Eclampsia in the Real Organism: A Paradigm of General Distress Applicable in Infants, Adults, Etc.
真实机体中的子痫:适用于婴儿、成人等的一般窘迫范式
by Raymond Peat
To prevent the appropriation and abuse of our language by academic and professional cliques, I like to recall my grandparents' speech. When my grandmother spoke of eclampsia, the word was still normal English, that reflected the Greek root meaning, “shining out,” referring to the visual effects that are often prodromal to seizures. The word was most often used in relation to pregnancy, but it could also be applied to similar seizures in young children. The word is the sort that might have been coined by a person who had experienced the condition, but the experience of seeing hallucinatory lights is seldom mentioned in the professional discussion of “eclampsia and preeclampsia.”
为了防止学术和职业派系挪用和滥用我们的语言，我喜欢回忆我祖父母的演讲。当我的祖母谈到子痫时，这个词仍然是正常的英语，它反映了希腊语词根的意思，“闪闪发光”，指的是通常是癫痫前兆的视觉效果。这个词最常用于怀孕，但它也可以用于年幼儿童的类似癫痫。这个词可能是由经历过这种情况的人创造出来的，但在“子痫和子痫前期”的专业讨论中，看到幻觉光的经历很少被提及。
Metaphoric thinking–using comparisons, models, or examples–is our natural way of gaining new understanding. Ordinary language, and culture, grow when insightful comparisons are generally adopted, extending the meaning of old categories. Although the free growth of insight and understanding might be the basic law of language and culture, we have no institutions that are amenable to that principle of free development of understanding. Institutions devoted to power and control are naturally hostile to the free development of ideas.
隐喻思维——使用比较、模型或例子——是我们获得新理解的自然方式。普通的语言和文化在普遍采用有见地的比较时成长，延伸了旧范畴的意义。尽管洞察力和理解力的自由发展可能是语言和文化的基本法则，但我们没有任何机构能够遵守这一自由发展理解力的原则。致力于权力和控制的机构自然不利于思想的自由发展。
Among physicians, toxemia (meaning poisons in the blood) has been used synonymously with preeclampsia, to refer to the syndrome in pregnant women of high blood pressure, albumin in the urine, and edema, sometimes ending in convulsions. Eclampsia is reserved for the convulsions themselves, and is restricted to the convulsions which follow preeclampsia, when there is “no other reason” for the seizure such as “epilepsy” or cerebral hemorrhage. Sometimes it is momentarily convenient to use medical terms, but we should never forget the quantity of outrageous ignorance that is attached to so many technical words when they suggest the identity of unlike things, and when they partition and isolate things which have meaning only as part of a process. Misleading terminology has certainly played an important role in retarding the understanding of the problems of pregnancy.
在医生中，毒血症(意思是血液中的毒素)与子痫前期是同义词，指的是孕妇的高血压、尿白蛋白和水肿综合征，有时以抽搐告终。子痫只出现在惊厥本身，并且仅限于子痫前期之后的惊厥，当时的发作“没有其他原因”，如“癫痫”或脑出血。有时是瞬间方便使用医学术语,但我们永远不会忘记的无知的数量应该是附加到很多技术词汇时显示不同的身份的东西,当他们分区和隔离的东西有意义只作为一个过程的一部分。误导的术语无疑在阻碍人们对怀孕问题的理解方面发挥了重要作用。
In 1974, when I decided to write Nutrition for Women, I was motivated by the awful treatment I saw women receiving, especially during pregnancy, from physicians and dietitians. Despite the research of people like the Shutes and the Biskinds, there were still “educated” and influential people who said that the mother's diet had no influence on the baby. (That strange attitude affects many aspects of behavior and opinion.)
1974年，当我决定写《女性营养》这本书的时候，我看到一些女性，尤其是在怀孕期间，从医生和营养师那里接受了可怕的治疗，这激励了我。尽管对舒特和比斯金德这样的人进行了研究，但仍有一些“受过教育的”和有影响力的人说，母亲的饮食对婴儿没有影响。(这种奇怪的态度影响着行为和观点的许多方面。)
How can people believe that the mother's diet has no effect on the baby's health? Textbooks used to talk about the “insulated” fetus, which would get sufficient nutrients from the mother's body even if she were starving. To “prove” the doctrine, it was pointed out that the fetus gets enough iron to make blood even when the mother is anemic. In the last few years, the recognition that smoking, drinking, and using other drugs can harm the baby has helped to break down the doctrine of “insulation,” but there is still not a medical culture in which the effects of diet on the physiology of pregnancy are appreciated. This is because of a mistaken idea about the nature of the organism and its development. “Genes make the organism,” according to this doctrine, and if there are congenital defects in the baby, the genes are responsible. A simple sort of causality flows from the genes to the finished organism, according to that idea. It was taught that if “the genes” are really bad, the defective baby can make the mother sick, and she contributed to the baby's bad genes.
人们怎么能相信母亲的饮食对婴儿的健康没有影响呢?过去，教科书中提到了“绝缘”胎儿，即使她饿了，胎儿也能从母亲的身体中获得足够的营养。为了“证明”这一学说，有人指出，即使母亲贫血，胎儿也能获得足够的铁来制造血液。在过去的几年里，人们认识到吸烟、饮酒和使用其他药物会伤害婴儿，这有助于打破“隔离”的学说，但在医学文化中，饮食对怀孕生理的影响仍然没有得到重视。这是由于对有机体的本质及其发展的错误认识。根据这一学说，“基因造就有机体”，如果婴儿有先天缺陷，是基因造成的。根据这种观点，基因和最终的有机体之间存在一种简单的因果关系。人们认为，如果“基因”真的不好，有缺陷的婴儿会让母亲生病，而母亲是导致婴儿基因不好的原因之一。
The idea isn't completely illogical, but it isn't based on reality, and it is demonstