of a coronary thrombosis, I raised her dose of alpha tocopherol from 300 units to 375 units a day. This precipitated congestive failure with marked trouble in breathing (dyspnea), inability to get her breath lying down (or-
四年前，因为她年逾五十多岁，且如果可能的话需要防范冠状动脉血栓形成的危险，尽管这种危险很遥远，我将她的α-生育酚剂量从每天 300 单位提高到 375 单位。这引发了充血性心力衰竭，伴有明显的呼吸困难（呼吸急促），躺下时无法正常呼吸（或—
thopnea), and a cough due to fluid in the alveoli of her lung. Correction of the dosage level by stopping it for one and a half days and resumption of 300 units led to rapid and complete recovery. After nearly 19 years of alpha tocopherol and nine years of 300 units, raising her dosage from 300 to 375 units could well have been fatal.
呼吸困难）和因肺泡内积液引起的咳嗽。通过停药一天半并恢复服用 300 单位的剂量，病情迅速且完全恢复。经过近 19 年的α-生育酚治疗和九年的 300 单位剂量，将剂量从 300 增加到 375 单位很可能是致命的。

The following cases are chosen because they were among the very first treated 23 years ago. All are still living and doing well. Obviously, they would all be dead by now but for alpha tocopherol.
以下病例之所以被选中，是因为它们是 23 年前最早接受治疗的病例之一。所有人至今仍然健在且状况良好。显然，如果没有α-生育酚，他们现在早已去世。

The first one was seen by a group of Canadian cardiologists who commented on the gross enlargement of his heart and obvious valvular murmurs.
第一位患者由一组加拿大心脏病学家诊断，他们评论了他心脏的明显肿大和明显的瓣膜杂音。

He gave no history of rheumatic fever and had always been healthy and rugged, enjoying outdoor activities. He was, therefore, surprised when he was rejected for army service because of evidence of rheumatic heart damage. At the age of 24 , he began to develop shortness of breath (dyspnea) on exertion and a distressing cough. He worked in a factory, packing pickles, a relatively easy job, and yet became so dyspneic that he had to sit down on a barrel to continue his work. He lived in a small house heated by a coal stove and brought up coal from the cellar for the stove in a coal scuttle. This exertion caused marked dyspnea. Frequently, he reached the stage where, when he washed his face and hands after work, he had to stop and sit down before he could dry them.
他没有风湿热病史，一直健康强壮，喜欢户外活动。因此，当他因风湿性心脏损害的证据而被拒绝入伍时，他感到很惊讶。24 岁时，他开始在劳累时出现呼吸急促（呼吸困难）和令人不安的咳嗽。他在一家工厂工作，包装泡菜，这是一份相对轻松的工作，但他却变得如此呼吸困难，以至于不得不坐在桶上继续工作。他住在一间用煤炉取暖的小房子里，从地窖里用煤铲取煤给炉子添煤。这种劳累引起了明显的呼吸困难。经常，当他下班后洗脸洗手时，必须停下来坐一会儿，才能擦干。

After three or four weeks, he came to the author as a physician, not knowing that I was beginning to use alpha tocopherol. He was one of those treated in the first year of our investigation of the use of alpha tocopherol in treating heart disease. We had not yet discovered that many such patients cannot tolerate large doses so we started him on 300 units a day from the beginning. He was completely well in three days and had changed his job and was “cutting sand” in the local foundry-a very hard job. We were both astonished, and I found it very nearly unbelievable. It was some time later before I realized how very lucky we both were. He was one of those who could tolerate 300 units
三四周后，他作为一名医生来找作者，却不知道我已经开始使用α-生育酚。他是我们在第一年研究使用α-生育酚治疗心脏病时治疗的患者之一。我们当时还没有发现许多此类患者无法耐受大剂量，因此一开始就给他服用了每天 300 单位。他三天内完全康复，换了工作，在当地铸造厂“切割砂子”——这是一项非常辛苦的工作。我们俩都感到非常惊讶，我几乎难以置信。过了一段时间，我才意识到我们俩是多么幸运。他是那些能够耐受 300 单位剂量的人之一。
from the beginning of treatment.
从治疗开始。
He was still working at the foundry when he was presented, some four months later, to a group of cardiologists and internists, who attested to the accuracy of the diagnosis and their amazement that he could do such work. His only treatment was alpha tocopherol.
大约四个月后，他仍在铸造厂工作时，被介绍给一群心脏病专家和内科医生，他们确认了诊断的准确性，并对他能够从事这样的工作感到惊讶。他唯一的治疗是服用α-生育酚。

He presented another peculiarity of alpha tocopherol therapy in chronic rheumatic heart disease. After two years of treatment he stopped taking his medication. It was a full six months before he began to develop the symptoms of cardiac failure again, even though he continued to work at the foundry. He was started back on 300 units of alpha tocopherol, since, although we had by now discovered the danger of such a large initial dose, he had responded to it originally. Again he was apparently well in four days. This is contrary to our usual experience in coronary heart disease in which the value of the drug is dissipated in as little as three days.
他提出了慢性风湿性心脏病中α-生育酚治疗的另一个特殊现象。经过两年的治疗后，他停止服药。尽管他继续在铸造厂工作，直到六个月后他才开始出现心力衰竭的症状。随后他重新开始服用 300 单位的α-生育酚，尽管我们此时已经发现如此大剂量的初始用量存在危险，但他最初对这种剂量有反应。四天后，他再次显得健康。这与我们在冠心病中的通常经验相反，后者中药物的效果在短短三天内就会消失。

Obviously, it would be highly desirable to be able to predict which patient could tolerate 300 units initially. So far no criteria have been discovered or developed, and so we must play safe and begin with the small initial dose and gradual increase- 90 units a day for a month, 120 units for a month, then 150 units.
显然，能够预测哪个患者最初能耐受 300 单位的剂量是非常理想的。到目前为止，还没有发现或制定出相关标准，因此我们必须谨慎行事，先从小剂量开始，逐渐增加——每天 90 单位，持续一个月；然后每天 120 单位，再持续一个月；接着每天 150 单位。

The New England Journal of Medicine (Volume 279, no. 22, November 28, 1968) carried an article on “Edema and Hemolytic Anemia in Premature Infants, A Vitamin E Deficiency Syndrome” by Ritchie, Fish, McMasters, and Grossman in which this same time interval for the development of clinical results is stated and in which the necessity of a properly standardized product is mentioned. To quote:
《新英格兰医学杂志》（第 279 卷，第 22 期，1968 年 11 月 28 日）刊登了一篇题为“早产儿的水肿和溶血性贫血，维生素 E 缺乏综合症”的文章，作者为 Ritchie、Fish、McMasters 和 Grossman，文中提到了临床结果出现的相同时间间隔，并提及了使用适当标准化产品的必要性。引用如下：
"Serum tocopherol level. The serum tocopherol rose to the adequate level of 0.4 mg . per 100 ml . or above within one to three weeks after institution of vitamin E therapy and reached a mean of 0.67 mg . per 100 ml . (range of 0.51 to 0.98 ) in four to six weeks.
血清生育酚水平。维生素 E 治疗开始后一到三周内，血清生育酚升至足够水平，即每 100 毫升 0.4 毫克或以上，并在四到六周内达到平均每 100 毫升 0.67 毫克（范围为 0.51 至 0.98）。
“Clearing of edema. The edema of all sites, and the associated symptoms, cleared completely within a month of the initiation of vitamin E therapy.”
“水肿消退。所有部位的水肿及相关症状在开始维生素 E 治疗一个月内完全消退。”

This article also states that oral iron negates the effect of vitamin E.
这篇文章还指出口服铁会抵消维生素 E 的效果。

In the light of the far-out theory of some cardiologists that polyunsaturated fatty acids are so desirable, the findings in this paper are certainly timely. “In animals and man, the amount of vitamin E requisite to prevent deficiency has been shown to rise when the polyunsaturated fatty acid (PUFA) content of the diet is increased.” Uncontrolled, unthinking increase of polyunsaturated fats in the human diet may well increase the incidence of coronary heart disease in patients and have an adverse effect in all other types of heart disease! They will interfere with the treatment of cardiac patients by alpha tocopherol, since much of the tocopherol will be used up in preventing oxidation of the fats.
鉴于一些心脏病学家提出的多不饱和脂肪酸极为有益的前卫理论，本文的发现无疑具有及时性。“在动物和人体中，已证明当饮食中多不饱和脂肪酸（PUFA）含量增加时，预防缺乏所需的维生素 E 量也会增加。”在人类饮食中不加控制、盲目增加多不饱和脂肪可能会增加冠心病患者的发病率，并对所有其他类型的心脏病产生不利影响！它们会干扰用α-生育酚治疗心脏病患者，因为大量的生育酚将被用于防止脂肪氧化。

We, here in Canada, have been very much interested in the participation of one of our biochemists currently on the staff of the Hospital for Sick Children in Toronto, Dr. David Turner. It was his research which revealed why earlier spacemen, up to and including the Borman flight, had suffered a loss of 20 to 30 per cent of their red blood cells during flights and thus became anemic and fatigued. The reason: a lack of vitamin E in the prepared foods carried by the astronauts. On the Apollo 10 flight, astronauts took vitamin E , and the breakdown of the red blood cells was prevented. They suffered no red cell loss. Two interesting comments made by Dr. Turner in a TV interview were these:
我们这里加拿大，非常关注我们的一位生物化学家——现任多伦多儿童医院工作人员的大卫·特纳博士的参与。他的研究揭示了为什么早期的宇航员，包括博尔曼飞行在内，在飞行过程中红细胞损失了 20%到 30%，因此出现贫血和疲劳。原因是宇航员携带的预制食品中缺乏维生素 E。在阿波罗 10 号飞行中，宇航员服用了维生素 E，红细胞的破坏得以防止，他们没有红细胞损失。特纳博士在一次电视采访中提出了两个有趣的评论：

He said that the solution was a guess but that it came to him because he had been in London, Ontario (the site of The Shute Institute), when two London doctors had claimed medical value for vitamin E and, secondly, that the present popular fad for replacing animal fats by the polyunsaturated form led to a decrease in utilizable and necessary vitamin E and that such patients should be given increasing vitamin E. He made the usual mistake, so common in scientists who have had no practical experience with the substance, of stating that vitamin E is in rich supply in normal diets. Vitamin E is, but alpha tocopherol, its only medically potent fraction, just is not.
他说这个解决方案只是一个猜测，但之所以想到它，是因为他曾在安大略省伦敦市（The Shute Institute 所在地），当时两位伦敦医生声称维生素 E 具有医疗价值；其次，目前流行用多不饱和脂肪替代动物脂肪，导致可利用且必需的维生素 E 减少，因此这类患者应增加维生素 E 的摄入。他犯了一个常见错误，这在没有实际使用经验的科学家中很普遍，即声称维生素 E 在正常饮食中供应充足。维生素 E 确实充足，但其唯一具有医疗效力的成分α-生育酚却并非如此。

Specific cases continue.  具体案例持续出现。
One worth mentioning is that of a 32 -year-old woman, seen ten months after delivery of her first and only child. As this is being written, this child is due to graduate next month in Honour Arts at a Western Canadian university.
值得一提的是一位 32 岁的女性，在生下她的第一个也是唯一的孩子十个月后就诊。写这段话时，这个孩子预计下个月将在加拿大西部一所大学荣誉艺术专业毕业。

At the age of 29 , before marriage and while teaching school, this woman had one attack of cardiac decompensation with auricular fibrillation. This was diagnosed as due to chronic rheumatic heart disease. On digitalis and bed rest, the rhythm returned to normal, the failure disappeared, and she returned to her teaching. She married a man who soon afterwards went overseas. On his return, they decided because they were now both over 30 , that if they were to have a family they should begin at once. However, mindful of her one episode of auricular fibrillation and failure, they wished to be reassured that it was safe for her to become pregnant. They, therefore, consulted a cardiologist and an obstetrician-both certified in their specialties, holding teaching posts at the university, and well regarded in this largest of Canadian cities. Both assured her that it was safe to proceed and that they would “watch her through,” whatever that means.
29 岁时，在结婚前且任教期间，这位女性曾发生一次心脏功能失代偿伴心房颤动的发作。诊断为慢性风湿性心脏病所致。在使用地高辛和卧床休息后，心律恢复正常，心力衰竭消失，她恢复了教学工作。她嫁给了一位不久后出国的男子。归国后，他们决定因为双方都已超过 30 岁，如果要有孩子，应立即开始。然而，考虑到她曾有一次心房颤动和心力衰竭发作，他们希望确认怀孕对她是否安全。因此，他们咨询了一位心脏病专家和一位产科医生——两人均为各自专业认证的大学教师，并在加拿大最大城市中享有盛誉。两位专家都保证怀孕是安全的，并表示会“全程监护”，无论这意味着什么。

The result was that seven days after delivery she started to fibrillate and went into deep failure. Under the care of her predelivery cardiologist, she tried to carry on in the home with the help of friends and her husband. The husband was trying to start his own business and was frustrated to the point of anger by the necessity of helping at home and store. By coincidence, recently, another much more recent patient recalled this case. She was one of the friends who attempted to help. She described the chaos and confusion of the household with an active infant and his invalid mother. She had furniture and equipment for looking after the baby at table height, since she was unable to lift the baby.
结果是在分娩七天后，她开始出现心房颤动并进入严重衰竭状态。在产前心脏病专家的照料下，她试图在家中继续生活，依靠朋友和丈夫的帮助。丈夫正试图创业，但因必须在家和店里帮忙而感到沮丧甚至愤怒。巧合的是，最近另一位更近的病人回忆起了这个病例。她是试图帮忙的朋友之一。她描述了有一个活泼婴儿和病弱母亲的家庭中的混乱和困惑。她带来了适合照顾婴儿的家具和设备，放在桌子高度，因为母亲无法抱起婴儿。

She came to us after ten months of this, in extreme failure and indeed, with our limited experience, we were sure we could not help her. She agreed to stay in the city and to attend the clinic daily. We started her on 300 units of alpha
她在经历了十个月的这种状况后来到我们这里，情况极度恶化，实际上，凭我们有限的经验，我们确信无法帮助她。她同意留在城里，每天来诊所。我们开始给她服用 300 单位的 alpha。
tocopherol a day, but she became rapidly much worse. We then started her over again on 75 units per day, with gradual increase, and her condition began to improve. Within six months, while ambulatory all this time, her failure disappeared, and she was able to look after her baby, her home, and her husband.
每天服用生育酚，但她的情况迅速恶化。然后我们重新开始给她每天 75 单位，逐渐增加，她的状况开始好转。六个月内，虽然这段时间一直能行走，她的衰竭消失了，她能够照顾她的宝宝、家庭和丈夫。

Now, after 20 years, still fibrillating, she is an officer in her university alumnae and the Ladies’ Aid of her church and sings in the choir. She has had the care of invalid parents, has moved twice as her husband gained promotions in a large company, and, at 53 , is considering giving up some of her social obligations. She will cross the continent next month to see her only son graduate from university.
现在，经过 20 年，仍然心房颤动，她是她所在大学校友会和教会妇女援助团的干事，并在合唱团唱歌。她照顾过病弱的父母，随着丈夫在一家大公司晋升，她搬了两次家，现年 53 岁，正在考虑放弃一些社交义务。下个月她将横跨大陆去看她唯一的儿子大学毕业。

Understanding the mode of action of alpha tocopherol in chronic rheumatic heart disease depends upon a knowledge of the pathology of the disease, as well as the many actions of the drug. The rheumatic fever episode or episodes that precipitated the cardiac damage consisted of multiple submiliary granuloma affecting the valves and the heart muscle both. Small areas of heart muscle die at the site of multiple Aschoff bodies, the most typical rheumatic granuloma. The resultant scars may be very numerous and certainly decrease the functional level of the myocardium. The healing of these lesions in the valve is effected by vascularization and scar-tissue formations. These processes continue throughout the lifetime of the patient, until the changes have reached the point where the heart can no longer function normally under normal conditions of living.
理解α-生育酚在慢性风湿性心脏病中的作用机制，依赖于对该疾病病理以及该药物多种作用的了解。引发心脏损伤的风湿热发作包括多个亚显微肉芽肿，影响心脏瓣膜和心肌。心肌小区域在多个 Aschoff 小体（最典型的风湿性肉芽肿）处坏死。由此形成的瘢痕可能非常多，且确实降低了心肌的功能水平。这些病变在瓣膜处的愈合通过血管化和瘢痕组织形成实现。这些过程贯穿患者一生，直到病变达到心脏在正常生活条件下无法正常功能的程度。

Of course, there are other factors involved. If the patient lives long enough he will inevitably develop a significant degree of coronary artery disease with consequent diminution of blood supply to the myocardium already damaged by rheumatic heart disease. The two insults to the myocardium add up to too much. Then, too, the continuing damage to the valve leads to a difficult mechanical state, which along with the muscle damage, adds up to a breakdown of cardiac function and the beginning of a failing circulation.
当然，还有其他因素。如果患者活得足够长，他不可避免地会发展出显著程度的冠状动脉疾病，导致血液供应减少，而心肌已经因风湿性心脏病受损。对心肌的这两重打击加起来太严重了。此外，瓣膜的持续损伤导致机械状态变得复杂，这与肌肉损伤一起，最终导致心脏功能衰竭和循环系统开始衰退。

Of course, incidental factors may precipitate failure, pregnancy being one well-known example. Overwork, acute
当然，偶发因素可能引发衰竭，怀孕就是一个众所周知的例子。过度劳累，急性
infections, or an accident are other such examples.
感染或事故是其他类似的例子。
For many years, the fact that such patients showed obvious abnormalities in heart sounds, due to the damage to the valves, led to over-concern with this factor alone. Then for a time the focus of attention was the myocardium, since it was obviously impossible to alter the valvular damage. Then again, attention was directed chiefly to the valvular abnormalities when the surgeon entered the picture.
多年来，由于瓣膜受损，这些患者表现出明显的心音异常，这一事实使人们过分关注这一因素。随后一段时间，注意力转向了心肌，因为显然无法改变瓣膜损伤。后来，当外科医生介入时，注意力又主要集中在瓣膜异常上。

However, the patient when he applies for treatment has had a marked degree of damage to the valves for years without symptoms, chiefly because the damaged myocardium has been able to cope with the added load placed upon it by valvular incapacities.
然而，患者在申请治疗时，心脏瓣膜已经受到了多年的明显损伤但无症状，主要是因为受损的心肌能够应对瓣膜功能障碍所带来的额外负担。

Alpha tocopherol prevents scar-tissue contraction which we have shown in our burn cases, to be discussed later. However, it also relaxes scar tissue already found in such cases as Dupuytren’s contracture and in Peyronie’s disease. There has been indirect evidence in our own cases of rheumatic heart disease in that many juvenile cases, treated early and continuously, have shown a disappearance of their murmurs. Presumably the degree of valvular damage was such that murmurs were beginning to be created, but alpha tocopherol treatment reversed the scar tissue formation or contraction, or both.
α-生育酚可以防止瘢痕组织收缩，这一点我们在烧伤病例中已经证明，稍后将讨论。然而，它也能放松已经存在于杜普伊特伦挛缩和佩罗尼氏病等病例中的瘢痕组织。在我们自身的风湿性心脏病病例中也有间接证据，许多早期且持续接受治疗的青少年病例其心脏杂音消失了。推测心脏瓣膜损伤程度刚好开始产生杂音，但α-生育酚治疗逆转了瘢痕组织的形成或收缩，或两者兼有。
Therefore, one important action of the drug is to halt the damage in the valve and to slowly, and probably to a widely varying degree, in different cases restore some of the elasticity and function to the valve.
因此，该药物的一个重要作用是阻止瓣膜的损伤，并在不同病例中以缓慢且可能差异很大的程度恢复瓣膜的一部分弹性和功能。

By the decrease in the oxygen need of the heart muscle its function is improved and eventually can once more cope with the added work load due to the valvular damage. Further, the restoration of normal capillary permeability and the establishment of normal gas transfers across the cell membranes halts the degenerative process of the disease and prevents the further, and otherwise inevitable and relentless, progress of the disease.
通过减少心肌对氧气的需求，其功能得以改善，最终能够再次应对因瓣膜损伤而增加的工作负荷。此外，恢复正常的毛细血管通透性和细胞膜上的正常气体交换，阻止了疾病的退行性过程，防止了疾病进一步且本不可避免且无情的进展。

Many cases of cardiac crippling due to this disease come to mind. The majority of our patients obtain worthwhile help, though a few do not. Some are too far advanced for
许多因这种疾病导致心脏残疾的病例浮现在脑海中。我们的大多数患者都获得了有价值的帮助，尽管有少数没有。一些患者病情已经过于严重，无法挽回。
help of any kind, and this type of case has, so far, been refused by the surgeon. Some improve for a time but then develop further trouble and deteriorate. Some discontinue treatment after a few years, only to inevitably return, but may be by then much harder to treat successfully.
任何形式的帮助，这类病例迄今为止已被外科医生拒绝。一些患者暂时有所好转，但随后出现进一步的问题并恶化。一些患者在几年后停止治疗，结果不可避免地复发，但此时可能更难成功治疗。

In the long run, the chronic rheumatic heart disease patient has given us some of our greatest satisfaction, partly because he is so often relatively young and a parent of a young family and is so badly needed.
从长远来看，慢性风湿性心脏病患者给了我们极大的满足感，部分原因是他们往往相对年轻，是年轻家庭的父母，且非常需要被照顾。

One case I remember well is that of a 47 -year-old man, a laborer and a physical exercise devotee, who developed a pain in the left shoulder and a rapid irregular heartbeat when he lifted an 800 -pound pipe out of a truck on his left shoulder. He became short of breath, developed an ache in the left side of his chest, and suffered “black-outs” on exertion.
我记得有一个病例，是一位 47 岁的男子，体力劳动者且热衷于体育锻炼，他在用左肩从卡车上抬起一根 800 磅重的管子时，左肩开始疼痛，心跳迅速且不规则。他感到呼吸急促，左胸部出现疼痛，并在用力时出现“晕厥”。

He was told he had an irregular heart and had developed heart failure. He was given digitalis and told to take it easier at work.
他被告知心脏不规则，已经发展成心力衰竭。他被开了地高辛，并被告知工作时要放松些。

On examination, his heart was enlarged to the left; his heart rate was 60 , with auricular fibrillation; he had a trace of pitting edema, and the murmurs of mitral stenosis.
检查时，他的心脏向左扩大；心率为 60，伴有心房颤动；有轻微凹陷性水肿，伴有二尖瓣狭窄的杂音。

Treatment consisted of 25 mgs . twice a day of Hydrodiuril, a diuretic which was discontinued after six months; digitalis sufficient to keep his apex rate at approximately 75 per minute, and the routine alpha tocopherol dosage of 90 units a day for a month, 120 units a day for the second month, and 150 units thereafter. After three and one-half months he was definitely better and was working steadily, but still had dyspnea with heavy work.
治疗包括每天两次各 25 毫克的 Hydrodiuril（一种利尿剂），六个月后停用；洋地黄剂量足以使他的心尖率保持在每分钟约 75 次；常规的α-生育酚剂量为第一个月每天 90 单位，第二个月每天 120 单位，此后每天 150 单位。三个月半后，他明显好转，工作稳定，但重体力劳动时仍有呼吸困难。

After five months he was able to do much heavier work, and after nine months he felt perfectly well.
五个月后，他能够做更重的工作，九个月后他感觉完全健康。

Eleven months after beginning treatment, he was injured at work and developed phlebitis, which yielded promptly and completely to 450 units of alpha tocopherol in four days.
开始治疗十一个月后，他在工作中受伤，患上了静脉炎，经过四天服用 450 单位的α-生育酚后，症状迅速且完全缓解。

He has been perfectly well ever since. He still has auricular fibrillation, the rate controlled with digitalis. In January, 1966, his dosage of alpha tocopherol was raised to 300 unit. successfully.
从那以后他一直非常健康。他仍然患有心房颤动，心率通过地高辛控制。1966 年 1 月，他的α-生育酚剂量成功提高到 300 单位。

This case is included for two reasons. This man developed auricular fibrillation and congestive heart failure in 1959, yet during the years 1962 to 1968, he worked as a laborer laying water pipe for the water works department of a city. His foreman was a religious fanatic and after a disagreement on religion made sure this patient did all the heavy work. Such work as he had to do called for a man of unusual strength. Secondly, as mentioned, he is a physical exercise “nut” and does push-ups, knee bends, etc., before work and before going to bed. He’s fantastic! He’s 57.
这个案例包含两个原因。这个人在 1959 年出现了心房颤动和充血性心力衰竭，但在 1962 年至 1968 年期间，他作为一名工人在一个城市的水务部门铺设水管。他的工头是个宗教狂热分子，在一次宗教争执后，确保这名患者做所有重体力活。他所做的工作需要非凡的力量。其次，如前所述，他是个体育锻炼“狂热者”，在工作前和睡觉前做俯卧撑、屈膝等运动。他非常了不起！他今年 57 岁。

Fortunately, since the foreman has retired, he has had a better and much easier job during the last year.
幸运的是，自从工头退休后，他在过去一年里有了一份更好且轻松得多的工作。

A single woman, aged 48, was first scen on May 2, 1962. She complained of extreme tiredness, shortness of breath on climbing stairs, edema of both ankles by evening, and severe muscle cramps in both feet.
一位 48 岁的单身女性于 1962 年 5 月 2 日首次就诊。她抱怨极度疲劳，上楼时呼吸急促，晚上双脚踝水肿，双脚严重肌肉痉挛。

She had two attacks of chorea (involuntary movements) as a child. She developed pneumonia at the age of 20 and following convalescence from this returned to work, but collapsed at her place of employment. She was seen by her doctor who referred her to the dean of cardiologists in Canada. He made the diagnosis of rheumatic heart disease, and she was put to bed for several months. She was able to work only six months from the age of 20 to 28 .
她小时候曾两次患舞蹈病（不自主运动）。20 岁时患肺炎，康复后回去工作，但在工作地点晕倒。她的医生看过她后，将她转诊给加拿大心脏病学主任。他诊断为风湿性心脏病，她卧床休息了几个月。从 20 岁到 28 岁，她只能工作六个月。

She did regain ability to work for the next 20 years by living a carefully restricted life. However, in the weeks before coming to me she had developed fast heartbeat and palpitation and the edema, etc., previously mentioned.
她通过过着严格限制的生活，确实恢复了接下来 20 年的工作能力。然而，在来找我之前的几周，她出现了心跳加快和心悸以及之前提到的水肿等症状。

On examination her heart was found to be considerably enlarged with particular enlargement of the left auricle. Her hemoglobin was 50 per cent (anemia), her blood pressure $120/80$$120/80$120//80120 / 80, pulse regular at a rate of 72 . She had a little edema of both ankles and moderate to small varicosities superficially in both legs.
检查时发现她的心脏明显增大，尤其是左心耳增大。她的血红蛋白为 50％（贫血），血压正常，脉搏规律，频率为 72。她双脚踝有轻微水肿，双腿表面有中等到轻微的静脉曲张。

She was started on the routine dosage schedule of alpha tocopherol - 90 units for four weeks, 120 units for the next four weeks, and then 150 units a day. For the first month she took all this in a single dose and an iron product in a
她开始按照常规剂量服用α-生育酚——前四周每天 90 单位，接下来的四周每天 120 单位，然后每天 150 单位。第一个月她将所有剂量一次性服用，并服用一种铁制剂。
single dose 12 hours later to avoid interference with her vitamin E . On this schedule her hemoglobin rose to 82 per cent, and she was symptom-free.
单次剂量在 12 小时后服用，以避免与她的维生素 E 发生干扰。按照这个时间表，她的血红蛋白升至 82%，且无症状。

In November, 1962, she developed a broncho-pneumonia with pain in her chest. On December twenty-eighth at 11 p.m. she developed a right-sided femoral artery thrombosis with numbness in the leg. She was immediately hospitalized, and on examination it was found that she had developed auricular fibrillation with râles in the base of both lungs. Her leg was cold and white, and there was no pulsation in the arteries below the inguinal ligament.
1962 年 11 月，她患上了支气管肺炎，胸部感到疼痛。12 月 28 日晚上 11 点，她出现了右侧股动脉血栓，腿部麻木。她立即住院，经检查发现她出现了心房颤动，双肺底部有罗音。她的腿冰冷发白，腹股沟韧带以下的动脉无搏动。

Her alpha tocopherol dosage was doubled, she was digitalized by the rapid method, and within hours the leg had returned to normal with a return of pulsation in all palpable vessels. She was discharged four weeks after admission.
她的α-生育酚剂量加倍，采用快速方法进行了地高辛治疗，数小时内腿部恢复正常，所有可触及血管的脉搏恢复。入院四周后她出院了。

She was able to return to work in two more weeks and remained quite well for the next five years. On her regular check-up on May 9, 1967, she reported blood in her stool. She was immediately sent to a surgeon who found a carcinoma (cancer) of the upper third of the rectum. Microscopically, the small invasive tumor did not penetrate the muscle layer, and the surgeon felt sure that there would be no recurrence.
她能够在两周后重返工作岗位，并在接下来的五年里保持相当健康。1967 年 5 月 9 日的定期检查中，她报告大便带血。她立即被送往外科医生处，发现直肠上三分之一处有一处癌（癌症）。显微镜下，这个小的侵袭性肿瘤未穿透肌肉层，外科医生确信不会复发。

The cardiologist assigned to watch her while in this hospital does not “believe” in vitamin E, and although the surgeon promised me she would be on her vitamin E while in the hospital, except for the day of the operation, she did not receive it. The result was a large area of acute thrombophlebitis in the right leg on the fourth post-operative day. The relatives called me, I went into town to see her, telephoned her surgeon who hastened down to the hospital, and restored her alpha tocopherol. She made an uneventful recovery and was discharged three weeks after surgery.
这家医院指派的心脏病专家不“相信”维生素 E，虽然外科医生答应我她在住院期间会服用维生素 E，但除了手术当天，她并没有服用。结果是在术后第四天，她的右腿出现了大面积急性血栓性静脉炎。亲属打电话给我，我赶到城里去看她，给她的外科医生打电话，医生迅速赶到医院，恢复了她的α-生育酚（维生素 E）治疗。她顺利康复，术后三周出院。

She has done very well since, and today was in for her regular check-up. After more than seven years of attendance here, she volunteered the information that she felt very well, better than for a long time.
她从那以后恢复得很好，今天来做定期检查。经过七年多的就诊，她主动表示自己感觉非常好，比很长一段时间以来都要好。

auxiliary instrument in the diagnosis of cardiac disorders, but its limitations must be understood and its rightful place realized. It is often quite normal in the presence of gross cardiac abnormality, and the abnormal patterns can occur in patients with perfectly normal hearts. It therefore gives false negatives as well as false positives.
辅助仪器在心脏疾病诊断中起辅助作用，但必须了解其局限性并认识其应有的位置。即使存在严重的心脏异常，其结果也常常是正常的，而异常模式也可能出现在心脏完全正常的患者中。因此，它既会出现假阴性，也会出现假阳性。

Moreover, in coronary heart discase, many tracings submitted to several cardiologists will produce widely different interpretations. Those called normal by some will be interpreted as showing evidence of heart damage by others. Of course, all will agree on the significance of certain specific changes in many tracings.
此外，在冠心病中，提交给多位心脏病专家的许多心电图会产生截然不同的解读。有些专家认为正常的心电图，其他人则会解读为显示心脏损伤的证据。当然，所有人都会对许多心电图中某些特定变化的重要性达成一致。

Dr. D. Short (113) of the Aberdeen Royal Infirmary investigated 206 consecutive cases of suspected mild or subacute coronary attacks. Of 36 patients who were later proven to have had a myocardial infarction, the initial electrocardiogram showed the infarction in only one quarter. Half of these initial electrocardiograms showed abnormalities which did not indicate infarction, and the balance had no abnormalities.
阿伯丁皇家医院的 D. Short 博士（113）调查了 206 例连续疑似轻度或亚急性冠状动脉发作的病例。在后来被证实患有心肌梗死的 36 名患者中，最初的心电图仅在四分之一的病例中显示了梗死。半数最初的心电图显示异常，但未指示梗死，其余则无异常。

In this study 100 electrocardiograms, along with the clinical notes originally submitted with the requisition, were submitted to 20 cardiologists. This group agreed entirely on 21 of the 100 electrocardiograms and most ( 90 to 95 per cent) agreed on another 23. A majority agreed on 77, but there was great disagreement on 23 .
在这项研究中，100 份心电图连同最初随申请提交的临床记录一起提交给了 20 位心脏病专家。该小组对 100 份心电图中的 21 份完全一致，对另外 23 份大多数（90%到 95%）达成一致。77 份获得了多数人的同意，但有 23 份存在很大分歧。

Of course, this is a very serious matter, since a firm diag-
当然，这是一个非常严重的问题，因为一个明确的诊断—
nosis of coronary occlusion was made in 49 cases by one cardiologist, but with the same tracings, on only 23 by another in contrast to 40 made originally!
冠状动脉闭塞的诊断由一位心脏病专家在 49 例中作出，但另一位专家仅根据相同的心电图记录诊断了 23 例，而最初诊断为 40 例！

Think what that variation meant to the patients concerned. The reverse is also worth dwelling upon, since 27 were said to be normal by one cardiologist, but only 14 by another!
想想这种差异对相关患者意味着什么。反过来也值得深思，因为一位心脏病专家说有 27 人是正常的，而另一位却只有 14 人！

Thirty per cent of the 206 cases had a final diagnosis of something in the heart other than infarction. In more than half of these the electrocardiogram was abnormal.
206 例中有 30%的最终诊断为心脏中除梗死以外的其他疾病。在这些病例中，超过一半的心电图异常。

Dr. Short concluded that “The limitation of the electrocardiogram lies in the fact that a single tracing recorded early in an attack of myocardial infarction frequently shows no absolutely diagnostic features, whereas in attacks not due to myocardial infarction, the electrocardiogram is often grossly abnormal on account of previous infarction or other cardiac disease.”
Short 博士总结道：“心电图的局限性在于，在心肌梗死发作早期记录的单次心电图往往没有绝对诊断特征，而在非心肌梗死引起的发作中，心电图常因既往梗死或其他心脏疾病而表现出明显异常。”

The diagnosis of acute rheumatic heart disease is made by the history of a preceding streptococcal infection and the clinical picture of a migrating acute arthritis, an increased sedimentation rate, etc. Most patients show transient electrocardiographic changes, typically a prolonged ST interval and may show peaked P waves, but these changes are usually missed.
急性风湿性心脏病的诊断依据是既往链球菌感染史和迁移性急性关节炎的临床表现、红细胞沉降率升高等。大多数患者表现出短暂的心电图变化，典型表现为 ST 间期延长，可能出现尖峰 P 波，但这些变化通常被忽视。

The diagnosis of chronic rheumatic heart disease is made on the basis of history and the typical murmurs as heard with the stethoscope. The electrocardiogram is usually normal if no auricular fibrillation has developed.
慢性风湿性心脏病的诊断是根据病史和用听诊器听到的典型杂音作出的。如果未发生心房颤动，心电图通常是正常的。

The diagnosis of hypertensive heart disease is made with the blood-pressure cuff. The electrocardiogram may show left axis deviation.
高血压性心脏病的诊断是通过血压袖带进行的。心电图可能显示左轴偏移。

In coronary atherosclerosis, with angina, even severe angina, the diagnosis is made purely on the patient’s history, perhaps reinforced by the effect of nitroglycerin on the attack. The electrocardiogram is commonly normal, although temporary changes may occur during an attack of pain.
在冠状动脉粥样硬化伴心绞痛，甚至严重心绞痛的情况下，诊断完全基于患者的病史，可能通过硝酸甘油对发作的效果加以确认。心电图通常正常，尽管在疼痛发作期间可能出现暂时性变化。

In coronary occlusion, as explained above, the initial electrocardiogram may be normal and the patient told that he does not have the condition. He may even be allowed to
如上所述，在冠状动脉闭塞时，最初的心电图可能是正常的，患者被告知他没有这种病症。他甚至可能被允许继续进行。
drive home to a distant city, as in several of the cases seen here. Usually, the electrocardiogram will show some diagnostic sign by the fifth day if it is going to. Then, too, patients with definite occlusions, with infarction, often appear weeks or months later with normal electrocardiograms, but with a definite diagnosis having been made elsewhere. This can be very confusing unless adequate electrocardiographic tracings were taken at appropriate intervals at the time of the occlusion and during hospitalization. This can be of utmost importance, of course, as the following case will illustrate.
驱车回到遥远的城市，就像这里看到的几个病例一样。通常，如果心电图要显示诊断性迹象，到了第五天就会出现。此外，确诊有闭塞和梗死的患者，往往在几周或几个月后出现正常的心电图，但在其他地方已经做出了明确诊断。除非在闭塞发生时及住院期间按适当间隔进行了充分的心电图记录，否则这可能会非常令人困惑。当然，这一点极为重要，以下病例将对此加以说明。

This man, aged 43, was seen on June 27, 1949, complaining of angina pectoris. His electrocardiogram was normal. In October, 1947 (20 months previously), while playing badminton in Montreal, he developed pain in his chest and right arm. He sat down for a few minutes and then finished the game. The pain recurred three weeks later. On November 27, 1947, he was hospitalized with the diagnosis of a posterior myocardial infarction from which he made an uneventful recovery. Shortly afterwards, he was offered a promotion, which involved moving to Toronto with his family, the move contingent upon evidence of adequate good health. Consequently, he was sent to another cardiologist, at a different hospital in the same city, who was, incidentally, the head of the medical staff. A tracing taken then was reported in these words, “One can read into this a degree of myocardial change, but I believe the changes are rather insignificant. There is certainly nothing to warrant a diagnosis of any coronary occlusion, and there is nothing very definite to suggest coronary sclerosis or insufficiency.”
这名 43 岁的男子于 1949 年 6 月 27 日就诊，主诉心绞痛。他的心电图正常。1947 年 10 月（20 个月前），他在蒙特利尔打羽毛球时，胸部和右臂出现疼痛。他坐下休息了几分钟后继续比赛。三周后疼痛复发。1947 年 11 月 27 日，他因诊断为后壁心肌梗死住院，恢复顺利。不久后，他获得晋升机会，需要携家人搬到多伦多，搬迁条件是健康状况良好。因此，他被送到同城另一家医院的心脏病专家处，该专家恰好是该院医务人员的负责人。当时的心电图报告写道：“可以看出一定程度的心肌变化，但我认为这些变化相当轻微。绝无任何证据支持冠状动脉闭塞的诊断，也没有明确迹象表明冠状动脉硬化或功能不全。”

Please note that he did not bother to contact the previous cardiologist in the same city or ask for the electrocardiogram from the other hospital. He further suggested that his symptoms might be due to gall bladder disease or to duodenal ulcer. X-rays showed a duodenal ulcer, which responded to treatment, and apparently absolved the heart of any complicity in the symptoms.
请注意，他没有费心联系同一城市的前一位心脏病专家，也没有向另一家医院索要心电图。他进一步提出，他的症状可能是由胆囊疾病或十二指肠溃疡引起的。X 光显示有十二指肠溃疡，经过治疗后有所好转，显然排除了心脏在症状中的任何牵连。

Of course, everyone was delighted. He received his promotion and moved his family to Toronto.
当然，大家都很高兴。他获得了晋升，并带着家人搬到了多伦多。

While skiing in February, 1949, he had a recurrence of chest pain. He was sent to the major hospital in Toronto, and an electrocardiogram taken reported as follows: “ST in CF-IV depressed. T-1 low diphasic and T-4 is low negative. The significance of the depressed ST-4 is unknown. The ST segments in leads I and II are a little low but would pass as within normal limits. Angina or coronary insufficiency can produce such a pattern.”
1949 年 2 月滑雪时，他胸痛复发。他被送往多伦多的一家大型医院，心电图报告如下：“CF-IV 导联 ST 段压低。T-1 低双相波，T-4 低负波。ST-4 段压低的意义不明。I 和 II 导联的 ST 段略低，但仍在正常范围内。心绞痛或冠状动脉功能不全可能导致这种表现。”

A review of this patient’s electrocardiograms obtained from all three hospitals and compared with ours proved that he had, indeed, had a coronary occlusion with a posterior myocardial infarction. While skiing he suffered an occlusion in the opposite artery, with the early changes of an anterior infarction, the two cancelling each other out and leading to a nearly normal electrocardiogram by June, 1949.
对这位患者在三家医院获得的心电图进行回顾，并与我们的心电图进行比较，证明他确实患有冠状动脉闭塞伴后壁心肌梗死。在滑雪时，他的另一条动脉发生闭塞，出现了前壁梗死的早期变化，这两者相互抵消，导致 1949 年 6 月的心电图几乎正常。

Obviously, his care and treatment, after two occlusions involving both anterior and posterior infarctions, differed somewhat from that accorded a man with a little occasional angina.
显然，在经历了涉及前部和后部梗死的两次闭塞后，他的护理和治疗与对待偶尔有轻微心绞痛的人的方式有所不同。

Nothing yet invented in this atomic and computer age approaches the importance of a careful, detailed history taken by a properly trained physician and that coupled with a careful physical examination and supplemented by whatever laboratory tests he deems wise.
在这个原子和计算机时代，还没有任何发明能比得上由受过专业训练的医生进行的细致、详细的病史采集，以及与之配合的细致体格检查，并辅以他认为必要的各种实验室检查的重要性。

sure? At a recent New York Heart Association conference, the 850 or so experts gathered there had to admit that 95 out of 100 times they did not know. There have been more than 20,000 scientific articles in the last 60 years on the subject of “primary” or “essential” or “idiopathic” hypertension, differing widely as to diagnostic criteria, estimates of its prevalence in the general population, and guesses as to its cause and mortality rate. However, it seems quite clear that most manifestations of the disease are the consequences of, or are made worse by, the presence of raised pressure. Also, the higher the arterial pressure, whether systolic or diastolic or mean, the higher the morbidity and mortality.
确定吗？在最近一次纽约心脏协会会议上，约 850 名专家不得不承认，他们有 95%的情况下并不知道答案。在过去 60 年里，关于“原发性”或“本质性”或“特发性”高血压的科学文章超过 2 万篇，这些文章在诊断标准、一般人群中的患病率估计以及病因和死亡率的猜测上差异很大。然而，很明显的是，该疾病的大多数表现都是高血压的结果，或者因高血压而加重。此外，无论是收缩压、舒张压还是平均动脉压，血压越高，发病率和死亡率也越高。

There is probably a fair proportion of cases in which glomerulonephritis (a kidney disease) in childhood was a causative factor. Also, some cases in the adult are due to a pheochromocytoma (an operable type of benign blood vessel tumor) and can be surgically corrected. Some cases follow the toxemia of pregnancy.
儿童时期的肾小球肾炎（一种肾脏疾病）可能是相当一部分病例的病因。此外，部分成人病例是由嗜铬细胞瘤（一种可手术切除的良性血管肿瘤）引起的，可以通过手术纠正。有些病例是妊娠毒血症引起的。

Hypertension, as a disease, affects about 10 million people in the U.S. Its victims eventually develop organic complications that cut their life expectancy by approximately 20 years. Heredity is vital, since if one parent has it, at least one of a large family will eventually become hypertensive, while if both parents have it, most of their children will also eventually develop it.
高血压作为一种疾病，影响着美国约一千万人的健康。其患者最终会出现器质性并发症，导致寿命缩短约 20 年。遗传因素非常重要，因为如果一方父母患有高血压，大家庭中至少有一人最终会患上高血压；而如果双方父母都有高血压，他们的大多数子女最终也会患上高血压。

In 1964, Dr. Irvine Page wrote accurately that, “Among
1964 年，Irvine Page 博士准确地写道，“在……中
the diseases of the heart and circulation, only arteriosclerotic disease of the blood vessels exceeds hypertension as a cause of death.” Since that time, during the past five years, the incidence of high blood pressure has been on the increase, yet the mortality rate due to this cause has slowly been falling. In the past 15 years deaths from hypertensive heart disease have decreased by from 50 to 55 per cent. It is no small accomplishment; and thanks for it are due almost exclusively to pharmaceutical research and the development of remarkably effective new anti-hypertensive agents.
心脏和循环系统的疾病中，只有血管的动脉硬化性疾病超过高血压成为死亡原因。”自那时起，在过去五年中，高血压的发病率一直在增加，但因高血压导致的死亡率却在缓慢下降。在过去 15 年中，高血压性心脏病的死亡率下降了 50%到 55%。这不是一项小成就，这几乎完全归功于药物研究和极为有效的新型抗高血压药物的开发。

In fact, it is these blood-pressure reducing agents that have solved what used to be the trickiest problem in vitamin E treatment of heart disease. The kind of large dosage, 400 to 1,600 units, of alpha tocopherol that has been found most effective in the treatment of coronary thrombosis and myocardial infarction, will usually improve the tone of the heart muscle and so raise the blood in the patient with hypertension. Immediately after a heart attack this may not represent a significant problem since one effect of the attack is to sharply lower the pressure. But where there has been a history of high blood pressure, as occurs in a very large proportion of these cases, in time the pressure will rise once more, and the greater strength of the beat of the improved heart muscle produced by vitamin E will tend to raise the pressure still higher.
事实上，正是这些降血压药物解决了维生素 E 治疗心脏病中曾经最棘手的问题。被发现对冠状动脉血栓形成和心肌梗死治疗最有效的那种大剂量（400 到 1600 单位）的α-生育酚，通常会改善心肌的张力，从而提高高血压患者的血压。心脏病发作后立即，这可能不是一个显著的问题，因为发作的一个效果是使血压急剧下降。但在有高血压病史的情况下，如这些病例中很大一部分所发生的，随着时间推移，血压会再次升高，而维生素 E 所改善的心肌更强的搏动力量会倾向于使血压进一步升高。

Formerly, we were faced constantly with this dilemma. The patient with obvious evidence of coronary heart disease, with a definite hypertension, must have an adequate dosage of the drug. However, in many cases the blood pressure, already too high, would rise still higher. This problem has been neatly resolved by the development of the anti-hypertensive medications. Of the range of these that have become available, I have found chlorothiazide and its derivatives the most useful. Where they are contraindicated, as with existing or latent diabetes, we use the Rauwolfia group, and sometimes if the pressure is high enough and the situation sufficiently critical, we will use the two in combination.
以前，我们经常面临这个两难境地。明显患有冠心病且确诊高血压的患者必须服用足够剂量的药物。然而，在许多情况下，已经偏高的血压会进一步升高。这个问题通过抗高血压药物的发展得到了巧妙的解决。在现有的多种药物中，我发现氯噻嗪及其衍生物最为有效。当这些药物禁用时，如已有或潜在的糖尿病患者，我们使用雷沃尔菲亚类药物，有时如果血压足够高且情况足够危急，我们会将两者结合使用。

The quick reduction in pressure obtained by use of these drugs and the continuing ability to control pressure with
通过使用这些药物迅速降低血压，并持续能够控制血压
them makes it possible to safely embark at once on a large dosage (from 400 to 1,600 units) of alpha tocopherol and secure a rapid beneficial effect on the heart and the coronary arteries. Ultimately, when sufficient recovery has been made, we will eliminate the hypertensive drugs and find that, in many cases, the blood pressure remains normal or nearly normal without them.
它们使得能够安全地立即开始大剂量（从 400 到 1600 单位）的α-生育酚治疗，并迅速对心脏和冠状动脉产生有益效果。最终，当恢复足够时，我们将停止使用降压药，并发现许多情况下血压在没有药物的情况下仍保持正常或接近正常。

The ability to suspend the use of these drugs instead of ${}^{-}$${}^{-}$^(-){ }^{-} continuing them perpetually is no small advantage. It is well known to all doctors that not only these, but all antihypertensive drugs, can sometimes be accompanied by serious complications, particularly under conditions of prolonged use.
能够暂停使用这些药物，而不是持续不断地使用它们，是一个不小的优势。所有医生都清楚，不仅这些药物，所有降压药有时都可能伴随严重的并发症，尤其是在长期使用的情况下。

One seemingly common result of using the thiazide derivatives is a build-up of uric acid in the system. The excess of uric acid in the blood-hyperuricemia - may be without serious consequences in some patients, while in others acute gouty arthritis, kidney stones, or even kidney collapse may ultimately result. While we are aware of these potential complications, experience has shown that these dangers are minimal in the patient on a large dose of alpha tocopherol.
使用噻嗪类衍生物的一个看似常见的结果是体内尿酸的积累。血液中尿酸过多——高尿酸血症——在某些患者中可能没有严重后果，而在其他患者中，最终可能导致急性痛风性关节炎、肾结石，甚至肾功能衰竭。虽然我们知道这些潜在的并发症，但经验表明，对于服用大剂量α-生育酚的患者，这些危险是极小的。

Although the thiazides do not cause any glucose build-up in the nondiabetic patient, where diabetes exists even as only a tendency or a latency, the thiazides may bring on hyperglycemia, a concentration of glucose in the blood above the normal limit. Inasmuch as the frequent urination brought on by diabetes is easily mistaken for the simple diuretic effect of the drug, it is entirely possible for the diabetes to advance to the stage of severe ketosis before the diabetic condition becomes apparent.
虽然噻嗪类利尿剂不会在非糖尿病患者体内引起葡萄糖积聚，但在存在糖尿病倾向或潜伏期的情况下，噻嗪类利尿剂可能引发高血糖，即血液中葡萄糖浓度超过正常限度。由于糖尿病引起的频繁排尿很容易被误认为是药物的单纯利尿作用，因此糖尿病可能在病情明显之前就发展到严重酮症酸中毒的阶段。

Fortunately, stopping use of the drug will quickly eliminate any enhancement of blood glucose levels that the drug has caused, and the chief danger is that the condition may go too long unnoticed because frequent urination is expected from a diuretic.
幸运的是，停止使用该药物将迅速消除药物引起的血糖水平升高，主要的危险在于由于利尿剂会导致频繁排尿，这种情况可能会长时间未被发现。

Of course, when there is frequent urination and a dehydrating effect for any reason, there is always the possibility of severe depletion of the electrolytes sodium, potassium, and chloride. While this is ordinarily prevented by dietary
当然，当因任何原因频繁排尿且有脱水效应时，总有可能严重耗尽电解质钠、钾和氯。虽然通常通过饮食可以预防这种情况
means, prevention or correction of such deficiencies can become extremely difficult in the presence of a kidney disorder.
这意味着，在肾脏疾病存在的情况下，预防或纠正此类缺陷可能变得极其困难。
There are mental changes that reportedly occur in about 15 to 25 per cent of those treated with Rauwolfia derivatives. They have been few in our own experience, because we do not continue the medication that long. But for those who keep patients more or less permanently on Rauwolfia, there is a high incidence of severe and lasting depression, which strongly resembles involutional melancholia or the depressed phase of manic-depressive psychosis. On occasion, the depressive effect of the drug has led to attempted suicides.
据报道，大约 15%到 25%的使用 Rauwolfia 衍生物治疗的患者会出现精神方面的变化。我们自己的经验中这种情况较少，因为我们不会让患者服用该药物太长时间。但对于那些让患者长期或几乎永久服用 Rauwolfia 的人来说，严重且持久的抑郁症发病率很高，这种抑郁症与衰老性忧郁症或躁郁症的抑郁期非常相似。有时，该药物的抑郁作用甚至导致了自杀未遂。

Other mental changes due to Rauwolfia include marked lethargy, frequent nightmares, and sometimes a tremor like that of Parkinsonism.
由于雷沃尔菲亚引起的其他精神变化包括明显的嗜睡、频繁的噩梦，有时还会出现类似帕金森病的震颤。

It is a decided problem that it sometimes takes from three to six months after withdrawal of the Rauwolfia for the mental changes to disappear.
这是一个确定的问题，即停用 Rauwolfia 后，精神变化有时需要三到六个月才能消失。

Rauwolfia also poses a very difficult problem at times when the need for surgery may arise. Anesthesia and even minimal losses of blood in such patients result in a profound drop in blood sugar, a danger at any time and marked danger to the patient with coronary heart disease. Angina pectoris, acute myocardial infarction, acute pulmonary edema, and cerebral thrombosis have been reported as the result of such hypotensive episodes following the administration of anesthesia.
雷沃尔菲亚有时也会带来非常棘手的问题，当需要手术时尤其如此。麻醉甚至在这类患者中造成的最小失血都会导致血糖显著下降，这在任何时候都是一种危险，对冠心病患者来说更是极大的危险。已有报道指出，麻醉后出现的低血压发作可能导致心绞痛、急性心肌梗死、急性肺水肿和脑血栓。

The side effects of these very good and highly effective drugs make it highly desirable that their use be discontinued as soon as possible.
这些非常好且高效药物的副作用使得尽快停止使用它们变得非常必要。

Before the advent of these antihypertensive drugs, we made the disconcerting discovery that the larger dosages of alpha tocopherol would elevate the blood pressure in about one-third of the hypertensive patients, often to a marked and, of course, dangerous degree. However, it would neither lower nor raise the pressure in another one-third and thus not reduce the dangers implicit in the hypertensive, while it would lower the blood pressure, occasionally to normal,
在这些抗高血压药物出现之前，我们令人不安地发现，大剂量的α-生育酚会使约三分之一的高血压患者血压升高，且常常达到显著且当然危险的程度。然而，它对另外三分之一的患者既不降低也不升高血压，因此无法减少高血压患者所隐含的危险，而对剩余患者则会降低血压，有时甚至降至正常水平，
in the other one-third. Obviously, then, if the full use of the blood-pressure lowering effect of these new drugs is added to alpha tocopherol, it is possible in all cases to initiate adequate treatment at once and so obtain the full benefit of the alpha tocopherol. However, those cases in which the pressure would drop to a lower or normal level were hidden by the use of the antihypertensive drugs, as were also the middle third in whom the blood pressure had not been elevated.
在另外三分之一的病例中显然，如果将这些新药的降血压作用与α-生育酚结合使用，那么在所有情况下都可以立即开始适当的治疗，从而充分发挥α-生育酚的全部益处。然而，那些血压会降至较低或正常水平的病例被降压药的使用所掩盖，中间三分之一的血压未升高的病例也是如此。

Therefore, when the desired clinical improvement has been obtained, the cautious decrease in the dosage of the antihypertensive drugs will reveal the fact that they are no longer necessary in approximately two-thirds of the hypertensives treated.
因此，当达到预期的临床改善时，谨慎减少降压药的剂量将显示出约三分之二接受治疗的高血压患者不再需要这些药物。

Where there is no emergency or the hypertensive drugs are contraindicated, it is possible to revert to a technique that we used to use before the advent of chlorothiazide and its companion drugs. It was based on the observation that small doses of alpha tocopherol will relieve spasms in the arteries and, by reducing the peripheral resistance in doing so, may lower an elevated blood pressure. We thus aimed at obtaining this effect first before increasing the dosage to the larger therapeutic levels that would benefit the heart itself.
在没有紧急情况或高血压药物禁用的情况下，可以恢复我们在氯噻嗪及其伴随药物出现之前使用的一种方法。该方法基于观察到小剂量的α-生育酚能够缓解动脉痉挛，并通过降低外周阻力，从而可能降低升高的血压。因此，我们首先旨在获得这种效果，然后再将剂量增加到对心脏本身有益的较大治疗水平。

In this method, the initial dosage of alpha tocopherol is no more than 90 international units a day and, perhaps, even less for a period of one month. For the second month, the dosage is raised only slightly to 120 international units, succeeded by 150 units in the third month.
在此方法中，初始剂量的α-生育酚每天不超过 90 国际单位，且可能在一个月内更少。第二个月剂量仅略增至 120 国际单位，第三个月则增至 150 单位。

Subsequent increases are handled very carefully until adequate therapeutic levels are reached.
随后逐步增加剂量，直到达到足够的治疗水平，整个过程都非常谨慎。

With this routine, many patients responded beautifully by a lowering of pressure, which did not become elevated again when therapeutic levels were reached.
通过这种常规治疗，许多患者的血压显著下降，并且在达到治疗水平后血压没有再次升高。

The treatment is obviously not as satisfactory as that which utilizes the hypertensive drugs, but there are cases in which the drugs would simply be too dangerous to use. In such a case, it is well worth trying. Results can be and have been very good at times.
这种治疗显然不如使用降压药物那样令人满意，但在某些情况下，使用药物会过于危险。在这种情况下，尝试这种方法是非常值得的。结果有时可以非常好，且确实如此。

the birth of babies with structural defects of the heart is by no means rare; and the paucity of medical writing on the subject was more because there was no treatment for the affliction than because it was not recognized as a problem. Approximately 25,000 children - from 0.3 per cent to 0.5 per cent of all live births - are born yearly with abnormal hearts in the U.S. alone. This figure does not include that other substantial number in which abnormal structure of the heart may occur along with other structural abnormalities, as happened in great numbers during the thalidomide tragedy.
先天性心脏结构缺陷的婴儿出生并非罕见；关于这一主题的医学文献稀少，更多是因为当时没有治疗方法，而不是因为这一问题未被认识到。仅在美国，每年约有 25,000 名儿童——占所有活产儿的 0.3%到 0.5%——出生时心脏异常。这个数字不包括那些心脏结构异常同时伴有其他结构异常的病例，比如在沙利度胺悲剧期间大量出现的情况。

With the vast forward leaps that have come in cardiac surgery in recent years, however, it has become possible to effect complete surgical cure in many types of congenital heart disease, in a few of them even without appreciable operative risk. Thus, it is no longer enough to make the nonspecific diagnosis of “congenital heart disease.” It is important to make a specific diagnosis of the precise type and of the severity of the heart anomaly.
然而，随着近年来心脏外科的巨大飞跃，许多类型的先天性心脏病已经可以通过手术实现完全治愈，其中少数甚至几乎没有明显的手术风险。因此，仅仅做出“先天性心脏病”的非特异性诊断已不够，重要的是要对心脏异常的具体类型和严重程度做出明确诊断。

Among the various kinds of congenital heart disease that can occur, there are at least three which allow of complete surgical cure with little operative risk. They are patent ductus arteriosus, a wide open condition of a fetal blood vessel which connects the pulmonary artery directly to the descending aorta, resulting in the recirculation of arterial blood back through the lungs; coarctation of the aorta which is a malformation causing stricture and narrowing of the
在各种可能发生的先天性心脏病中，至少有三种可以通过手术完全治愈，且手术风险很小。它们是动脉导管未闭，这是一种胎儿血管的开放状态，该血管直接连接肺动脉与降主动脉，导致动脉血重新循环回肺部；主动脉缩窄，这是一种导致主动脉狭窄和收缩的畸形；
aorta; and interatrial septal defect, in which there is an abnormal opening, large or small, between the right and left auricles.
主动脉；以及房间隔缺损，即右心房和左心房之间存在异常开口，大小不一。

Other congenital defects of the heart can also be treated surgically, although the operative risk is greater than in the three conditions mentioned above. Thus, if there is any reason at all to suspect that there might be a congenital defect of the heart, a thorough cardiological investigation of the newborn has become a matter of prime importance.
其他先天性心脏缺陷也可以通过手术治疗，尽管手术风险比上述三种情况更大。因此，如果有任何理由怀疑可能存在先天性心脏缺陷，对新生儿进行彻底的心脏病学检查已成为一项极其重要的任务。

While many cases remain unexplained, three specific causes of congenital anomalies are known and make painstaking check of the newborn heart obligatory.
虽然许多病例原因不明，但已知三种先天异常的具体原因，因此必须对新生儿心脏进行仔细检查。

The best known, of course, and perhaps the prime cause, as well, is rubella - German measles. Occurring during the first two months of pregnancy, rubella will lead to congenital defects including those of the heart in most babies. If the mother should contract the disease later in her pregnancy, the danger is diminished, but by no means eliminated. Occurring any time during pregnancy, rubella demands a suspicious and searching examination of the child’s heart.
最著名的，当然也许是主要原因，是风疹——德国麻疹。在怀孕的前两个月发生时，风疹会导致大多数婴儿先天性缺陷，包括心脏缺陷。如果母亲在怀孕后期感染此病，危险会降低，但绝非完全消除。无论怀孕何时发生风疹，都需要对婴儿的心脏进行怀疑和深入的检查。

Drugs taken by the mother during pregnancy may also cause abnormalities in the fetus. The best-known example of this, by far, is the large number of abnormal babies born to mothers who were given thalidomide to relieve morning sickness. Even aspirin, however, has experimentally been shown to be capable of causing congenital anomalies, and the spectrum of drugs that might possibly damage the development of the fetus has now become so wide that many physicians will refuse to prescribe any drug during the first trimester of pregnancy except in extreme emergency.
孕期母亲服用的药物也可能导致胎儿异常。迄今为止，最著名的例子是大量服用沙利度胺以缓解孕吐的母亲所生的畸形婴儿。然而，实验表明，即使是阿司匹林也可能引起先天性异常。现在，可能损害胎儿发育的药物种类已经非常广泛，许多医生在怀孕前三个月除非极端紧急情况，否则拒绝开任何药物。

A third cause for many congenital anomalies has been well established by Dr. Evan Shute, who has also shown convincing proof that many such cases can be prevented.
第三个导致许多先天性异常的原因已被 Evan Shute 博士确立，他还提供了令人信服的证据表明许多此类病例是可以预防的。

Except where there has been reason to suspect that congenital heart disease might develop and a well-trained cardiologist has made an examination with the stethoscope at birth, in many young patients the defects may be minor and the condition unrecognized during the first few years of life.
除非有理由怀疑可能会发生先天性心脏病，并且经过良好训练的心脏病专家在出生时用听诊器进行了检查，否则许多年轻患者的缺陷可能较轻微，且在生命的最初几年内未被发现。

It will not be overlooked, of course, in the presence of cyanosis, increasing when the infant cries. This condition is
当然，在出现发绀时不会被忽视，婴儿哭泣时发绀加重。这种情况是
due to admixture of venous and arterial blood through an abnormal pathway between the two systems. The oxygen saturation of the blood leaving the lungs is usually normal, but it becomes mixed with venous blood before it arrives at the site of the right-to-left shunt. When the equivalent of approximately five grams per 100 ml . of unsaturated hemoglobin is present in the arterial blood, the blueness or cyanosis in nail-beds, mucous membranes of the cheeks, and in the lips becomes clinically evident. In some cases, though, cyanosis is not obvious, and in others there is none.
由于静脉血和动脉血通过两系统之间的异常通道混合。离开肺部的血液氧饱和度通常正常，但在到达右向左分流部位之前与静脉血混合。当动脉血中存在相当于每 100 毫升约五克未饱和血红蛋白时，指甲床、颊部黏膜和嘴唇的发绀或青紫在临床上变得明显。然而，在某些情况下，发绀并不明显，另一些情况下则没有发绀。

Victims of congenital heart disease show symptoms in varying degrees, depending upon the type and severity of the abnormality. Most cyanotic cases develop polycythemia (an excess of red blood cells), and these patients have, therefore, an increased danger of forming clots leading to cerebrovascular thrombosis. Especially is this true if dehydration, for any reason, occurs.
先天性心脏病患者根据异常类型和严重程度表现出不同程度的症状。大多数发绀型病例会出现红细胞增多症（红细胞过多），因此这些患者形成血栓导致脑血管血栓的危险增加。尤其是在因任何原因发生脱水时更是如此。

In children with congenital heart defects there is a greatly increased incidence of infection, particularly respiratory. Bronchitis and pneumonia, as well as frequent colds, are the rule. Many little patients breathe easier and are more comfortable if they rest in a squatting position. Characteristically they will often sit in a chair with knees drawn up and clasped by their hands. Such children may be very uncomfortable if made to stand up straight, or if placed on an X-ray table and tilted backwards.
先天性心脏缺陷的儿童感染率大大增加，尤其是呼吸道感染。支气管炎和肺炎，以及频繁的感冒，是常见现象。许多小患者如果采取蹲坐姿势休息，呼吸会更顺畅，感觉更舒适。典型地，他们常常坐在椅子上，膝盖弯曲并用手抱住。如果被迫站直或放在 X 光检查台上向后倾斜，这些孩子可能会感到非常不适。

Ten per cent of all cases of subacute bacterial endocarditis occur in cases of congenital heart disease. This complication, which is an ever-present danger, was invariably fatal until the advent of antibiotics.
所有亚急性细菌性心内膜炎病例中有百分之十发生在先天性心脏病患者中。这种并发症是一种始终存在的危险，直到抗生素出现之前，它总是致命的。

Finally, brain abscess, while not common, is another danger that is always present in these patients.
最后，脑脓肿虽然不常见，但在这些患者中始终存在另一种危险。

Even those medical men who treat these patients without alpha tocopherol are agreed that how such cases are handled depends upon an accurate assessment of the surgical risk, the possibility of worthwhile improvement from surgery, and the prospects for life and health with medical management alone.
即使是不使用α-生育酚治疗这些患者的医生也一致认为，如何处理此类病例取决于对手术风险的准确评估、手术带来有意义改善的可能性，以及仅通过药物管理维持生命和健康的前景。

Of course, we agree and insist that all our patients are
当然，我们同意并坚持所有患者都是
adequately investigated, diagnosed, and evaluated and that all cases of patent ductus arteriosus, coarctation of the aorta and atrial septal defect, all of which can be surgically corrected with low risk, submit to operation.
充分调查、诊断和评估所有病例，对于动脉导管未闭、主动脉缩窄和房间隔缺损这三种均可通过低风险手术纠正的情况，应接受手术治疗。
Years ago, when the question first arose of treating patients with congenital heart disease, we embarked upon their care very gingerly, since it was perfectly obvious that no medication taken by mouth could have any ability to correct a birth defect. Even though it cannot alter a defective structure, however, the oxygen-sparing action of alpha tocopherol and its antithrombin activity are of great value in those cases which cannot be treated surgically. It is also the ideal treatment preoperatively and postoperatively for all those undergoing surgical repair.
多年前，当首次提出治疗先天性心脏病患者的问题时，我们非常谨慎地开始照顾他们，因为显而易见，口服任何药物都无法纠正先天缺陷。尽管它不能改变有缺陷的结构，然而，α-生育酚的节氧作用及其抗血栓活性在那些无法手术治疗的病例中具有极大价值。它也是所有接受手术修复患者术前和术后的理想治疗方法。

We have seen cases of maximal cyanosis, which it should be remembered indicates insufficient oxygen in the blood, as well as many with moderate to mild degrees. In every case, the cyanosis was decreased with an adequate dosage level of vitamin E. In the mild to moderate cases, the cyanosis disappeared. Coincidentally, the “squatters” ceased to squat, there were no episodes of cerebral thrombosis, the number of upper respiratory infections lessened, and, among most of our patients, these symptoms are no more frequent than among the “normal” members of the population. Many of our patients lead normal lives, and they survive.
我们见过最大程度的发绀病例，应当记住这表明血液中氧气不足，也见过许多中度到轻度的病例。在每个病例中，适量的维生素 E 剂量都减少了发绀。在轻度到中度病例中，发绀消失了。巧合的是，“蹲坐者”停止了蹲坐，脑血栓发作不再发生，上呼吸道感染次数减少，在我们大多数患者中，这些症状的发生频率不比“正常”人群更高。我们的许多患者过着正常的生活，并且存活下来。

For any doctor interested in a rapid evaluation of the clinical effectiveness of alpha tocopherol, I suggest that he treat:
对于任何希望快速评估α-生育酚临床效果的医生，我建议他进行治疗：

He will find the effects unmistakable and very likely beyond his expectations.
他会发现效果显而易见，很可能超出他的预期。

Occasionally, patients with congenital heart disease develop rheumatic heart disease as well, following an episode of rheumatic fever. When this is suspected, we immediately become more cautious in treatment and start such patients on smaller initial doses of the drug. Otherwise, these patients seem to tolerate the larger doses very well indeed. A trial dosage level of 300 units a day is about right. In the younger patients, this may be adequate, although we tend to increase the amount of alpha tocopherol at six-week intervals until satisfied that the maximum response for that particular patient has been obtained.
偶尔，先天性心脏病患者在经历风湿热发作后，也会发展成风湿性心脏病。当怀疑这种情况时，我们会立即在治疗上更加谨慎，并给这类患者服用较小的初始剂量。否则，这些患者似乎能够很好地耐受较大剂量。每天 300 单位的试验剂量大致合适。对于较年轻的患者，这个剂量可能足够，尽管我们倾向于每六周增加一次α-生育酚的用量，直到确认该患者已达到最大反应为止。

The older patient is usually begun on 600 units a day, with increases if necessary at six-week intervals, until we are satisfied that no further improvement will be obtained.
年长患者通常从每天 600 单位开始服用，如有必要，每六周增加一次，直到我们确定不会有进一步的改善为止。

Up to the time of the publication of “Alpha Tocopherol (Vitamin E) in Cardiovascular Disease” in April, 1954, the Shute Clinic had treated 28 cases. Twelve or 43 per cent became completely asymptomatic, seven or 25 per cent showed a very worthwhile improvement, two were helped, one helped but little, and three died. Two of these fatalities were adults, both in extremis. Both were helped initially, but they soon died. One, who had been started on our slow regime which does not help or give protection until after the third month, died on the thirtieth day of treatment. The second, who seemed to be doing very well, died in his sleep on the fortieth day - his dose 300 units a day. The first of these did not have time to respond to treatment; the second nearly made it. The third death could be laid at the door of a university cardiologist who, somehow and for some strange reason, persuaded the parents of a child, who had become perfectly well on alpha tocopherol, to stop using it.
截至 1954 年 4 月《Alpha Tocopherol (Vitamin E) in Cardiovascular Disease》一书出版时，Shute 诊所已治疗了 28 例病例。12 例（占 43%）完全无症状，7 例（占 25%）有显著改善，2 例有所帮助，1 例帮助不大，3 例死亡。这三例死亡中有两名成人，均处于极危状态。两人最初有所好转，但很快去世。其中一人开始采用我们的缓慢方案，该方案在第三个月之前无效且无保护作用，该患者在治疗第 30 天去世。第二人情况似乎非常好，但在第 40 天睡梦中去世——每日剂量为 300 单位。第一位患者没有时间对治疗产生反应；第二位几乎成功。第三例死亡可归咎于一位大学心脏病专家，他以某种奇怪的理由说服了一名儿童的父母停止使用α-生育酚，而该儿童在使用该药后已完全康复。

Since then, a third adult has died under rather unusual circumstances. She had become much better on alpha tocopherol, yet was still somewhat cyanotic and dyspneic. Her one ambition in life was to have a child of her own, and in spite of all contrary arguments made by every physician who saw her and by her husband, she insisted on becoming pregnant. She had several miscarriages, one while
从那时起，又有第三位成年人在相当不寻常的情况下去世。她在服用α-生育酚后情况大为好转，但仍有些发绀和呼吸困难。她人生的唯一愿望是拥有自己的孩子，尽管每位看过她的医生和她的丈夫都提出了反对意见，她仍坚持要怀孕。她经历了几次流产，其中一次是在怀孕期间。
under our care. Her last pregnancy was somehow maintained to term by an excellent local obstetrician. She delivered easily. The obstetrician brought the child to her after the cord was cut. She looked at her child, smiled a beautiful, happy smile, and was dead. We don’t know how her pregnancy was maintained, or whether anything antagonistic to her vitamin E was used or actually the cause of her death. Air embolism was most unlikely. Embolism from the pelvic veins was a stronger possibility. There is also a distinct possibility that the work of delivery in a prone position was just too much for her heart.
在我们的照料下。她的最后一次怀孕在一位出色的当地产科医生的帮助下勉强维持到足月。她顺利分娩。脐带剪断后，产科医生将孩子抱给她。她看着自己的孩子，露出了美丽而幸福的微笑，然后去世了。我们不知道她的怀孕是如何维持的，也不知道是否使用了任何与她的维生素 E 相抵触的东西，或者这些是否实际上导致了她的死亡。空气栓塞几乎不可能。来自盆腔静脉的栓塞可能性更大。还有一种明显的可能性是，俯卧位分娩的劳累对她的心脏来说实在太过沉重。

The following are representative histories of three of these original cases and one or two seen more recently.
以下是三例最初病例和一两例最近观察到的病例的代表性病史。

The first is a woman, aged 28, who first was seen on September 29, 1948 (approximately 21 years ago). The doctor who delivered her thought there was some abnormality of her heart, but she seemed to develop normally until the age of 13, at onset of menses. As is well known in the natural history of congenital heart disease, this is the event which often precipitates symptoms. On the advice of her physician she stopped school and stayed at home doing light household chores. Her heart would pound and beat rapidly on any exertion. At the age of 20 she took a business course and worked for five years during which she felt very well, then had to stop because any exertion, such as walking upstairs or uphill, gave her rapid heartbeat, shortness of breath, and palpitation.
第一个病例是一位 28 岁的女性，首次就诊于 1948 年 9 月 29 日（大约 21 年前）。接生她的医生认为她的心脏有某种异常，但她似乎一直正常发育，直到 13 岁月经初潮时。众所周知，先天性心脏病的自然病程中，这一事件常常引发症状。在医生的建议下，她辍学在家，做一些轻微的家务劳动。任何体力活动都会使她心跳加速、心脏剧烈跳动。20 岁时，她参加了一个商业课程并工作了五年，在此期间她感觉非常好，后来不得不停下来，因为任何体力活动，如上楼梯或爬坡，都会引起她心跳加速、呼吸急促和心悸。

Her lesion was an auricular septal defect. There was some enlargement and characteristic deformity of the heart.
她的病变是心房间隔缺损。心脏有一定程度的扩大和典型的畸形。

Her treatment consisted of 300 units a day of alpha tocopherol. On this she became asymptomatic until June of 1957, when she awakened with pounding, spots before her eyes, orthopnea (inability to breath while reclining), and palpitation. The certified cardiologist in the northern Ontario metropolis where she lived insisted on full investigation by a Toronto cardiologist, who informed her that she must have surgery and that otherwise she would be dead within two years.
她的治疗包括每天服用 300 单位的α-生育酚。在此期间，她无症状，直到 1957 年 6 月，她醒来时感到心跳剧烈，眼前出现斑点，仰卧时呼吸困难（不能平躺呼吸），并伴有心悸。她所在的北安大略大都市的认证心脏病专家坚持让多伦多的心脏病专家进行全面检查，后者告知她必须接受手术，否则两年内将会死亡。

She elected to go on with her alpha tocopherol, since the
她选择继续服用她的α-生育酚，因为
episode that prompted this investigation was the first she had had in nine years.
引发这次调查的发作是她九年来的第一次。

In 1965, a refresher course and clinic was held in her home town, and the visiting lecturer was the Toronto cardiologist who had supervised her investigation in 1957. He admitted to her that he found her condition hard to believe. She actually felt better in 1965 than ever. She was working normally and had been taking a daily exercise walk of onehalf to one mile.
1965 年，在她的家乡举办了一次进修课程和诊所，来访的讲师是多伦多的心脏病专家，他曾在 1957 年监督她的调查。他向她承认，他觉得她的状况难以置信。实际上，她在 1965 年感觉比以往任何时候都好。她正常工作，并且每天坚持步行锻炼半英里到一英里。

During 1968 she decreased her dosage of vitamin E and soon noticed dyspnea. She raised it back to 300 units a day and was well again until Christmas, when she had a bad cold which developed into a more severe infection, for which she was given antibiotics. (In some patients both fever and antibiotics seem to decrease the effect of alpha tocopherol.) She went down to Florida to convalesce, but either the climate or the aftereffects of her illness and treatment were not helpful. She became dyspneic and developed pain in both arms. So she increased her dosage level to 375 units a day and rapidly improved. When last seen, April 14, 1969, she was once more perfectly well. She is now 49 years old.
1968 年期间，她减少了维生素 E 的剂量，很快就注意到呼吸困难。她将剂量提高回每天 300 单位，身体又恢复了健康，直到圣诞节时，她感冒严重，发展成更严重的感染，医生给她开了抗生素。（在某些患者中，发烧和抗生素似乎都会降低α-生育酚的效果。）她去了佛罗里达休养，但气候或疾病及治疗的后遗症并没有帮助她。她出现了呼吸困难，并且双臂疼痛。于是她将剂量提高到每天 375 单位，病情迅速好转。最后一次见面是在 1969 年 4 月 14 日，她再次完全康复。她现在 49 岁。

The second case is that of a boy, aged two and one-half years, when seen November 3, 1950, with the diagnosis made, after complete investigation in Detroit, of pulmonary artery stenosis and interventricular septal defect. A heart murmur was discovered at birth, at three months he was hospitalized with a respiratory infection, and he was in an oxygen tent for five days.
第二个病例是一名两岁半的男孩，1950 年 11 月 3 日就诊，经底特律全面检查后诊断为肺动脉狭窄和室间隔缺损。出生时发现心脏杂音，三个月时因呼吸道感染住院，曾在氧气帐篷中治疗五天。

He was not too susceptible to such infections, however. He was cyanotic only on exertion, but could not run or play hard without obvious dyspnea.
然而，他对这种感染并不太敏感。他只有在用力时才会发绀，但不能跑步或剧烈玩耍，否则会明显呼吸困难。

X-ray showed a 25 per cent enlargement of the heart, and when he cried he was definitely cyanotic. His electrocardiogram, then and since, has shown a marked degree of right axis deviation with widening of the QRS complex and negative T waves in the right side of the precordial leads. Yet with alpha tocopherol treatment he is now in junior college, lives normally, and plays golf without trouble.
X 光显示心脏扩大了 25%，当他哭泣时明显出现发绀。他的心电图当时及之后均显示右轴明显偏移，QRS 波群增宽，前胸导联右侧出现 T 波倒置。然而，经过α-生育酚治疗后，他现在正在读初级大学，生活正常，打高尔夫球也没有问题。

The third case is that of a boy aged ten when first seen on December 29, 1952. He seemed quite nornnal at birth, but a murmur was detected when he was examined during the third week of life. He became quite cyanotic with activity when three or four years old. He began at this time to assume a squatting position a great part of the time, or to sit in a chair with knees drawn up to his chin. He was able to go to school but was tired out by Thursday. He could ride a bicycle, but only a short distance and could climb stairs only slowly.
第三个病例是一名十岁男孩，首次就诊时间为 1952 年 12 月 29 日。他出生时看起来相当正常，但在生命第三周体检时发现有心脏杂音。三四岁时活动时出现明显发绀。那时他开始大部分时间采取蹲姿，或坐在椅子上，膝盖抱到下巴。他能上学，但到星期四就感到疲惫。他能骑自行车，但只能骑短距离，爬楼梯也很慢。

This boy was given progressively larger and larger doses of alpha tocopherol as he grew up - beginning with 300 units a day. He now takes 800 units a day. With great difficulty, we have been able to persuade college and university admission departments that this boy was worth educating. He was last seen July $8,1968$$8,1968$8,19688,1968. He was feeling “real well.” He bowls tenpins without trouble, teaches school and night school and summer school. He has his Master’s Degree in Education and should easily obtain his Ph.D. next year.
这个男孩随着成长逐渐服用了越来越大剂量的α-生育酚——起初每天 300 单位。现在他每天服用 800 单位。我们费了很大劲才说服大学和学院的招生部门，这个男孩值得接受教育。最后一次见到他是在 7 月 $8,1968$$8,1968$8,19688,1968 。他感觉“非常好”。他能轻松地打保龄球，教日校、夜校和暑期学校。他拥有教育学硕士学位，明年应该能轻松获得博士学位。

Another case is a woman who was 37 when first seen in April, 1960. She was as cyanotic as any patient I have ever seen, was obviously very dyspneic, and complained of a “fullness” in her chest. She had always been bothered with palpitation and tachycardia. She was able to walk a bit some days. On other days she could not walk at all.
另一个病例是一位 37 岁的女性，首次就诊于 1960 年 4 月。她的发绀程度是我见过的患者中最严重的，明显呼吸困难，并抱怨胸部有“充满感”。她一直被心悸和心动过速困扰。有些日子她还能走一点路，其他日子则完全无法行走。

She was a “blue baby” at birth. She had rheumatic fever at the age of nine years. She developed in 1946 a shadow in her lung, diagnosed as tuberculosis at first, later said to be pneumonia. It probably was tuberculosis, since she developed a full blown case of this disease in 1963 and was four and one-half months in the sanitarium.
她出生时是个“蓝婴”。九岁时患了风湿热。1946 年她的肺部出现阴影，起初被诊断为结核病，后来说是肺炎。很可能是结核病，因为她在 1963 年发展成了完全发作的结核病，并在疗养院住了四个半月。

On examination her heart was grossly abnormal in shape with marked dilatation of the left auricle. With both rheumatic heart disease and congenital heart disease, the significance of her murmurs was hard to evaluate. However, she had a loud systolic at aortic and mitral areas, louder at the aortic, and a mitral diastolic with a sharp second sound. As stated, she was very cyanotic, and her fingers and toenails showed a marked degree of clubbing and incurvation.
检查时，她的心脏形状明显异常，左心耳明显扩张。由于既有风湿性心脏病又有先天性心脏病，她的杂音意义难以评估。然而，她在主动脉和二尖瓣区有响亮的收缩期杂音，主动脉区更响亮，二尖瓣区有舒张期杂音，伴有清晰的第二心音。如前所述，她非常发绀，手指和脚趾甲明显出现杵状指和弯曲。

She was started on 300 units a day, thought she was better in the second week, but then developed a cold.
她开始每天服用 300 单位，第二周感觉好转，但随后感冒了。

On May twenty-first, I doubled her dose since she was not obviously improved, and she became much less cyanotic. She was very well by April 24, 1961 - “an awful lot better than she used to be.”
5 月 21 日，我将她的剂量加倍，因为她没有明显好转，她的发绀明显减轻。到 1961 年 4 月 24 日，她状况非常好——“比以前好多了。”

On 1,000 units a day she improved still further and had still less cyanosis. Since then, she has had a rough time food poisoning, tuberculosis, thrombophlebitis, and frequent colds. The thrombophlebitis occurred on a large dose of alpha tocopherol and cleared up on 1,600 units a day. However, this was too large a dose for her heart to tolerate, and her dyspnea, pounding, dizziness, and nausea recurred. As soon as the phlebitis cleared up her alpha tocopherol was reduced to 1,000 units a day with some improvement.
每天服用 1000 单位后，她的情况进一步好转，发绀也减少了。此后，她经历了食物中毒、结核病、血栓性静脉炎和频繁感冒。血栓性静脉炎发生在大剂量服用α-生育酚时，服用 1600 单位每天后症状消失。然而，这对她的心脏来说剂量过大，呼吸困难、心悸、头晕和恶心又复发。静脉炎一消失，她的α-生育酚剂量就减少到每天 1000 单位，情况有所改善。

AS THE TERM IS COMMONLY USED, disease of the peripheral blood vessels - those of the leg and foot or arm and hand - is considered as being limited to those particular conditions in which the flow of blood to the extremities is reduced because of some abnormality in their own blood vessels. In actuality, however, there are a number of more remote conditions that are equally capable of reducing the blood supply to an extremity. There is, for example, the not uncommon occurrence of a cervical rib which can exert pressure on the artery passing across it as it is stretched and compressed. The peripheral blood supply can also be diminished by general systemic diseases, such as anemia; polycythemia vera, blood disease involving a disproportionate increase in red cell mass; hypothyroidism; myxedema, and cardiac disease.
通常所说的外周血管疾病——即腿和脚或手臂和手的血管疾病——被认为仅限于那些由于血管本身异常而导致血液流向肢体减少的特定情况。然而，实际上，还有许多更远端的情况同样能够减少肢体的血液供应。例如，颈肋的发生并不少见，它会在被拉伸和压迫时对经过的动脉施加压力。全身性疾病也可能导致外周血液供应减少，如贫血、真性红细胞增多症（一种红细胞数量异常增加的血液病）、甲状腺功能减退、黏液水肿以及心脏病。

Whichever the cause, the symptoms and diagnostic signs of peripheral vascular disease stem from either a deficiency of blood flow while the patient is at rest or a relative deficiency when the affected tissues demand additional blood, or both.
无论原因如何，周围血管疾病的症状和诊断体征均源于患者静息时血流不足，或受影响组织需要额外血液时的相对不足，或两者兼有。

Of the clinical manifestations that are induced by a deficient blood supply to the peripheral blood vessels, the commonest is intermittent claudication.
由外周血管供血不足引起的临床表现中，最常见的是间歇性跛行。

The onset is gradual. The patient first begins to feel a pain on walking that is annoying rather than extreme. Although it is sometimes felt in the foot or thigh, it is the calf of the leg that is the commonest site of discomfort. As
发作是逐渐的。患者最初开始感到走路时有一种令人烦恼而非剧烈的疼痛。虽然有时疼痛出现在脚或大腿，但小腿是最常见的不适部位。随着
time goes on, the patient shows a markedly limited tolerance to exercise, noting usually that he can walk a relatively constant distance without discomfort, but that then suddenly there is sharp constricting pain in one or both legs and, perhaps, severe fatigue. The trouble occurs faster if he walks faster, and it occurs more readily in cold weather. If the exercise is continued, usually the muscles will become spastic and cramped, although occasionally a patient will discover that, if he continues to walk at a slower pace, the pain is reduced.
随着时间的推移，患者对运动的耐受性明显降低，通常会注意到他可以在没有不适的情况下走相对固定的距离，但随后突然出现一条或两条腿的剧烈收缩性疼痛，可能还有严重的疲劳。如果走得更快，问题出现得更快，且在寒冷天气中更容易发生。如果继续运动，通常肌肉会变得痉挛和抽筋，尽管偶尔有患者发现，如果他以较慢的速度继续行走，疼痛会减轻。

The patient quickly learns that he can walk three blocks or one block or no more than 50 paces and then will suddenly feel his symptoms and be unable to go further. If he rests at that point, however, the symptoms are promptly relieved.
患者很快就会发现，他可以走三条街区、一条街区，或者最多走 50 步，然后会突然感到症状出现，无法继续前进。然而，如果他在那个时候休息，症状会立即缓解。

When intermittent claudication exists, involvement of the heart is so common that a painstaking cardiological examination is obligatory. The sequence of occurrence will vary, with cardiac ischemia or deficient blood supply occurring months or years before the onset of the intermittent claudication in many, while many others first develop the claudication and only later develop angina pectoris. Although arteriosclerosis is frequently present, it is seldom a general condition, but affects specific areas to greater or lesser degree, while other areas and blood vessels remain free of the condition, or relatively so. However, when there is a serious degree of artriosclerotic involvement in one area, it is usually followed in time by signs of serious involvement in one or more other major areas.
当存在间歇性跛行时，心脏受累非常常见，因此必须进行细致的心脏病学检查。发生的顺序会有所不同，许多人在间歇性跛行发作前数月或数年就出现心脏缺血或血液供应不足，而另一些人则先出现跛行，随后才发展为心绞痛。虽然动脉硬化常常存在，但它很少是全身性的，而是以不同程度影响特定区域，而其他区域和血管则保持无病或相对无病状态。然而，当某一区域出现严重的动脉硬化时，通常随后会在一个或多个其他主要区域出现严重受累的迹象。

Particularly in heavy smokers, intermittent claudication is frequently the initial complaint in what develops into Buerger’s disease or thromboangiitis obliterans. It is a condition that frequently begins as a phlebitis of the lower extremities without any obvious predisposing cause. With or without phlebitis, of course, a heavy smoking habit diminishes blood flow by narrowing the arterial lumen. In Buerger’s disease characteristically the leg pains are not for long limited to times of exercise, but rapidly begin occurring at rest as well. The patient is awakened by severe
特别是在重度吸烟者中，间歇性跛行常常是发展为布尔格病或血栓闭塞性脉管炎的最初症状。这种病症通常始于下肢静脉炎，且没有明显的诱发原因。当然，无论是否伴有静脉炎，重度吸烟习惯都会通过缩小动脉腔径来减少血流。在布尔格病中，腿部疼痛的特点是不仅仅局限于运动时，而是很快开始在休息时也发生。患者会被剧烈的疼痛惊醒。
cramping that can involve both calves and feet and must either get upright and walk about or at least must hang his feet over the edge of the bed in order to secure relief. The condition is also recognizable by the very slow growth of the toenails and a tendency of the hair on the dorsum of the toes to disappear. The hands have a tendency to tingle or become numb and are clumsy.
抽筋可能同时发生在小腿和脚部，必须站起来走动，或者至少必须将脚悬挂在床边以获得缓解。该状况还可以通过脚趾甲生长非常缓慢以及脚背上的毛发有消失的趋势来识别。手部有刺痛或麻木的倾向，且动作笨拙。

When there is phlebitis, as is often the case, it is both extensive and highly resistant to treatment. It may lead to localized ulceration and sometimes to gangrene, particularly in the toe or an entire foot.
当发生静脉炎时，情况通常既广泛又极难治疗。它可能导致局部溃疡，有时甚至导致坏疽，特别是在脚趾或整个脚部。

There is also, of course, arteriosclerosis obliterans, and an arterial venous fistula can cause similar symptoms by the admixture of saturated and unsaturated hemoglobin in the admixture of arterial and venous blood.
当然，还有闭塞性动脉硬化症，动静脉瘘也能通过动脉血和静脉血中饱和和不饱和血红蛋白的混合引起类似症状。

All are peripheral vascular disease and susceptible to the same treatment.
都是周围血管疾病，且对相同的治疗方法敏感。

Our original cases were elderly men with atherosclerotic peripheral vessels with decreased resistance to mild trauma and with consequent multiple small areas of superficial gangrene. Pulsations in the vessels of the area were diminished or absent. Alpha tocopherol led to healing of the lesions and a partial return of pulsation to the vessels. This was very gratifying to the patients, but more so to us, since here was visual evidence of the tissue-sparing action of alpha tocopherol. Such cases were photographed and along with our burn and varicose ulcer cases were irrefutable. They could not be helped by “the force of our personalities,” as one cardiologist claimed was the case in our cardiac cases.
我们最初的病例是患有动脉粥样硬化周围血管的老年男性，这些血管对轻微创伤的抵抗力降低，导致多个小面积的浅表性坏疽。该区域血管的搏动减弱或消失。α-生育酚促使病变愈合，血管搏动部分恢复。这对患者来说非常令人欣慰，但对我们来说更是如此，因为这提供了α-生育酚保护组织作用的直观证据。这些病例被拍照记录，连同我们的烧伤和静脉曲张溃疡病例一起，成为无可辩驳的证据。正如一位心脏病专家所说，这些病例并非靠“我们个性的力量”所能帮助的，就像我们的心脏病例一样。

The specific actions of the vitamin E which were chiefly active in such cases, of course, are chiefly two - the oxygensparing action directly on the tissues affected and the opening up of collateral circulation.
维生素 E 在此类病例中主要起作用的具体机制当然主要有两个——对受影响组织的节氧作用和侧支循环的开放。

During the last 20 years we have seen many such cases and have done, on more than one occasion, something which most textbooks and most scientific medical articles have said cannot be done. We have restored life to dying tissue proximal to large areas of gangrene on the heels of patients with severe degrees of atherosclerotic ischemic peripheral artery
在过去的 20 年里，我们见过许多这样的病例，并且不止一次地做了大多数教科书和科学医学文章所说的不可能做到的事情。我们使严重动脉粥样硬化缺血性周围动脉患者脚后跟大面积坏疽近端的垂死组织恢复了生命。
disease. This allowed the gradual sloughing off of the dead tissue and the healing, without contraction, of the tissues underneath.
疾病。这使得死组织逐渐脱落，下面的组织得以愈合且不收缩。

A characteristic of this oxygen-sparing action of alpha tocopherol, that we keep stressing, is the very wide variation in the degree in various patients. Most patients get satisfactory results; some do not. However, in even the most extreme cases, results can be excellent and very, very few of our patients have come to amputation.
我们一直强调的α-生育酚这种节氧作用的一个特点是，不同患者之间效果差异非常大。大多数患者能获得满意的结果；有些则不能。然而，即使在最极端的情况下，效果也可能非常好，我们的患者中极少有人需要截肢。

Begg and Richards have reported on 198 cases of intermittent claudication followed for five to 12 years or to death. The over-all mortality was 46.5 per cent, while the mortality at five years was 25 per cent. Most of the deaths were due to cardiovascular. disease, usually myocardial infarction. The over-all amputation rate was 7.1 per cent. Claudication, they concluded, indicates atherosclerosis, usually generalized, since the ten-year survival rate is compared with that of patients who had angina or had survived a myocardial infarction, for the results are similar.
Begg 和 Richards 报告了 198 例间歇性跛行患者，随访时间为五年至十二年或直至死亡。总体死亡率为 46.5%，五年死亡率为 25%。大多数死亡原因是心血管疾病，通常是心肌梗死。总体截肢率为 7.1%。他们得出结论，跛行表明动脉粥样硬化，通常是全身性的，因为其十年生存率与患有心绞痛或曾经心肌梗死患者的生存率相似。

Larsen and Lassen reported on the effects of a six-month regime of vigorous daily walks. The patients walked as energetically as possible for an hour, resting when the pain became too great. They were able to increase their walking distance, measured on a treadmill, to three times the original values. These patients were not on alpha tocopherol, and the beneficial effects of exercise were due to increasing collateral circulation.
Larsen 和 Lassen 报告了为期六个月的每日剧烈步行的效果。患者尽可能有力地步行一小时，当疼痛过大时休息。他们能够将跑步机上测量的步行距离增加到最初值的三倍。这些患者没有服用α-生育酚，运动的有益效果归因于侧支循环的增加。

This, of course, recalls the experiments of Enria and $\mathrm{Fe}-$$\mathrm{Fe}-$Fe-\mathrm{Fe}- rerro (25) in ligation of the femoral vein and the demonstration of the rapid and extensive opening up of collateral channels with alpha tocopherol. Similar experiments by Dominguez and Dominguez (27) in artificial obstruction of the femoral artery have shown the same effect in the collateral circulation when alpha tocopherol was administered.
这当然让人想起 Enria 和 $\mathrm{Fe}-$$\mathrm{Fe}-$Fe-\mathrm{Fe}- rerro（25）在股静脉结扎实验中，展示了使用α-生育酚时侧支循环迅速且广泛开放的现象。Dominguez 和 Dominguez（27）在股动脉人工阻塞的类似实验中也显示了相同的效果，当给予α-生育酚时，侧支循环得到了改善。

The combination of alpha tocopherol and a planned consistent course of exercise should give still better results in these cases. We have not instituted a regime of heavy exercise in these cases, chiefly because it was necessary to first establish the actual benefit of the alpha tocopherol alone
α-生育酚与有计划且持续的锻炼相结合，在这些情况下应能取得更好的效果。我们尚未在这些病例中实施高强度锻炼，主要是因为首先需要确定单独使用α-生育酚的实际效果。
and then to follow up our cases for long-term evaluation of their results.
然后对我们的病例进行长期随访评估其结果。

The value of this treatment has now been confirmed by a group of doctors in the University of Alberta Hospital; by W. M. Toone, (111) of the Veterans’ Hospital in Victoria, British Columbia, Canada; but more importantly by Professor A. M. Boyd of the University of Manchester, who reported good results with 1,650 patients and stated that the drug increased the survival rate, a matter of great importance.
这一治疗方法的价值现已得到阿尔伯塔大学医院的一组医生的确认；加拿大不列颠哥伦比亚省维多利亚退伍军人医院的 W. M. Toone（111）；但更重要的是曼彻斯特大学的 A. M. Boyd 教授，他报告了对 1650 名患者的良好效果，并指出该药物提高了生存率，这一点非常重要。

Color photographs of a very few of our impossible cases have been published in our book Alpha Tocopherol (Vitamin E) in Cardiovascular Disease and in the Canadian Medical Association Journal, (Vol. 76, No. 9, p. 730, May 1, 1957).
我们在《Alpha Tocopherol (Vitamin E) in Cardiovascular Disease》和《Canadian Medical Association Journal》（第 76 卷，第 9 期，第 730 页，1957 年 5 月 1 日）中发表了极少数我们那些不可能治愈病例的彩色照片。

Male, aged 60, when first seen January 22, 1958.
男性，60 岁，首次就诊于 1958 年 1 月 22 日。
His original complaint was of angina pectoris and dyspnea of four years’ duration. Angina developed after walking one to two blocks. Alpha tocopherol relieved his angina fairly well, although he did continue to experience some attacks occasionally.
他最初的主诉是持续四年的心绞痛和呼吸困难。走一到两个街区后出现心绞痛。Alpha tocopherol（α-生育酚）相当有效地缓解了他的心绞痛，尽管他偶尔仍会经历一些发作。

On August 27, 1967, he developed pain in the three central toes of his right foot, and they were definitely cyanotic, but by the next day they were white, and there was no digital artery or dorsalis pedis artery pulsation. On an increased dose of alpha tocopherol ( 1,600 units daily) there was gradual improvement, and by October 18, 1967, pulsation had returned to the arteries. He has had no further trouble.
1967 年 8 月 27 日，他的右脚中间三趾出现疼痛，且明显发绀，但到第二天这些脚趾变白，数字动脉和足背动脉均无搏动。在增加了α-生育酚剂量（每日 1600 单位）后，情况逐渐好转，到 1967 年 10 月 18 日，动脉搏动恢复。他此后未再出现问题。

A second patient was seen as an emergency in my office on December 29, 1959, at the age of 63. He had had a coronary occlusion on December 18, 11 days previously. Four or five days before I saw him the left foot became very sore and painful and cold. A small area of darkening appeared on the top of the fourth toe and a small spot on the great toe, with edema and discoloration of the whole foot
1959 年 12 月 29 日，我办公室紧急接诊了第二位患者，时年 63 岁。他在 11 天前的 12 月 18 日曾发生冠状动脉闭塞。在我见他前四五天，左脚变得非常疼痛、酸痛且冰冷。第四脚趾顶部出现一小块发黑区域，大脚趾上也有一小点，同时整个脚出现水肿和变色。
to the ankle on the left side, with a similar lesion on the first and second toes of the right foot.
左侧至脚踝，右脚第一和第二脚趾有类似病变。

The rest of the legs were very cold and white.
其余的腿非常冰冷且发白。
On examination, it was obvious that he had suffered a mural thrombus on the left ventricle of his heart under the myocardial infarct. This thrombus had broken loose and had finally become lodged over the bifurcation (fork) of the common iliac arteries, shutting off the blood supply to both legs. There was incipient gangrene of the first, second, and third toes of his left foot.
检查时，显然他在心肌梗死部位的左心室壁上形成了血栓。该血栓脱落后最终卡在了髂总动脉分叉处，阻断了两条腿的血液供应。他左脚的第一、第二和第三脚趾出现了初期坏疽。

He was placed in the hospital, with feet protected by wrapping in cotton under a cradle, and started at once on 1,600 units of alpha tocopherol a day. The end result was that both legs were saved, with the loss of the second toe, which became totally gangrenous and was allowed to slough off spontaneously, since obviously, as far as it was possible, insult to the living tissue immediately proximal was to be avoided. Later, it became obvious that he now had a mild diabetes mellitus, easily controlled by Orinase.
他被送进医院，双脚用棉花包裹并置于支架下保护，立即开始每天服用 1600 单位的α-生育酚。最终结果是双腿得以保全，仅失去了第二个脚趾，该脚趾完全坏疽，允许其自然脱落，因为显然应尽可能避免对近端活组织的进一步损伤。后来，明显发现他患有轻度糖尿病，服用 Orinase 后易于控制。

An almost impossible coincidence occurred in this patient’s later experience. He was at a motel in Florida, one winter two or three years later, where he met another guest who had an almost identical history. He had had a myocardial infarct. He had had a “saddle” or “riding” thrombus; he had been put in hospital and treated with 1,600 units of alpha tocopherol. He had ended up losing the second toe, albeit on the other foot. This patient came from south of Cleveland, Ohio.
这位患者后来经历了几乎不可能的巧合。两三年后的一个冬天，他在佛罗里达的一家汽车旅馆遇到了另一位客人，后者有着几乎相同的病史。他曾患过心肌梗死，曾有“鞍状”或“骑乘”血栓；他被送进医院，接受了 1600 单位的α-生育酚治疗。最终他失去了第二个脚趾，尽管是在另一只脚上。这位患者来自俄亥俄州克利夫兰以南。

Another patient at the age of 43, in the summer of 1949, entered the over-40 race at a Sunday School picnic. Two thirds of the way down the course, he was brought to an abrupt halt with severe cramps in the calves of both legs. After a few days, the pain subsided, but thereafter cramping in the calves of one leg would develop on walking one-half to one block. This patient had been taking 600 units of alpha tocopherol a day for years before this episode and by his own judgment increased it to 1,600 units a day. Within a month he was improved and within six weeks symptom-free. He could walk or run and could walk a long and hilly 18 -hole
另一位患者，43 岁，1949 年夏天，在一次主日学野餐活动中参加了 40 岁以上的比赛。在赛程进行到三分之二时，他因双腿小腿严重抽筋而被迫停下。几天后，疼痛减轻，但此后走半个到一个街区时，一条腿的小腿仍会抽筋。这位患者在此事件发生前多年每天服用 600 单位的α-生育酚，凭自己的判断将剂量增加到每天 1600 单位。一个月内他的情况有所改善，六周内症状消失。他可以走路或跑步，还能走完一个漫长且多坡的 18 洞球场。
golf course without trouble for the next 18 years - at the end of which period there was a mild recurrence on the golf course. A slight increase in dosage soon relieved the condition completely, and as of now he is completely free of symptoms.
在接下来的 18 年里，他在高尔夫球场上没有任何问题——在这段时间结束时，高尔夫球场上出现了轻微的复发。剂量稍微增加后，很快完全缓解了症状，到目前为止，他已经完全没有症状。

This case illustrates the rapid relief obtained by some patients when given an appropriate dose of alpha tocopherol, by which the oxygen need of the tissues is greatly reduced.
这个案例说明了一些患者在给予适当剂量的α-生育酚后迅速获得缓解，因为这大大减少了组织对氧气的需求。

This man, aged 57, seen on January 24, 1969, four months earlier had developed intermittent claudication in the left leg on walking one block. Now symptoms were beginning in the right leg. An artificial artery transplant was suggested by a cardiovascular surgeon, but through his brother he decided to try vitamin E first.
这名 57 岁的男子于 1969 年 1 月 24 日就诊，四个月前开始在左腿行走一街区时出现间歇性跛行。现在右腿也开始出现症状。一位心血管外科医生建议进行人工动脉移植，但他通过他的兄弟决定先尝试维生素 E。

On examination, the feet were pale and cold, the left more so than the right. There was no pulsation in the dorsalis pedis artery in either foot and none in the posterior tibial on the left side.
检查时，双脚苍白且冰冷，左脚比右脚更甚。两脚的足背动脉均无搏动，左侧胫后动脉也无搏动。

On 1,600 units of alpha tocopherol a day, his feet were definitely warmer in six weeks, and by the end of the third month of treatment he was able to walk half a mile before mild cramping set in. At the end of six months’ treatment, pulsation had returned in the left posterior tibial artery.
每天服用 1600 单位的α-生育酚，六周后他的脚明显变暖，治疗三个月结束时，他能够在轻微抽筋出现前走半英里。六个月治疗结束时，左后胫动脉的搏动恢复了。

It should be noted in passing that he was still smoking 20 cigarettes a day.
顺便一提，他仍然每天抽 20 支香烟。

Another man was 61 when seen on October 18, 1960. He had developed intermittent claudication five years previously and in this time had consulted several specialists with various diagnoses, treatment, and suggestions, including surgery.
另一名男子在 1960 年 10 月 18 日被看到时 61 岁。他五年前开始出现间歇性跛行，在此期间曾咨询过几位专家，得到过各种诊断、治疗和建议，包括手术。

His feet and legs were painful and uncomfortable most of the time. On examination, his feet were pale and cold, and there was no pulsation in either dorsalis pedis artery.
他的双脚和双腿大部分时间都感到疼痛和不适。检查时，他的双脚苍白且冰冷，双侧足背动脉均无搏动。

This man’s improvement on 1,600 units of vitamin E a day was spasmodic at first. However, after nine years, he can walk normally without pain. His home is on a ravine,
这个人在每天服用 1600 单位维生素 E 后，最初的改善是断断续续的。然而，九年后，他可以正常行走且无痛。他的家位于一个峡谷边，
with 165 steps in front, and he can come up 120 steps without a stop.
前面有 165 级台阶，他可以连续上 120 级台阶不休息。

This case illustrates the value of alpha tocopherol therapy after an aortic transplant, which incidentally did not improve this patient’s condition. We have had, similarly, success with chronic rheumatic heart disease patients whose surgery was unsatisfactory or partially satisfactory or in whom there was a regression after several months.
这个案例说明了在主动脉移植术后使用α-生育酚治疗的价值，尽管该手术并未改善这位患者的状况。我们同样在慢性风湿性心脏病患者中取得了成功，这些患者的手术效果不理想或部分理想，或者在几个月后出现了病情倒退。

This patient, aged 47, when first seen on December 11, 1968, had had a coronary occlusion, with an anterioseptal infarct, in August of 1966. He had had intermittent claudication for six or seven years and had a Teflon graft inserted on September 11, 1967 with no change whatsoever in his symptoms.
这位 47 岁的患者，首次就诊于 1968 年 12 月 11 日，曾于 1966 年 8 月发生冠状动脉闭塞，伴有前间隔心肌梗死。他有间歇性跛行症状已有六七年，并于 1967 年 9 月 11 日植入了特氟龙移植物，但症状没有任何变化。

On 2,400 units of alpha tocopherol a day, he can now walk fairly well, about twice as far as he could previously. We anticipate further improvement.
每天服用 2400 单位的α-生育酚，他现在可以走得相当好，距离大约是以前的两倍。我们预计会有进一步的改善。

Another patient was aged 62 when first seen on April 25, 1968. He had developed intermittent claudication in 1964, usually on walking one block. In July of 1967 he developed angina for the first time and since then has had it many times on mild exertion or excitement.
另一位患者在 1968 年 4 月 25 日首次就诊时年龄为 62 岁。他在 1964 年出现了间歇性跛行，通常走一街区时发作。1967 年 7 月，他首次出现心绞痛，此后在轻微劳累或激动时多次发作。

On 1,600 units of alpha tocopherol daily he no longer has any angina, can walk any distance if he takes his time, and is well satisfied.
每天服用 1600 单位的α-生育酚后，他不再有任何心绞痛，如果他慢慢走，可以走任何距离，并且感到非常满意。

Still another patient is the owner of a large real estate business and is particularly active in selling farms, which means he must walk over many acres of meadow, bush, and cultivated land. He was 53 years old when first seen September 12, 1968. He first noticed difficulty in walking in 1965, and this had increased steadily. Finally, he was able to walk but one block on pavement and a little more on farm properties, and his legs ached continuously after a day’s work. He had had angina for ten years and was a known hypertensive.
还有一位患者是一家大型房地产公司的老板，特别活跃于农场销售，这意味着他必须走过许多草地、灌木丛和耕地。1968 年 9 月 12 日首次就诊时，他 53 岁。他在 1965 年首次注意到行走困难，且情况逐渐加重。最终，他只能在铺装路面上走一条街区，在农场地块上走得稍多一些，工作一天后双腿持续疼痛。他患有心绞痛已有十年，并且是已知的高血压患者。

On examination, there was no pulsation in the right foot and a very weak one in the posterior tibial artery on that side. The left leg showed excellent pulsation in the dorsalis pedis artery and weak pulsation in the posterior tibial. By February 10, 1969, he could walk three times as far and by April 9 was able to walk over three farms in the course of his day’s work. By June 25, 1969 there was a definite return of pulsation in the right dorsalis pedis and improved circulation throughout.
检查时，右脚无脉搏，右侧胫后动脉脉搏非常微弱。左腿背侧足动脉脉搏良好，胫后动脉脉搏微弱。到 1969 年 2 月 10 日，他的行走距离增加了三倍，到 4 月 9 日，他能够在一天的工作中走过三个农场。到 1969 年 6 月 25 日，右侧背侧足动脉的脉搏明显恢复，整体循环有所改善。

Also, any condition that obstructs venous flow and distends collateral veins over long periods of time, especially pregnancy and pelvic or abdominal neoplasm, will produce varicosities.
此外，任何阻碍静脉血流并使侧支静脉长期扩张的情况，尤其是妊娠和盆腔或腹部肿瘤，都会导致静脉曲张。

Our training was traditional, and so, of course, this explanation was accepted. Therefore, we at first paid little or no attention to the effects of alpha tocopherol on varicose veins. However, when we compared notes and found that our patients were insisting that their varicose veins were getting smaller, we became interested.
我们的训练是传统的，因此，这种解释当然被接受了。因此，起初我们几乎没有注意到α-生育酚对静脉曲张的影响。然而，当我们对比记录，发现患者坚持说他们的静脉曲张在变小时，我们开始产生了兴趣。

My own experience began with a male patient, who on his first visit for a cardiac problem showed me a large varicose vein about 8 inches long inside his left knee. Later, on a subsequent visit, he mentioned that this vein had “disappeared.” He must have noticed my smile and look of incredulity. He said, “You don’t believe me, do you?” He then exposed the knee, and there was no visible varicose vein. I could palpate the vein but it seemed normal in size.
我自己的经历始于一位男性患者，他第一次因心脏问题来访时，向我展示了他左膝内侧一条大约 8 英寸长的静脉曲张。后来，在一次随访中，他提到这条静脉“消失了”。他一定注意到了我微笑和难以置信的表情。他说：“你不相信我，是吗？”然后他露出膝盖，那里没有可见的静脉曲张。我能触摸到那条静脉，但它的大小似乎正常。

A second convincing case was that of a girl in her middle twenties, a member of a large family, many of whom had been patients of mine for years. She asked me to give her vitamin E for her veins, since she was about to be married
第二个令人信服的案例是一位二十多岁的女孩，来自一个大家庭，家中许多人多年来一直是我的病人。她请求我给她开维生素 E 来治疗她的静脉问题，因为她即将结婚。
and didn’t want to walk down the aisle with her legs as they were. Obviously, this was in the days of short skirts and sheer stockings! I refused, since the synthetic product we were using at this time was very expensive -57 cents per 100 units - and obviously also, no drug should be used indiscriminately. Certainly mere vanity was not an adequate reason for treating a patient. I explained this point of view and said that it would be a different matter if she had had any heart trouble. Then she said, “Well, I am supposed to have a damaged valve.” She had at that time asymptomatic chronic rheumatic mitral stenosis, so I did treat her for her heart. She was delighted with the effects on her veins and walked happily down the aisle at her wedding. She has remained a patient, has no family, has beautiful legs, and her heart, except for one brief episode, has given her no trouble.
她不想以当时那样的腿走过教堂的过道。显然，那是短裙和透明长袜的时代！我拒绝了，因为我们当时使用的合成产品非常昂贵——每 100 单位 57 美分——而且显然，没有药物应该被滥用。仅仅出于虚荣心绝不是治疗病人的充分理由。我解释了这一观点，并说如果她有心脏问题，那情况就不同了。然后她说：“嗯，我被认为有一个受损的瓣膜。”当时她患有无症状的慢性风湿性二尖瓣狭窄，所以我确实为她的心脏进行了治疗。她对静脉的效果感到非常满意，并在婚礼上高兴地走过了过道。她一直是我的病人，没有家人，腿部漂亮，除了有一次短暂的发作外，她的心脏一直没有给她带来麻烦。

Since these experiences, we have treated patients with varicose veins, with and without previous surgery, with gratifying results. However, the reasons for treatment have been not to shrink the varicosities, but to reduce the symptoms. The distended and torturous veins cause a chronic venous stasis which produces edema, stabbing and aching pain, and, if severe enough and prolonged enough, indolent ulceration, overgrowth of comective tissue, and occasionally, hemorrhages or ecchymosis, leakage of blood under the skin. The ulceration is a condition we have long treated successfully with alpha tocopherol, and, of course, this was our initial interest. It was a bonus to us, however, that the treatment of varicose veins almost always completely relieves the pains and aches by decreasing the oxygen need of the tissues involved; by opening up effective collateral circulation, it also relieves the edema.
自那次经历以来，我们治疗了有静脉曲张的患者，包括有无既往手术史的患者，取得了令人满意的效果。然而，治疗的目的并不是缩小静脉曲张，而是减轻症状。扩张且曲折的静脉引起慢性静脉淤滞，导致水肿、刺痛和隐痛，如果严重且持续时间足够长，还会引发难愈性溃疡、结缔组织过度增生，有时还会出现出血或瘀斑，即皮下出血。溃疡是我们长期用α-生育酚成功治疗的病症，当然，这也是我们最初的关注点。然而，治疗静脉曲张几乎总能通过减少受累组织的氧气需求来完全缓解疼痛和不适；通过打开有效的侧支循环，也能减轻水肿，这对我们来说是一个额外的收获。

Any patient who is content with comfort and doesn’t care too much about the appearance of her legs, especially now that stockings are available which give gentle elastic pressure and support and look good, will be satisfied with her response.
任何满足于舒适且不太在意腿部外观的患者，尤其是在现在有了既能提供温和弹性压力和支撑又美观的长袜的情况下，都会对她的反应感到满意。

Most such patients resist surgical intervention to remove
大多数此类患者抵制通过手术干预来切除
the affected veins; and we explain to our patients the results with surgery.
受影响的静脉；我们向患者解释手术的结果。

The Canadian Medical Protective Association annually warns doctors to consider the operation of the ligation and stripping of veins as “one of the most potentially dangerous any patient may have to undergo because of the irreversible results which generally follow error . . . It is only part of the answer to say that vein stripping should be done only by skilled, experienced surgeons . . . it can be demonstrated that skill alone is not enough, as witness the fact that some of these difficulties have arisen at the hands of the most highly skilled and widely respected practitioners.”
加拿大医学保护协会每年都会警告医生，考虑进行静脉结扎和剥除手术时应视其为“患者可能经历的最危险的手术之一，因为错误通常会导致不可逆转的后果……仅仅说静脉剥除应由技术娴熟、经验丰富的外科医生来完成是不够的……事实证明，仅有技术是不够的，正如一些最有技能且备受尊敬的医生也曾出现这些并发症所证明的那样。”

Recurrence rates are high after surgical treatment. The etiology of varices is obscure. Accurate and adequate ligation of all communicating veins may still not prevent recurrence because of pre-existing and continuing deep vein incompetence not amenable to surgical correction. There can be no guaranteed permanent cure of this condition. Complications of varicose vein surgery may run as high as 52 per cent, the results bad in four per cent and only fair in 18 per cent. (Editorial and article by Phillips in the Scottish Medical Journal 9: 357, 1964.)
手术治疗后复发率很高。静脉曲张的病因尚不清楚。即使准确且充分地结扎所有交通静脉，也可能无法防止复发，因为存在先天性和持续性的深静脉功能不全，无法通过手术纠正。对此病症无法保证永久治愈。静脉曲张手术的并发症发生率可高达 52%，效果不佳的占 4%，仅一般的占 18%。（摘自 1964 年《苏格兰医学杂志》9 卷 357 页，Phillips 的社论和文章。）

Brown et al in the same journal earlier (6: 322, 1961) reported that of 107 limbs with high ligation 59 per cent showed recurrence of the varicosities, and 89 per cent of these were due to incompetent communicating veins. In only 44 of the 107 legs were the results clinically satisfactory.
Brown 等人在同一杂志早些时候（6: 322, 1961）报道，在 107 条进行高位结扎的肢体中，有 59%出现了静脉曲张复发，其中 89%是由于交通静脉功能不全。107 条腿中只有 44 条的临床结果令人满意。

Contrast this with alpha tocopherol therapy:
将此与α-生育酚疗法进行对比：
One woman patient was aged 35 when first seen on January 26, 1961. Following her first pregnancy, she had developed varicose veins, which had become worse after the second pregnancy. In 1954 she had had vein ligation with some initial benefit, but by October, 1960, her varicose veins were worse than originally. She had them “stripped” by an excellent vascular surgeon with multiple incisions along the courses of the veins in both legs. The result was a singularly unsightly leg with deep hollows at the site of the incisions where all the subcutaneous tissue seemed atrophied.
一位女性患者在 1961 年 1 月 26 日首次就诊时年龄为 35 岁。她在第一次怀孕后出现了静脉曲张，第二次怀孕后情况加重。1954 年她接受了静脉结扎手术，最初有所好转，但到 1960 年 10 月，她的静脉曲张比最初更严重。她由一位优秀的血管外科医生进行了“剥脱”手术，沿着双腿静脉走向做了多处切口。结果是她的腿非常难看，切口处出现深陷，所有的皮下组织似乎都萎缩了。

She had had rheumatic fever at the age of 12 and had been confined to bed for several weeks at that time.
她在 12 岁时患过风湿热，当时卧床休息了好几周。

Her legs were cold but not particularly painful. However, she was told that her veins would have to be “kept down” by subsequent operations.
她的腿很冷，但并不特别疼痛。然而，有人告诉她，她的静脉必须通过后续手术来“控制住”。

A complication in her case was a duodenal ulcer, which had hemorrhaged severely in 1955 and October, 1959, and recurred again in March of 1969, requiring three transfusions, so her treatment with alpha tocopherol was interrupted while she was in the hospital.
她的病情复杂之处在于十二指肠溃疡，曾在 1955 年和 1959 年 10 月严重出血，并于 1969 年 3 月再次复发，需输血三次，因此她在住院期间接受的α-生育酚治疗被中断。

Because of the ulcer history and the rheumatic fever history and the typical murmurs of rheumatic heart disease, she was started very gradually on alpha tocopherol- 90 units a day for a month, 120 units for the second month, and then 150 units. By August of 1961 she stated that her legs felt much better. However, her veins were beginning to show some recurrence of the varices, so her alpha tocopherol was gradually raised to 300 units a day. On this quantity her legs have steadily improved. There are no more varices, and they now no longer bother her. She has had no recurrence of ulcer symptoms. The hollows in the subcutaneous tissue at the site of incision are definitely filled in to a degree, though still very obvious.
由于有溃疡病史和风湿热病史，以及典型的风湿性心脏病杂音，她开始非常缓慢地服用α-生育酚——第一个月每天 90 单位，第二个月每天 120 单位，然后增加到 150 单位。到 1961 年 8 月，她表示双腿感觉好多了。然而，她的静脉开始出现静脉曲张的复发迹象，因此她的α-生育酚剂量逐渐增加到每天 300 单位。在这个剂量下，她的双腿持续改善。静脉曲张不再出现，也不再困扰她。溃疡症状没有复发。切口处皮下组织的凹陷明显填平了一部分，尽管仍然很明显。
A man, aged 48 when first seen on March 27, 1961, worked all day on the floor of the stock exchange. Gradually varicose veins appeared in both legs, and they ached and cramped at work. He had developed a patch of varicose eczema, secondarily infected with a fungus, which healed when the fungus was cleared up on 150 units of alpha tocopherol prescribed by a nurse who was also a patient of mine. He was advised to have his veins stripped, but reported to me instead, since his wife was also my patient.
一名 48 岁男子，首次就诊于 1961 年 3 月 27 日，整天在证券交易所的交易大厅工作。双腿逐渐出现静脉曲张，工作时感到疼痛和痉挛。他发展出一块静脉曲张湿疹，继发真菌感染，在一位同时也是我患者的护士开出的 150 单位α-生育酚治疗下，真菌被清除后湿疹愈合。他被建议进行静脉剥除手术，但由于他的妻子也是我的患者，他选择来找我。

On alpha tocopherol, in six weeks his legs felt warmer and had become “no bother at all.” He had no pain or ache or cramps. However, the area over the vein previously treated was bothering him again. Alpha tocopherol in vanishing cream was applied to this lesion with “stupendous results.” It is now more than eight years since treatment began.
服用α-生育酚六周后，他的双腿感觉更温暖，且“完全不成问题”。他没有疼痛、酸痛或抽筋。然而，之前治疗过的静脉区域又开始让他感到不适。将含α-生育酚的消失霜涂抹在该病变处，效果“惊人”。自治疗开始至今已超过八年。

A woman, aged 39 when first seen June 23, 1964, had a mild attack in both legs of thrombophlebitis which accompanied a pregnancy in 1959. This recurred in her left leg again with her last pregnancy in March of 1963. Since that time the left leg would become edematous by night.
一名 39 岁的女性，首次就诊于 1964 年 6 月 23 日，曾在 1959 年怀孕期间双腿轻度发生血栓性静脉炎发作。1963 年 3 月最后一次怀孕时，她的左腿再次出现此症状。从那时起，左腿晚上会出现水肿。

On 600 units of alpha tocopherol the edema disappeared in four weeks, and her legs ceased to bother her.
服用 600 单位的α-生育酚后，水肿在四周内消失，她的腿也不再困扰她。

In November, 1964, with another pregnancy, her legs once more began to ache, so her alpha tocopherol was raised to 800 units daily. At this level her legs once more ceased to bother her. She had no more trouble. Her daughter was born on June 27, 1965, and she has had no trouble with her legs since.
1964 年 11 月，怀孕期间，她的双腿再次开始疼痛，于是她的α-生育酚剂量提高到每天 800 单位。在这个剂量下，她的双腿再次不再困扰她。她没有再出现问题。她的女儿于 1965 年 6 月 27 日出生，从那以后她的双腿就没有再出现问题。

A woman, aged 65 when first seen July 15, 1958, had had varicose veins in both legs since her first pregnancy. During the previous four years there was marked discoloration of both ankles and the lower halves of both legs. It had become worse since varicose eczema and an episode of infection from scratching had set in.
一位女性，首次就诊时年龄为 65 岁（1958 年 7 月 15 日），自第一次怀孕以来双腿都有静脉曲张。在过去四年中，双脚踝及双腿下半部出现明显变色。自从出现静脉曲张性湿疹和因抓挠引发的感染后，情况变得更严重。

This case is remarkable in that she has 16 children, eight boys and eight girls, and raised all 16 on a Western prairie farm. Her legs bothered her all the time, showing extensive varices in both legs, with severe cramping in bed.
这个案例很特别，她有 16 个孩子，八个男孩和八个女孩，并且在西部草原农场养育了全部 16 个孩子。她的双腿一直困扰着她，双腿有广泛的静脉曲张，晚上躺床时严重抽筋。

On alpha tocopherol these varicose veins of nearly 50 years duration, aggravated by numerous pregnancies, not only ceased to cause symptoms of venous stasis, but diminished greatly in size. She now wears normal nylon stockings and has a nice pair of legs, just like her eight daughters.
在服用α-生育酚后，这些近 50 年病史的静脉曲张（因多次怀孕而加重）不仅不再引起静脉淤滞的症状，而且大小大大缩小。她现在穿着普通的尼龙长袜，拥有一双漂亮的腿，就像她的八个女儿一样。

A woman, aged 35 when first seen September 4, 1962, first developed varicose veins with her first pregnancy 15 years previously. Her left leg was the more painful of the two, especially since the birth of her second child four years previously. With this second child, she had a thrombophlebitis while in the hospital. Both legs ached continuously, especially as the day progressed.
一名女性，35 岁，首次就诊于 1962 年 9 月 4 日，15 年前第一次怀孕时开始出现静脉曲张。她的左腿比右腿更疼痛，尤其是在四年前生下第二个孩子之后。第二次怀孕期间，她在医院时患有血栓性静脉炎。两条腿持续疼痛，尤其是随着一天的推移疼痛加剧。

On alpha tocopherol therapy her legs ceased to bother her by December (after three months’ treatment).
经过三个月的治疗，到十二月时，她的腿部不再感到不适。

A woman, aged 49 when first seen on September 2, 1964, had had several recurring attacks of thrombophlebitis in her right leg for the prior six years. The last attack was in May, 1964; and the leg was still painful if she was on her feet for any length of time.
一名 49 岁的女性，于 1964 年 9 月 2 日首次就诊，过去六年中右腿多次反复发生血栓性静脉炎。最后一次发作是在 1964 年 5 月；如果长时间站立，腿部仍然感到疼痛。

She had three episodes of pulmonary embolism following a cholecystectomy in June of 1964 at the time of a phlebitis in her right leg. She was a teacher who taught home economics at a technical school.
1964 年 6 月，她在右腿静脉炎期间，胆囊切除术后发生了三次肺栓塞。她是一名教师，在一所技术学校教授家政学。

On 800 units daily of alpha tocopherol her legs were better in six weeks. However, her doctor had put her on iron, and since neither he nor the patient knew that this interfered with alpha tocopherol therapy, the left leg started to pain again. When it was explained that she could only take iron by taking all her alpha tocopherol at once and all her iron eight to 12 hours later, the legs once more became asymptomatic.
每天服用 800 单位的α-生育酚，六周后她的腿部情况有所好转。然而，她的医生给她开了铁剂，由于医生和患者都不知道铁剂会干扰α-生育酚治疗，左腿又开始疼痛。当解释清楚她只能一次性服用所有的α-生育酚，然后在 8 到 12 小时后服用所有的铁剂时，腿部症状再次消失。

Another patient, aged 51 years on August 30, 1960, had had varicose veins since 1930-some 30 years. She had phlebitis in both legs in 1935 and an acute thrombus in 1960. The varices had increased for the past two years and had a dead heavy feeling in them. There was edema of feet and ankles for 20 years.
另一位患者，1960 年 8 月 30 日时 51 岁，自 1930 年代起已有静脉曲张，约 30 年。她在 1935 年双腿患有静脉炎，1960 年出现急性血栓。过去两年静脉曲张加重，感觉沉重麻木。双脚和脚踝有 20 年水肿。

In 1956 she had an attack of what may well have been a pulmonary embolus and was in bed a few days.
1956 年，她可能患了肺栓塞，卧床休息了几天。

On 300 units of alpha tocopherol a day, the aching was all gone in six weeks. She decreased her dose of alpha tocopherol and bought an inferior brand because it was cheaper. Her legs started to ache again. On a good brand and 600 units a day, her legs ceased to bother her at all.
每天服用 300 单位的α-生育酚，六周后疼痛完全消失。她减少了α-生育酚的剂量，并购买了一个较便宜的劣质品牌。她的腿又开始疼痛。在使用优质品牌且每天服用 600 单位时，她的腿完全不再疼痛。

A woman, aged 52, was seen first on May 1, 1967. She had been bothered with varicose veins since a pregnancy 24 years before, the left leg being the worse. There was a marked degree of varicose eczema in both legs, and there was a fair degree of edema by the end of the day.
一名 52 岁的女性于 1967 年 5 月 1 日首次就诊。她自 24 年前怀孕以来一直受静脉曲张困扰，左腿情况较重。双腿都有明显的静脉曲张性湿疹，且到一天结束时有相当程度的水肿。

On 800 units of alpha tocopherol the eczema and edema cleared up completely, so she stopped taking the alpha tocopherol. The condition recurred, and she started back on treatment. Once more her legs lost the eczema, so she
服用 800 单位的α-生育酚后，湿疹和水肿完全消失，于是她停止了服用α-生育酚。病情复发，她又开始治疗。她的腿再次摆脱了湿疹，所以她...
stopped her capsules again, and the eczema took some time to come back. The edema disappeared. She continues to treat her condition off and on, as above, in spite of my. attempts to explain the virtues of continuous treatment! I used succinate (succinic acid salt) in this case because of the varicose eczema and the suspicion that there might be an allergic element in the lesion. There is a lessened chance of allergy with the succinate, although I feel that the usual natural form of alpha tocopherol is more potent and useful.
她又停止服用胶囊，湿疹过了一段时间才复发。水肿消失了。尽管我试图解释持续治疗的好处，她仍然断断续续地治疗她的病情！在这种情况下，我使用了琥珀酸盐（琥珀酸盐酸盐），因为有静脉曲张性湿疹，并怀疑病变中可能存在过敏成分。使用琥珀酸盐过敏的可能性较小，尽管我认为通常的天然形式的α-生育酚更有效且更有用。

One patient had a combination of varicose veins and a hemorrhagic tendency, the latter also clearing up on alpha tocopherol therapy. She was 46 years old when first seen on November 14, 1961. She would develop large superficial bruises on her arms, legs, and hands particularly, but anywhere on her body in response to the mildest trauma. She had edema of both legs to the knees, due to varicose veins in both legs. These had been injected 12 years previously and ligated two years later. She suffered cramps in her feet and in the calves of both legs at night.
一位患者同时患有静脉曲张和出血倾向，后者在接受α-生育酚治疗后也得到了改善。她于 1961 年 11 月 14 日首次就诊时 46 岁。她的手臂、腿和手部特别容易出现大面积浅表瘀伤，但身体任何部位在轻微外伤后都会出现瘀伤。由于双腿静脉曲张，她的双腿至膝部出现水肿。12 年前她曾接受过静脉注射治疗，2 年后进行了结扎手术。她夜间双脚和小腿肌肉会抽筋。

On 600 units of alpha tocopherol and calcium with vitamin D, she was much improved in six weeks; she had no more bruises, no more cramps, no more edema, and no more aching legs. She has been perfectly free of all these symptoms now for seven and one-half years.
服用 600 单位的α-生育酚和含维生素 D 的钙剂后，她在六周内有了很大改善；不再有淤青、抽筋、水肿和腿痛。现在她已经完全没有这些症状七年半了。

Finally, here is the history of a patient included because of the extent of varicosities recurring after ligation and stripping of veins eleven years before and the degree of improvement achieved in a short time on alpha tocopherol therapy.
最后，这是一位患者的病史，因十一年前静脉结扎和剥脱术后静脉曲张反复发作的程度而被纳入研究，以及在短时间内通过α-生育酚治疗所取得的改善程度。

The operation, bilaterally, involved six incisions in each leg. When I first saw her August 10, 1967, the whole internal saphenous veins system on the right side was involved in multiple large varicosities to the region of the saphenous opening, and she had large varices on the right side of her vulva. The left side showed the same picture, but to a lesser degree. She had a phlebitis in the left thigh during the
手术是双侧进行的，每条腿各有六个切口。1967 年 8 月 10 日我第一次见到她时，右侧整个内侧大隐静脉系统出现多处大静脉曲张，延伸至隐静脉口区域，右侧外阴也有大静脉曲张。左侧情况相同，但程度较轻。她左大腿曾有静脉炎。
whole month of January, and in August her right thigh was very painful.
整个一月份，八月份时她的右大腿非常疼痛。

On 300 units of alpha tocopherol a day she was much improved, her legs didn’t ache any more, and the phlebitis was clinically cleared in the right thigh.
每天服用 300 单位的α-生育酚后，她的情况大为好转，腿部不再疼痛，右大腿的静脉炎在临床上已消除。

This patient was a professional seamstress and made all the clothes for herself and her children. Only at the sewing machine did she notice aching and pain in the right thigh and leg. For this reason her dosage was raised to 600 units a day, and she lost all symptoms. Her legs lost the edema, were slimmer and the veins less prominent and not as dark blue in color.
这位患者是一名专业裁缝，为自己和孩子们缝制所有衣服。只有在使用缝纫机时，她才注意到右大腿和腿部的疼痛和酸痛。为此，她的剂量被提高到每天 600 单位，所有症状都消失了。她的腿部浮肿消失了，变得更纤细，静脉不那么突出，颜色也不再那么深蓝。

tion made between a primary, simple clot, or thrombosis, in the lumen of the vein, without apparent inflammation, which is called phlebothrombosis, and a similar condition, with active inflammation of the wall of the affected vein, which is, therefore, called thrombophlebitis.
区分了原发性、简单的血栓或静脉腔内的血栓形成，无明显炎症，称为静脉血栓症，以及类似情况但伴有受影响静脉壁的主动炎症，因此称为血栓性静脉炎。

Predisposing factors are: (I) reduced flow of blood through the veins (venous stasis) associated, for example, with prolonged bed rest or external pressure; (2) local injury of the endothelium by stretching, contusion, chemicals, or bacteria; and (3) changes in the circulating blood that favor coagulation.
诱发因素包括：(1) 静脉血流减少（静脉淤滞），例如与长期卧床休息或外部压力有关；(2) 由拉伸、挫伤、化学物质或细菌引起的内皮局部损伤；(3) 促使血液凝固的循环血液变化。

There are also many clinical conditions which may lead to thrombophlebitis, such as myocardial failure, obesity, debility, senility, varicose veins, trauma, and surgery.
还有许多临床状况可能导致血栓性静脉炎，如心肌衰竭、肥胖、虚弱、衰老、静脉曲张、外伤和手术。

The condition can chiefly or entirely affect the superficial veins, those at or near the skin surface, or may affect the deep veins chiefly or entirely, depending to some degree on the condition of the communicating veins. It is a condition that is usually not difficult to diagnose in the superficial veins, but may be very difficult indeed in the deep veins. This accounts for the wide variation in the reported incidence of deep vein thrombosis, since it may be easily overlouked unless carefully sought for in every bedridden or convalescent patient. In view of how often the possibility is not investigated, it may well be supposed that thrombophlebitis is more common than is generally known.
这种情况主要或完全影响浅表静脉，即位于皮肤表面或附近的静脉，或者主要或完全影响深静脉，这在某种程度上取决于交通静脉的状况。浅表静脉的诊断通常不难，但深静脉的诊断可能非常困难。这解释了深静脉血栓形成报告发病率的巨大差异，因为除非在每个卧床或康复患者中仔细寻找，否则很容易被忽视。鉴于这种可能性经常未被调查，可以合理推测血栓性静脉炎比普遍认知的更为常见。

The condition in a patient can be very widespread. It
患者的病情可能非常广泛。它
usually begins in the leg or thigh but may easily occur in or spread to the pelvic veins, particularly in surgical cases. Of course, the main danger is embolism; as the clot disintegrates, many small emboli or a single large embolus can occur. Deposited in the lungs, such emboli can be rapidly fatal or lead to a serious, long-protracted illness.
通常始于小腿或大腿，但也可能发生在骨盆静脉或扩散至骨盆静脉，尤其是在手术病例中。当然，主要的危险是栓塞；随着血块的分解，可能出现许多小栓子或一个大的栓子。沉积在肺部时，这些栓子可能迅速致命或导致严重且长期的疾病。

In recent years there has been a great rise in the incidence of deep vein thrombophlebitis and so of pulmonary embolism. A study in two Oxford, England, hospitals showed that the incidence in 1961 was about five times that of 1952. The mortality rate was also greatly increased, since about onehalf of the cases recorded were fatal. The authors advance the possibility that this phenomenon represents merely one facet of an epidemic of thrombotic disease affecting Western society. During the period under review, the number of patients admitted to the hospitals with coronary and cerebral thrombosis had also risen steeply (S. S. B. Gilder quoting the work of Morrell and her colleagues in the Canadian Medical Association Journal, Vol. 89, December 21, 1963, p. 1,300).
近年来，深静脉血栓性静脉炎及肺栓塞的发病率大幅上升。英国牛津的两家医院的一项研究显示，1961 年的发病率约为 1952 年的五倍。死亡率也大幅增加，因为记录的病例中约有一半是致命的。作者提出，这一现象可能仅仅是影响西方社会的血栓性疾病流行的一个方面。在审查期间，因冠状动脉和脑血栓入院的患者数量也急剧上升（S. S. B. Gilder 引用 Morrell 及其同事在《Canadian Medical Association Journal》，第 89 卷，1963 年 12 月 21 日，第 1300 页的研究）。
G. Stringer in the New York Journal of Medicine (62: 3423,1962 ) reported that among 150 patients, with phlebitis, followed from five to more than 20 years after the initial illness, 25 had recurrences. There were 20 instances of pulmonary embolism among them. The most commonly occurring sequelae were edema, varicosities, and ulceration. Yet the condition is easy to control with vitamin E.
G. Stringer 在《纽约医学杂志》(62: 3423, 1962)中报道，在 150 名静脉炎患者中，随访时间从发病后五年到二十多年不等，有 25 人复发。其中有 20 例发生了肺栓塞。最常见的后遗症是水肿、静脉曲张和溃疡。然而，这种情况用维生素 E 很容易控制。

Very soon after our rediscovery of the value of alpha tocopherol in cardiac disease, Dr. Evan Shute treated a case of antepartum (before childbirth) thrombophlebitis with a “lump” the size of a man’s fist in the woman’s lower thigh, the veins involved extending from mid-thigh to midcalf with marked edema in the tissues surrounding the affected veins. On alpha tocopherol the mass and cellulitis disappeared in four days, and the patient left the hospital in ten days. On a maintenance dose, there was no recurrence at delivery. Since then, we have treated a great many such patients, and in the fresh acute stage the response is always within 48 to 96 hours and, by that time, nearly complete. Of course, when a patient is seen some days after the
在我们重新发现α-生育酚在心脏病中的价值后不久，Evan Shute 博士治疗了一例产前（分娩前）血栓性静脉炎，患者下大腿有一个拳头大小的“肿块”，受累静脉从大腿中部延伸到小腿中部，受影响静脉周围组织明显水肿。服用α-生育酚后，肿块和蜂窝织炎在四天内消失，患者十天后出院。维持剂量下，分娩时未见复发。从那时起，我们治疗了许多此类患者，在急性新发阶段，反应总是在 48 到 96 小时内出现，且几乎完全恢复。当然，当患者在几天后才就诊时，情况会有所不同。
beginning of the phlebitic change, the improvement is slower and less likely to be as complete, since, of course, the clot has become organized.
静脉炎变化的初期，改善较慢且不太可能完全恢复，因为血块已经形成组织。

However, by far the most startling and most important effect is that these patients do not throw off emboli. We were alert to this danger in our phlebitic cases, but only oncehave I had a patient throw a pulmonary embolus. This was in the early days of vitamin E therapy, and at this time we were following the old practice of six weeks in bed for a case of coronary thrombosis.
然而，迄今为止最令人震惊且最重要的效果是这些患者不会发生栓塞。在我们的静脉炎病例中，我们对此危险保持警惕，但我只遇到过一次患者发生肺栓塞。这是在维生素 E 治疗的早期阶段，当时我们仍遵循冠状动脉血栓病例卧床六周的旧做法。

On routine check-up one morning, one such patient was found to have a thrombophlebitis in his left leg. I promptly increased the dosage of his alpha tocopherol. The very next day he suffered a pulmonary embolus. Since I had already increased the alpha tocopherol, I didn’t change it, and in two days his pulmonary embolus was gone. He really wasn’t very sick with it.
在一次例行检查中，发现一位患者左腿有血栓性静脉炎。我立即增加了他的α-生育酚剂量。第二天，他发生了肺栓塞。由于我已经增加了α-生育酚剂量，所以没有改变，结果两天后他的肺栓塞消失了。他实际上并没有因此病得很重。

Consider the implications of this treatment. Instead of vigorous and highly dangerous anticoagulant treatment or, if the condition is advancing, the radical surgery still advocated, one just gives the patient vitamin E and keeps him ambulatory.
考虑这种治疗的意义。与其采用剧烈且极具危险性的抗凝治疗，或者在病情加重时仍然主张的激进手术，不如给患者服用维生素 E，并保持其活动能力。

Dr. Alton Ochsner, famous in his own right as head of the Ochsner Clinic, “the little Mayo’s of the South,” has long been interested in thrombophlebitis and its prevention and treatment. He was sent a preliminary paper of ours for perusal and apparently decided to try alpha tocopherol. The results were so excellent that he reported them at the International Congress of Surgeons and in the various medical journals, the Journal of the American Medical Association, the Annals of Surgery, etc., and lectured on the subject at various medical societies. In the New England Journal of Medicine (271, 4, July 23, 1964) appears a letter over Dr. Ochsner’s signature commenting on an editorial in the June 4th issue of the journal entitled “Thromboembolism Spring, 1964.” He suggests that it is far more important to stress the desirability of prevention of venous thrombosis rather than treatment of the complication, pulmonary embolism. Later on in this letter he states that “in all patients in whom venous thrombosis might develop, for a number of
奥尔顿·奥克斯纳医生，作为奥克斯纳诊所（“南方的小梅奥”）的负责人，本身就颇有名气，他长期关注血栓性静脉炎及其预防和治疗。他曾收到我们的一篇初步论文进行审阅，显然决定尝试使用α-生育酚。结果非常出色，他在国际外科医师大会以及《美国医学会杂志》、《外科年鉴》等多种医学期刊上报告了这些成果，并在各医学学会讲授该主题。在《新英格兰医学杂志》（271 卷，第 4 期，1964 年 7 月 23 日）上，有一封署名奥克斯纳医生的信，评论了该杂志 6 月 4 日刊登的一篇题为“1964 年春季血栓栓塞”的社论。他建议应更加重视预防静脉血栓形成的重要性，而非仅仅治疗并发症肺栓塞。在信的后半部分，他指出“对于所有可能发生静脉血栓的患者，应采取多种措施……”
years we have routinely prescribed alpha tocopherol, 100 international units, three times a day, until the patient is completely ambulatory . . . Alpha tocopherol is a potent inhibitor of thrombin that does not produce a hemorrhagic tendency and therefore, is a safe prophylactic against venous thrombosis. . . . The prophylactic treatment is generally simple and safe.”
多年来，我们常规开具α-生育酚，每次 100 国际单位，每天三次，直到患者完全能够行走……α-生育酚是一种强效的凝血酶抑制剂，不会引起出血倾向，因此，是预防静脉血栓形成的安全措施……预防性治疗通常简单且安全。

Dr. Ochsner (67) has since stated that since using this form of prophylaxis, he has not had one single case of pulmonary embolism. If this is so, he is almost certainly the only surgeon in America in practice more than a year, who can say so.
奥克斯纳医生（67 岁）此后表示，自从使用这种预防方法以来，他没有发生过一起肺栓塞病例。如果情况属实，他几乎可以说是美国所有执业超过一年的外科医生中唯一能这么说的人。

Currently, there is much in the medical literature about the increased dangers of thrombophlebitis in women taking contraceptive pills, and the case has been fairly well made out, at least in England. However, “the pill” is probably safer statistically than pregnancy or driving an automobile; and certainly nothing will stop the millions of women who rely on and are delighted with it.
目前，医学文献中有大量关于服用避孕药的女性血栓性静脉炎风险增加的报道，这一观点至少在英国已经得到了相当充分的论证。然而，从统计学上看，“避孕药”可能比怀孕或开车更安全；而且，肯定没有什么能阻止数以百万计依赖并且对其感到满意的女性。

These women and their physicians ought to know that, just as every patient whose doctor has put him on a polyunsaturated fat diet needs increased vitamin E, so does the woman who takes the pill. With the simple addition of a vitamin to her diet, she reduces virtually to zero the danger of thrombophlebitic complications. So, also the woman who is convinced by TV advertising that she must use a certain brand of oleomargarine, because it contains polyunsaturated fats derived from corn oil, needs extra vitamin E.
这些女性及其医生应该知道，就像每个被医生安排服用多不饱和脂肪饮食的患者需要增加维生素 E 一样，服用避孕药的女性也需要。通过在饮食中简单添加一种维生素，她几乎可以将血栓性静脉炎并发症的危险降至零。同样，那些被电视广告说服必须使用某种含有玉米油提取的多不饱和脂肪的品牌人造黄油的女性，也需要额外的维生素 E。

How much is a daily preventive quota of vitamin E ? I am not aware that it has ever been computed with any degree of accuracy or with anything like a full knowledge of the nature of vitamin E deficiency disease. When I make what you might call an educated guess it is 200 international units daily for the adult in normal good health.
每日预防性维生素 E 的剂量是多少？我不知道它是否曾经被以任何准确的程度或基于对维生素 E 缺乏症本质的充分了解而计算过。当我做出你可以称之为有根据的猜测时，成人在正常健康状态下的剂量是每天 200 国际单位。

As a treatment for thrombophlebitis I use an initial dosage of 600 international units daily. Attempts at lower dosages have uniformly had inadequate effects, and in occusional cases I have even seen embolisms occur while the lower dosage was being administered. Six hundred international
作为治疗血栓性静脉炎，我使用每天 600 国际单位的初始剂量。尝试使用较低剂量的效果一贯不理想，且在个别情况下，我甚至见过在使用较低剂量时发生栓塞。六百国际单位
units of alpha tocopherol a day will result in consistently satisfactory effects.
每天摄入一定单位的α-生育酚将带来持续令人满意的效果。

Unless the diagnostic signs indicate a large number of clots or one that is indeed massive in extent, there is no need to immobilize the patient. With a sufficient dosage of alpha tocopherol - and the sufficiency of the dosage is readily checked and progress confirmed by a rise in the platelet count - the danger of embolism is for all practical purposes eliminated. Although it always exists in theory, I have never seen an embolism occur, once alpha tocopherol treatment has taken hold.
除非诊断迹象表明有大量血栓或确实存在大范围血栓，否则无需使患者固定不动。通过足够剂量的α-生育酚——剂量的充足可以通过血小板计数的上升轻松检查并确认进展——栓塞的危险在实际操作中已被消除。尽管理论上栓塞总是存在，但我从未见过在α-生育酚治疗生效后发生栓塞的情况。

With this treatment clinical improvement should be apparent and confirmed by a rise in the platelet count within two days. If it does not occur as expected, the answer is to double the dosage. I am convinced there is no such thing as a thrombophlebitis that will not resolve with a concomitant rapid increase in the platelet count in response to a high dosage of alpha tocopherol.
通过这种治疗，临床改善应当显现，并在两天内通过血小板计数的上升得到确认。如果没有如预期发生，解决办法是加倍剂量。我坚信不存在一种血栓性静脉炎不会随着高剂量α-生育酚引起的血小板计数迅速增加而得到解决。

On the other hand, if the initial platelet count is normal or nearly so, the response to the same treatment will be slower, and in such a patient I sometimes will start therapy with a dose as high as 800 international units daily.
另一方面，如果初始血小板计数正常或接近正常，对相同治疗的反应会较慢，在这种患者中，我有时会以每天高达 800 国际单位的剂量开始治疗。

I believe this phenomenon occurs because, while a fresh fibrin net will trap platelets thoroughly and cause a low platelet count, the older clot will be harder and partially shrunken and will permit more circulating platelets to pass it. Thus a higher platelet count is an indication of a clot that will be more difficult to dissolve.
我相信这种现象的发生是因为，虽然新鲜的纤维蛋白网会彻底捕获血小板并导致血小板计数降低，但较旧的血块会更坚硬且部分收缩，从而允许更多循环中的血小板通过。因此，较高的血小板计数表明血块更难溶解。

Treatment of an older clot takes longer, usually, but it will quickly render the lesion quiescent. However, in such cases, once the edema and inflammation have subsided, a residual mass of vein enclosing an organized thrombus can be felt.
较旧的血栓治疗通常需要更长时间，但它会迅速使病变平静下来。然而，在这种情况下，一旦水肿和炎症消退，仍能触及包裹着已组织化血栓的静脉残余肿块。

Some cases may be quite difficult to handle when a concomitant cardiac condition is present. I once saw a patient, a middle-aged, very obese nurse, with a very extensive acute thrombophlebitis of some days’ duration, involving varicose veins of the thigh up to her inguinal region and, therefore, quite possibly extending into her pelvic veins. Examination revealed chronic rheumatic heart disease with mild con-
当存在伴随的心脏疾病时，有些病例可能相当难以处理。我曾见过一位患者，是一位中年、非常肥胖的护士，患有持续数天的广泛急性血栓性静脉炎，涉及大腿的静脉曲张，直到腹股沟区域，因此很可能延伸到她的盆腔静脉。检查显示慢性风湿性心脏病，伴有轻度心脏功能不全。
gestive failure and moderate hypertension. For the phlebitis she required a large dose of alpha tocopherol. For her heart and blood pressure, she couldn’t take a large dose.
消化功能衰竭和中度高血压。对于静脉炎，她需要大量服用α-生育酚。对于她的心脏和血压，她不能服用大剂量。

Fortunately, she was a local patient and could be watched closely and was always at the other end of the phone. Being a nurse, she could describe any condition that might arise. She was given 800 units a day and told that she could almost certainly take that much for five days, but probably no longer. By the fourth day her phlebitis was much improved, but had not disappeared. On the fifth day she developed severe palpitation, fast heartbeat, shortness of breath, inability to breathe, except sitting up, and a cough. Her alpha tocopherol was stopped for two days with, fortunately, little change in the phlebitis. On the third day, 800 units a day was started again since the cardiac symptoms had cleared up. Four days later, the phlebitis was clinically cleared. However, because of the possibility of extension into the pelvic veins and because there might still be some residual, the dosage was unchanged. The next day she called to say that all her cardiac symptoms had returned.
幸运的是，她是当地的病人，可以被密切观察，并且总是在电话那头。作为一名护士，她能够描述可能出现的任何状况。她每天服用 800 单位，并被告知几乎可以连续服用五天，但可能不能更久。到第四天时，她的静脉炎有了很大改善，但尚未消失。第五天，她出现了严重的心悸、心跳加快、呼吸急促，除坐着外无法呼吸，并伴有咳嗽。她的α-生育酚被停用两天，幸运的是静脉炎几乎没有变化。第三天，由于心脏症状已消失，800 单位每天的剂量重新开始。四天后，静脉炎临床上已清除。然而，由于可能扩展到盆腔静脉，且可能仍有残留，剂量保持不变。第二天，她打电话说所有心脏症状又复发了。

When I went to see her I was surprised to have her open the door for me. I looked at her large legs with prominent varicose veins and asked how it happened that she was apparently well again. She explained that she was the patient’s identical twin!
当我去看她时，令我惊讶的是她为我开了门。我看着她那双布满明显静脉曲张的大腿，问她怎么会看起来又恢复健康了。她解释说她是病人的同卵双胞胎！

Recovery was complete after the third four-day treatment and before her cardiac symptoms recurred. Thereupon, we instituted proper treatment of her chronic rheumatic heart disease, and there has been no recurrence of the phlebitis.
经过第三次为期四天的治疗后，恢复完全，在她的心脏症状复发之前。随后，我们对她的慢性风湿性心脏病进行了适当治疗，静脉炎未再复发。

A letter in a small but excellent medical journal some years ago described two cases of peripheral edema of unexplained origin, not yielding to treatment. Many chemical and blood tests had been rum without anything seriously abnormal. Both were in women, one in a teen-ager, one middle-aged. Finally, by luck, the problem was solved. Both had begun to wear panty girdles sometime before their symptoms began, and their removal cured both cases.
几年前，一本小而优秀的医学期刊中有一封信描述了两例原因不明的外周水肿病例，治疗无效。进行了许多化学和血液检查，但未发现严重异常。两例均为女性，一例为青少年，另一例为中年人。最终，幸运地解决了问题。两人均在症状出现前不久开始穿戴紧身内裤，脱下后症状均得到治愈。

I have a patient, a nurse, who has had some trouble over the years with phlebitis in the right leg. One morning she
我有一位病人，是一名护士，多年来右腿静脉炎一直有些问题。一天早晨她...
developed phlebitis in the left leg. Since she was taking enough alpha tocopherol to protect the right leg, I was puzzled as to how this could happen, until the modern short skirt helped me solve her problem. Her mother had given her a lovely expensive panty girdle for her birthday!
左腿出现了静脉炎。由于她摄入了足够的α-生育酚来保护右腿，我感到困惑，不明白这是怎么发生的，直到现代短裙帮我解决了她的问题。她母亲在她生日时送给她一条漂亮昂贵的塑身内裤！

Because this book is intended to show how an experienced user of alpha tocopherol meets a varicty of problems, this case is presented here.
因为本书旨在展示一位经验丰富的α-生育酚使用者如何应对各种问题，所以这里呈现了这个案例。

A 63-year-old hairdresser had rheumatic fever at the age of 16, was quite ill at the time, and was kept in bed for one year. On June 13, 1969 she developed thrombophlebitis in her right leg. She was hospitalized for five days and given Butazolidin. There was some decrease in the thrombophlebitis; but all the symptoms were still present, and she was unable to stand on the leg for any length of time.
一位 63 岁的理发师在 16 岁时患过风湿热，当时病情相当严重，卧床休息了一年。1969 年 6 月 13 日，她右腿出现血栓性静脉炎。她住院五天，服用了 Butazolidin。血栓性静脉炎有所减轻，但所有症状仍然存在，她无法长时间站立在那条腿上。

On June 13th her doctor discovered that her blood pressure was elevated and placed her on Serpasil-hydrochlorothiazide pills.
6 月 13 日，她的医生发现她的血压升高，开始给她服用 Serpasil-氢氯噻嗪片。

When seen here on July 7, 1969, her blood pressure was 145/90 and her right leg showed a purplish red discoloration along the course of the great saphenous vein, which could be seen and palpated for ten inches below the knee and which was very tender and obviously thrombosed.
1969 年 7 月 7 日检查时，她的血压为 145/90，右腿沿大隐静脉走向出现紫红色变色，膝盖以下十英寸处可见并触及该静脉，且非常疼痛，明显有血栓形成。

She presented an obvious problem in that she had a damaged rheumatic heart and had recently had hypertension. She was put on 225 mgs . of alpha tocopherol a day (see the precautions outlined in the chapter on chronic rheumatic heart disease and in Chapter XIX, “Tailoring the Dose”). It was hoped that this might be enough to control the thrombophlebitis and not so much that it might precipitate heart symptoms. Then, too, we originally used such a dosage on many cases.
她表现出一个明显的问题，因为她患有风湿性心脏病且最近出现了高血压。她每天服用 225 毫克的α-生育酚（参见慢性风湿性心脏病章节和第十九章“调整剂量”中列出的注意事项）。希望这剂量足以控制血栓性静脉炎，同时又不会引发心脏症状。此外，我们最初在许多病例中也使用了这样的剂量。

Fortunately, she responded well, although slowly. In two and one-half to three weeks there was marked improvement, and in four weeks all signs of inflammation were gone. There was still a three-inch length of vein that was firm to palpation; but there was no tenderness, no discomfort, and she was able to work. She felt well in herself. Her blood pressure was 140/90 and her pulse 76 .
幸运的是，她反应良好，尽管恢复较慢。两周半到三周内有显著改善，四周后所有炎症迹象消失。仍有一段三英寸长的静脉触之坚硬；但无压痛，无不适，她能够工作。她感觉很好。她的血压是 140/90，脉搏 76。

A male patient, aged 45 when first seen April 23, 1969, had had an area of thrombophlebitis inside the knee six weeks previously. He was treated with an anticoagulant and then developed a large subcutaneous hemorrhage a week and a half later. Since he was forced to put more weight on the right leg, the veins on that side were beginning to ache.
一名 45 岁男性患者，首次就诊于 1969 年 4 月 23 日，六周前膝盖内侧出现了血栓性静脉炎。他接受了抗凝治疗，但一周半后出现了大面积皮下出血。由于不得不更多地依赖右腿承重，该侧的静脉开始感到疼痛。

This man’s varicose veins in his left leg had been tied 11 years before, because they had been large and bulging and the leg ached. The leg was somewhat improved for four or five years, and then gradually the original condition returned and then worsened still further.
这个男人左腿的静脉曲张在 11 年前被结扎过，因为静脉又大又突出，腿部感到疼痛。腿部状况在四五年内有所改善，随后原来的情况逐渐恢复，且变得更加严重。

When this acute thrombosis occurred he was given the anticoagulant which brought about a definite decrease in the thrombophlebitis. At this point, a specialist was called in to advise upon further prophylactic care to prevent recurrences. He suggested the injection of some substance intramuscularly every six hours for a week or so. The patient then developed a severe sciatica, which has persisted now for five months, causing severe difficulty in walking. Then the hemorrhage in the thigh occurred, so he was transfused with whole blood. Because he had fainted with the pain, he was put in oxygen. Of course, the anticoagulant was discontinued. He was in hospital for another two weeks.
当发生急性血栓时，他被给予抗凝剂，血栓性静脉炎明显减轻。此时，召来一位专家就进一步的预防护理提出建议。专家建议每六小时肌肉注射某种物质，持续一周左右。随后患者出现严重的坐骨神经痛，至今已持续五个月，导致行走困难。接着大腿发生出血，他接受了全血输血。由于疼痛导致晕厥，他被给予吸氧治疗。当然，抗凝剂被停用。他在医院又住了两周。

He was seen here six weeks after he was first admitted to hospital. At this time, the left leg was black and blue and swollen and hot behind the thigh and knee over a very large area around the varices and the vein itself. The thrombosis and ecchymosis around the vessel were palpable and visible. His temperature was 99 degrees, his pulse 84.
他在首次入院六周后被看到。此时，左腿发黑发青，肿胀且大腿后侧及膝盖周围静脉曲张和静脉本身的大片区域发热。血栓和血管周围的瘀斑可触及且可见。他的体温为 99 度，脉搏为 84。

He was given 1,200 units of alpha tocopherol a day. Two weeks later there was less aching, there was no edema, the subcutaneous hemorrhage was much less apparent, he had no fever, and his pulse rate was 68.
他每天服用 1200 单位的α-生育酚。两周后，疼痛减轻，水肿消失，皮下出血明显减少，没有发烧，脉搏为 68。

A month later the clot could still be palpated between the two ligations in that area. By August 13, 1969 his leg felt better than it had for years, the hemorrhage was gone and the vein and varices barely visible. He still had difficulty walking, with the sciatica still present, very little improved, and not yielding to treatment.
一个月后，在该区域两个结扎之间仍能触及血块。到 1969 年 8 月 13 日，他的腿感觉比多年来任何时候都好，出血消失，静脉和曲张几乎看不见。他仍然行走困难，坐骨神经痛依然存在，几乎没有改善，且对治疗无反应。

troduction, the leading cause of death in the civilized world today is thrombi forming in the coronary artery. It must be obvious that thrombi can form anywhere in the cardiovascular tree and that the danger of embolism from such thrombi is, of course, always present. That thrombi in the veins of the extremities and pelvis are now very commonly found in puerperal and postoperative patients and in the chronically ill and bedridden and that the incidence of such thrombi has increased in almost parallel fashion to coronary thrombi is becoming evident (112). Similarly thrombosis of the cerebral arteries is becoming more common.
引言：当今文明世界的主要死因是冠状动脉内形成的血栓。显然，血栓可以在心血管系统的任何部位形成，且此类血栓引发栓塞的危险始终存在。如今，在产后和术后患者以及慢性病卧床患者的四肢和骨盆静脉中常见血栓的形成，且这种血栓的发生率几乎与冠状动脉血栓的发生率同步增加，这一点已逐渐显现（112）。同样，脑动脉血栓形成也变得越来越常见。

In all cases of thrombosis, the treatment of choice is alpha tocopherol. In venous thrombosis, treated immediately the diagnosis is made, the results are spectacular; if treatment is begun later, however, it is less so. The vitamin’s ability to dissolve fresh venous thrombi is well documented.
在所有血栓形成的情况下，首选治疗方法是α-生育酚。在静脉血栓形成中，如果在诊断后立即进行治疗，效果非常显著；但如果治疗开始较晚，效果则不那么明显。该维生素溶解新鲜静脉血栓的能力已有充分的文献证明。

In acute coronary thrombosis the direct action of the alpha tocopherol on the clot in the artery is greatly curtailed by the mechanical difficulty of getting the tocopherol to the clot because of the relative and absolute paucity of collateral vessels. Therefore, the clinical evidence of the effect of the drug depends upon the clinical effect on the patient and upon the serial changes in the electrocardiogram. In general terms, it can be stated that the electrocardiogram shows the same serial changes as occur in a typical case not treated with alpha tocopherol, but to a much lesser degree. How-
在急性冠状动脉血栓形成中，α-生育酚对动脉内血栓的直接作用因侧支血管的相对和绝对稀少而受到机械性限制，导致生育酚难以到达血栓。因此，药物效果的临床证据依赖于对患者的临床影响以及心电图的连续变化。一般来说，可以说心电图显示的连续变化与未使用α-生育酚治疗的典型病例相同，但程度要轻得多。如何—
ever, the electrocardiogram recovery is much more rapid and much more complete than in the untreated patient. Clinically, the patient is usually much less ill, and has a quieter convalescence and an unusually rapid and complete recovery.
然而，心电图的恢复比未治疗的患者快得多且更为完全。临床上，患者通常病情较轻，康复期更为平静，恢复异常迅速且完全。

We think the same to be probably true of the victim of cerebral thrombosis, but neither this nor the direct effect on the thrombus in the coronary artery is susceptible to proof and must, at least at present, remain a clinical impression.
我们认为脑血栓患者的情况可能也是如此，但无论是这一点还是对冠状动脉血栓的直接影响都无法得到证实，至少目前只能作为临床印象存在。

However, there is an interesting analogy between these two situations and the demonstrable effect of alpha tocopherol on burns. If alpha tocopherol ointment is applied to a burn immediately, only that tissue destroyed by the injurious agent is lost. Without alpha tocopherol ointment, the toxic products of the dead tissue destroy the injured but viable tissue beneath, and the burn deepens. Similarly, in the coronary and cerebral accident the zone of injury and the zone of anoxia are invaded by the alpha tocopherol, and the infarct or area of softening is reduced. Recovery, therefore, is more rapid and complete. This is logical, and this we believe to be self-evident.
然而，这两种情况之间存在一个有趣的类比，即α-生育酚对烧伤的显著效果。如果立即将α-生育酚软膏涂抹在烧伤处，只有被损伤因素破坏的组织会丧失。若不使用α-生育酚软膏，死去组织的有毒产物会破坏下面受伤但仍然存活的组织，导致烧伤加深。同样，在冠状动脉和脑部意外中，α-生育酚会侵入受伤区和缺氧区，减少梗死或软化区域。因此，恢复更快且更完全。这是合乎逻辑的，我们相信这是不言自明的。

Embolism is an ever-present danger and one that we have feared in treating coronary occlusions (from mural thrombi under the infarcted area) in our cases of thrombophlebitis and in our cases of chronic rheumatic heart disease with auricular fibrillation. We have had very, very few, indeed, to our great joy.
栓塞是一种始终存在的危险，我们在治疗冠状动脉闭塞（由梗死区下的壁血栓引起）、静脉炎病例以及伴有心房颤动的慢性风湿性心脏病病例时一直心存畏惧。令我们非常高兴的是，发生的情况极其少见。

I can remember but one embolism occurring in a coronary occlusion, and the pulmonary embolus resulting rapidly resolved with very little discomfort to the patient. There have been none in memory in cases of thrombophlebitis and several, but still relatively rare, emboli in chronic rheumatic heart disease with auricular fibrillation.
我只记得一次冠状动脉闭塞中发生的栓塞，肺栓塞迅速消退，患者几乎没有不适。在静脉炎病例中没有记忆中的栓塞，而在伴有心房颤动的慢性风湿性心脏病中有几例栓塞，但仍相对罕见。

Two cases of peripheral arterial embolism have been reported elsewhere. One, a riding or saddle thrombus occluding the common iliac arteries in both legs in a case of coronary occlusion, the other an embolus to the right common iliac artery in a patient with chronic rheumatic heart disease with auricular fibrillation.
另外报道了两例外周动脉栓塞病例。一例是在冠状动脉闭塞病例中，骑跨或鞍状血栓堵塞了双腿的髂总动脉；另一例是在患有慢性风湿性心脏病伴心房颤动的患者中，栓子堵塞了右侧髂总动脉。

These cases certainly support our impression that the effect of the alpha tocopherol is directly upon the fresh thrombus itself, as has been demonstrated by several authors in the case of acute thrombophlebitis.
这些病例无疑支持了我们的印象，即α-生育酚的作用直接针对新鲜血栓，正如几位作者在急性血栓性静脉炎的病例中所证明的那样。

Such ulcers are remarkably persistent. Indeed, they tend to spread as the toxic products of tissue breakdown and the usual surface infection destroy fresh marginal cells. Healing forces simultaneously come into play, but the new tissue may in turn break down, giving a typical chronic edge to the ulcer. Very often there is a dilated “sentinel vein” just above the ulcer. The base of the ulcer is usually covered with a soft layer of material made up of fibrin, leucocytes, and purulent exudate, often foul-smelling.
此类溃疡极为顽固。实际上，它们往往会扩散，因为组织分解的有毒产物和常见的表面感染破坏了新鲜的边缘细胞。愈合力量同时发挥作用，但新组织可能反过来分解，使溃疡呈现典型的慢性边缘。溃疡上方常常有扩张的“哨兵静脉”。溃疡底部通常覆盖着由纤维蛋白、白细胞和化脓性渗出物组成的软层，常带有恶臭。

Many forms of treatment have been used, often with success. Among them are various antibiotic ointments and support of the edematous surrounding tissue by elastic bandage or Unna’s paste bandage to form a soft cast. Many cases have had the sentinel vein tied off or injected, although this maneuver is rarely of much value. When it works, of course,
许多治疗方法已被使用，且常常取得成功。其中包括各种抗生素软膏以及通过弹性绷带或 Unna 膏绷带对水肿周围组织的支持，以形成软性石膏。许多病例进行了哨兵静脉结扎或注射，尽管这一操作很少有多大效果。当然，当它有效时，...
such treatment heals the ulcer once, and it may stay healed. More commonly, though, it breaks down eventually, or new ulcers form in the same area or adjacent to it.
这种治疗能使溃疡愈合一次，并且可能保持愈合状态。然而，更常见的是，溃疡最终会破裂，或者在同一部位或邻近区域形成新的溃疡。

Many such ulcers do not even heal once by any of the methods mentioned. Here alpha tocopherol treatment can be effective with or without the aid of pressure bandages, etc. Some of those ulcers we have treated successfully have been huge by any standard, and the results have many times far exceeded our expectations.
许多此类溃疡即使采用上述任何方法也无法愈合一次。在这里，α-生育酚治疗无论是否配合加压绷带等辅助措施，都可能有效。我们成功治疗的一些溃疡按任何标准来看都非常巨大，且结果多次远远超出我们的预期。

It is only fair to state that we have failed in some cases, including some which seemed ideal for this treatment, and that in two cases, I recall, the ulcers were subsequently healed by others. I would like to mention them first since they explain both the chief mode of action of alpha tocopherol treatment and the obvious reason for the initial failure.
公平地说，我们在某些情况下失败了，包括一些看似非常适合这种治疗的病例，而且据我记得，有两例溃疡后来是由其他人治愈的。我想先提到这些病例，因为它们既解释了α-生育酚治疗的主要作用方式，也说明了最初失败的明显原因。

One occurred in a man, aged 62, who was treated for six months with some help, but whose treatment seemed doomed to failure. He was sent to a surgeon who inserted needles into the femoral artery and injected pure oxygen. The initial reaction was spasm of the artery, with blanching of the limb, and then a suffusion with increased color of the tissues. After two months the ulcers were nearly healed. This man had been a severe diabetic for years, and probably the combination of arteriosclerosis in the arteries of the legs and the varicose veins were the reason that the varicose ulcer would not heal with alpha tocopherol alone.
有一例发生在一名 62 岁的男子身上，他接受了六个月的治疗，情况有所好转，但治疗似乎注定失败。他被送到一位外科医生那里，医生在股动脉插入针头并注入纯氧。最初的反应是动脉痉挛，肢体发白，随后组织颜色加深充血。两个月后，溃疡几乎愈合。该男子多年来患有严重糖尿病，腿部动脉硬化和静脉曲张的结合，可能是单靠α-生育酚无法治愈静脉曲张性溃疡的原因。

The second patient was 71 when first seen, and her ulcer has just now healed, nine years later. It was five inches by three inches approximately, when first seen, and responded fairly well at first to alpha tocopherol ointment and alpha tocopherol by mouth. However, after it became about onequarter healed, further treatment with various adjuvant methods failed to heal it. She was consequently referred to a surgeon, who hospitalized her for months and applied a treatment he had devised and which has apparently been used successfully on other patients. The leg was enclosed in a plastic boot and stocking and pure oxygen piped into the enclosed plastic chamber so formed. The treatment was re-
第二位患者初次就诊时 71 岁，她的溃疡直到九年后才刚刚愈合。初次就诊时溃疡大约有五英寸乘三英寸，起初对α-生育酚软膏和口服α-生育酚反应相当好。然而，在溃疡愈合约四分之一后，采用各种辅助方法的进一步治疗未能使其愈合。因此，她被转诊给一位外科医生，后者将她住院数月，并采用他设计的一种治疗方法，这种方法显然已成功用于其他患者。该治疗将腿部包裹在塑料靴和长袜中，并将纯氧输送到所形成的封闭塑料腔内。治疗被重新—
peated two or three times over the course of four years, and the ulcer healed completely.
在四年内重复进行了两到三次，溃疡完全愈合了。

Two comments need to be made. Both patients continued their oral alpha tocopherol, and this may have helped. However, the chief point of interest is that it was increased oxygen supplied to the tissues that led to the healing, and that is precisely what vitamin E does in a different waynamely, by reducing the oxygen need of tissues. However, as has been so often stated in this book, the degree of oxygen conservation varies widely in individual patients.
需要做两点说明。两位患者都继续服用口服α-生育酚，这可能有所帮助。然而，最主要的关注点是，正是组织供氧的增加促成了愈合，而这正是维生素 E 以不同方式发挥作用的地方——即通过减少组织对氧的需求。然而，正如本书中多次提到的，氧气节约的程度在不同患者之间差异很大。

By contrast, let us consider a case treated in 1949, in which presumably the specific action of oxygen conservation of alpha tocopherol allowed the tissues to heal themselves completely and rapidly. Obviously the degree of oxygen conservation here was maximal. Certainly, everything was against such a result. The patient was very obese, weighing 254 pounds, partly because of inactivity necessitated by the painful legs. She had an initial blood pressure of $228/124$$228/124$228//124228 / 124, and the ulcers were huge and had been so for 13 years with no signs of healing. Indeed, we initially told her we felt sure we could not help her, but were willing to try if she wished us to.
相比之下，让我们考虑一个 1949 年治疗的案例，其中α-生育酚的特定节氧作用使组织能够完全且迅速地自我修复。显然，这里的节氧程度是最大的。当然，一切都不利于这样的结果。患者非常肥胖，体重 254 磅，部分原因是因腿部疼痛而不得不减少活动。她的初始血压为 $228/124$$228/124$228//124228 / 124 ，溃疡巨大，且已经持续了 13 年，没有愈合的迹象。事实上，我们最初告诉她，我们确信无法帮助她，但如果她愿意，我们愿意尝试。

She had an ulcer on the right leg which almost completely girdled the lower one-third of the leg, while the ulcer on the left leg was equally wide and somewhat larger, extending beyond the natural crease between the foot and ankle into the upper part of the foot.
她右腿有一个溃疡，几乎完全环绕了小腿下三分之一部位，而左腿的溃疡同样宽大且稍大一些，超出了脚与脚踝之间的自然折痕，延伸到了脚的上部。

Since this was in 1949, before the advent of effective antihypertensive drugs, because of the hypertension her initial dose of alpha tocopherol was only 100 units a day. She was given alpha tocopherol ointment to use only on her left leg, the worse one, since we wanted to assess the degree of improvement from the ointment alone, especially since so small an oral dosage was probably relatively useless, except as a slow relaxer of the peripheral resistance in her vascular tree and a consequent lowering of blood pressure.
由于这是 1949 年，在有效抗高血压药物出现之前，因为高血压，她最初的α-生育酚剂量仅为每天 100 单位。她被给予α-生育酚软膏，仅用于左腿，即较严重的一侧，因为我们想评估仅用软膏的改善程度，尤其是口服剂量如此之小，可能相对无效，除了作为血管树周围阻力的缓慢松弛剂，从而降低血压。

On her second visit it was obvious that there was much greater improvement in her left leg than in the right, and so thereafter the ointment was used on both legs. Her blood pressure did drop to 184/88, but for financial reasons she
在她第二次来访时，显然她的左腿比右腿有了更大的改善，因此此后药膏被用于双腿。她的血压确实降到了 184/88，但出于经济原因她...
did not increase her dosage of alpha tocopherol as requested, until her family finally assisted her. On 600 units of alpha tocopherol a day, given after the fall in blood pressure, these huge ulcers healed.
她没有按要求增加α-生育酚的剂量，直到她的家人最终帮助了她。在血压下降后服用每天 600 单位的α-生育酚，这些巨大的溃疡愈合了。

Note that again she demonstrated the type of healing that is so characteristic of vitamin E treatment - in spite of no specific attempts to keep the wound sterile, the infected granulation tissue of the ulcer base cleared up, and healthy granulation tissue replaced the infected tissue, forming an ideal base for the inward growth of the epithelium. There was no contraction or heaping-up of the new skin, and it was nontender.
请注意，她再次展示了维生素 E 治疗所特有的愈合类型——尽管没有特别尝试保持伤口无菌，溃疡基底的感染肉芽组织得以清除，健康的肉芽组织取代了感染组织，形成了上皮向内生长的理想基础。新皮肤没有收缩或堆积，且无压痛。

This was one of several such cases which exhibited a unique characteristic noted first with some disbelief and no ready explanation - self-grafting. As of now, the likely explanation seems to me that the flakes of skin around the ulcer seem to be displaced by the bandaging and to fall upon the healthy granulation tissue of its base. If the cell falls with its deep surface inward, it grows as an island, and such islands, eventually touching other such growing islands or the periphery of the ulcer, coalesce. We have seen several cases, such as this, who partially grafted themselves.
这是几个类似病例中的一个，表现出一种独特的特征，最初有人对此表示怀疑且没有现成的解释——自我移植。到目前为止，我认为可能的解释是，溃疡周围的皮肤片被绷带挤压移位，落在其基底的健康肉芽组织上。如果细胞以其深面朝内落下，它会作为一个岛屿生长，而这些岛屿最终会与其他生长中的岛屿或溃疡的边缘相接合。我们已经见过几个类似的病例，他们部分地实现了自我移植。

The very first case I saw of a large, chronic, persistent ulcer, healed completely, was one I never did treat, although I have seen the patient almost annually for years because of the concomitant collagenosis.
我见过的第一个完全愈合的大型、慢性、顽固性溃疡病例，是一个我从未治疗过的病例，尽管由于伴发的胶原病，我几乎每年都见这位患者多年。

She lived in a mining town in the Canadian north, had had a persistent large ulcer on the medial side of the lower one-third of her leg in an area of extreme collagenosis and pigmentation. As a result, her foot felt numb all the time. This ulcer was treated with various ointments and compression bandages for years, and finally the patient consulted a second doctor, who pointed out the sentinel vein above the ulcer and sent her south to a university hospital where this vein was surgically ablated. This surgery did not help, and after several months she consulted a third physician who advised hot soaks. This treatment as carried out by the patient proved to be too severe, and the added insult to the already anoxic tissues surrounding the ulcer led to a marked increase in size. She then returned to her
她住在加拿大北部的一个矿业小镇，腿下三分之一内侧有一个持续存在的大溃疡，位于极度胶原病变和色素沉着的区域。因此，她的脚一直感到麻木。这个溃疡多年来用各种软膏和加压绷带治疗，最终患者咨询了第二位医生，医生指出溃疡上方的哨兵静脉，并将她送往南方的一所大学医院，在那里这条静脉被外科切除。手术没有效果，几个月后她又咨询了第三位医生，医生建议热敷。患者进行的这种治疗过于激烈，给已经缺氧的溃疡周围组织带来了额外的伤害，导致溃疡明显增大。随后她回到了她的...
original doctor, who was angry with her, apparently, and said that now there was nothing that could be done but amputation.
原来的医生显然对她很生气，并说现在除了截肢别无他法。

Just at this time, all Canadian papers carried articles for and against the use of vitamin E for cardiovascular disease. Its use was advocated by our group but immediately condemned by experts, none of whom knew what vitamin E was and none of whom had ever used it or seen a patient on whom it had been used. However, this patient seized upon the hope it offered and began to take it “in large doses” as vaguely recommended in these newspaper reports.
就在这时，所有加拿大报纸都刊登了支持和反对使用维生素 E 治疗心血管疾病的文章。我们的团队提倡使用维生素 E，但立即被专家们谴责，这些专家既不知道维生素 E 是什么，也从未使用过它或见过使用过它的病人。然而，这位病人抓住了它带来的希望，开始按照这些报纸报道中模糊推荐的“高剂量”服用维生素 E。

Soon she noticed an increased tingling in her foot; the ulcer began to heal a little, and she tried then to enlist her doctor’s interest. He wouldn’t see her until she consented to amputation, so she continued to treat herself. After several months, she appeared at my office, related the above history, and showed me a leg with a large healed ulcer scar in an area of collagenosis, involving the lower one-third of the leg with maximum purplish discoloration.
很快她注意到脚部的刺痛感增加；溃疡开始稍有愈合，于是她试图引起医生的关注。医生不愿见她，除非她同意截肢，所以她继续自行治疗。几个月后，她来到我的办公室，讲述了上述病史，并向我展示了一条腿，腿上有一个大面积愈合的溃疡疤痕，位于胶原病变区域，涉及小腿下三分之一，伴有明显的紫色变色。

In the 22 years since, the collagenosis first softened and then completely disappeared. We have many cases in which the area of collagenosis decreases and the area seems to soften, but she is still the only one in which it has disappeared. Almost all cases with varicose eczema, and with collagenosis, show a definite and often marked decrease in the pigmentation in the area.
在过去的 22 年里，胶原病变首先变软，然后完全消失。我们有许多病例中胶原病变的区域减少，且该区域似乎变软，但她仍是唯一一个病变完全消失的病例。几乎所有伴有静脉曲张性湿疹和胶原病变的病例，其病变区域的色素沉着都有明显且常常显著的减少。

A word of caution: About one patient in ten cannot tolerate full strength alpha tocopherol ointment. Some cannot tolerate it at all, but most of these sensitive persons can tolerate it when it is diluted $50-50$$50-50$50-5050-50 with petroleum jellyits usual base.
一句警告：大约十分之一的患者无法耐受全浓度的α-生育酚软膏。有些人完全不能耐受，但大多数敏感者在将其用凡士林（其常用基质）稀释后可以耐受。

tion is a disorder of the carbohydrate metabolism. Associated with a disturbance of the normal insulin-producing mechanism, it is characterized by excessive levels of blood sugar (hyperglycemia) and glycosuria, sugar in the urine. Accompanying the diabetic disorder of the carbohydrate metabolism, there are readily demonstrated abnormalities of the protein and fat metabolisms which may give rise to simple acidosis, to ketosis, a type of acidosis involving abnormal production of acetone, to coma, and to death. Diabetics often-but not always-have inherited a predisposition toward the disease, although when it develops late in life in maturity-onset diabetes, its principal cause may well be improper diet. Whether the disease is congenital or contracted, when it reaches its fully developed form, those afflicted by it show weakness, lassitude, and loss of weight. Excessive thirst and frequent urination are prominent symptoms.
糖尿病是一种碳水化合物代谢紊乱。由于正常胰岛素产生机制的障碍，其特征是血糖水平过高（高血糖）和尿糖（尿中含糖）。伴随着糖尿病性碳水化合物代谢紊乱，还可以明显观察到蛋白质和脂肪代谢的异常，这些异常可能导致单纯性酸中毒、酮症（一种涉及异常丙酮产生的酸中毒）、昏迷甚至死亡。糖尿病患者常常——但并非总是——遗传了对该病的易感性，尽管当其在成年后期发病（成人发病型糖尿病）时，其主要原因很可能是不当饮食。无论疾病是先天性的还是后天获得的，当其发展到完全形式时，患者表现出虚弱、疲乏和体重减轻。过度口渴和频繁排尿是显著症状。

Since Banting and Best produced insulin in 1921 and demonstrated its ability to control the level of glucose in the blood and urine, medical treatment has been able to prolong the lives of diabetics by an average of 20 years or more over the previous life expectancies of these unfortunates. The majority of diabetics can look forward to reasonably long and productive lives after their metabolic abnormality is discovered. As medical ability to control blood sugar levels has improved and the armamentarium of available drugs has increased, it has more and more become the case that diabetic patients die, not of diabetes, but of
自从班廷和贝斯特于 1921 年生产出胰岛素并证明其能够控制血液和尿液中的葡萄糖水平以来，医学治疗已经能够使糖尿病患者的寿命比以前这些不幸者的预期寿命平均延长 20 年或更长时间。大多数糖尿病患者在发现其代谢异常后，可以期待过上相当长且富有成效的生活。随着医学控制血糖水平的能力不断提高以及可用药物种类的增加，糖尿病患者越来越多地不是死于糖尿病本身，而是死于
the derivative abnormalities of the cardiovascular system that are either caused by or associated with the diabetic condition.
心血管系统的衍生异常，这些异常要么由糖尿病引起，要么与糖尿病相关。

Beginning with secondary abnormalities of the small blood vessels, and in no way corrected by insulin administration, the condition eventually leads to kidney failure, or blindness, or neuritis, hypertension or congestive heart failure, or a combination of two or more of these problems.
从小血管的继发性异常开始，且绝不通过胰岛素治疗得到纠正，这种状况最终会导致肾功能衰竭、失明、神经炎、高血压或充血性心力衰竭，或上述两种或多种问题的组合。

Thus, while in the last 48 years enormous progress has been made in the treatment of diabetes and in the accumulation of far more extensive and precise knowledge of what causes the hyperglycemia and of the variety of ways it may be controlled, little progress has been made in the vascular aspects of the disease. With modern treatment, the control of the blood-sugar levels can be obtained quite consistently. Consequently it is the prevention and treatment of the effects on the vascular system that have become the major problems of diabetes. While some diabetic specialists would disagree, a large number of experts in this disease believe that whether the disease is mild, moderate, or severe and whether control is excellent or poor in no way alters the progress of the vascular damage.
因此，尽管在过去的 48 年里，糖尿病的治疗取得了巨大进展，并且对高血糖的成因及其多种控制方法积累了更广泛且更精确的知识，但在疾病的血管方面进展甚微。通过现代治疗，血糖水平的控制可以相当稳定地实现。因此，预防和治疗对血管系统的影响已成为糖尿病的主要问题。虽然一些糖尿病专家持不同意见，但许多该病领域的专家认为，无论疾病是轻度、中度还是重度，无论控制是优秀还是差，都不会改变血管损伤的进展。

In all diabetics, there is apparent a thickening of the basement membrane of the small arterioles. As this thickening increases, there is intercapillary inflammation in the kidneys (glomerulonephritis) which results. Eventually large masses of transparent (hyaline) material appear, followed by hardening and destruction of the glomeruli.
在所有糖尿病患者中，小动脉的基底膜明显增厚。随着这种增厚的加剧，肾脏中出现毛细血管间炎症（肾小球肾炎）。最终，大量透明（玻璃样）物质出现，随后肾小球硬化和破坏。

These same changes occur in the vessels of skin, nerves, muscles, and various other organs. The retinal changes involve also small aneurysmal dilatations of the venules or venous ends of the capillaries. These may rupture and lead to vascularization of the vitreous humor with scarring and retinal detachment. Premature atherosclerosis frequently involves most of the large vessels, especially the cerebral, coronary, and peripheral vessels, particularly of the legs. As well as the usual type of atherosclerosis, Monckeberg’s sclerosis is also increased, and there may be premature calcification of these large and intermediate arteries as a result.
这些相同的变化也发生在皮肤、神经、肌肉及其他各种器官的血管中。视网膜的变化还包括毛细血管静脉端或小静脉的微小动脉瘤样扩张。这些扩张可能破裂，导致玻璃体血管化，伴随瘢痕形成和视网膜脱离。过早的动脉粥样硬化常常累及大多数大血管，尤其是脑血管、冠状动脉和外周血管，特别是腿部血管。除了常见类型的动脉粥样硬化外，Monckeberg 硬化症也有所增加，结果可能导致这些大动脉和中等动脉的过早钙化。

It is well to point out that diabetes is a relatively com-
值得指出的是，糖尿病是一种相对常见的疾病——
mon disease affecting just under two per cent of the population, although in the age group over 60 as many as ten per cent may be affected. Some drugs interfere with carbohydrate metabolism, and so do certain hormones, such as the adrenal corticosteroids and pituitary growth hormone and the chlorothiazides. Of course, surgery to the pancreas by ablation of the islet cells or inflammatory disease can cause the disease.
这种疾病影响了不到百分之二的人口，尽管在 60 岁以上的年龄组中，受影响的人数可能高达百分之十。一些药物会干扰碳水化合物代谢，某些激素也会如此，例如肾上腺皮质类固醇、垂体生长激素和氯噻嗪类药物。当然，胰腺的手术切除胰岛细胞或炎症性疾病也可能导致该病。

Since the advent of insulin and the antibiotics, deaths from coma have become relatively rare, while deaths from cardiovascular disease have more than tripled.
自从胰岛素和抗生素问世以来，昏迷导致的死亡变得相对罕见，而心血管疾病导致的死亡则增加了三倍多。

Our involvement with diabetes mellitus and its vascular complication began early. Since alpha tocopherol had proven so effective in our original cardiac cases and since there was so very little that doctors could do with such cases, we innocently expected quick confirmation and rapid general adoption of this treatment. When the great local authorities, none of whom knew what alpha tocopherol was (none of whom had ever used it in a single case, or had seen a single case in whom it had been used) stated for publication that the drug was useless, we turned to the treatment of cases of peripheral vascular disease where the condition before treatment could be seen visually; could be photographed before, during, and after treatment, and in which, therefore, the results were irrefutable. Among such cases treated were many with gangrene of extremities, with perforating ulcers, etc., due to their diabetes. Involvement with these cases, of course, meant total involvement in the patients’ care, and other aspects of their response were perforce noted.
我们早期就开始关注糖尿病及其血管并发症。由于α-生育酚在我们最初的心脏病例中被证明非常有效，而医生们对这类病例几乎无能为力，我们天真地期望这一治疗方法能迅速得到确认并广泛采用。当当地权威人士——他们中没有一个知道α-生育酚是什么（没有一个在任何病例中使用过，也没有见过使用过的病例）——公开声明该药无效时，我们转而治疗周围血管疾病病例，这些病例在治疗前的状况可以直观观察；可以在治疗前、治疗中和治疗后拍照，因此结果无可辩驳。在这些治疗的病例中，有许多因糖尿病导致的肢体坏疽、穿孔性溃疡等。当然，参与这些病例的治疗意味着全面参与患者的护理，并且不得不注意他们反应的其他方面。

Now we can confidently state that every diabetic must have adequate control of his disease through diet and insulin or another anti-diabetic drug so that he will not develop coma or hyperglycemia reactions. It is of equal importance that he have alpha tocopherol to minimize the result of his vascular involvement. All three are indispensable for effective treatment.
现在我们可以自信地说，每个糖尿病患者都必须通过饮食和胰岛素或其他抗糖尿病药物来充分控制病情，以避免发生昏迷或高血糖反应。同样重要的是，他需要摄取α-生育酚以减少血管受累的后果。三者对于有效治疗都是不可或缺的。

There has been very substantial support for the use of alpha tocopherol in diabetes mellitus, probably because the
在糖尿病中使用α-生育酚得到了非常有力的支持，可能是因为…
outlook in diabetic arteritis is so hopeless without it, and the results with it are so rapid, so obvious, and so good (42) (44) (50) (51) (52) (53) (54) (55) (56) (57) (69).
糖尿病动脉炎的预后如果没有它是如此绝望，而使用它的结果是如此迅速、明显且良好（42）（44）（50）（51）（52）（53）（54）（55）（56）（57）（69）。

We have had so many cases of gangrene of the extremities, in which only the tissue already dead when treatment started was lost, that it is hard to choose case histories. Reproductions in color of two such cases can be found in the Canadian Medical Association Journal (76, No. 9, May 1, 1957, p. 730).
我们遇到过许多肢体坏疽的病例，其中只有在治疗开始时已经死亡的组织被丢失，因此很难选择病例历史。两例此类病例的彩色复制图可见于《加拿大医学会杂志》（76 卷，第 9 期，1957 年 5 月 1 日，第 730 页）。

A woman aged 85, developed gangrene of the left great toe. When she was seen in consultation with her physician, the gangrene had extended primally to the level of the web between the great toe and the second toe. She had just been diagnosed as a diabetic, with this lesion the first indication. Her blood pressure was 150/92.
一位 85 岁的女性，左脚大脚趾发生了坏疽。她与医生会诊时，坏疽已经向近端扩展到大脚趾和第二脚趾之间的蹼部。她刚被诊断为糖尿病，这个病变是首次表现。她的血压为 150/92。

She was given 600 units of alpha tocopherol daily, in addition to control of her diabetes with an 1,800 -calorie diabetic diet and 58 units of insulin. She was not hospitalized. Poor local hygiene led to infection, which spread proximally to about the level of the metatarsophalangeal joint. At this point, four days after treatment began, the dosage of alpha tocopherol was doubled. The live tissue just proximal to the gangrenous tissue became reddened, and a line of demarcation formed and separated the living from the dead tissue. One month later the dead toe was cut away. With the loss of the gangrenous tissue, the insulin requirement dropped to 15 units a day.
她每天服用 600 单位的α-生育酚，此外通过 1800 卡路里的糖尿病饮食和 58 单位的胰岛素控制糖尿病。她没有住院。局部卫生状况差导致感染，感染向近端扩散至跖趾关节水平。治疗开始四天后，α-生育酚的剂量加倍。坏疽组织近端的活组织变红，形成一条分界线，将活组织与坏死组织分开。一个月后，坏死的脚趾被切除。随着坏疽组织的去除，胰岛素需求降至每天 15 单位。

By the end of four months, the wound left after amputation had healed completely.
四个月结束时，截肢后留下的伤口已完全愈合。

The following case is of interest, because it has been so positively stated in several textbooks and medical journals that diabetic gangrene involving the heel cannot be conservatively treated, but means that above-the-knee amputation must be done.
以下病例值得关注，因为多本教科书和医学期刊中都明确指出，涉及脚跟的糖尿病性坏疽无法通过保守治疗，必须进行膝上截肢。

A woman, aged 61, was brought to the Shute Institute with gangrene involving the heel of the right foot. It had begun as a small ulcer some ten months previously. She had been a known diabetic for 33 years and had been well controlled for all those years.
一名 61 岁的女性被送到 Shute 研究所，右脚跟部出现坏疽。大约十个月前开始出现一个小溃疡。她患糖尿病已有 33 年，且这些年病情一直得到良好控制。

On examination, her blood pressure was 165/85. Her urine showed no glucose although her fasting blood sugar was 280 mg . per cent. She was very thin and seemed almost comatose, though slowly obeying orders from her daughter and the doctors. I remember that we told the daughter that we thought the condition too advanced, but would try to help. Within seven days there was a definite line of demarcation forming between the living and the dead tissue as if a knife had been used. On 1,200 units of alpha tocopherol daily her insulin requirement dropped from 35 to ten units daily. By the end of four and one-half months the gangrenous heel pad had been nearly completely separated by the proliferation of capillary buds and the necrosis of the dead cells immediately adjacent. The gangrenous tissue extended to the periosteum of the bone beneath and entirely through the subcutaneous tissue in its center so as to expose muscle fibers.
检查时，她的血压为 165/85。她的尿液中没有葡萄糖，尽管她的空腹血糖为 280 毫克/分升。她非常消瘦，几乎处于昏迷状态，虽然慢慢地听从她女儿和医生的指令。我记得我们告诉女儿，我们认为病情已经太严重，但会尽力帮助。在七天内，活组织和坏死组织之间出现了明显的分界线，就像用刀切开一样。在每天服用 1200 单位的α-生育酚后，她的胰岛素需求从每天 35 单位降至 10 单位。四个半月结束时，坏疽的脚跟垫几乎完全被毛细血管芽的增生和紧邻的坏死细胞的坏死所分离。坏疽组织延伸到骨头下的骨膜，并完全穿透其中心的皮下组织，暴露出肌肉纤维。

Here occurred the unique and most valuable characteristic of the healing of wounds under alpha tocopherol treatment, confirmed elsewhere (89). The epithelial tissue healed without contracture, and so the healed wound showed no shrinking and no tenderness, and she was able to walk in perfect comfort on a rubber pad in her shoe. Her insulin requirement was stabilized at ten units daily.
这里出现了在α-生育酚治疗下伤口愈合的独特且最宝贵的特性，这一点在其他地方也得到了证实（89）。上皮组织愈合时没有收缩，因此愈合的伤口没有缩小也没有压痛，她能够在鞋内的橡胶垫上舒适地行走。她的胰岛素需求稳定在每天十单位。

In our book Alpha Tocopherol (Vitamin E) in Cardiovascular Disease-now long out of print-are color pictures of a large perforating ulcer in a diabetic, healed with alpha tocopherol.
在我们的书《Alpha Tocopherol (Vitamin E) in Cardiovascular Disease》中——现已绝版——有一张彩色图片，展示了一位糖尿病患者的大型穿孔性溃疡，经α-生育酚治疗后愈合。

Two cases of relatively successful treatment of the retinal changes in diabetes mellitus are worth reporting. However, in our experience, treating the effects of vascular changes in the brain and retina is much less satisfactory than treating the relatively similar abnormalities in heart, kidney, and extremity. This is to be expected, since nerve cells are so highly specialized and so extremely sensitive to anoxia.
值得报告两例糖尿病视网膜病变相对成功的治疗案例。然而，根据我们的经验，治疗脑部和视网膜血管变化的效果远不如治疗心脏、肾脏和四肢中相对类似的异常。这是可以预料的，因为神经细胞高度专业化，对缺氧极为敏感。

Whereas the heart functions as a whole pump and can work efficiently with a large area knocked out by disease, as is so often the case after recovery from a massive infarction, the brain works as a myriad of independent cells, each
心脏作为一个整体泵功能运作，即使有大面积因疾病受损，也能高效工作，这在大面积心肌梗死恢复后常见；而大脑则由无数独立的细胞组成，每个细胞独立工作
with its special and prescribed function. Therefore, we do not like to treat the victims of cerebral accidents, especially when we see them first some weeks or months after the initial accident. Though we can often return to normal function the oxygen-lacking but still-living areas around the area of softening, the total result is moderate help only. To take a bed patient out of bed, to make a chair patient able to walk with a cane, to make a patient who can walk with a cane walk without one are relatively hollow victories, in comparison with the results of alpha tocopherol treatment of cardiac cases.
具有其特殊且规定的功能。因此，我们不喜欢治疗脑血管意外的患者，尤其是当我们在初次事故发生几周或几个月后首次见到他们时。虽然我们常常能够使缺氧但仍存活的软化区域周围的功能恢复正常，但总体效果仅是中等程度的帮助。让卧床病人下床，让坐轮椅的病人能够拄拐杖行走，让能够拄拐杖行走的病人能够不用拐杖行走，这些相较于α-生育酚治疗心脏病病例的效果来说，都是相对空洞的胜利。

The same principle applies to diabetic patients losing their sight. With alpha tocopherol, the process can be slowed or halted in many and reversed to a moderate degree in some few; but on the whole results are not very good.
同样的原理适用于视力逐渐丧失的糖尿病患者。使用α-生育酚，这一过程在许多患者中可以减缓或停止，在少数患者中可以在一定程度上逆转；但总体来说，效果并不理想。

I first saw one man, aged 47, on November 5, 1959. He had been a diabetic for 27 years. Five years previously he had suffered a retinal hemorrhage in his right eye which left him with ten per cent vision. He had four separate hemorrhages in the left eye in the previous two years, the last one three weeks before I saw him. He had no other complaints. On 800 units of alpha tocopherol, both eyes showed improvement, and within six weeks he was able to drive his car. The right eye, in which he was nearly blind, definitely improved.
我第一次见到一位 47 岁的男子，是在 1959 年 11 月 5 日。他患糖尿病已有 27 年。五年前，他的右眼发生视网膜出血，导致视力仅剩百分之十。过去两年里，他的左眼发生了四次出血，最后一次是在我见到他前三周。他没有其他不适。在服用 800 单位的α-生育酚后，双眼视力都有所改善，六周内他能够开车。几乎失明的右眼明显好转。

His diabetic specialist on September 21, 1960, stated that there had been a remarkable change, that the hemorrhages in both eyes were becoming absorbed and were clearing up, although there was very little subjective change. His ophthalmologist became very excited on examining his eyes and said he had never seen anything such as this before.
他的糖尿病专家在 1960 年 9 月 21 日表示，情况有了显著变化，双眼的出血正在被吸收并逐渐清除，尽管主观感受几乎没有变化。他的眼科医生在检查他的眼睛时非常激动，说他以前从未见过这样的情况。

On November 1, 1960 this patient fell 28 feet, broke four ribs, and suffered facial injuries and an external hemorrhage of the left eye, but no retinal damage. The right eye had continued to clear, and vision was improving.
1960 年 11 月 1 日，这名患者从 28 英尺高处跌落，造成四根肋骨骨折，面部受伤，左眼外部出血，但视网膜未受损。右眼持续清晰，视力正在改善。

By September 1, 1961, his diabetic specialist said that he could see through the old hemorrhage in the vitreous and could see the retina for the first time in two years. His field of vision in this eye was definitely expanding.
到 1961 年 9 月 1 日，他的糖尿病专家说他能够透过玻璃体中的旧出血，第一次在两年内看到了视网膜。他这只眼睛的视野明显扩大了。

Improvement continued slowly until June of 1966 when he developed a small hole in the retina. However, his ophthalmologist told him not to let anyone touch it. “Whatever you’re doing, keep it up,” he said. The regression of the scar tissue in the retina was remarkable, he had never seen better, and there were no signs of fresh hemorrhages. Two months later the hole was seen to be sealing itself off.
病情持续缓慢好转，直到 1966 年 6 月，他的视网膜出现了一个小孔。然而，他的眼科医生告诉他不要让任何人碰它。“无论你在做什么，都要坚持下去，”他说。视网膜瘢痕组织的退化非常显著，医生从未见过更好的情况，也没有新出血的迹象。两个月后，发现这个孔正在自行封闭。

In February of 1968 he reported continued improvement in the right eye, but he had just had a fresh hemorrhage in the left, the first in nearly nine years. By November of 1968 his eyesight was about the same as when I first saw him in November of 1959.
1968 年 2 月，他报告右眼持续好转，但左眼刚刚发生了新的出血，这是近九年来的第一次。到 1968 年 11 月，他的视力与我 1959 年 11 月第一次见到他时大致相同。

The second patient was 35 when first seen on September 30,1958 . He had been a diabetic for 20 years. His eyesight was deteriorating, and he had had hemorrhages in both eyes for the past six years. His left eye was nearly blind. He showed other evidence of arteriosclerosis and had a threeplus albuminuria, for example.
第二位患者在 1958 年 9 月 30 日首次就诊时 35 岁。他患糖尿病已有 20 年。视力正在恶化，过去六年中双眼均有出血。他的左眼几乎失明。他还表现出动脉硬化的其他迹象，例如尿蛋白三加。

On 600 units of alpha tocopherol a day, his eyesight began to improve within six weeks and was nearly normal in six months. His albuminuria was greatly decreased, and he was feeling really well.
每天服用 600 单位的α-生育酚，他的视力在六周内开始改善，六个月内几乎恢复正常。他的尿白蛋白显著减少，感觉非常好。

In June of 1962 he suffered a fresh hemorrhage in one eye, and his dosage of alpha tocopherol was promptly doubled. His eyesight returned to normal within two weeks. He admitted that he had become careless and had decreased his alpha tocopherol to 400 units a day.
1962 年 6 月，他的一只眼睛发生了新的出血，随即将他的α-生育酚剂量加倍。他的视力在两周内恢复正常。他承认自己变得粗心，将α-生育酚的剂量减少到了每天 400 单位。

On April 18, 1963 he suffered an anterior myocardial infarction, this in spite of 1,000 units a day of alpha tocopherol. While in the hospital, he read for many hours a day, and among his books was one on very poor, cheap yellow stock with relatively poor type. With armchair treatment and an increase in his vitamin E, he made an uneventful recovery. As of the present, he takes 48 units of insulin a day. He owns a dry cleaning plant but moonlights as a maintenance engineer in a large hospital-heating plant. He has a two-plus albuminuria. He sees and reads well obviously, since both of his occupations require that he be able to do so.
1963 年 4 月 18 日，他发生了前壁心肌梗死，尽管每天服用 1000 单位的α-生育酚。在医院期间，他每天阅读数小时，他的书中有一本用非常劣质、廉价的黄色纸张印刷，字体相对较差。通过坐着休养和增加维生素 E 的摄入，他顺利康复。截至目前，他每天注射 48 单位胰岛素。他拥有一家干洗厂，但兼职在一家大型医院的供暖厂担任维修工程师。他有 2+以上的蛋白尿。显然，他视力良好，阅读能力也很好，因为他的两份工作都要求他具备这些能力。

It is now nearly 11 years since he was first treated with alpha tocopherol. It should be remembered that many other physicians, including ophthalmologists have also had very good results (55) (58) (107).
自从他首次接受α-生育酚治疗已经将近 11 年了。应当记住，许多其他医生，包括眼科医生，也取得了非常好的效果（55）（58）（107）。

This disease was first adequately described by Richard Bright in the ninetcenth century. He recognized the fact that acute nephritis usually followed an infection.
这种疾病最早由理查德·布莱特在十九世纪进行了充分描述。他认识到急性肾炎通常发生在感染之后。

There has been a definite cause-and-effect relationship established in the majority of cases of acute glomerulonephritis between an infection with Group A hemolytic streptococci, frequently type 12 strain, and the onset of the disease after a latent period of one to four weeks. Many consider the disease an immune reaction to the infection. Infections with streptococcus viridans and pneumococci can also lead to acute glomerulonephritis.
在大多数急性肾小球肾炎病例中，已经确定了明确的因果关系，即感染 A 群溶血性链球菌（常为 12 型菌株）与疾病在一至四周潜伏期后发作之间的关系。许多人认为该疾病是对感染的免疫反应。绿链球菌和肺炎球菌感染也可能导致急性肾小球肾炎。

The kidney appears normal in size or slightly enlarged, but is pale with punctate hemorrhages on the surface. Sections under the microscope show the glomeruli, which are coils of blood vessels, swollen, with the lumina or inner passages of the capillaries diffusely narrowed by proliferations of endothelial cells. Usually, polymorphonuclear leucocytes are present in the lumina of the capillaries and, occasionally, appear to completely close them off. At times, tissue death of some capillary loops, due to thrombi, can be
肾脏大小正常或略有肿大，但表面苍白，伴有点状出血。显微镜下切片显示肾小球（血管盘）肿胀，毛细血管的腔隙或内通道因内皮细胞增生而弥漫性狭窄。通常，毛细血管腔内存在多形核白细胞，偶尔似乎完全堵塞了腔隙。有时，由于血栓，部分毛细血管环发生组织坏死。
seen, often with adhesions to Bowman’s capsule.
常见，常伴有与鲍曼氏囊的粘连。
There are also deposits of the clotting agent fibrin, commonly concentrated in Bowman’s space. As a result, with healing, small areas of scarring develop. In the early stages there is a moderate to severe interstitial edema and, later, interstitial fibrosis.
还有凝血因子纤维蛋白的沉积，通常集中在鲍曼氏囊内。因此，随着愈合，小范围的瘢痕形成。在早期阶段，有中度到重度的间质水肿，随后出现间质纤维化。

The chronic phase shows diffuse involvement of all glomeruli by endothelial hypercellularity. As the disease progresses, there are obliterated and scarred glomeruli, adhesions, and hyalinization.
慢性期表现为所有肾小球弥漫性内皮细胞增生。随着疾病进展，出现闭塞和瘢痕化的肾小球、粘连及透明变。

The disease affects people of all ages, but it occurs in males twice as frequently as females. Classical symptoms are bloody urine, a reduced quantity of urine, puffiness around the eyes, and edema of feet or ankles.
该疾病影响所有年龄段的人，但男性发病率是女性的两倍。典型症状包括血尿、尿量减少、眼周浮肿以及足部或踝部水肿。

Headache, malaise, loss of appetite, with often some aching in the lumbar region, are common symptoms. In mild cases, there may be no signs or symptoms other than edema and moderate hypertension, whereas in severe cases, massive edema, dyspnea, nausea and vomiting, convulsions or coma, extreme hypertension, and enlarged heart, with gallop rhythm, may be present along with such other signs of circulatory congestion as visual disturbances with papilledema and retinal hemorrhages. Conversely, gross hematuria and edema may be the only manifestations, and even these signs may be absent. Many cases are discovered only because the patient was given a routine urinalysis.
头痛、不适、食欲减退，常伴有腰部疼痛，是常见症状。轻度病例可能除了水肿和中度高血压外，没有其他体征或症状，而严重病例则可能出现大量水肿、呼吸困难、恶心呕吐、抽搐或昏迷、极度高血压和心脏肥大，伴有奔马律，以及视乳头水肿和视网膜出血等循环充血的其他体征。相反，明显的血尿和水肿可能是唯一的表现，甚至这些体征也可能不存在。许多病例仅因患者接受常规尿液分析而被发现。

This latter aspect of the disease explains why accurate statistics are virtually nonexistent. Certainly, less than five per cent die in hospital in the acute phase. Of the 95 per cent who leave the hospital, some go on to the chronic phase, while others become apparently healed. Many live for 20 to 30 years or more with no clinical evidence except slight albuminuria and slight hematuria. In many of these, kidney function slowly decreases, although symptoms do not appear until the function has become less than 20 per cent. Then nocturia, elevated blood urea nitrogen, anemia, and hypertension develop.
疾病的这一后期方面解释了为什么准确的统计数据几乎不存在。确实，急性期在医院死亡的不到百分之五。在离开医院的 95%患者中，有些进入慢性期，而另一些则表面上痊愈。许多人在没有临床证据的情况下生活了 20 到 30 年甚至更长时间，只有轻微的白蛋白尿和轻微的血尿。在许多患者中，肾功能缓慢下降，尽管症状直到功能降至不到 20%时才出现。然后出现夜尿、血尿素氮升高、贫血和高血压。

In using vitamin E in the treatment of impaired kidney function and in the treatment of noneclamptic pregnancy
在使用维生素 E 治疗肾功能受损和非子痫妊娠的过程中
toxemia it was occasionally observed that albuminurias and edemas either disappeared or were much improved. These experiences, together with the prior work of Martin and Moore-who found that the kidneys of chronically E-deficient rats revealed extensive degeneration of the renal convoluted tubules, the loops of Henle, and the collecting tubules-suggested that it might prove to be of value to treat patients with acute nephritis by means of vitamin E.
在中毒症中，偶尔观察到白蛋白尿和水肿要么消失，要么有很大改善。这些经验，加上 Martin 和 Moore 之前的研究——他们发现慢性缺乏维生素 E 的大鼠肾脏显示出肾小管、亨利袢和集合管的广泛退化——表明用维生素 E 治疗急性肾炎患者可能会有价值。

Alpha tocopherol has a direct effect upon capillary permeability, reducing the abnormal capillary permeability that is present with most injurious agents. It therefore, has a direct effect upon the glomerular capillaries, which reduces the local edema both in the glomeruli and the interstitial tissues. It does this within hours and protects against any tendency toward necrosis of capillary loops. It prevents or removes the thrombi associated with the pathological process. Excellent results are obtained by its administration early in the disease, the earlier the better.
α-生育酚对毛细血管通透性有直接影响，能够减少大多数有害物质引起的异常毛细血管通透性。因此，它对肾小球毛细血管有直接作用，减少肾小球和间质组织的局部水肿。它在数小时内起效，防止毛细血管环坏死的倾向。它还能预防或清除与病理过程相关的血栓。早期使用其治疗效果极佳，越早越好。

There are very few conditions in which the result of treatment is so rapid and so complete as a case of acute glomerulonephritis treated as soon as the diagnosis has been established. Of course, when the patient is seen later in the development of the disease, after necrosis of some of the glomeruli, with scarring and scar-tissue contraction, alpha tocopherol can be of great use, but only through the restoration of function and normalcy to those glomeruli still surviving.
急性肾小球肾炎一经确诊并立即治疗，其治疗效果极为迅速且彻底，这种情况非常少见。当然，当患者在疾病发展后期就诊，部分肾小球已发生坏死、瘢痕形成及瘢痕组织收缩时，α-生育酚仍然非常有用，但其作用仅限于恢复尚存肾小球的功能和正常状态。

The decrease of oxygen-need, characteristic of the action of the drug, allows the tissues to combat the injury better and is an important factor in establishing maximum recovery.
该药物作用的特征是降低氧气需求，使组织能够更好地抵抗损伤，这是实现最大恢复的重要因素。

Again we call attention to the extensive confirmation of the excellent results with this treatment by other physicians (17) (82) (83) for example.
我们再次提醒大家注意其他医生（例如（17）（82）（83））对这种治疗卓越效果的大量确认。

A girl, aged 14 years, was first seen on March 3, 1946. A history of one attack of acute glomerulonephritis at five years was elicited. There had been several subsequent upper respiratory tract infections, none of which had presented any urinary complications. Physical examination then re-
一名 14 岁的女孩于 1946 年 3 月 3 日首次就诊。病史显示她五岁时曾有一次急性肾小球肾炎发作。此后曾多次上呼吸道感染，但均未出现任何尿路并发症。体格检查随后继续进行—
vealed an acute follicular tonsillitis, a purulent nasal discharge and acute right-sided otitis media, moderate edema of the face, eyelids, hands, and ankles, and a fever of 103 degrees. Three days later, on March 6, a gross hematuria and four-plus albuminuria appeared.
显示急性滤泡性扁桃体炎、化脓性鼻涕和急性右侧中耳炎，面部、眼睑、手和脚踝中度水肿，体温 103 度。三天后，即 3 月 6 日，出现大量血尿和四度蛋白尿。

The treatment begun on March 7, 1946, consisted of bed rest, a rigid “nephritic diet” which excluded salt, milk, and meat, as well as a daily dose of 200 units of vitamin E. By March 9 her temperature had fallen to normal, and her edema had disappeared. By March 21 all gross hematuria had ceased. By March 26 there was no longer any microscopic hematuria, and the albumin in the urine had decreased to a mere trace. It is interesting to note that no casts were found throughout the period of treatment, despite careful microscopic search for them.
治疗始于 1946 年 3 月 7 日，包括卧床休息、严格的“肾病饮食”，排除盐、牛奶和肉类，以及每天服用 200 单位的维生素 E。到 3 月 9 日，她的体温已恢复正常，水肿消失。到 3 月 21 日，所有明显的血尿已停止。到 3 月 26 日，显微镜下已无血尿，尿蛋白减少到仅有微量。有趣的是，尽管进行了仔细的显微镜检查，整个治疗期间未发现任何管型。

During a routine examination on September 3, 1946, an upper respiratory tract infection was revealed, this time in the form of a subacute pharyngitis with a temperature of 99 degrees. There was also microscopic hematuria again, but no albuminuria. She had not received any vitamin E since the end of the preceding March. It was at once administered as before. In 48 hours all microscopic hematuria had disappeared. Weekly observations since have shown no albuminuria, no casts, no white or red cells. She has started to grow rapidly, and her family state that she is feeling better than she has for years.
1946 年 9 月 3 日的一次常规检查中发现了上呼吸道感染，这次表现为亚急性咽炎，体温为 99 度。显微镜下再次发现血尿，但无蛋白尿。自前一年的三月底以来，她未曾服用任何维生素 E。维生素 E 随即按之前的方法开始服用。48 小时内所有显微镜下的血尿均消失。此后每周观察均未发现蛋白尿、管型、白细胞或红细胞。她开始迅速成长，家人表示她感觉比多年来任何时候都要好。

Another early case was that of a boy, four years of age. On August 18, 1946, this patient developed acute tonsillitis, with a fever of 102.3 degrees. There was also oliguria and frequent vomiting, but no abdominal or costovertebral tenderness. He was treated with the classical dosage of sulfamerazine, and his temperature reverted to normal in 36 hours. On August 26 he passed normal appearing urine in the morning, but at 1:00 p.m. his urine was “as red as beet juice,” and when this was examined it revealed a tremendous hematuria and three-plus albuminuria. The boy was immediately given a daily dose of 150 units of vitamin E. Twenty-four hours later his urine had become grossly clear of blood. In 48 hours from the onset of his hematuria there
另一个早期病例是一名四岁的男孩。1946 年 8 月 18 日，该患者患急性扁桃体炎，体温为 102.3 度。还出现少尿和频繁呕吐，但无腹部或肋脊角压痛。采用经典剂量的磺胺甲噁唑治疗，36 小时内体温恢复正常。8 月 26 日早晨他排出外观正常的尿液，但下午 1 点他的尿液“像甜菜汁一样红”，检查显示大量血尿和三度蛋白尿。男孩立即每天服用 150 单位维生素 E。24 小时后，他的尿液明显无血。血尿发作 48 小时内，情况...
was no albumin in it, nor could any red blood cells be found microscopically. On September 3 his tonsils were still swollen but not inflamed, and the boy’s urine again showed no albumin and only two red and one white cell per low power field. A urinalysis on September 15 showed no cells. He has been perfectly well since.
其中没有白蛋白，显微镜下也找不到红细胞。9 月 3 日，他的扁桃体仍然肿大但没有发炎，男孩的尿液再次显示无白蛋白，每个低倍视野仅有两个红细胞和一个白细胞。9 月 15 日的尿液分析显示无细胞。从那以后他一直完全健康。

Male, aged 16 years. This boy suffered from a chronic abscess of his left lower first molar which developed early in June, 1946. On August 9, 1946, while on a fishing trip on Manitoulin Island, he developed a sore throat with malaise, nausea, and vomiting and, on one occasion, a chill. His face began to swell on August 11, and by the morning of August 12 his ankles and fingers were also swollen considerably. This edema gradually progressed. When he was first seen by the writer on August 16 his eyes were nearly closed, and the outline of his ankle bones could not be seen. His urine at that time showed a three-plus albumin, and there were many red and white cells to be seen microscopically. There was no fever at this time, however.
男性，16 岁。该男孩患有左下第一磨牙的慢性脓肿，始于 1946 年 6 月初。1946 年 8 月 9 日，在 Manitoulin 岛钓鱼时，他出现了喉咙痛、全身不适、恶心和呕吐，并曾有一次发冷。8 月 11 日，他的脸开始肿胀，到 8 月 12 日早晨，他的脚踝和手指也明显肿胀。这种水肿逐渐加重。8 月 16 日作者首次见到他时，他的眼睛几乎闭合，脚踝骨轮廓已无法看见。当时他的尿液显示蛋白质三加，显微镜下可见许多红细胞和白细胞，但当时没有发烧。

Treatment was started immediately and consisted of bed rest with a daily dose of 300 units of vitamin E. An abscessed tooth was removed at once (August 16), revealing a pus pocket extending deeply into the underlying alveolar bone.
治疗立即开始，包括卧床休息和每天服用 300 单位的维生素 E。一个脓肿牙齿于 8 月 16 日被立即拔除，发现有一个脓液囊袋深入到下方的牙槽骨中。

By August 18 the microscopic hematuria had decreased, and only a trace of albumin remained. All edema had disappeared. On August 20 no albumin or blood cells were detectable in the urine, and the patient “felt well.” He became ambulant on August 23 just seven days after treatment began and returned at once to his work in a garage. An examination on September 3 showed no albuminuria or edema and only two to three erythrocytes per low power field in his urine. He had continued to work and feel well. Curiously, his friends comment that his “face is not as fat” as it has been for at least four years past. An examination on October 10, 1946, showed no microscopic cellular elements or albuminuria.
到 8 月 18 日，显微镜下的血尿减少，只剩少量白蛋白。所有水肿已消失。8 月 20 日，尿液中未检测到白蛋白或血细胞，患者“感觉良好”。他于 8 月 23 日开始行走，距治疗开始仅七天，随即返回车库工作。9 月 3 日检查显示无蛋白尿或水肿，尿液中每低倍视野仅有两到三个红细胞。他继续工作并感觉良好。奇怪的是，他的朋友们评论说他的“脸不像过去四年那样胖了”。1946 年 10 月 10 日的检查显示无显微镜下的细胞成分或蛋白尿。

A ten-year-old girl was brought to me at the urging of a
一位十岁女孩在某人的催促下被带到我这里
local osteopath whose vacation cottage adjoined that of her parents. While at the cottage the child had developed a severe upper respiratory tract infection, which was followed by some edema and led to the diagnosis of acute nephritis by her family physician. She was referred to the largest and most prestigious children’s hospital in Canada where she spent some weeks without resolution of her nephritis. Her infection left her with a chronic antrum infection. She was returned to her home under the care of her family physician, and I saw her approximately 11 months later. She had gross edema of ankles, legs, lower back, and abdomen and of her eyelids. She had a four-plus albuminuria, numerous casts, and a few red cells and leucocytes per high power field.
当地一位整骨医生，她的度假小屋与她父母的相邻。孩子在小屋期间患上了严重的上呼吸道感染，随后出现了一些水肿，家庭医生诊断为急性肾炎。她被转诊到加拿大最大、最负盛名的儿童医院，在那里住了几周，但肾炎未见好转。感染使她留下了慢性鼻窦感染。她在家庭医生的照料下回到了家中，我大约在 11 个月后见到了她。她的脚踝、腿部、下背部、腹部和眼睑都有明显水肿。尿液中蛋白质呈四加，显微镜下可见大量管型，以及少量红细胞和白细胞。

She was given 300 units of alpha tocopherol a day. In two weeks all the edema had cleared up, but she still showed a one-plus albuminuria. She was well enough to go to school, although she twice showed a slight increase in albuminuria with an acute upper respiratory tract infection. She continued to have a trace of albuminuria and so was returned to the children’s hospital for evaluation. Now they decided that they could safely do a “radical antrum” operation, and following this she lost all clinical and laboratory signs of her nephritis.
她每天服用 300 单位的α-生育酚。两周后，所有水肿都消失了，但她仍显示一加号的蛋白尿。她身体状况良好，可以去上学，尽管她在两次急性上呼吸道感染时蛋白尿略有增加。她持续有微量蛋白尿，因此被送回儿童医院进行评估。现在他们决定可以安全地进行“根治性胃窦切除”手术，手术后她所有的肾炎临床和实验室症状均消失。

A postscript should here be added. She was ten years old when first seen in 1948. Ten years later she was accepted in this same children’s hospital as a nurse-in-training. During her training she was assigned to a ward with a large number of nephritics getting no effective treatment that she could see. She was greatly disturbed by this, since she knew how rapidly and well they would respond to proper treatment. She took her problem home with her to the osteopath who had sent her to me. Of course, his advice was that as a nurse-in-training she must remain helpless to do anything for these children.
这里应当补充一段附言。她在 1948 年第一次被看到时只有十岁。十年后，她作为一名护士实习生被同一家儿童医院录取。在培训期间，她被分配到一个有大量肾炎患者的病房，而她看到这些患者没有得到有效的治疗。她对此感到非常不安，因为她知道这些患者如果接受适当的治疗，恢复会非常迅速且效果显著。她把这个问题带回了把她介绍给我的整骨医生那里。当然，他的建议是，作为一名护士实习生，她必须无能为力，无法为这些孩子做任何事情。

If and when she graduated she could decide for herself what course she should take and whom she should approach. It is sad when the treatment available is so nearly nothing
如果她毕业了，她可以自己决定应该选择什么课程以及应该找谁。这种情况下可用的治疗几乎为零，令人感到悲哀。
when adequate treatment is available and when doctors in charge must know that it is.
当有适当的治疗方法可用时，负责的医生必须知道这一点。

This again is a major reason for this book. It reminds me so much of the treatment given my uncle who died and my two brothers who very nearly died of lobar pneumonia in the days before the sulfa drugs and antibiotics were available, and the contrast between their experience and the occasional patient with a similar pneumonia who is now so easily and so successfully treated.
这又是本书的一个重要原因。它让我想起了我叔叔的治疗过程，他去世了，还有我两个兄弟，他们在磺胺药和抗生素出现之前，几乎死于叶肺炎，以及他们的经历与现在偶尔出现的类似肺炎患者之间的对比，而这些患者现在可以如此轻松且成功地治疗。

A red-headed boy 14 years old was admitted to hospital on June 6, 1952, two days before we saw him. He had been treated by a pediatrician and carefully investigated before we were called in to supervise his treatment. His illness had begun two weeks before admission with a sore throat, fever, and cough. He had noted a “stomach-ache” and slight headache the day before admission, accompanied by a darkening of his urine. His ankles and legs had begun to swell on the day of admission.
一名 14 岁的红发男孩于 1952 年 6 月 6 日入院，就在我们见到他前两天。他曾接受儿科医生的治疗并经过仔细检查，随后我们被请来监督他的治疗。他的病情始于入院前两周，表现为喉咙痛、发烧和咳嗽。入院前一天，他感到“胃痛”和轻微头痛，同时尿色变深。入院当天，他的脚踝和腿开始肿胀。

On examination, his eyelids and cheeks appeared to be puffy. The retinae were edematous. A systolic murmur was heard, loudest in the mitral area and transmitted to the axilla. Breath sounds were diminished in the right base. He showed marked pitting edema about the ankles and feet, the edema extending to the knees. His blood pressure was 194/126. His urine showed no sugar, a two-plus albuminuria, three to six leucocytes, and 25 to 40 red cells per high power field. His N.P.N. was 29.6 mgm . per cent, creatinine 1.1 mgm . per cent, and cholesterol 248 mgm . per cent. His hemoglobin was red blood cells $4,030,000$$4,030,000$4,030,0004,030,000 and white blood cells 7,900 . An X-ray of the chest taken three days after admission and 12 hours after his first dose of alpha tocopheiol showed enlargement of the heart, pulmonary congestion, and a small right-sided pleural effusion.
检查时，他的眼睑和面颊显得浮肿。视网膜水肿。听诊发现收缩期杂音，最响于二尖瓣区，并传导至腋下。右肺底呼吸音减弱。他的踝部和足部出现明显的凹陷性水肿，水肿延伸至膝盖。血压为 194/126。尿液无糖，白蛋白尿为 2+，白细胞 3 至 6 个，高倍视野红细胞 25 至 40 个。非蛋白氮（N.P.N.）为 29.6 毫克/分升，肌酐为 1.1 毫克/分升，胆固醇为 248 毫克/分升。血红蛋白为红细胞 $4,030,000$$4,030,000$4,030,0004,030,000 ，白细胞为 7,900。入院三天后及首次服用α-生育酚 12 小时后的胸部 X 光显示心脏扩大、肺部充血及右侧少量胸腔积液。

Alpha tocopherol was given on the third evening after admission (on June 8th at 6 p.m.), and thereafter, during his hospital stay he was given 450 international units daily. His progress is best indicated by the following table:
α-生育酚于入院第三天晚上（6 月 8 日晚上 6 点）给予，此后在住院期间每天给予 450 国际单位。他的进展情况如下表所示：

His temperature reached a daily high of 99.3 degrees until June 9 , dropped to normal until June 14 when it reached 101.3 degrees; but with continued alpha tocopherol therapy and nothing else, it was normal on June 15 and subsequently. Note that following this exacerbation of fever he had a transient increase in red cells in his urine.
他的体温直到 6 月 9 日每天最高达到 99.3 度，随后降至正常，直到 6 月 14 日达到 101.3 度；但在继续接受α-生育酚治疗且没有其他治疗的情况下，6 月 15 日及以后体温恢复正常。注意，在这次发热加重后，他的尿液中红细胞短暂增加。

He was discharged 12 days after we saw him first, clinically well. An X-ray of the chest on June 19 showed a return of the heart to normal size and shape and complete resolution of the effusion, although there was still some pulmonary congestion.
他在我们第一次见他后 12 天出院，临床状况良好。6 月 19 日的胸部 X 光显示心脏恢复到正常大小和形状，积液完全消失，尽管仍有一些肺部充血。

He has been perfectly well since. There is now no cardiac murmur.
他从那以后一直完全健康。现在没有心脏杂音。

Another patient was a red-headed boy aged six years. In January, 1953 he had “flu” twice and following his second attack developed hematuria, almost daily headache, severe nausea and vomiting, and fever. He was hospitalized
另一位患者是一个六岁的红发男孩。1953 年 1 月，他两次患“流感”，在第二次发作后出现血尿、几乎每天头痛、严重恶心和呕吐以及发烧。他被送入医院治疗。
on February 6, 1953 and placed under the care of a pediatrician who investigated the case thoroughly before arriving at the diagnosis of acute nephritis. Blood agglutinations, tuberculin tests, blood cultures, blood chemistry - all these tests were essentially negative. His hemoglobin was 49 per cent. His red cell count was 2.5 million and his sedimentation rate 20 mm . per hour. The urinalysis revealed a trace of albumin and three to six red cells per high power field. His temperature reached 100 degrees on admission to hospital, and he ran a daily fever thereafter until February 21. His treatment before he was placed in our hands on February 23,1953 was conservative. He was given only a “meatfree and egg-free diet.” On February 12 he was transfused with whole blood because of his anemia, and on February 16 he was given a normal diet. On February 18 he was given aureomycin for one day only.
1953 年 2 月 6 日，他被送入医院，由一位儿科医生负责照料，该医生在彻底调查病例后诊断为急性肾炎。血液凝集试验、结核菌素试验、血液培养、血液化学检查——所有这些检测基本上都是阴性。他的血红蛋白含量为 49%。红细胞计数为 250 万，沉降率为每小时 20 毫米。尿液分析显示微量白蛋白和每高倍视野 3 至 6 个红细胞。入院时体温达到 100 度，之后每日发热，直到 2 月 21 日。在 1953 年 2 月 23 日交由我们治疗之前，他的治疗是保守的。只给予“无肉无蛋饮食”。2 月 12 日因贫血输注了全血，2 月 16 日恢复正常饮食，2 月 18 日仅服用了一天的金霉素。

The sequence of his urinalysis is shown in the following table:
他的尿液分析顺序如下表所示：

Physical examination on admission revealed pallor, no obvious throat infection, a palpable spleen, no edema. An X-ray on February 7, 1953 “showed spleen down a slight distance below left rib margin. There is an increase in the transverse diameter of the heart, which appears fairly marked, and some increase in the bronchovascular markings in both hilar regions.”
入院时的体格检查显示面色苍白，无明显咽喉感染，脾脏可触及，无水肿。1953 年 2 月 7 日的 X 光显示“脾脏稍微低于左肋缘。心脏横径增大，较为明显，双侧肺门区的支气管血管纹理有所增加。”

On February 23, 1953 another X-ray revealed: “residual pulmonary congestion left upper and right lower lobes. No other abnormality in the heart and lungs. Heart shadow now normal.”
1953 年 2 月 23 日，另一张 X 光片显示：“左上叶和右下叶残留肺充血。心脏和肺部无其他异常。心影现正常。”

As has been indicated, we began to treat him on February 23,1953 . We ordered no change in treatment except the addition of 400 international units of alpha tocopherol daily. Within three days his urine cleared up completely, and it has remained normal since.
如前所述，我们于 1953 年 2 月 23 日开始治疗他。我们没有改变治疗方案，只是每天增加了 400 国际单位的α-生育酚。三天内他的尿液完全清澈，此后一直保持正常。

Still another case was a boy, aged four years, who was seen first at the age of 22 months for congenital heart disease. He was one of those sent to Dr. Gordon Murray in Toronto for investigation, although he was asymptomatic on alpha tocopherol therapy. Dr. Murray agreed that he had either an interauricular or interventricular septal defect, and we agreed that he should be investigated still further when older. Late in May, 1952, he developed hematuria two weeks after an attack of flu. He had had no alpha tocopherol for some time before this because of financial difficulties due to his father’s illness. He was, of course, once more immediately given 300 international units of alpha tocopherol daily. His urine was virtually free of red cells and albumin in three days and was perfectly normal in one week. He has remained well since.
还有一个病例是一个四岁的男孩，22 个月大时首次因先天性心脏病就诊。他是被送往多伦多的 Gordon Murray 医生进行检查的患者之一，尽管在服用α-生育酚治疗时无症状。Murray 医生同意他有房间隔或室间隔缺损，我们也同意他长大后应进一步检查。1952 年 5 月底，他在一次流感发作两周后出现血尿。在此之前，由于父亲生病导致经济困难，他已经有一段时间没有服用α-生育酚了。当然，他立即每天再次服用 300 国际单位的α-生育酚。三天内他的尿液几乎无红细胞和白蛋白，一周内完全正常。从那以后，他一直保持健康。

A girl patient was 14 years old when first seen on August 18, 1966, with a history of glomerulonephritis since the age of four, with a mild fever every afternoon since. At the age of five a pyleogram and catheterization confirmed the diagnosis. At age 13 , she had an episode of difficulty in voiding with some burning and pain and pyuria.
一名女患者在 1966 年 8 月 18 日首次就诊时 14 岁，自四岁起有肾小球肾炎病史，每天下午有轻微发热。五岁时，肾盂造影和导管检查确认了诊断。13 岁时，她出现排尿困难，伴有灼热感、疼痛和脓尿。

On 800 units of alpha tocopherol daily, she still ran a slight but decreased fever for six weeks, since when it has remained normal.
每天服用 800 单位的α-生育酚，她仍然持续发轻微但减轻的发烧六周，从那时起体温一直保持正常。

There is no evidence on urinalysis of red cells, white cells, or casts, and she has no urinary symptoms.
尿液分析中没有红细胞、白细胞或管型的证据，她也没有尿路症状。

However, the greatest change is in the patient herself. She feels completely well, and her mother confirms the obvious and great improvement.
然而，最大的变化发生在患者本人身上。她感觉完全健康，她的母亲也证实了明显且巨大的改善。

An adult male patient was first seen on March 20, 1953, after 27 months in the Veteran’s Hospital.
一名成年男性患者于 1953 年 3 月 20 日首次就诊，此前已在退伍军人医院住院 27 个月。

In December, 1945, while in the army, he was hospitalized for 30 days with an attack of acute glomerulonephritis. In March of 1952 he developed ascites (excess fluid in the abdominal cavity), pleural effusion and dependent edema. He was sent home with a four-plus albuminuria and told that they could do no more for him.
1945 年 12 月，他在军队服役期间因急性肾小球肾炎发作住院 30 天。1952 年 3 月，他出现腹水（腹腔内过多液体）、胸腔积液和下肢水肿。医生发现他有四度以上的白蛋白尿，便将他送回家，并告知无法再为他做更多治疗。

When first seen at the Shute Institute in London, he had a three-plus albuminuria, numerous fine, granular and hyaline casts, no leucocytes, but five to ten red blood cells per high power field. He had edema of feet and legs and fluid in the abdominal cavity. He was very pale and slightly cyanotic with obvious dyspnea even at rest.
当他首次在伦敦的 Shute 研究所就诊时，尿蛋白超过三度，有大量细小的颗粒状和透明管型，无白细胞，但每高倍视野有五到十个红细胞。他的双脚和双腿有水肿，腹腔内有积液。他面色苍白，略带青紫，静息时明显呼吸困难。

An initial dose of 600 units of alpha tocopherol daily was prescribed, and he was able to return to work in less than one month. He still had some peripheral edema, and his urine showed a trace of albumen, but was otherwise negative. He eventually bought a gas station where he worked up to 14 hours a day.
最初每天开了 600 单位的α-生育酚剂量，他在不到一个月的时间内就能重返工作岗位。他仍有一些周围水肿，尿液中有微量白蛋白，但其他检查均为阴性。他最终买了一家加油站，每天工作长达 14 小时。

He has been well now for 16 years after being sent home from the Veteran’s Hospital with a very grave prognosis.
在从退伍军人医院被送回家时被诊断为病情非常严重后，他现在已经健康了 16 年。

cal of any panacea, any treatment which works perfectly for many different diseases or pathological conditions. Such skepticism should be well tempered these days, however, by the general acceptance of broad spectrum antibiotics and of ACTH and Cortisone, used in so many apparently diverse and unrelated areas of medicine. When one understands the action of alpha tocopherol, that it is an antioxidant acting on all the body’s tissues; that it acts directly on clots, diminishing the risk of embolism or extension of the clot; that it dilates blood vessels, the capillaries at least, and certainly relieves spasm in arteries; that it decreases abnormal capillary permeability and softens some scars; then it is obvious that it must help almost any condition in which all or part of the problem is due to thrombosis or to decreased blood flow and consequent tissue anoxia.
任何灵丹妙药，任何对多种不同疾病或病理状况都能完美治疗的方法都是不存在的。然而，现如今这种怀疑态度应当被广谱抗生素以及在许多看似不同且无关的医学领域中使用的 ACTH 和可的松的普遍接受所适度缓和。当人们理解了α-生育酚的作用——它是一种作用于全身组织的抗氧化剂；它直接作用于血栓，减少栓塞或血栓扩展的风险；它扩张血管，至少是毛细血管，并且肯定能缓解动脉痉挛；它减少异常的毛细血管通透性并软化某些疤痕——那么显然，它必定有助于几乎所有因血栓形成或血流减少及随之而来的组织缺氧而引起的疾病。

Vitamin E is not a specific drug with limited effect on a specific organ or type of tissue, but affects all parts of the body.
维生素 E 不是一种对特定器官或组织类型有有限作用的特定药物，而是影响身体的所有部分。

Thus, many patients born with an abundant supply of sweat glands, when being treated with alpha tocopherol may be somewhat inconvenienced by excessive sweating and need a stronger deodorant. Patients all notice that their fingernails and toenails grow more rapidly, as does the hair. Unfortunately, the vitamin seems of no use in preserving the precious adornment in the male with hereditary alopecia.
因此，许多天生汗腺丰富的患者在接受α-生育酚治疗时可能会因出汗过多而感到不便，需要使用更强效的除臭剂。所有患者都注意到他们的指甲和脚趾甲生长更快，头发也是如此。不幸的是，这种维生素似乎对遗传性脱发的男性保持宝贵的装饰无效。

It acts on the whole animal as shown by decompression endurance studies on rats and by Lambert’s experience with
它作用于整个动物，这一点通过对大鼠的减压耐受性研究以及 Lambert 的经验得以证明
its use in racing greyhounds. A lengthy study has gained it full acceptance for conditioning race horses in the top Canadian racing stable, leading to its wide use by all leading stables. Further support for the vitamin’s over-all value is offered by the author’s experience in its use for conditioning world champion figure skaters and international champion swimmers.
它在赛跑灵缇犬中的使用。一项长期研究使其在加拿大顶级赛马马厩中被完全接受用于调理赛马，导致所有领先马厩广泛使用。作者在为世界冠军花样滑冰选手和国际冠军游泳运动员调理时的经验，进一步支持了这种维生素的整体价值。

Thus, though it may seem far afield from the heart, I have learned that vitamin E is of maximum use in treating burns, from the small domestic burn, due to contact with a heated iron or a stove burner or scalding steam and water, to the most severe third degree burns. Here the results are more important, because the scars that result from vitamin E treatment are unique and uniformly render unnecessary the usual costly, protracted skin grafting with resultant pain and agony to the patient.
因此，尽管这看起来与心脏关系不大，我了解到维生素 E 在治疗烧伤方面具有最大的作用，从因接触加热的熨斗、炉灶燃烧器或烫蒸汽和水而引起的小型家庭烧伤，到最严重的三度烧伤。在这里，效果更为重要，因为维生素 E 治疗后形成的疤痕独特且一致，使得通常昂贵且漫长的皮肤移植手术变得不必要，从而避免了患者的痛苦和折磨。

The implications of the results in burns are staggering to the imagination. Among existing problems, industrial burns, napalm burns, burns to firemen, etc.; could be much better treated than they are now in even the great medical centers. We do our best, in a pitifully small way, to rescue such patients and treat them properly as the following cases will illustrate.
烧伤结果的影响令人难以想象。在现有的问题中，工业烧伤、凝固汽油弹烧伤、消防员烧伤等；即使在大型医疗中心，这些烧伤的治疗也可以比现在好得多。我们尽力以极其有限的方式抢救这些患者并给予适当治疗，以下案例将说明这一点。

Our first case was a boy of six who, as well as his brothers and sisters, was delivered by Dr. Evan Shute. When he suffered a second degree burn to the dorsum of the fingers of his left hand from a hot laundry iron, his father called, not to discuss his treatment, but to find out which of the local surgeons should be entrusted with the care and grafting of the burned hand, particularly important in this case because the child was left-handed. Instead, he was treated at home with 300 units of alpha tocopherol by mouth, since this was before there was such a preparation as vitamin $E$$E$EE ointment. The result was excellent. There was no infection and no deepening of the damaged tissue, i.e., only the tissue killed by the heat of the iron was lost. Healing was rapid, and the resulting scar did not contract and was never tender. The boy regained completely normal function. He was not hospitalized and needed no skin grafting or other surgery,
我们的第一个病例是一个六岁的男孩，他和他的兄弟姐妹一样，都是由 Evan Shute 医生接生的。当他左手手指背部被热熨斗烫伤，造成二度烧伤时，他的父亲打电话来，不是为了讨论治疗方案，而是想知道当地哪位外科医生适合负责烧伤手的护理和植皮，这在这个病例中特别重要，因为孩子是左撇子。结果，他在家中口服了 300 单位的α-生育酚治疗，因为当时还没有维生素 E 软膏这种制剂。结果非常好。没有感染，也没有烧伤组织的进一步恶化，即只有被熨斗热量杀死的组织被损失。愈合迅速，留下的疤痕没有收缩，也从未感到疼痛。男孩完全恢复了正常功能。他没有住院，也不需要植皮或其他手术，
because there was no injury to the living tissue just below the necrotic tissue, and so no involvement of the tendons or tendon sheaths immediately below.
因为坏死组织正下方的活组织没有受伤，因此紧贴其下的肌腱或肌腱鞘也未受影响。

A much more serious case was that of another boy of six, who was badly scalded by a kettle of boiling water with multiple burns over his neck, torso, back and front, and left thigh. He was in the hospital for ten weeks under the care of a university professor. A skin grafting operation was performed using a four-inch square area from the right abdominal wall. None of the grafting was successful, and the whole area became grossly infected. The effect on the child was rather frightful. There were large raw areas, and the frequent dressings, along with the excoriated skin from the pus escaping and running over it, had made him a cringing, unhappy pitiful creature. There was infected, heaped up granulation tissue and no evidence of healing except at the ends of the burn on the thigh; and here the scar seemed to be heaped up and contracted like a keloid or pseudokeloid.
另一个六岁男孩的情况更为严重，他被一壶开水严重烫伤，颈部、躯干、背部、前胸和左大腿多处烧伤。他在医院接受了一位大学教授的治疗，住院十周。医生从右腹壁取了一个四英寸见方的皮肤进行移植手术，但移植全部失败，整个区域严重感染。对孩子的影响相当可怕。伤口大面积裸露，频繁换药，加上脓液流出导致皮肤糜烂，使他变得畏缩、不安且可怜。伤口处有感染的、堆积的肉芽组织，除了大腿烧伤末端外，没有愈合迹象；而那里疤痕似乎像瘢痕疙瘩或假瘢痕疙瘩一样隆起并收缩。

By this time alpha tocopherol ointment was available and, alternating with an antibiotic ointment, was used directly on the wound. He was also given 300 units of alpha tocopherol a day by mouth. The infection cleared up in the first four days; and after ten days of treatment, only the vitamin E ointment was used. Complete healing occurred in 13 weeks.
此时，α-生育酚软膏已经可用，并与抗生素软膏交替直接涂抹在伤口上。他还每天口服 300 单位的α-生育酚。感染在最初四天内消退；经过十天的治疗后，仅使用维生素 E 软膏。完全愈合发生在 13 周内。

As everyone knows, skin will not grow over heaped up vascular granulation tissue, and we planned to have any necessary skin grafting done when the right time arrived. However, every time we saw him the skin had grown in still further. The heaped up granulation tissue subsided in front of it. Ultimately we found he did not need grafting. Here again the unique characteristics of scars formed under alpha tocopherol therapy were evident. Whereas the scar formed on the thigh when he was first seen was heaped up and seemed to be keloid, the scar formed with alpha tocopherol was smooth and nontender. Moreover, there was no scar tissue contraction. The areas of healed scar were exactly the same size as the open wounds were when he was first seen.
众所周知，皮肤不会覆盖堆积的血管肉芽组织，我们计划在适当的时候进行必要的皮肤移植。然而，每次见到他时，皮肤都长得更进一步。堆积的肉芽组织在皮肤前方消退。最终我们发现他不需要移植。这里再次显现出在α-生育酚治疗下形成的疤痕的独特特性。最初在大腿上形成的疤痕是隆起的，似乎是瘢痕疙瘩，而在α-生育酚治疗下形成的疤痕则光滑且无压痛。此外，没有疤痕组织收缩。愈合的疤痕区域与他初次见到时的开放伤口大小完全相同。

In this patient we noted a direct confirmation of the capillary effect of alpha tocopherol. Whenever the ointment was applied, the granulation tissue became swollen and protruded. Therefore, raised well above the former surface of the wound and clearly visible in the swollen tissue, there could be seen numerous dilated capillary buds. If the ointment was carefully removed, the tissues would shrink, would blanch out, and return to the same level as before. This was repeated several times for the education of various doctors, as well as our own investigation, and we have several excellent color slides of this phenomenon.
在这位患者身上，我们直接确认了α-生育酚的毛细血管效应。每当涂抹药膏时，肉芽组织就会肿胀并突出。因此，在肿胀的组织中，伤口原有表面明显隆起，可以看到许多扩张的毛细血管芽。如果小心地去除药膏，组织会收缩，变得苍白，并恢复到之前的水平。为了教育多位医生以及进行我们自己的研究，这一过程重复了多次，我们还拍摄了几张该现象的优秀彩色幻灯片。

Five years ago, a man aged 45 decided to retar the roof of his house during his holiday. He heated the tar in a pail on the roof and was almost ready to begin work. When he went to reach for the brush, it fell into the pail. Without thinking, he automatically reached for the brush to rescue it and plunged his hand into the hot tar.
五年前，一位 45 岁的男子决定在假期期间重新涂抹他房子的屋顶沥青。他在屋顶上的桶里加热沥青，几乎准备开始工作。当他去拿刷子时，刷子掉进了桶里。他没有多想，本能地伸手去捞刷子，结果手伸进了热沥青中。

In the office, we used alpha tocopherol ointment on the hand and patiently wiped off the softened tar until the hand was fairly clean. The ointment was applied daily. However, he was unable to return to work for six weeks, since he works in oil and grease all day as an automobile mechanic.
在办公室里，我们在手上使用了α-生育酚软膏，耐心地擦去软化的焦油，直到手相当干净。软膏每天涂抹一次。然而，他因为整天接触油脂，作为一名汽车机械师，六周内无法重返工作岗位。

Since recovery, the hand has been normal in every way. There has been no loss of function and no tenderness of tissue, even while he does his heavy work on cars.
自康复以来，手部在各方面均恢复正常。功能没有丧失，组织也没有压痛，即使他从事汽车重活。

Today, his wife told me that when he gets his hand really clean on week-ends, the skin on that hand looks pink like a baby’s. There is no scarring evident, and only those who know about the burn would notice it.
今天，他的妻子告诉我，当他周末把手洗得非常干净时，那只手的皮肤看起来像婴儿一样粉红。没有明显的疤痕，只有了解烧伤的人才会注意到。

Our most recent case was that of a very obese woman aged 58, who was severely burned with boiling water on May 18, 1969. She was at a summer cottage on a cold weekend, getting the cottage ready for the summer. There was a large kettle of water on the wood stove, and her husband thought it was just warm. Not realizing that it was boiling, he poured the whole kettle into a big plastic jug and put it in the bed beside his wife who had lain down to rest. She felt it was hot and looked up at it. With
我们最近的一个案例是一位 58 岁的非常肥胖的女性，1969 年 5 月 18 日被沸水严重烫伤。那天是一个寒冷的周末，她正在夏季小屋里为夏天做准备。木炉上有一个大水壶，她的丈夫以为水只是温热的。没意识到水已经沸腾，他把整壶水倒进一个大塑料壶里，放在躺下休息的妻子床边。她感觉水很烫，抬头看了看。随着
the movement, the top blew off, and the water poured over her. She had on three sweaters and slacks, which held the scalding water to her. She jumped up and ran screaming around the cabin. She had to be taken two miles by boat and 32 miles by road to get to the nearest hospital, from which she was transferred to a large metropolitan hospital for further care.
运动时，顶盖被掀开，水倾泻而下淋湿了她。她穿着三件毛衣和长裤，这些衣物挡住了烫热的水。她跳起来，尖叫着绕着小屋跑。她不得不乘船两英里，再乘车三十二英里，才能到达最近的医院，随后被转送到一家大型都市医院接受进一步治疗。

She had a third degree burn of the left arm from the middle of the arm, involving about two-thirds of the circumference and all of the forearm to the wrist, with all the posterior surface and a half or more of the anterior surface involved. Roughly, the area involved measured 18 inches by eight inches. She involuntarily grasped the left arm with the right hand and sustained a burn on the tips of all the fingers and thumb and a burn on the anterior surface of the wrist from the hypothenar eminence across the crease between palm and forearm and into the thumb.
她左臂中部有三度烧伤，约占手臂周长的三分之二，前臂至手腕全部烧伤，后侧全部受累，前侧一半或更多受累。大致受伤面积为 18 英寸乘 8 英寸。她不由自主地用右手抓住左臂，导致所有手指和拇指指尖烧伤，手腕前侧从小鱼际隆起穿过掌与前臂之间的皱褶延伸至拇指处也有烧伤。

There was a large burned area under her left breast where the band of her brassiere held the water to her body, and this was 12 inches long and three inches wide at its lateral end.
她左胸下方有一大片烧伤区域，胸罩带将水紧贴在她身体上，这片区域长 12 英寸，侧端宽 3 英寸。

She had a large burned area involving her “adipose apron,” measuring 12 inches by two and one-half inches to four inches, and an area on the anterior abdominal wall extending upwards and inwards for four inches, which was three inches wide. Above, at a right angle to it, there was another area four inches by two and one-half inches.
她有一大片烧伤区域，涉及她的“脂肪围裙”，面积为 12 英寸乘 2.5 英寸至 4 英寸，腹部前壁有一块区域向上和向内延伸 4 英寸，宽 3 英寸。在上方，与之成直角的还有另一块区域，尺寸为 4 英寸乘 2.5 英寸。

The crease in her groin was covered by the adipose apron, but immediately below on her left anterior thigh was an area seven inches by two and one-half inches to three inches of scalded area.
她腹股沟的褶皱被脂肪垂覆盖，但在左前大腿正下方有一块七英寸乘二点五到三英寸的烫伤区域。

When she was able to remove her sweaters at the cottage, the skin of the top surface of her arm and forearm and the bottom surface of the forearm came away in sheets.
当她能够在小屋里脱下毛衣时，她上臂和前臂上表面以及前臂下表面的皮肤成片脱落。

She was treated with saline soaks in hospital, and it was explained to her that she would need extensive grafting, that the burns on her left arm were third degree burns, and that most of the rest of her burns were second and third degree. Meanwhile, while she was being prepared
她在医院接受了盐水浸泡治疗，并被告知她需要进行大面积移植，她左臂的烧伤是三度烧伤，其余大部分烧伤是二度和三度烧伤。与此同时，在她准备期间
for surgery, the burns on the abdomen and under her breast became infected, and pus and blood ran down her body when she stood up, she says now “down her legs as far as her slippers.”
手术后，她腹部和乳房下方的烧伤部位感染了，站起来时脓液和血液顺着身体流下，她现在说“流到腿上，甚至到了拖鞋那里。”

She was in agony and says she screamed when they were dressing her wounds and when they were applying the solution which she presumes was with sponges wrung out in saline.
她痛苦不堪，说在给她包扎伤口和涂抹溶液时她都尖叫着，她猜那是用盐水浸湿的海绵。

She had been a patient at the Shute Institute years before, and her husband had been my patient, so she signed herself out of the hospital and came to my office. It took a nurse three solid hours to remove the bandages. The area under the breast was covered by thick black crusts from under the edges of which pus flowed. The burns on the left arm presented a raw red area oozing serum and blood. The wounds yere then dressed with alpha tocopherol ointment on gauze using an entire one-half pound jar of ointment that first time.
多年前她曾是 Shute 研究所的病人，她的丈夫也曾是我的病人，于是她自行出院，来到我的诊所。护士花了整整三个小时才拆掉绷带。乳房下方的区域覆盖着厚厚的黑色结痂，结痂边缘下流出脓液。左臂的烧伤呈现出渗出血清和血液的红色生肉区域。伤口随后用含有α-生育酚的软膏敷在纱布上包扎，第一次就用了整整半磅的软膏。

Since it was impossible to get a bed at this time in the local hospital, she went to her daughter’s home and the Victorian Order of Nurses, a very capable order of visiting nurses, dressed the wounds daily. The infected areas cleared up in four or five days, and healing began.
由于当时当地医院无法安排床位，她便去了女儿家，维多利亚护士团——一个非常有能力的巡回护士组织——每天为她换药。感染部位在四五天内消退，开始愈合。

Now, three months later, all areas are healed except on the posterior surface of the left arm, which still must be dressed daily, since there are five or six areas about onequarter to one-half inch across that are open and raw. However, she has been back at work for a couple of weeks as a switchboard operator.
现在，三个月后，除了左臂后侧外，所有部位都已愈合，该处仍需每天包扎，因为有五六个约四分之一到二分之一英寸大小的开放且未愈合的区域。然而，她已经作为接线员回去工作了几个星期。

She volunteered the information that as the burns were healing the surfaces were red and angry looking and raised above the surface of the skin, but that as the skin grew in and the area healed, this subsided.
她主动提供信息说，随着烧伤的愈合，表面呈现红肿且凸起于皮肤表面，但随着皮肤生长和区域愈合，这种情况逐渐消退。

Now the healed areas are still red, but are fading. At the edges for some distance - up to one or two inches in some cases - one must look carefully to see where the burn had been. The burned area on the arm is still elevated above the surrounding tissue.
现在愈合的区域仍然发红，但正在逐渐消退。在边缘处，有一段距离——在某些情况下可达一到两英寸——必须仔细观察才能看出烧伤的位置。手臂上的烧伤区域仍然高出周围组织。

Again, the unique characteristics of the burn scar healed
同样，烧伤疤痕愈合后的独特特性
under this treatment are very obvious. There is no contraction of scar tissue anywhere, and the scar is already pliable and nontender. She has used 27 pounds of ointment to date. The nurses of the Victorian Order are not only converts, but the most ardent of advocates.
在这种治疗下的效果非常明显。任何地方都没有瘢痕组织的收缩，瘢痕已经柔软且无压痛。到目前为止，她已经使用了 27 磅药膏。维多利亚骑士团的护士们不仅成为了信徒，而且是最热情的倡导者。

Obviously, anyone familiar with the results of the use of alpha tocopherol for burns must realize the import of such cases. The prevention of shock, of infection, and of toxic injury to the still viable but insulted tissues beneath are specific answers to the major dangers of burns, recognized and poorly combated in every severely burned case in every major hospital and medical center everywhere.
显然，任何熟悉使用α-生育酚治疗烧伤效果的人都必须意识到这些案例的重要性。预防休克、感染以及对仍然存活但受损组织的毒性伤害，是对烧伤主要危险的具体应对措施，而这些危险在每个大型医院和医疗中心的每个严重烧伤病例中都被认识到但未得到有效控制。

The freeing of hospital beds is of major importance these days, as everyone knows, but the economic consideration is as nothing compared to the elimination of the need of skin grafting in most cases. The agony of the patient with the usual “accepted” methods of treatment is something else to consider. This was the one major feature of this last case which the patient and her husband kept talking about!
众所周知，腾出医院床位如今非常重要，但与大多数情况下无需进行皮肤移植相比，经济因素微不足道。采用通常“公认”的治疗方法时，患者所经历的痛苦是另一件需要考虑的事情。这是最后一个病例中患者和她丈夫一直谈论的一个主要特点！

erol in ointment form for indolent ulcers in 1947, but did not report its use for superficial wounds until the next year.
1947 年以软膏形式用于治疗迟缓性溃疡，但直到次年才报告其用于表浅伤口。

The oral administration of alpha tocopherol should be begun simultaneously with the topical ointment, since, while either alone may be effective, one complements the other. Open wounds so handled, whether traumatic or ascribable to prolonged decubitus, heal faster, with less scar-tissue contraction, with a more pliable subcutaneous layer and with less tender surface covering, than do such wounds treated in any other way. The usefulness of alpha tocopherol ointment in burns, whether thermal in origin or due to X-ray or radium, has also been demonstrated. Noteworthy is the limitation of necrosis so achieved in thermal burns and this even in severe cases. Prompt application is essential, of course. First-degree burns so treated may almost disappear in two or three days. As we have pointed out elsewhere, there is a singular freedom from infection, toxemia, and contracture which often makes skin-grafting unnecessary. Incidentally, this ointment is excellent for small domestic burns and has a very practical application in the inconvenient, uncomfortable, and very common sunburn.
口服α-生育酚应与外用软膏同时开始使用，因为虽然单独使用任何一种都可能有效，但两者相辅相成。这样处理的开放性伤口，无论是外伤引起的还是因长期卧床引起的，愈合速度更快，瘢痕组织收缩较少，皮下层更柔韧，表面覆盖层疼痛感也较轻，优于其他任何治疗方法。α-生育酚软膏在烧伤中的有效性也已得到证明，无论是热源引起的还是由 X 射线或镭引起的烧伤。值得注意的是，这种治疗在热烧伤中能限制坏死范围，即使在严重病例中也是如此。当然，及时应用至关重要。经过这种治疗的一度烧伤几乎可以在两三天内消退。正如我们在其他地方指出的，这种治疗显著减少了感染、中毒和挛缩，常常使皮肤移植变得不必要。顺便提一下，这种软膏对小型家庭烧伤非常有效，在不便、不舒服且非常常见的晒伤中也有非常实用的应用。

Elsewhere we have reported the ability of oral alpha tocopherol to improve the circulation in limbs showing small areas of gangrene. By its means the viable tissues just proximal to the dead cells can, by the usual process of capillary budding and phagocytosis of dead cells with liquefaction,
在其他地方，我们已经报道了口服α-生育酚改善肢体循环的能力，这些肢体显示出小面积的坏疽。通过这种方式，死细胞近端的可存活组织可以通过毛细血管芽生和死细胞液化吞噬的常规过程，
separate necrotic from living tissue at the zone of separation. Healing of the raw subgangrenous areas left when the gangrenous patches detach themselves can be accelerated by the local use of tocopherol ointment.
在分离带将坏死组织与活组织分开。当坏疽斑块脱落后留下的原始亚坏疽区域的愈合，可以通过局部使用生育酚软膏来加速。

Recalling the early studies of Steinberg, lumbago was early treated by us with inunction of tocopherol ointment over the affected area, followed by heat. Within an hour or so pain and disability could disappear. We have used this treatment on many cases of fibrositis and myositis. The discovery that alpha tocopherol in ointment form apparently penetrated intact skin, and might have a direct effect upon underlying joints, led to trials of this agent on a variety of conditions where diminished blood supply or decreased tissue oxygenation could be a part of the picture. Thus we have seen a few cases of rheumatoid arthritis in which the swelling and pain in the joints were materially reduced and mobility increased. One such patient who had been nearly immobile for 18 months returned to normal activity with residual flexion deformity in but three joints. The ointment, rubbed into fingers showing rheumatoid arthritis, can be especially helpful. Not all cases respond, of course, and our experience is relatively limited.
回想起 Steinberg 的早期研究，我们最初用生育酚软膏涂抹患处并加热治疗腰痛。大约一小时内，疼痛和功能障碍就能消失。我们在许多纤维炎和肌炎病例中使用了这种治疗方法。发现α-生育酚软膏形式显然能穿透完整的皮肤，并可能对下方的关节产生直接影响后，我们开始在多种可能涉及血液供应减少或组织缺氧的疾病中试用这种药物。因此，我们见过一些类风湿性关节炎病例，关节肿胀和疼痛明显减轻，活动能力增加。其中一位患者几乎 18 个月无法活动，经过治疗后恢复正常活动，仅有三个关节残留屈曲畸形。将软膏涂抹于显示类风湿性关节炎的手指上尤其有帮助。当然，并非所有病例都有反应，我们的经验也相对有限。

The ointment is of real value in relieving the itching of the abdominal skin associated so often with striae gravidarum and for pruritis ani or vulvae and even for the irritation of keloids.
该软膏在缓解腹部皮肤瘙痒方面具有真正的价值，这种瘙痒常与妊娠纹相关，也适用于肛门或外阴瘙痒，甚至对瘢痕疙瘩的刺激也有效。

A field in which our experience has been extensive is that of chest pain of non-cardiac origin. So often in righthanded persons there is pain in the left chest wall, most frequently found in the fourth or fifth interspace, accompanied by tenderness on pressure between the ribs which may extend around to a point just lateral to the spinous processes of the vertebral bodies. This pain may closely simulate true angina pectoris, since exertion and any resultant deep breathing may irritate the lesion and evoke the pain. It can usually be differentiated from true angina by the fact that it begins with a change in position on sitting in a too-easy chair or on lying on a too-soft mattress, is tender, and is aggravated by coughing, twisting, or even
我们在非心源性胸痛领域有丰富的经验。右利手者常常在左侧胸壁感到疼痛，最常见于第四或第五肋间隙，伴有肋间按压时的压痛，压痛可能延伸至脊椎体棘突外侧一点的位置。这种疼痛可能非常类似于真正的心绞痛，因为运动和由此引起的深呼吸可能刺激病变并引发疼痛。通常可以通过以下事实将其与真正的心绞痛区分开来：疼痛始于坐在过软的椅子上或躺在过软的床垫上时姿势的改变，有压痛，并且会因咳嗽、扭转甚至...
deep breathing. It is frequently misdiagnosed and can even be labeled status anginosus. The variety of terms applied to this condition is evidence of its interest, e.g., intercostal neuritis, spondylitis, even arthritis of the spine. Vitamin E ointment, gently rubbed in for ten minutes, followed by heat for ten minutes and applied to the paravertebral area only, will relieve the pain in one to three days in many cases. Thiamin chloride, given orally or by injection, is very valuable, of course. We often recommend manipulation and note with interest that a recent report has commented favorably on such treatment.
深呼吸。它经常被误诊，甚至可能被标记为心绞痛持续状态。对这种情况使用的各种术语证明了它的复杂性，例如肋间神经炎、脊椎炎，甚至脊柱关节炎。维生素 E 软膏，轻轻按摩十分钟，然后热敷十分钟，仅应用于椎旁区域，在许多情况下能在一到三天内缓解疼痛。氯化硫胺素，口服或注射，当然非常有价值。我们经常推荐手法治疗，并且有兴趣注意到最近的一份报告对这种治疗给予了积极评价。

In 1949 Scardino and Hudson reported the beneficial effect of oral alpha tocopherol on Peyronie’s disease. We have seen a few such cases co-incidentally in patients under treatment with vitamin E for cardiac conditions. Some have reported improvement, rarely complete; some have no improvement; none have worsened. In one case we suggested that it might be possible to increase the concentration of alpha tocopherol locally by the use of the ointment and heat. It should be noted that this patient has been ingesting a large dosage of alpha tocopherol daily for three years, the status of the Peyronie’s disease remaining the same. Using tocopherol ointment the condition improved greatly in three months.
1949 年，Scardino 和 Hudson 报道了口服α-生育酚对佩罗尼氏病的有益效果。我们在接受维生素 E 治疗心脏病的患者中偶然见过一些此类病例。有些报告有所改善，完全康复的很少；有些没有改善；没有恶化的。在一例中，我们建议通过使用软膏和热敷，可能局部提高α-生育酚的浓度。值得注意的是，该患者每天摄入大量α-生育酚已达三年，佩罗尼氏病的状况保持不变。使用生育酚软膏后，病情在三个月内大为改善。

Finally, we wish to report the use of tocopherol ointment in a case of recurring corneal ulcer, in the hope that this suggestion may be tested further by ophthalmologists. A man has been under our care since June, 1954, for intermittent claudication and accordingly has been given 300 to 1,600 units of alpha tocopherol daily. In May, 1957, while taking 750 units daily, he developed a recurrent corneal ulcer for the sixth time since 1940. Originally, a piece of radium paint from an aircraft instrument had flown into his eye, and the resulting ulceration had been treated by an ophthalmologist for six weeks. Originally, and during the ensuing four attacks, ophthalmic ointments of several types and oral and parenteral antibiotics had failed to heal the ulcer until it was cauterized. When this sixth recurrence was noted, we decided to instill half-strength tocopherol ointment. Two
最后，我们希望报告生育酚软膏在一例复发性角膜溃疡中的使用，期望这一建议能被眼科医生进一步验证。一名男子自 1954 年 6 月起接受我们的治疗，患有间歇性跛行，因此每天服用 300 至 1600 单位的α-生育酚。1957 年 5 月，当他每天服用 750 单位时，出现了自 1940 年以来第六次复发的角膜溃疡。最初，一块来自飞机仪表的镭漆飞入他的眼睛，导致溃疡，眼科医生对其进行了六周的治疗。最初及随后的四次发作中，使用了多种眼科软膏以及口服和注射抗生素，但均未能治愈溃疡，直到进行了烧灼治疗。当发现第六次复发时，我们决定滴入半浓度的生育酚软膏。两次...
days later full strength ointment was applied. The lesion healed in two weeks, and there were no untoward effects from the introduction of the ointment into the eye. No previous observation of this sort has been found in the literature. We may add that his sight has not worsened appreciably with this last episode.
几天后涂抹了全强度的软膏。病变在两周内愈合，且将软膏引入眼睛后没有出现不良反应。文献中未发现类似的先前观察。我们还可以补充说，他的视力在这次发作后并未明显恶化。

We occasionally see an indolent leg ulcer in which the ointment increases local irritation or even provokes an id rash. Perhaps a dilute ointment containing 15 international units of alpha tocopherol per gram should be used initially on such patients and should be applied on limited areas. If that causes no general or local reaction but does not promote healing in the lesion, then a stronger tocopherol ointment can be used safely.
我们偶尔会见到一种懒惰性腿部溃疡，使用软膏会加重局部刺激甚至引发皮疹。对于这类患者，或许应初步使用含有每克 15 国际单位α-生育酚的稀释软膏，并仅涂抹于有限区域。如果这样既无全身或局部反应，又未促进病变愈合，则可以安全使用更浓的生育酚软膏。

we treated the first ten cardiac patients with alpha tocopherol. During these years we have personally cared for or supervised the treatment of more than 30,000 cardiovascular patients. Because much has been learned from this large experience and because of the appearance of some new and useful adjuncts to alpha tocopherol therapy, it now seems a good idea to specify the dosage schedule for the different cardiovascular conditions commonly met in such a practice.
我们用α-生育酚治疗了最初的十名心脏病患者。在这些年里，我们亲自照顾或监督治疗了三万多名心血管患者。由于从这大量的经验中学到了很多东西，并且出现了一些对α-生育酚疗法有用的新辅助方法，现在似乎有必要为在此类诊疗中常见的不同心血管疾病指定剂量方案。

It is noteworthy that time has shown alpha tocopherol to be unique in its ability to prevent coronary thrombosis, to dissolve fresh venous thromboses, and to decrease or abolish the symptoms that usually follow such disasters. Since these symptoms are chiefly limitation of exercise tolerance due to dyspnea, or angina pectoris, or both, the important action of alpha tocopherol here is its oxygen conservation. As shown in the experiments of air-force investigators, the administration of alpha tocopherol to normal animals decreases the oxygen requirements of muscle, cardiac and skeletal. Houchin and Mattill have also demonstrated this action of alpha tocopherol. In cardiac cases the oxygen needs are reduced, so anoxia to the degree that initiates angina pectoris or dsypnea is not reached as readily or at all. It should be noted that there are no safe rival drugs available to contest its powers and usefulness. The other fibrinolysins are still in the cautious, experimental stage.
值得注意的是，时间已经证明α-生育酚在预防冠状动脉血栓形成、溶解新鲜静脉血栓以及减轻或消除通常随之而来的症状方面具有独特的能力。由于这些症状主要是由于呼吸困难或心绞痛或两者兼有导致的运动耐力受限，α-生育酚在这里的重要作用是节约氧气。正如空军研究人员的实验所示，给予正常动物α-生育酚可以减少肌肉（心肌和骨骼肌）的氧气需求。Houchin 和 Mattill 也证明了α-生育酚的这种作用。在心脏病病例中，氧气需求减少，因此引发心绞痛或呼吸困难的缺氧程度不易达到或根本不会达到。应当注意，目前没有安全的竞争药物能够与其功效和实用性相抗衡。其他纤溶酶仍处于谨慎的实验阶段。

Although it is about 110 years since Vogel first discovered cholesterol in the aorta, there is still no satisfactory evidence
尽管自 Vogel 首次在主动脉中发现胆固醇已经大约 110 年了，但仍然没有令人满意的证据
that coronary attacks can be prevented by controlling cholesterol values in the blood stream. Indeed it has been stated that cholesterol is not the major constituent in plaques in the coronary artery, yielding precedence to triglycerides. Talbott’s article on cholesterol is refreshingly sane.
冠状动脉发作可以通过控制血液中的胆固醇值来预防。事实上，有人指出胆固醇并不是冠状动脉斑块中的主要成分，三酰甘油更为重要。Talbott 关于胆固醇的文章令人耳目一新，观点理智。

The almost universal use of the anticoagulants by cardiologists in treating coronary thrombosis, in both the acute phase and as long-term treatment, followed the paper published in 1948 by Irving S. Wright and his group. Why it took 12 more years for several thousand cardiologists and clinicians to discover that these drugs were of dubious value and also highly dangerous is hard to explain, just as it is hard to explain why these drugs are still in common use in 1969, some nine or ten years after they should have been widely discarded, at least for chronic patients.
心脏病专家几乎普遍使用抗凝剂治疗冠状动脉血栓，无论是在急性期还是作为长期治疗，这一做法始于 1948 年 Irving S. Wright 及其团队发表的论文。为什么又过了 12 年，数千名心脏病专家和临床医生才发现这些药物价值可疑且极其危险，这很难解释；同样难以解释的是，为什么这些药物在 1969 年仍被广泛使用，尽管它们至少在慢性患者中早在九到十年前就应该被广泛弃用。

Similarly, bed rest for six weeks after an acute coronary episode is apparently more dangerous than useful, as discovered and reported by Samuel Levine in 1952. In this year, 1969, Levine’s armchair treatment (with a reduction of the death rate to ten per cent) is just beginning to be used in some parts of Canada by more than the author. As recently as 1964, one great Ontario hospital was reported to be disturbed by its 40 per cent coronary death rate. The conclusion is inescapable that, for 11 years, this hospital had permitted four times as many patients with coronary occlusion to die as in a similar hospital in Boston! Early ambulation was the obvious major difference in the two centers.
同样，1952 年，Samuel Levine 发现并报告称，急性冠状动脉事件后卧床休息六周显然比有益更危险。到了 1969 年，Levine 的“扶手椅治疗法”（使死亡率降至百分之十）才开始在加拿大部分地区被更多人采用。直到 1964 年，安大略省一家大型医院的冠状动脉死亡率高达 40%，这让人感到震惊。结论不可避免：在过去 11 年里，这家医院允许冠状动脉闭塞患者的死亡人数是波士顿一家类似医院的四倍！两地的明显主要差异是早期活动。

Not only is alpha tocopherol the drug of choice in treating coronary artery narrowing and/or occlusion, but it is also effective in treating all other forms of heart disease with or without the help of other old and new drugs, such as digitalis, the chlorothiazides, Rauwolfia, diuretics, and such.
α-生育酚不仅是治疗冠状动脉狭窄和/或闭塞的首选药物，而且在有无其他传统和新药物（如地高辛、氯噻嗪类、雷沃尔菲亚、利尿剂等）辅助的情况下，也能有效治疗所有其他形式的心脏病。

However, as is true for any useful drug, one must know how to use alpha tocopherol and must have a reliable preparation, properly assayed and labeled and one with which the physician is thoroughly familiar. Indeed, general acceptance of alpha tocopherol in treating cardiovascular disease might have been achieved long since had the earliest workers in the field used the same dosage schedule and product that we had used and upon which our original findings were
然而，正如任何有效药物一样，必须知道如何使用α-生育酚，并且必须有一种经过可靠检测和标记的制剂，且医生对其非常熟悉。事实上，如果该领域最早的研究者使用了我们所用的相同剂量方案和产品，并基于此得出我们的最初发现，α-生育酚在治疗心血管疾病方面的广泛认可或许早已实现。
released to the medical profession. For example, only the alpha fraction of the tocopherols is really effective. For this reason, it is essential to use a product in which the alpha fraction is assayed. So many of the tocopherol preparations are a combination of the tocopherols, and, unless the alpha fraction is potent and its potency known by assay, one is likely to earn a poor result.
发布给医学界。例如，只有生育酚的α部分真正有效。因此，使用经过α部分含量测定的产品是必不可少的。许多生育酚制剂是生育酚的混合物，除非α部分具有高效力且通过测定了解其效力，否则很可能得不到理想的效果。

Primarily it is because of its value as fibrinolysin and its oxygen conservation powers that alpha tocopherol is so useful in cardiovascular disease, although in acute rheumatic fever and acute glomerulonephritis its ability to decrease capillary permeability in a very short time may be what allows it to dispel signs and symptoms.
主要是因为其作为纤溶酶和氧气保存能力的价值，α-生育酚在心血管疾病中非常有用，尽管在急性风湿热和急性肾小球肾炎中，其在极短时间内降低毛细血管通透性的能力可能使其能够消除体征和症状。

This note is, therefore, intended to serve as a guide to its intelligent therapeutic use. The key to success depends upon fitting the dosage to the individual patient’s peculiar requirements. Different forms of cardiovascular disease require different ranges of effective dosage. For example, coronary artery insufficiency, whatever the underlying pathology, responds usually to 800 to $1,200\mathrm{I}.\mathrm{U}$$1,200\mathrm{I}.\mathrm{U}$1,200I.U1,200 \mathrm{I} . \mathrm{U}. of alpha tocopherol daily. However, individual patients may need much more. Starting a victim of chronic rheumatic heart disease on such a dose can lead to rapid deterioration or death. Intermittent claudication may be relieved on 800 I.U. a day, but this rarely. Sixteen hundred I.U. a day seems to be a wiser dose, and 2,400 I.U. can be needed.
因此，本说明旨在作为其智能治疗使用的指南。成功的关键在于将剂量调整到个别患者的特殊需求。不同形式的心血管疾病需要不同范围的有效剂量。例如，冠状动脉功能不全，无论其潜在病理如何，通常对每天 800 至 $1,200\mathrm{I}.\mathrm{U}$$1,200\mathrm{I}.\mathrm{U}$1,200I.U1,200 \mathrm{I} . \mathrm{U} 单位的α-生育酚有反应。然而，个别患者可能需要更多剂量。对慢性风湿性心脏病患者开始使用此剂量可能导致病情迅速恶化或死亡。间歇性跛行可能在每天 800 国际单位的剂量下得到缓解，但这种情况很少见。每天 1600 国际单位似乎是更明智的剂量，甚至可能需要 2400 国际单位。

(a) Those patients who have a normal blood pressure, i.e., $120/80$$120/80$120//80120 / 80 or very nearly that, who have angina pectoris on effort or excitement, but no evidence of congestive failure, and whose electrocardiograms do not show evidence of myocardial infarction in the standard or five precordial leads.
(a) 那些血压正常，即 $120/80$$120/80$120//80120 / 80 或非常接近该值，且在劳累或激动时出现心绞痛，但无充血性心力衰竭迹象，且其心电图在标准导联或五个胸前导联中无心肌梗死证据的患者。

These should be checked out very carefully to rule out intercostal tenderness in the left chest, a very frequent finding in right-handed people and a lesion which can simulate angina pectoris due to coronary sclerosis. We treat this intercostal neuralgia intensively in all patients, since
应非常仔细地检查这些，以排除左胸肋间压痛，这在右撇子中非常常见，是一种病变，可能因冠状动脉硬化而模拟心绞痛。我们对所有患者都积极治疗这种肋间神经痛，因为
it may either complicate a true case of angina pectoris or simulate it in cardiologically normal people.
它可能会使真实的心绞痛病例变得复杂，或者在心脏病学正常的人群中模拟出心绞痛。

We give these coronary patients 800 I.U. alpha tocopherol daily for six weeks. Since alpha tocopherol in cardiac patients takes five to ten days to begin to take effect and four to six weeks to diminish or relieve symptoms to the point where the results are obvious to patient and physician alike, we check all such patients after six weeks of treatment and often carry out a practical exercise tolerance test at the end of five or six weeks to establish the approximate degree of improvement.
我们给这些冠心病患者每天服用 800 国际单位的α-生育酚，持续六周。由于α-生育酚在心脏病患者体内需要五到十天才能开始起效，且需要四到六周才能减轻或缓解症状，达到患者和医生都能明显感受到的效果，我们会在治疗六周后对所有此类患者进行检查，并常在五到六周结束时进行实际的运动耐力测试，以确定大致的改善程度。

If all or nearly all symptoms have disappeared, we maintain the patient on that dose indefinitely. He must take the full dose every day, since he can lose all relief from the treatment within three to seven days after cessation of therapy. A diminution of dosage will, of course, lead to a slower but certain return of symptoms. Very rarely a dosage of this degree may lead to gastric distress, but this will nearly always respond to the addition of three teaspoonsful of skim milk powder in a little milk or water after each meal with the added precaution of taking the alpha tocopherol half way through each meal.
如果所有或几乎所有症状都消失了，我们会无限期地维持患者服用该剂量。他必须每天服用全剂量，因为停药后三到七天内可能会失去所有治疗效果。剂量减少当然会导致症状缓慢但确定地复发。极少数情况下，这种剂量可能会引起胃部不适，但几乎总能通过每餐后在少量牛奶或水中加入三茶匙脱脂奶粉，并在每餐中途服用α-生育酚来缓解。

If the patient is not improved on the original dosage level we raise it by 200 I.U. per day at six-week intervals until he is relieved or until we must admit defeat. Even then, mindful of our own experience and of Zierler’s and Ochsner’s work, we maintain a dosage of $800\mathrm{I}.\mathrm{U}$$800\mathrm{I}.\mathrm{U}$800I.U800 \mathrm{I} . \mathrm{U}. a day to prevent intravascular clotting - aware that such patients stand a very real danger of coronary thrombosis.
如果患者在原始剂量水平下没有改善，我们每六周将剂量增加 200 国际单位，直到患者得到缓解或我们不得不承认失败。即使如此，考虑到我们自己的经验以及 Zierler 和 Ochsner 的研究，我们仍保持每天 $800\mathrm{I}.\mathrm{U}$$800\mathrm{I}.\mathrm{U}$800I.U800 \mathrm{I} . \mathrm{U} 的剂量以防止血管内血栓形成——因为我们知道这类患者面临冠状动脉血栓形成的真实危险。

Formerly we had to be very careful of patients in this category who had an elevated blood pressure, since large doses of alpha tocopherol, by increasing the tone of cardiac muscle, could elevate the blood pressure still more. However, we now start such patients on 800 I.U. a day, and proceed just as above, except that we place them on a suitable dose of hydrochlorothiazide. On their return visit in six weeks the blood pressure is usually lowered and can be satisfactorily controlled. Occasionally, we must add Rauwolfia or other such drugs. Rarely is the blood pressure reading higher than on the original examination.
以前我们必须非常小心这类血压升高的患者，因为大剂量的α-生育酚通过增强心肌张力，可能会使血压进一步升高。然而，现在我们开始给这类患者每天服用 800 国际单位，并按上述方法进行，只是同时给予适量的氢氯噻嗪。在六周后的复诊中，血压通常会降低并得到满意的控制。偶尔，我们需要添加雷沃尔菲亚或其他类似药物。血压读数很少会高于最初检查时的水平。

(b) Acute phase. The only correct time to begin the treatment of a case of coronary occlusion with alpha tocopherol is immediately upon establishment of the probable diagnosis! In such cases the full value of the oxygen-conserving power of alpha tocopherol and of its ability as a capillary dilator has a chance to salvage the heart. The infarct can be greatly reduced in size, and adjacent tissue death may be largely prevented. Later it is too late to prevent extensive tissue necrosis. Then all that can be done is to promote healing in the damaged myocardium surrounding the infarct, the areas commonly known as the zones of injury and ischemia; to increase the rate and extent of the opening up and establishment of collateral circulation and to ensure a firm scar tissue repair of the infarcted area. Of course, decreasing the oxygen need of the rest of the laboring heart is of real value and usually insures an added chance of survival.
（二）急性期。开始用α-生育酚治疗冠状动脉闭塞病例的唯一正确时机是在可能诊断确立的那一刻！在这种情况下，α-生育酚节约氧气的能力及其作为毛细血管扩张剂的作用，才有机会挽救心脏。梗死面积可以大大缩小，邻近组织的坏死也可以在很大程度上被防止。之后就太晚了，无法防止广泛的组织坏死。那时所能做的就是促进梗死周围受损心肌的愈合，这些区域通常被称为损伤区和缺血区；加快侧支循环的开放和建立的速度与范围，并确保梗死区形成坚固的瘢痕组织修复。当然，减少其余负荷心脏的氧气需求具有实际价值，通常能增加生存的机会。

These cases are ideal test problems, since in them all the powers of alpha tocopherol have their chance to demonstrate themselves. Indeed, one of the most dramatic proofs of the value of alpha tocopherol in coronary occlusion is demonstrable here, since in such fresh cases the electrocardiogram will show the change typical of the lesion, but to a diminished degree; thenceforward, the recovery of the electrocardiogram is more rapid and complete than it is without alpha tocopherol. We now have an interesting collection of such electrocardiograms.
这些病例是理想的测试问题，因为在它们中，α-生育酚的所有功效都有机会得到展示。事实上，α-生育酚在冠状动脉闭塞中的价值最具戏剧性的证明之一就在这里，因为在这些新鲜病例中，心电图会显示出病变的典型变化，但程度较轻；从此以后，心电图的恢复比没有使用α-生育酚时更快更完全。我们现在拥有一组有趣的此类心电图。

The well-known drop in blood pressure that occurs in acute myocardial infarction allows full and immediate dosage in every case. Previously elevated pressures often remain within a normal range after recovery. Some will need antihypertensive drugs later, however.
急性心肌梗死时血压显著下降，使得每例患者都能立即且充分用药。先前升高的血压在康复后通常保持在正常范围内，但有些患者以后仍需使用降压药。

We now start all acute cases on 1,600 I.U. of alpha tocopherol per day. A smaller dose is certainly adequate in the majority of cases, but it is better to make sure that maximum help is being given.
我们现在对所有急性病例每天开始服用 1600 国际单位的α-生育酚。大多数情况下较小的剂量当然足够，但最好确保给予最大的帮助。

© We are seeing more and more fresh occlusions in consultation or in our own practice, but, of course, the majority of post-occlusal cases seen by us during the last twenty years have come weeks, months, or years after their accident. If cardiologists really believe that a majority of patients regain good or near-normal health following an occlusion, they are mistaken. Such patients are not deceived by the usual reassurance and six-monthly visits. The majority of those we have seen have had a definite and usually marked abnormality of the electrocardiogram. In the evaluation of treatment in these patients, the pulse rate and electrocardiographic changes become the best objective evidence of adequate dosage and, therefore, of adequate protection.
© 我们在会诊或自己的诊所中看到越来越多的新鲜闭塞病例，但当然，在过去二十年中我们所见的大多数闭塞后病例都是在事故发生数周、数月或数年后出现的。如果心脏病专家真的相信大多数患者在闭塞后能恢复良好或接近正常的健康状态，那他们就是错误的。这些患者不会被通常的安慰和每六个月一次的复诊所欺骗。我们所见的大多数患者的心电图都有明确且通常明显的异常。在评估这些患者的治疗效果时，脉搏率和心电图变化成为判断剂量是否足够、从而是否有足够保护的最佳客观证据。

Here is one place where the climician unaccustomed to tocopherol therapy must learn something entirely new. The myocardial infarct itself, the “zone of injury” next to it, and the “zone of ischemia” just outside that again form a total area affecting the electrocardiogram. As time goes on this area either is slightly decreased by the slowly forming anastomoses, or it remains constant, or it gradually spreads as the basic disease process worsens accordingly. The electrocardiogram either shows spontaneous improvement, or reaches a static state for months or years, or gradually shows an increase of abnormality, depending upon whatever variation just described has developed. However, when such a patient responds to adequate alpha tocopherol therapy we believe that the zone of injury may lessen, the zone of ischemia may perhaps become physiologically normal, and the total area can thereby be greatly reduced. At least such improvement is reflected by corresponding changes in the $T$$T$TT wave of the electrocardiogram. This sequence, may we repeat, is scarcely known to the older cardiologists because it so rarely occurred in their experience before the day of alpha tocopherol.
这里是临床医生不熟悉生育酚治疗时必须学习的一个全新领域。心肌梗死本身、其旁的“损伤区”以及再外侧的“缺血区”共同构成了影响心电图的总区域。随着时间推移，这一区域要么因缓慢形成的侧支循环而略有缩小，要么保持不变，或者随着基础疾病的恶化逐渐扩大。心电图要么显示自发性改善，要么在数月或数年内保持静止状态，或者逐渐显示异常加重，这取决于上述变化的发展情况。然而，当这样的患者对足量的α-生育酚治疗产生反应时，我们认为损伤区可能减小，缺血区或许恢复生理正常，从而总面积可以大幅减少。至少这种改善会反映在心电图的 $T$$T$TT 波相应变化中。我们再强调，这一过程在老一辈心脏病学家中几乎不为人知，因为在α-生育酚出现之前，这种情况极为罕见。

For some reason patients with coronary occlusions often respond more rapidly and completely to alpha tocopherol therapy than do those having coronary sclerosis and angina
出于某种原因，冠状动脉闭塞的患者对α-生育酚治疗的反应通常比冠状动脉硬化和心绞痛患者更快且更完全
pectoris, but without definite electrocardiographic evidence of infarction. Morris has shown convincingly that coronary thrombosis may be quite independent of atherosclerosis, although angina pectoris presupposes atheromatous changes.
心绞痛，但没有明确的心电图梗死证据。莫里斯已令人信服地证明，冠状动脉血栓形成可能与动脉粥样硬化完全无关，尽管心绞痛预设了动脉粥样硬化的变化。

Patients in this category are started also on 800 I.U. a day, with increases of 200 to 400 I.U. a day at six-week intervals, until improvement is obtained.
此类患者也开始每天服用 800 国际单位，每六周增加 200 到 400 国际单位，直到病情好转。

(a) Acute Rheumatic Fever. The first attack: Here, as with acute coronary occlusion, the proper time to treat the patient is the moment the probable diagnosis is made. Under such circumstances all evidences of disease may disappear in as little as three to seven days - at least by three to four weeks. Fever, joint symptoms and signs, tachycardia, and elevated sedimentation rate will in many a case disappear entirely. Here also, irrespective of age, the full dosage of 600 units daily should be given by mouth.
(a) 急性风湿热。第一次发作：在这里，与急性冠状动脉阻塞一样，治疗患者的适当时机是在可能诊断作出时。在这种情况下，所有疾病的迹象可能在短短三到七天内消失——至少在三到四周内消失。发热、关节症状和体征、心动过速以及红细胞沉降率升高在许多病例中会完全消失。在这里，无论年龄大小，都应口服每日 600 单位的全剂量。
(b) Continuing Rheumatic Fever, with marked damage to the heart, and with or without congestive failure, as long as there is no auricular fibrillation present.
(b) 持续性风湿热，伴有明显的心脏损伤，有或无充血性心力衰竭，只要没有心房颤动。

Herein the ideal treatment is still as in (a) above. However, there are many cases in which the damage from earlier attacks is so great that the full dosage cannot be given immediately without precipitating congestive failure. If the heart size is nearly normal and heart damage moderate or relatively slight, we try full dosages as in (a). If we can send the patient to hospital and have full laboratory and other such facilities for treatment, we give a trial of full dosage, since here we are able to detect adverse responses as soon as they occur. In the majority of cases, however, we must treat these patients cautiously, giving 90 I.U. per day for the first four weeks, 120 I.U. daily for the second four weeks, and 150 I.U. for the third four weeks. Usually 150 I.U. is the maximum safe level of dosage.
理想的治疗仍如上述(a)所述。然而，许多病例中，早期发作造成的损伤非常严重，无法立即给予全剂量，否则会引发充血性心力衰竭。如果心脏大小接近正常且心脏损伤中等或相对轻微，我们会尝试如(a)中所述的全剂量治疗。如果能将患者送往医院，并具备完整的实验室及其他治疗设施，我们会尝试全剂量治疗，因为这样可以在不良反应发生时立即发现。然而，在大多数情况下，我们必须谨慎治疗这些患者，前四周每天给予 90 国际单位，第二个四周每天 120 国际单位，第三个四周每天 150 国际单位。通常 150 国际单位是安全剂量的最大水平。
© Patients with beginning failure, after years of normal or comparatively normal health following recovery from an attack of acute rheumatic fever.
© 患有早期心力衰竭的患者，在经历急性风湿热发作康复后，经过多年正常或相对正常的健康状态。

This group is ideal to demonstrate the value of alpha
这个群体非常适合展示α的价值
tocopherol therapy. Compensation can be restored in most of them within a few weeks, and they seem to continue to improve steadily thereafter. It is in this group that diminution, and even the very occasional disappearance, of murmurs has been demonstrated by Dowd; even diminution of a moderate degree of cardiac enlargement can develop after two to three years of therapy. This is not too hard to understand if one thinks of the properties of alpha tocopherol, especially its effect on scar tissue - and mitral stenosis, of course, is a scar process involving the angles of the cups of the mitral valve.
生育酚疗法。大多数患者在几周内可以恢复代偿功能，之后似乎持续稳定改善。正是在这组患者中，Dowd 证明了心脏杂音的减弱，甚至极少数情况下杂音完全消失；经过两到三年的治疗，中度心脏肥大的减轻也可能出现。如果考虑到α-生育酚的特性，尤其是它对瘢痕组织的影响，这并不难理解——而二尖瓣狭窄当然是一种涉及二尖瓣瓣叶角的瘢痕过程。

Many of these patients are first seen early in pregnancy and in these compensation is more difficult to achieve, requiring usually a larger dosage of alpha tocopherol and longer treatment.
许多患者在怀孕早期首次就诊，此时补偿更难实现，通常需要更大剂量的α-生育酚和更长时间的治疗。

Such patients should be started very gradually on alpha tocopherol. It will be 12 to 15 weeks before they notice real improvement. Meanwhile, if they show early congestive failure, it can now be easily and successfully treated with the newer diuretics until the end of this period of three and one-half months, after which such adjuncts to treatment can usually be safely stopped. We start such patients on 90 I.U. a day for one month, then give 120 I.U. for one month and then 150 I.U. permanently. 150 I.U. is usually an effective dose, and there is no need to increase it. Indeed, it may be several years before the maximum safe dose in such cases ( 300 I.U. a day) can be reached. Any attempt to increase beyond 150 I.U. can precipitate fresh congestive failure or palpitation. Strangely enough, a patient living a normal life on 300 I.U. for years ( 10 to 15 ) can sometimes be precipitated into failure by a mere 75 I.U. more.
这样的患者应非常缓慢地开始服用α-生育酚。需要 12 到 15 周他们才能注意到真正的改善。与此同时，如果他们出现早期充血性心力衰竭，现在可以用较新的利尿剂轻松且成功地治疗，直到这三个月半的治疗期结束，之后通常可以安全地停止这些辅助治疗。我们让这样的患者每天服用 90 国际单位一个月，然后一个月服用 120 国际单位，之后永久服用 150 国际单位。150 国际单位通常是有效剂量，无需增加。实际上，可能需要几年时间才能达到此类病例的最大安全剂量（每天 300 国际单位）。任何试图超过 150 国际单位的增加都可能引发新的充血性心力衰竭或心悸。奇怪的是，一个正常生活、长期服用 300 国际单位（10 到 15 年）的患者，有时仅仅增加 75 国际单位就可能诱发心力衰竭。

A few cases require months to show satisfactory improvement, but persistence should turn virtually every case in this category into a satisfied patient.
少数病例需要数月时间才能显示出令人满意的改善，但坚持治疗几乎可以使该类别中的每个病例都成为满意的患者。
(d) Chronic Rheumatic Heart Disease. These end states show congestive failure, auricular fibrillation, and very little or no exercise tolerance.
(d) 慢性风湿性心脏病。这些终末状态表现为充血性心力衰竭、心房颤动，以及几乎没有或完全没有运动耐力。

These cases which are so very common illustrate the
这些非常常见的案例说明了
failure of all conventional methods of treatment in rheumatic heart disease. This stage of partial to complete invalidism lasts for five to ten years, and its effect upon the patient and his relatives is sad to watch.
风湿性心脏病中所有常规治疗方法的失败。这个从部分到完全丧失劳动能力的阶段持续五到十年，对患者及其亲属的影响令人痛心。

It is difficult to treat such cases even with alpha tocopherol, because it, of course, requires a miracle to make a heart so badly damaged function well enough to restore the patient even to a limited degree of normal living. A 50 per cent improvement in a patient confined to bed still leaves him an invalid. Yet we have had patients in this category who had spent six to 19 months in bed under classical therapy, who were able to resume full activity and to maintain normal living with increasing strength. This has occurred in as little as a month of tocopherol treatment. Apparently the factors determining the extent of improvement are many and complex, although many of these are obvious to anyone understanding the basic pathology and the pharmacological effect of alpha tocopherol. We could mention just one here - alpha tocopherol has been shown to reduce the oxygen requirement of heart muscle by a great deal.
即使使用α-生育酚治疗这类病例也很困难，因为要使一颗严重受损的心脏功能恢复到足以让患者恢复到有限正常生活水平，当然需要奇迹。即使患者卧床不起的状况改善了 50%，他仍然是个病残者。然而，我们确实有一些患者属于这一类，他们在传统治疗下卧床六个月到十九个月，后来能够恢复全部活动并保持正常生活，且体力逐渐增强。这种情况在仅仅一个月的生育酚治疗中就发生了。显然，决定改善程度的因素很多且复杂，尽管对于理解基本病理和α-生育酚药理作用的人来说，许多因素是显而易见的。这里我们只提一个——α-生育酚已被证明能大大减少心肌的氧气需求。

This type of case is still worth attempting to treat, since the results can be so valuable occasionally. Need we stress the fact that every aid in the pharmacopoeia must be used, especially at first, until the effect of alpha tocopherol has had a chance to show itself? Then gradually these older agents may be dispensed with, or used less often or in smaller dosage.
这种类型的病例仍然值得尝试治疗，因为结果有时可能非常宝贵。我们是否需要强调，必须使用药典中的每一种辅助药物，尤其是在初期，直到α-生育酚的效果显现出来？然后逐渐可以停止使用这些旧药，或减少使用频率或剂量。

The most important point in treating these patients is to bring the congestive failure under control as quickly as possible by the use of the right amount of digitalis and diuretics, given as often as is necessary to relieve the failure completely. At the same time alpha tocopherol is begun. If the patient is under close supervision he should be given 300 I.U. of alpha tocopherol daily from the begirning, provided the physician is sufficiently experienced in using alpha tocopherol to know when his patient is showing evidence of excessive dosage. Since alpha tocopherol will not show much effect for about ten days and since intensive treatment of the congestive failure should show a steady im-
治疗这些患者最重要的一点是通过使用适量的地高辛和利尿剂，尽可能快地控制充血性心力衰竭，必要时多次给药以完全缓解衰竭。同时开始使用α-生育酚。如果患者受到密切监护，从一开始每天应给予 300 国际单位的α-生育酚，前提是医生在使用α-生育酚方面有足够经验，能够判断患者是否出现过量用药的迹象。由于α-生育酚大约需要十天时间才会显现明显效果，而对充血性心力衰竭的强化治疗应显示出持续的改进—
provement by the first ten days of treatment, this overdosage is being reached if the patient begins to show signs of increasing failure at about the ten- to 14 -day period. If, however, the patient begins to improve more rapidly at this phase, full dosage is maintained thereafter until the fourth week, when the other accessory medications can often be reduced or stopped entirely. Some digitalis, usually much less than before treatment and much less than is necessary during the first two weeks, may be continued. That is a matter for professional experience and judgment.
在治疗的前十天内有所改善，如果患者在大约第十到第十四天期间开始出现心力衰竭加重的迹象，就达到了过量用药的程度。然而，如果患者在此阶段开始更快地改善，则此后维持全剂量，直到第四周，届时其他辅助药物通常可以减少或完全停止。某些地高辛，通常远少于治疗前和前两周所需的剂量，可以继续使用。这是专业经验和判断的问题。

If however, the patient is one of those who cannot tolerate so large an initial dose, then alpha tocopherol should be stopped for two full days and the slower schedule adopted - 90 I.U. for four weeks, 120 I.U. for four weeks, and then 150 I.U. a day therefter.
然而，如果患者属于无法耐受如此大初始剂量的类型，则应停止服用α-生育酚两整天，并采用较慢的方案——四周每天 90 国际单位，四周每天 120 国际单位，然后每天 150 国际单位。

Curiously, patients in this group often do best on 150 I.U. a day - even better, indeed, than on the large dosage. One must find out by trial. For example, one patient was told by a very competent cardiologist that she would never do another bit of work of any kind, but has done her own housework for the last four years, taking 150 I.U. a day and nothing else, except for two short periods - once when she became dyspneic on 180 I.U. a day and once when she reduced her dose to 120 I.U. a day - with the recurrence of complete failure. So narrow a dosage tolerance is fairly common in this type of patient. In no other type is it so necessary to tailor the dose to the individual patient’s requirement.
奇怪的是，这组患者通常在每天服用 150 国际单位时效果最好——实际上比大剂量时效果更好。必须通过试验来确定。例如，一位患者被一位非常有能力的心脏病专家告知她将永远无法再做任何工作，但她在过去四年里一直自己做家务，每天服用 150 国际单位，除此之外没有服用其他药物，只有两次例外——一次是在她每天服用 180 国际单位时出现呼吸困难，另一次是在她将剂量减少到每天 120 国际单位时，完全衰竭再次发生。因此，这类患者对剂量的耐受范围非常狭窄。在其他类型的患者中，没有哪种情况像这种患者一样需要根据个体需求量身定制剂量。

Most of our patients come from many miles away, and so we usually follow the slow dosage procedure. By the end of six weeks on any given dosage one can usually tell if it is the dose that will give the optimum results. Once improvement begins it will usually continue slowly for many months or years. While the improvement is so slow as to be very discouraging for three months or more on this slow schedule, it is really the most accurate way of arriving at the individual’s correct dosage.
我们的大多数患者都来自很远的地方，因此我们通常采用缓慢的剂量调整程序。在任何给定剂量下，经过六周后通常可以判断该剂量是否能带来最佳效果。一旦开始改善，通常会在接下来的数月或数年内缓慢持续。虽然在这种缓慢的方案下，三个月或更长时间的改善非常缓慢，令人沮丧，但这实际上是确定个体正确剂量的最准确方法。

When too large a dose is given in any type of heart disease, the patient often shows an unusually rapid and encouraging response and then becomes worse again. When
当在任何类型的心脏病中给予过大剂量时，患者常常表现出异常迅速且令人鼓舞的反应，然后又变得更糟。 当
this happens, it is evidence that the optimum dosage level was reached and then exceeded. Since alpha tocopherol is rapidly excreted, stop the dosage for three days - no more - and begin again at approximately the right level, or just less.
这种情况发生时，说明已经达到了最佳剂量水平并且超过了。由于α-生育酚会迅速排出体外，停药三天——不超过三天——然后以大约合适的剂量或稍低的剂量重新开始服用。

In tailoring the dose to the individual’s requirement, remember the general rule: a patient with a normal or low blood pressure and with no evidence of congestive failure can nearly, but not quite always, tolerate any quantity of alpha tocopherol. “It can do him no harm.” So give him enough to do the job. Like digitalis and insulin and thyroid extract, the right dose is the dose that begins to show definite improvement, in four to six weeks in this case. The maintenance dose is the same. However, in the presence of hypertension or congestive failure, in advanced rheumatic heart disease, or both, be careful. Probably you can kill the patient if you are overzealous.
在根据个体需求调整剂量时，请记住一般规则：血压正常或偏低且无充血性心力衰竭迹象的患者几乎总能耐受任何剂量的α-生育酚，“它不会对他造成伤害。”因此，给他足够的剂量以发挥作用。像地高辛、胰岛素和甲状腺提取物一样，正确的剂量是在四到六周内开始显示明显改善的剂量。维持剂量相同。然而，在高血压或充血性心力衰竭、晚期风湿性心脏病或两者兼有的情况下，要小心。过于积极可能会危及患者生命。

However, an exception to the presence of congestive failure, as a contraindication to high dosage of alpha tocopherol, is coronary heart disease following occlusion. In such a case we give full dosage, and the failure tends to clear up with the disappearance of myocardial anoxia. In rare cases where the patient is obviously dying of congestive failure in hypertensive heart disease the same applies. Tailor your dose to the patient’s needs. Maintaining full dosage in the postocclusive patient maintains better myocardial oxygenation.
然而，充血性心力衰竭作为高剂量α-生育酚禁忌症的例外情况是冠状动脉闭塞后的冠心病。在这种情况下，我们给予全剂量，随着心肌缺氧的消失，心力衰竭往往会好转。在罕见的病例中，患者明显因高血压性心脏病的充血性心力衰竭而濒临死亡时，同样适用。根据患者的需要调整剂量。在闭塞后患者中维持全剂量可保持更好的心肌供氧。

Unlike previous space voyages, the Apollo 11 Moon Walk Crew, Armstrong, Aldrin and Collins, were provided a food supply that had been substantially enriched with vitamin E.
与以往的太空航行不同，阿波罗 11 号登月队员阿姆斯特朗、奥尔德林和柯林斯所携带的食物供应中大幅增加了维生素 E 的含量。

Only preliminary medical information has been released at this writing, and that has appeared in newspapers; but it is noteworthy that there has been no mention at all of the “blood deconditioning process”-a euphemism for hemolytic anemia-that was reported after earlier space voyages of a duration of more than eight days, notably the BormanLovell Gemini 7 flight in December, 1965.
截至目前仅发布了初步的医学信息，这些信息已见于报纸；但值得注意的是，完全没有提及“血液退化过程”——这是溶血性贫血的委婉说法——这种情况曾在早期超过八天的太空飞行中报告过，特别是 1965 年 12 月的 Borman-Lovell 双子座 7 号飞行。

Actually, in view of the fact that spacecrafts up to now have carried pure oxygen atmospheres, it is strange that it should have taken so long to recognize the need for vitamin E. It was determined many years ago, at the very beginning of the U.S. program of manned space flights, that crews are better able to withstand the fantastic accelerations required to break free of the earth’s gravitational pull in an atmosphere of pure oxygen than in any other type of atmosphere. Yet it is no secret to any scientist that pure oxygen rapidly begins to demonstrate toxic effects. As early as 1935,
实际上，鉴于迄今为止航天器都携带纯氧环境，花这么长时间才认识到维生素 E 的必要性，实在令人奇怪。多年前，在美国载人航天计划刚开始时就确定，宇航员在纯氧环境中比在任何其他类型的环境中更能承受摆脱地球引力所需的巨大加速度。然而，对任何科学家来说，纯氧迅速表现出毒性效应并不是什么秘密。早在 1935 年，

Behnke, Johnson, Poppen, and Motley, writing in the American Journal of Physiology (110: 565, 1935) showed that pure oxygen is toxic and that as the atmospheric pressure increases, the toxicity of pure oxygen increases also. The hyperbaric administration of oxygen demonstrated toxic effects that quickly became well known; and by 1964 it was possible for a research team writing in Aerospace Medicine to assume that the toxic effect of pure oxygen was generally recognized by readers.
Behnke、Johnson、Poppen 和 Motley 在《American Journal of Physiology》（110: 565, 1935）中写道，纯氧具有毒性，且随着大气压力的增加，纯氧的毒性也随之增加。高压氧的使用显示出迅速为人所知的毒性效应；到 1964 年，撰写《Aerospace Medicine》的一个研究团队已经可以假设读者普遍认可纯氧的毒性效应。

This particular paper, titled “Oxygen Toxicity and Vitamin E,” was presented by the authors, Drs. Kann, Mengel, Smith, and Horton, at an Aerospace Medical Association meeting in May, 1964. Their paper should have received much wider attention than it did.
这篇题为《氧气毒性与维生素 E》的论文由 Kann 博士、Mengel 博士、Smith 博士和 Horton 博士于 1964 年 5 月在航空航天医学协会会议上发表。他们的论文本应获得比实际更多的关注。

At the time their study was performed, it had already been found that when space capsule environments were simulated, with high oxygen concentrations, the volunteers who were subjected to such environments tended to develop convulsions and hemolytic anemia. Kann, Mengel, Smith, and Horton speculated that the toxic effect might derive from the peroxidation of unsaturated fatty acids, a condition that is best prevented in a normal environment by the presence of enough vitamin E in the bloodstream.
在他们进行研究时，已经发现当模拟太空舱环境，高浓度氧气环境下，接受这种环境的志愿者倾向于出现抽搐和溶血性贫血。Kann、Mengel、Smith 和 Horton 推测这种毒性作用可能源自不饱和脂肪酸的过氧化，而在正常环境中，这种情况最好通过血液中足够的维生素 E 来预防。

It ought to be apparent that just as an abnormal supply of unsaturated fatty acids requires additional vitamin E to prevent their peroxidation, so an abnormally large supply of oxygen would set up the same requirement. Nevertheless such a conclusion is better demonstrated than theorized about, and the Duke University research team set about performing an objective study with mice. They were able to demonstrate that vitamin E-deficient mice in a hyperbaric oxygen unit did develop hemolytic anemia and convulsions, whereas those whose diets were supplemented with vitamin E did not.
应该很明显，正如不正常供应的不饱和脂肪酸需要额外的维生素 E 来防止其过氧化一样，异常大量的氧气供应也会产生同样的需求。然而，这样的结论更适合通过实验来证明，而不是仅仅理论推测，杜克大学的研究团队开始对小鼠进行客观研究。他们能够证明，维生素 E 缺乏的小鼠在高压氧舱中确实会发生溶血性贫血和抽搐，而那些饮食中补充了维生素 E 的小鼠则没有出现这些症状。

In conclusion the authors pointed out that their studies suggested that “certain manifestations of oxygen toxicity can be avoided in humans exposed to hyperoxia by pretreatment with vitamin E.”
总之，作者指出他们的研究表明，“通过维生素 E 的预处理，可以避免人类在暴露于高氧环境中出现某些氧毒性的表现。”

Thus vitamin E should not have been exactly unknown
因此维生素 E 本不应该完全是未知的
to those planning the diets of astronauts. A year after the report of the Duke University study, it was reviewed in Clinical Pharmacology and Therapeutics (6: 6, pages 777778 ) by Captain Carlos J. G. Perry of the U. S. Air Force Medical Corps. Captain Perry pointed out that, in addition to protection against peroxidation, vitamin E also has protective properties against extremes of temperature, hypoxia, and radiation exposure.
对于那些为宇航员制定饮食计划的人来说。在杜克大学研究报告发布一年后，美国空军医疗队的 Carlos J. G. Perry 上尉在《临床药理学与治疗学》（第 6 卷第 6 期，第 777-778 页）中对该研究进行了评述。Perry 上尉指出，除了防止过氧化作用外，维生素 E 还具有防护极端温度、缺氧和辐射暴露的保护作用。

Yet in December of that same year, 1965, when Gemini 7 took off, the diet of the astronauts was supplemented with one gram of calcium a day to help counteract bone demineralization, but there was no vitamin E to protect them against the reductions in red cell mass and in blood plasma that had already been found after the Gemini 4 mission of McDivitt and White and the Gemini 5 mission of Cooper and Conrad.
然而就在同年 1965 年 12 月，当双子座 7 号发射时，宇航员的饮食中补充了一克钙，以帮助抵抗骨质流失，但并没有补充维生素 E 来保护他们免受红细胞量和血浆减少的影响，而这些减少已在麦克迪维特和怀特的双子座 4 号任务以及库珀和康拉德的双子座 5 号任务中被发现。

It should have been known that the problem was bound to recur. Studies at the U. S. Army Medical Research and Nutrition Laboratory in Denver, Colorado, have shown very well that under conditions of high stress, it is not necessary for the diet to be high in polyunsaturates for the level of free fatty acids in the bloodstream to rise. They are mobilized from the triglyceride pool of adipose tissue. Their peroxidation in a pure oxygen atmosphere represented an obvious hazard, the answer to which was known but apparently ignored until 1969.
本应知道这个问题必然会再次出现。美国科罗拉多州丹佛市美国陆军医学研究与营养实验室的研究清楚地表明，在高压环境下，饮食中不必含有大量多不饱和脂肪酸，血液中游离脂肪酸的水平也会升高。它们是从脂肪组织的三酰甘油库中动员出来的。在纯氧环境中它们的过氧化作用显然是一种危险，这一问题的解决方案早已为人所知，但显然直到 1969 年才被重视。

According to stories that appeared in the Toronto newspapers, the crew that circled the moon at Christmas 1968, again commanded by Colonel Borman, returned to earth showing a loss of between 20 and 30 per cent of their red blood cell mass. And so it was finally decided in preparing for the moon walk flight of Armstrong, Aldrin, and Collins, to supplement their diets with vitamin E as well as with calcium. In fact, they were given a full range of vitamins, since it was theorized that the dehydrated diet given them to save weight might be responsible for multiple vitamin deficiencies. In fact, the stripping of vitamin E from the diet during food processing is so universal that nearly everyone suffers from a vitamin E deficiency regardless of whether or
根据多伦多报纸上出现的报道，1968 年圣诞节绕月飞行的机组人员，由 Borman 上校再次指挥，返回地球时红细胞质量减少了 20%到 30%。因此，在为阿姆斯特朗、奥尔德林和柯林斯的登月飞行做准备时，最终决定在他们的饮食中补充维生素 E 和钙。实际上，他们被给予了全套维生素，因为有人推测，为了减轻重量而给他们提供的脱水饮食可能导致多种维生素缺乏。事实上，在食品加工过程中维生素 E 的流失是如此普遍，以至于几乎每个人都患有维生素 E 缺乏症，无论是否
not his food is dehydrated. If not, I have shown in the introductory chapter, there would probably be no coronary thrombosis.
他的食物不是脱水的。如果不是这样，我在引言章节中已经表明，可能就不会有冠状动脉血栓形成。

In any case, we can probably be sure that the astronauts of the future will be well supplied with vitamin E on their voyages, and as a result, not only will they be spared thes hemolytic anemia that has afflicted earlier crews, but they, will also avoid the general weakening of the cardiovascular : system that has been such a puzzle to the Aeronautics and 1 Space Administration doctors.
无论如何，我们大概可以确定，未来的宇航员在航行中将会得到充足的维生素 E 供应，因此，他们不仅能够避免早期宇航员所患的溶血性贫血，还能避免困扰航空航天局医生的心血管系统普遍衰弱问题。

whole concept underlying this work derived from the many pathological conditions that accompany hyperestrogenism and their correction by reducing the estrogen level to normal. At first, it was menorrhagia and dysmenorrhea that were successfully treated by my father and older brother and later by myself and younger brother. Then it was found that the alpha fraction of vitamin E could control the antiproteolytic factor found in the serum of aborting women and that it could prevent abruptia placentae, this between the years 1935 and 1937.
这项工作的整个概念源自伴随高雌激素血症的多种病理状况及通过将雌激素水平降低至正常来纠正这些状况。起初，是由我的父亲和哥哥成功治疗了月经过多和痛经，后来由我和弟弟继续治疗。随后发现，维生素 E 的α组分能够控制流产妇女血清中的抗蛋白酶因子，并且能够预防胎盘早剥，这一发现发生在 1935 年至 1937 年间。

Gradually, it became apparent that there were at least four estrogen antagonists, namely progesterone, thyroid extract, alpha tocopherol, and testosterone and that these could be used singly or in combination. The result was a simple and effective method of treating the many conditions associated with the overproduction of estrogen by the body.
渐渐地，人们发现至少有四种雌激素拮抗剂，分别是孕酮、甲状腺提取物、α-生育酚和睾酮，这些可以单独使用或组合使用。其结果是一种简单而有效的方法，用于治疗与体内雌激素过度产生相关的多种疾病。

Most of these concepts have now been accepted. Paul Starr (116) for example, states without the need for reference that “in women during the reproductive years, hypothyroidism should be considered in any case of amenorrhea, infertility, habitual abortion, menorrhagia, or other menstrual disorders. It must be remembered that some of these cases are characterized by hyperestrogenism. . . .” No references are really necessary since most of the information was published between 1935 and 1942 over Dr. Evan Shute’s name.
这些观点大多现已被接受。例如，Paul Starr（116）无需引用便指出，“在育龄期女性中，任何闭经、不孕、习惯性流产、月经过多或其他月经紊乱的病例都应考虑甲状腺功能减退。必须记住，这些病例中有些表现为雌激素过多……”实际上不需要引用文献，因为大部分信息都是在 1935 年至 1942 年间以 Evan Shute 博士的名义发表的。

Since menorrhagia and dysmenorrhea respond so well to thyroid extract, that is if there is no other cause, such
由于月经过多和痛经对甲状腺提取物反应良好，前提是没有其他原因，诸如
as fibroids or polyps or pelvic inflammatory disease, it follows that such patients must be hypothyroid. However, there really has been no accurate measure of low thyroid activity available until the advent of the Protein Bound Iodine and Iodine Uptake Tests. When these tests did become available, random samplings of the American population, especially one in the Chicago area, confirmed our long-standing and often-stated impression that there was a great deal of subclinical hypothyroidism. The Chicago study produced the figure of 55 per cent of females and 45 per cent of males in this category.
如子宫肌瘤、息肉或盆腔炎症性疾病，推断这些患者必定患有甲状腺功能减退症。然而，直到蛋白结合碘和碘摄取测试出现之前，实际上并没有准确的低甲状腺功能测量方法。当这些测试变得可用时，对美国人口的随机抽样调查，特别是在芝加哥地区的一项调查，证实了我们长期以来并多次声明的印象，即存在大量亚临床甲状腺功能减退症。芝加哥的研究数据显示，55%的女性和 45%的男性属于这一类别。

Before the days of the P.B.I. and the Iodine Uptake Test we relied entirely on a careful history and the physical examination of the patient. We long ago abandoned the Basal Metabolic Rate Test as inaccurate and misleading, in fact, useless. In this view, we have not been alone. Hamolsky and Freedberg (115) point out that the B.M.R. has been largely abandoned in many clinics and is being replaced by a therapeutic trial.
在 P.B.I.和碘摄取测试出现之前，我们完全依赖于对患者的详细病史和体格检查。我们早已放弃了基础代谢率测试，因为它不准确且具有误导性，实际上是无用的。在这一观点上，我们并不孤单。Hamolsky 和 Freedberg（115）指出，基础代谢率测试在许多诊所已被广泛放弃，取而代之的是治疗试验。

The patient with subacute hypothyroidism will have some but not necessarily all of the following symptoms: dry hair; dry skin, which if dry enough will often crack around the ends of the fingers or around the nails in winter; a tendency to gain weight easily, to have cold feet in bed (a very typical symptom), and to have one other symptom hard to describe in a few words. Many subclinical hypothyroids are slow starters, find it hard to get going in the morning, are usually doing at 11 o’clock what they ought to have done by nine o’clock and doing at four p.m. what they ought to have done by two p.m. However, as the day goes on they become more efficient, and by nine o’clock at night have “caught up” and are now full of life and ambition. They may be hard to get to bed at night and just as hard to get up in the morning. A woman who regularly irons at nine o’clock at night and sings as she irons, is a hypothyroid.
亚急性甲状腺功能减退症患者会有以下一些但不一定全部的症状：头发干燥；皮肤干燥，如果干燥到一定程度，冬天手指末端或指甲周围常会开裂；容易体重增加，睡觉时脚冷（这是一个非常典型的症状），以及另一个难以用几句话描述的症状。许多亚临床甲状腺功能减退患者起步较慢，早晨难以启动，通常上午 11 点才做本应 9 点完成的事情，下午 4 点才做本应 2 点完成的事情。然而，随着一天的进行，他们变得更有效率，到晚上 9 点时已经“赶上进度”，充满活力和雄心。他们晚上可能很难入睡，早晨也很难起床。一个晚上九点定期熨衣服并边熨边唱歌的女性，就是甲状腺功能减退患者。

This symptom has nothing to do with intelligence or ambition. In fact, an overly energetic, highly educated young woman who became my patient was far from fat, served on several Y.W.C.A. boards, was engaged in several
这种症状与智力或抱负无关。事实上，一位过于精力充沛、受过高等教育的年轻女性成为了我的病人，她远非肥胖，曾在多个 Y.W.C.A.董事会任职，参与了多个项目。
civic activities, played badminton and bridge, and was obviously a typical hyperthyroid until her history was taken in detail, when she became just as obviously a hypothyroid.
参加社区活动，打羽毛球和桥牌，显然是典型的甲状腺功能亢进症患者，直到详细了解她的病史后，她显然变成了甲状腺功能减退症患者。

If the patient is a woman in her reproductive years, the diagnosis is much easier. She may have the typical symptoms associated with her menstrual cycle, the symptoms of overproduction of estrogen, namely, premenstrually sore, tender, and swollen breasts with a gain of weight due to water retention, irritability, and a heavy sensation in her abdomen. Her periods will usually be heavy, with clots, accompanied by dysmenorrhea and unduly prolonged. She may have pelvic pain at the time of ovulation.
如果患者是处于生育期的女性，诊断会容易得多。她可能会有与月经周期相关的典型症状，即雌激素过度分泌的症状，具体表现为经前乳房疼痛、压痛和肿胀，因水肿而体重增加，易怒，以及腹部沉重感。她的月经通常量多，伴有血块，伴随痛经且时间异常延长。排卵时她可能会有盆腔疼痛。

On examination, she may obviously have the typical dry hair and skin, a poor outer third of the eyebrows, sideburns, beard, and mustache, and quite frequently hairs around the areola or between her breasts. Occasionally there will be a typical masculine distribution of pelvic hair with hair growing upwards to or toward the umbilicus. She is apt to have hairý legs.
检查时，她可能明显表现出典型的干燥头发和皮肤，眉毛外三分之一稀疏，鬓角、胡须和小胡子稀少，而且相当频繁地在乳晕周围或两乳之间有毛发。有时会出现典型的男性骨盆毛发生长分布，毛发向上生长至或朝向肚脐。她的腿毛往往较多。

These signs and symptoms are much more dependable than most tests. They make the diagnosis fairly certain, although a slow pulse is a necessary accompaniment, and in some forms of heart disease the pulse may not be slow until the heart condition comes under control.
这些体征和症状比大多数检测更可靠。它们使诊断相当确定，尽管缓慢的脉搏是必要的伴随症状，在某些类型的心脏病中，脉搏可能直到心脏状况得到控制后才变慢。

It has become very obvious that the majority of cardiac and peripheral vascular disease patients that I see daily, are frankly hypothyroid and this condition must be corrected if possible, if complete treatment is to be attained.
我每天见到的大多数心脏和周围血管疾病患者显然都是甲状腺功能减退，如果要实现彻底治疗，这种情况必须尽可能得到纠正。

Support for all this appeared unexpectedly and vividly when I came upon the feature article in World Wide $Ab$$Ab$AbA b stracts of General Medicine, (Vol. 5, no. 9, October, 1962) entitled “Subclinical Hypothyroidism - to treat or not to treat?” by Paul Starr (116). In it he states . . . "Chronic hypothyroidism results in the following disorders:
对所有这些的支持出人意料且生动地出现在我偶然看到的《World Wide $Ab$$Ab$AbA b stracts of General Medicine》（第 5 卷，第 9 期，1962 年 10 月）中的专题文章“亚临床甲状腺功能减退症——治疗还是不治疗？”作者 Paul Starr（116）中。文中他指出……“慢性甲状腺功能减退导致以下疾病：
"1. Arteriosclerosis - especially of the brain.
1. 动脉硬化——尤其是大脑的动脉硬化。
"2. Myocarditis - sufficient to produce heart failure.
2. 心肌炎——足以导致心力衰竭。
"3. Slow mentation, delayed comprehension, poor memory, loss of initiative.
3. 思维迟缓，理解延迟，记忆力差，缺乏主动性。
"4. Atherosclerosis of the coronary arteries, with resulting angina pectoris.
4. 冠状动脉动脉粥样硬化，导致心绞痛。
"5. Anemia, resembling either the primary or secondary form.
5. 贫血，类似于原发性或继发性形式。
"6. Somatic muscle weakness, leading to orthopedic disability.
6. 体肌无力，导致骨科残疾。
"7. Anorexia and constipation, even to the point of obstruction.
7. 厌食和便秘，甚至达到梗阻的程度。
"8. Fibrositis, with body-wide pains resembling gout.
8. 纤维炎，伴有类似痛风的全身疼痛。
“9. Phlebothrombosis, with resulting embolism.”
9. 静脉血栓形成，导致栓塞。
Subsequently, he emphasizes the point, that “the citizen being damaged by hypothyroidism does not know it.” In other words, it requires careful history taking and a knowledge of the physical signs and peculiar symptomatology to establish the diagnosis.
随后，他强调了这样一个观点：“患有甲状腺功能减退症的公民并不知道自己有病。”换句话说，确诊需要仔细询问病史以及了解体征和特殊症状。

The patient correctly treated may well feel like a normal human being for the first time in his or her life, and the effect on the family that comes with the discovery of a different and more happy and efficient housewife is also a joy and a wonder.
经过正确治疗的患者可能会第一次感受到像正常人一样的生活，而随着发现一个不同的、更快乐、更高效的家庭主妇，家庭也会因此感到喜悦和惊奇。

One can always safely give the patient a clinical trial, starting at a safe level of crude or not too refined thyroid product and increasing until the desired effect is achieved, remembering that one out of ten who need thyroid can’t take it, but that an overdosage is easy to detect and completely harmless as long as the drug is discontinued or reduced relatively promptly.
患者总是可以安全地进行临床试验，从安全剂量的粗制或不过于精制的甲状腺制品开始，逐渐增加直到达到预期效果，记住需要甲状腺药物的患者中有十分之一不能服用，但只要相对及时停止或减少用药，过量服用很容易被发现且完全无害。

The hypothyroid female produces too much estrogen. This can nearly always be controlled by thyroid medication. If not detected and controlled she may well in later life develop the cardiovascular and other damage enumerated by Paul Starr and then need the full treatment with alpha tocopherol and thyroid.
甲状腺功能减退的女性会产生过多的雌激素。这几乎总是可以通过甲状腺药物控制。如果未被发现和控制，她在晚年很可能会出现 Paul Starr 列举的心血管及其他损伤，届时需要用α-生育酚和甲状腺进行全面治疗。

tions in human medicine that we have treated successfully with alpha tocopherol, but in so few cases that it is not possible to state categorically what can be expected in a large series. For example, we have treated two cases of fragilitas ossium (a brittle condition of the bones), with conspicuous success, and have noted in the literature a report by Dr. Compere of Chicago, an orthopedic surgeon, on the successful treatment of a case of myositis ossificans, bony deposits and inflammation in muscle tissue.
我们在人体医学中用α-生育酚成功治疗过一些疾病，但案例太少，无法断言在大量病例中会有何种效果。例如，我们成功治疗了两例骨脆症（骨骼脆弱状况），并在文献中注意到芝加哥骨科医生 Compere 博士关于成功治疗一例肌肉骨化性肌炎（肌肉组织中的骨质沉积和炎症）的报告。

I have treated two graduate nurses, who, following radical mastoidectomies, had persistent drainage from the ears of 20 and 25 years’ duration, one with complete cure, the other with some help. We have treated with complete success several draining sinuses in osteomyelitis cases, one which was the result of a war wound. Unfortunately, the others were Workmen’s Compensation Board cases, and they were immediately removed from our care by the board, as soon as our participation was learned. These patients were subjected to emergency radical surgery.
我治疗过两名研究生护士，她们在接受根治性乳突切除术后，耳朵持续流脓分别长达 20 年和 25 年，其中一人完全治愈，另一人有所好转。我们成功治疗了几例骨髓炎引起的流脓窦道，其中一例是战争伤口所致。不幸的是，其他病例属于工人赔偿委员会的案件，一旦委员会得知我们参与治疗，便立即将患者从我们这里转走。这些患者被迫接受了紧急根治性手术。

Therefore, the treatment of many and various types of cases must remain happy horizons!
因此，治疗许多不同类型的病例必须保持美好的前景！

Some rare conditions, how many no one can say until alpha tocopherol treatment is tried, respond to alpha tocopherol and to nothing else. Such a condition is epidermolysis bullosa dystrophica, an especially unpleasant skin disease.
一些罕见的疾病，有多少人无法确定，直到尝试了α-生育酚治疗后才知道，只对α-生育酚有效，对其他治疗无效。其中一种疾病是营养不良性大疱性表皮松解症，这是一种特别令人不快的皮肤病。

The uses of alpha tocopherol in the obstetrical and
α-生育酚在产科中的用途及
gynecological fields is certainly well established and widely confirmed, but, of course, not within the scope of this book. Note please that all this is due to the investigation of and the published work of my brother, Dr. Evan Shute.
妇科领域的应用无疑已被广泛确立和证实，但当然不在本书的范围内。请注意，所有这些都是基于我兄弟 Evan Shute 博士的研究和已发表的工作。

Certainly our work has inspired a vast interest in the substance throughout the civilized world. Confirmations of the earliest work done are even now for the first time appearing in the medical literature.
当然，我们的工作激发了整个文明世界对这种物质的广泛兴趣。最早的研究成果的确认甚至现在才首次出现在医学文献中。

Then, too, it is a matter of personal satisfaction that we were responsible for the excellent physical health of the astronauts as explained by Dr. David Turner on Canadian television. He is a biochemistry research associate at the Hospital for Sick Children in Toronto, Canada, and a consultant to the United States Aeronautics and Space Administration for both the Gemini and Apollo programs. When the astronauts who circled the moon last Christmas eve were examined, it was found that they had lost between 20 and 30 per cent of their red blood cell mass and that this loss of hemoglobin caused severe fatigue. Because Dr. Turner was in London, Canada, when we reported our work on vitamin E, the thought occurred to him that a deficiency in this vitamin might explain the astronauts’ problem, and it proved to be so. This explanation and the solution were explored and published under N.A.S.A. sponsorship by Kann and associates in 1964, but apparently their work had been forgotten. So, once again, our work provided the solution to a most important problem, this time in space flight. Unfortunately, the astronauts and the members of their vast team will never know this, probably.
此外，我们对宇航员的出色身体健康负有责任，这一点由加拿大电视台的 David Turner 博士解释。他是加拿大多伦多儿童医院的生物化学研究员，也是美国国家航空航天局双子星和阿波罗计划的顾问。当去年圣诞前夜绕月飞行的宇航员接受检查时，发现他们的红细胞质量减少了 20%到 30%，这种血红蛋白的流失导致了严重的疲劳。由于 Turner 博士当时在加拿大伦敦，我们报告维生素 E 的研究成果时，他想到维生素 E 的缺乏可能解释宇航员的问题，事实证明确实如此。这个解释和解决方案由 Kann 及其同事在 1964 年在美国国家航空航天局的资助下进行了研究并发表，但显然他们的工作已被遗忘。因此，我们的工作再次为一个极其重要的问题提供了解决方案，这次是在太空飞行中。不幸的是，宇航员及其庞大团队的成员可能永远不会知道这一点。

A most interesting comment of Dr. Turner’s was his remark that the effect of vitamin E supplementation on the astronauts might lead to a breakthrough in the treatment of cardiac and other ailments!
特纳博士最有趣的评论是，他指出维生素 E 补充对宇航员的影响可能会在治疗心脏病及其他疾病方面带来突破！

The two previously mentioned cases of chronic suppuration and drainage continuing for years following mastoidectomy are interesting for two reasons. They were both nurses in the same Ontario Provincial Hospital, both had the same very common name, and both had mastoidectomies done over 20 years previously. Although working in the same
前面提到的两例慢性化脓和引流持续多年，发生在乳突切除术后的病例有两个原因值得关注。她们都是安大略省同一家省立医院的护士，名字都非常常见，且两人均在 20 多年前接受过乳突切除术。虽然在同一单位工作
hospital, they had never met; but the results achieved with treatment of the first case filtered through the hospital grapevine to the second one. Results with the first case, using alpha tocopherol by mouth, 600 units a day, was a complete disappearance of all discharge within four weeks, and it did not recur when there were subsequent head colds. The second case reported a diminution but not a disappearance of discharge, and it did not increase with subsequent head colds.
他们在医院里从未见过面；但第一个病例的治疗结果通过医院的传闻传到了第二个病例。第一个病例使用口服α-生育酚，每天 600 单位，四周内所有分泌物完全消失，且在随后的感冒中未复发。第二个病例报告分泌物减少但未消失，且在随后的感冒中未增加。

Theoretically, the reason for the continuing discharge in both parties was incomplete removal of infected bone cells and subsequent inadequate drainage. The first case may well have had adequate drainage; and with the increased blood supply in the bone cells immediately below the infected ones, they were able to slough off the diseased cells, just as happens routinely in our peripheral gangrenes. The second case may have differed in several ways, with more and deeper involvement of mastoid cells in the infective process, or may have had inadequate drainage and so have kept the cavity bathed in pus. Or, of course, this patient’s lack of a more complete response to therapy could be due to an insufficient decrease in oxygen need.
理论上，双方持续分泌的原因是感染的骨细胞未被完全清除，随后引流不足。第一个病例可能有足够的引流；由于感染骨细胞下方的骨细胞血液供应增加，它们能够脱落病变细胞，就像我们外周坏疽中常见的情况一样。第二个病例可能在多方面有所不同，感染过程中乳突细胞的受累更广泛更深，或者引流不足，导致腔体持续浸泡在脓液中。当然，该患者对治疗反应不完全也可能是由于氧气需求未能充分降低。
The case of epidermolysis bullosa dystrophica was reported in detail in the Canadian Medical Association Journal, 90: 1315-1316, June 6, 1964. Reference is made in this article to three individual cases treated by their dermatologists with similar improvement.
表皮松解性大疱症的病例详细报道于《加拿大医学会杂志》，第 90 卷，第 1315-1316 页，1964 年 6 月 6 日。文章中提到三个由皮肤科医生治疗并取得类似改善的个案。

This rare disease, in which the bones are unusually fragile but in which fractures heal rapidly, has no ascertained cause and there has been no effective treatment. In many cases the usual treatment for any fracture that develops cannot be applied because either the apparatus used or the force necessary to accomplish reduction may cause fresh breaks. After a number of years the result can be numerous fractures with good healing but with poor alignment and, therefore, multiple deformities.
这种罕见疾病中，骨骼异常脆弱，但骨折愈合迅速，尚无确定的病因，也没有有效的治疗方法。在许多情况下，常规的骨折治疗无法实施，因为所用的器械或施加的复位力量可能导致新的骨折。多年后，结果可能是多次骨折虽愈合良好，但排列不正，因而出现多重畸形。

It may be interesting to report here two cases in which there has been apparent relief of the condition. Neither showed any evidences of rickets or syphilis.
这里报告两个病例可能会很有趣，这两个病例的病情似乎得到了缓解。两者均无佝偻病或梅毒的迹象。

Case 1. A blonde, blue-eyed baby girl with perhaps faintly blue sclera. The patient was the third child and was delivered uneventfully at term after a normal pregnancy. Her birth weight was six lbs. three oz. When the baby was brought home from the hospital, the parents noted that she did not use the left lower extremity. Her mother thought exercise was needed and provided it. The femur broke in her hands. Then an X-ray revealed a healing fracture of the hip as well as the fresh fracture of the femur. A month later, while dressing the baby, the mother lifted the baby’s left hand and fractured the wrist. The following week the left tibia was fractured by trivial trauma.
病例 1。一名金发碧眼的女婴，可能巩膜略带淡蓝色。患者是第三个孩子，经过正常妊娠，足月顺利分娩。出生体重为六磅三盎司。婴儿从医院带回家时，父母注意到她不使用左下肢。母亲认为需要锻炼并进行了锻炼，结果股骨在她手中骨折。随后 X 光显示髋部有愈合中的骨折，同时股骨有新鲜骨折。一个月后，母亲给婴儿穿衣时抬起婴儿左手，导致手腕骨折。接下来一周，左胫骨因轻微外伤骨折。

When a month old the baby was given a series of injections of ACTH twice a week for six weeks, with no result, the two last fractures occurring during treatment. She has been treated from the age of four months with 200 I.U. of alpha tocopherol daily, as well as the usual amounts of calcium and vitamin D. There have been no fractures during the course of treatment, which is now of 11 months’ duration.
当婴儿一个月大时，每周两次注射 ACTH，持续六周，但无效果，最后两次骨折发生在治疗期间。从四个月大开始，她每天接受 200 国际单位的α-生育酚治疗，以及常规剂量的钙和维生素 D。在长达 11 个月的治疗过程中，没有发生骨折。

Since the institution of alpha tocopherol treatment, the child has learned to crawl and stand up. She has fallen from her high-chair and from a sofa without injury.
自从开始使用α-生育酚治疗后，孩子学会了爬行和站立。她从高脚椅和沙发上摔下来都没有受伤。

Case 2. The second patient was discovered quite by accident. Her father, a cardiac patient treated for several months at the Shute Institute, developed pain in the chest and was put to bed in his daughter’s bedroom. I called on him there and asked for a spoon to use as a tongue-depressor. I noticed they gave me a tongue-depressor from the dresser drawer, where they were kept together with every possible first aid item the daughter could require. My questions led to the information that this girl had been diagnosed as a case of fragilitas ossium and had learned to splint broken fingers and such minor fractures herself!
案例 2。第二位患者是偶然发现的。她的父亲是一名心脏病患者，在 Shute 研究所接受了几个月的治疗，后来胸部出现疼痛，被安置在女儿的卧室休息。我去看望他时，向他们要了一把勺子当作压舌板。我注意到他们给了我一把从梳妆柜抽屉里拿出的压舌板，那里还放着女儿可能需要的各种急救用品。我的提问得知，这个女孩被诊断为骨质脆弱症，并且已经学会了自己为断指和其他轻微骨折做夹板固定！

She is red-headed and aged 22. Her sclera are not bluish. She has been under alpha tocopherol treatment for over four months so far. However, in that time, she has twice fallen downstairs - once down a steel staircase in the university library and once at her home. She has had several other minor mishaps, which resulted in bruises and abrasions, but no fractures. She observes that these falls formerly would have led to fractures. Since preparing this report, she reports falling forward over the handle bars of a bicycle without fractures!
她是红发，22 岁。她的巩膜没有发蓝。到目前为止，她已经接受了超过四个月的α-生育酚治疗。然而，在这段时间里，她曾两次从楼梯上摔下——一次是在大学图书馆的钢制楼梯上，一次是在家里。她还有几次其他轻微的意外，导致瘀伤和擦伤，但没有骨折。她观察到，以前这些跌倒通常会导致骨折。自准备本报告以来，她报告说曾骑自行车时向前摔过车把，但没有骨折！

During the last five years she has had many fractures on small pretext. For example, she stumbled one time while going through a doorway; put her hand up to catch herself and broke two fingers. On another occasion, she put her foot in a stirrup to mount a horse and broke her ankle. In addition she has broken the bones of her left forearm and her nose after trivial trauma.
在过去的五年里，她因小小的意外多次骨折。例如，有一次她经过门口时绊倒，伸手支撑自己，结果弄断了两根手指。另一次，她把脚放进马镫准备上马时，摔断了脚踝。此外，她还因轻微外伤弄断了左前臂的骨头和鼻子。

Her treatment in our hands has consisted of 300 I.U. of alpha tocopherol daily, as well as calcium and vitamin D.
她在我们这里的治疗包括每天服用 300 国际单位的α-生育酚，以及钙和维生素 D。

We should point out that the mechanisms by which alpha tocopherol acts have been well-established by both animal and clinical investigation, and that it can be especially effective whenever there is a deficiency in tissue oxygenation or in blood supply. We theorized that alpha tocopherol could be tried in these two cases because it is a safe drug under these conditions; there is no other treatment; and theoretically there are tenuous reasons for associating it with calcium metabolism. It seems to have been effective.
我们应指出，α-生育酚的作用机制已通过动物和临床研究得到充分证实，并且在组织缺氧或血液供应不足时尤其有效。我们推测α-生育酚可以在这两种情况下尝试使用，因为在这些条件下它是一种安全的药物；没有其他治疗方法；理论上也有一些微弱的理由将其与钙代谢联系起来。它似乎确实有效。

An extension of the successful use of alpha tocopherol in treating kraurosis vulvae and leucoplakia vulvae with microscopically proven tissue rejuvenation reported by Dr. Evan Shute (117) led to its use in treating the one patient with leucoplakia of the vocal cords who ever applied to us for treatment.
埃文·舒特博士（117）报道了α-生育酚在治疗阴唇萎缩症和阴唇白斑症中成功应用并显微镜下证实组织再生的延伸，促使其被用于治疗唯一一位因声带白斑症来我处求治的患者。

This man, aged 47, was first seen on December 6, 1948 with involvement of both vocal cords. In June, 1947, a small nodule had been removed from the left cord, and the condition of leucoplakia was diagnosed at this time. Hoarseness recurred in November, 1947.
这名 47 岁的男子于 1948 年 12 月 6 日首次就诊，双侧声带均受累。1947 年 6 月，左侧声带切除过一个小结节，当时诊断为白斑病。声音嘶哑于 1947 年 11 月复发。

He was given 300 units of alpha tocopherol daily. He was due for a check-up on December 26, 1948 - three weeks after treatment began - and he was instructed to say nothing about the vitamin E treatment. This was important in his case since the otolaryngologist who was caring for him was attached to a major Detroit hospital, and his unbiased opinion was, therefore, very valuable.
他每天服用 300 单位的α-生育酚。1948 年 12 月 26 日——治疗开始后三周——他需要进行一次检查，并被指示不要提及维生素 E 治疗。这在他的情况下非常重要，因为为他治疗的耳鼻喉科医生隶属于底特律一家大型医院，因此他的公正意见非常宝贵。

As reported by the patient, the doctor said that “he had never seen such improvement.” The same doctor made the same comment a month later and told the patient he need not report again for six months.
据患者报告，医生说“他从未见过如此的改善。”同一位医生一个月后也作了同样的评论，并告诉患者六个月内无需再来复诊。

In June, 1949, the vocal cords were declared normal, and it was said that no one would suspect the diagnosis who had not seen the original condition.
1949 年 6 月，声带被宣布为正常，据说没有见过最初状况的人是不会怀疑这个诊断的。

Again, perhaps it was too small a series from which conclusions might be drawn, but at least this is one more hopeful horizon.
或许这次的样本量太小，无法得出结论，但至少这是又一个充满希望的前景。

have been asked many times what I really want from it. I hope it will be the means of making available to all sufferers from heart disease the help they deserve - a proven, successful treatment, so superior to any presently available that it makes the knowledgeable wonder whatever is the matter with organized medicine.
我多次被问到我真正想从中得到什么。我希望它能成为让所有心脏病患者获得他们应得帮助的手段——一种经过验证、成功的治疗方法，远远优于目前任何可用的治疗，以至于让有见识的人不禁怀疑现代医学到底出了什么问题。

By now, most cardiologists must know they have nothing to offer but diagnosis and vague theories of the causation of a plague which threatens to engulf us as no plague or world war has ever been able to do. Many of these must know that there is a proven answer to the problem of clots. Certainly all surgeons must know of Dr. Alton Ochsner’s work. How can it possibly be ignored much longer?
到现在为止，大多数心脏病专家一定知道，他们除了诊断和对一种威胁我们、前所未有的瘟疫成因的模糊理论外，别无他法。他们中许多人一定知道，血栓问题有一个经过验证的解决方案。所有外科医生肯定都知道 Alton Ochsner 博士的工作。这样的事实还能被忽视多久呢？

I hope the screams of the many victims of burns may be stilled and that they will avoid long and painful surgical treatments and grafts, that they will not end up with hideous scars and contraction deformities.
我希望许多烧伤受害者的尖叫声能够平息，他们能够避免漫长而痛苦的外科手术和移植，不会留下可怕的疤痕和挛缩畸形。

I hope that many gangrenous legs of diabetics may be saved, just as we have been saving them for years when no one else could.
我希望许多糖尿病患者的坏疽腿能够被挽救，就像多年来我们在别人无能为力时所做的那样。

I hope that many more men with poor blood supply to their legs may step out briskly again.
我希望更多血液供应不足的腿部患者能够再次轻快地迈步。

I do think that what is good enough for the astronauts is good enough for the American citizen, whose taxes pay for their training, and the many thousands of workmen and scientists who are involved in each flight. If they can get vitamin E, why can’t everyone?
我确实认为，适合宇航员的东西也同样适合美国公民，他们的税款支付了宇航员的训练费用，以及参与每次飞行的成千上万的工人和科学家。如果他们能获得维生素 E，为什么每个人不能呢？

I hope that somehow the publicity-seeking heart trans-
我希望某种方式上那些寻求宣传的心脏移植者——
plant surgeons may cease to be heroes, since any medical man with such a record of failures would be read out of the profession.
植物外科医生可能不再是英雄，因为任何一位有如此多失败记录的医生都会被逐出行业。

Certainly many hundreds of patients with just as serious heart damage as most of the transplant victims have had years of comfortable life after receiving adequate treatment with alpha tocopherol, especially now that adequate diuretics are available.
当然，许多心脏损伤与大多数移植患者同样严重的患者，在接受足量的α-生育酚治疗后，尤其是在现有足够利尿剂的情况下，已经度过了多年的舒适生活。

I have lived long enough to see new medical discoveries change the whole course of serious disease. Insulin was discovered in Canada while I was an undergraduate, and it has meant years of health and life to millions.
我活得足够长，见证了新的医学发现改变了严重疾病的整个进程。胰岛素是在我还是本科生时在加拿大被发现的，它为数百万人带来了多年的健康和生命。

While I was an interne in internal medicine in Chicago, a Dr. Robertson was brought all the way from the famous medical school in Peking, China, to work at the University of Chicago doing research in lobar pneumonia, in which he had already done some distinguished research work. As an interne, I took numerous nasal swabs, cultured sputum, and took material directly from the lungs, if necessary, to type the pneumococcus responsible for that particular patient’s pneumonia. The patient was on a special bed with the mattress cut away behind his chest so that X-rays could be taken without disturbing him. In spite of some serum for specific strains, the mortality approximated 33 per cent, and the ones who survived often suffered with purulent pleural effusions and other complications. All were gravely ill for ten to 16 days. I had lost a beloved uncle and very nearly lost both my brothers with this disease. Then, along came the sulfonamides and the antibiotics. Lobar pneumonia and many acute and frequently fatal infections are now treated successfully and casually with a few pills and “call me if you’re not better in a couple of days.”
当我在芝加哥做内科住院医生时，一位罗伯逊医生从中国著名的北京医学院远道而来，在芝加哥大学从事肺叶炎的研究，他在这方面已经做出了一些杰出的研究工作。作为住院医生，我采集了大量的鼻拭子、培养痰液，并在必要时直接从肺部取材，以确定引起该患者肺炎的肺炎球菌类型。患者躺在一张特殊的床上，床垫在胸部后方被切开，以便在不打扰患者的情况下拍摄 X 光片。尽管使用了针对特定菌株的血清，死亡率仍接近 33%，幸存者常常伴有化脓性胸膜积液和其他并发症。所有患者都严重病倒，病程持续十到十六天。我曾失去一位深爱的叔叔，几乎也失去了我的两个兄弟。随后，磺胺药和抗生素出现了。肺叶炎以及许多急性且常致命的感染现在可以通过几片药丸成功且轻松地治疗，并且医生会说“如果几天内没有好转，给我打电话。”

My father knew typhoid fever epidemic in spring and fall and saw many cases of diphtheria. I have made the diagnosis of typhoid fever once and have seen no cases of diphtheria.
我父亲知道春秋两季的伤寒疫情，并见过许多白喉病例。我曾诊断出一次伤寒，但未见过白喉病例。

My father saw few cases of coronary occlusion and few diabetics. I have seen thousands. There was no coronary thrombosis in 1900. There need be none in the year 1980. It’s up to yoú now.
我父亲见过的冠状动脉闭塞和糖尿病患者很少，而我见过成千上万。1900 年没有冠状动脉血栓形成，1980 年也不必有。现在取决于你了。

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Alpha tocopherol, 13-23  α-生育酚，13-23
Alpha tocopherol antagonists, 18, 191-194
α-生育酚拮抗剂，18，191-194
Alpha tocopherol dosage, 18, 175-185
α-生育酚剂量，18，175-185
Alpha tocopherol ointment, 48, 139, 141, 165-169, 171-174
α-生育酚软膏，48，139，141，165-169，171-174
Angina pectoris, 20, 43-59, 177-178
心绞痛，20，43-59，177-178
Antihypertensive drugs, 35, 92-95
降压药，35，92-95
Antioxidant properties of alpha tocopherol, 21, 45
α-生育酚的抗氧化特性，21，45
Antithrombin properties of alpha tocopherol, 11, 13-14, 22, 26-27
α-生育酚的抗凝血酶特性，11，13-14，22，26-27
Arterial thrombosis, 133-135
动脉血栓形成，133-135
Arteriosclerosis, 108  动脉硬化，108
Atherosclerosis, 10, 51, 144
动脉粥样硬化，10，51，144
Bed rest, 19-20, 27-28, 32
卧床休息，19-20，27-28，32
Bibliography, 203-207  参考书目，203-207
Birth defects, 97-105  先天缺陷，97-105
Blood pressure (high), 11, 34-35, 91-95
血压（高），11，34-35，91-95
Blood vessel diseases, 107-115
血管疾病，107-115
Blue babies, 97-105  蓝色婴儿，97-105
Buerger’s Disease, 108-109
布尔格病，108-109
Burns, 23, 163-169
Cardiovascular treatments, 15-23
心血管治疗，15-23
Congenital heart disease, 97-105
先天性心脏病，97-105
Coronary Arterial Thrombosis, 133-135
冠状动脉血栓形成，133-135
Coronary heart disease, 51, 177-178
冠心病，51，177-178
Coronary occlusion, 25-49, 179-181
冠状动脉闭塞，25-49，179-181
Coronary thrombosis, 7-13, 24-42
冠状动脉血栓形成，7-13，24-42
Diabetes, 143-150  糖尿病，143-150
Diagnostic techniques, 87-90
诊断技术，87-90
Digitalis, 34  地高辛，34
Dosages of alpha tocopherol, 175-185
α-生育酚的剂量，175-185

Electrocardiogram, 87-90  心电图，87-90
Embolism, 133-135  栓塞，133-135
Estrogen, 18, 191  雌激素，18，191
Exercise, 110-111  锻炼，110-111
Fragilitas Ossium, 195, 197-200
骨脆症，195，197-200
Gangrene, 145-147  坏疽，145-147
Glomerulonephritis, 91, 144, 151-161
肾小球肾炎，91，144，151-161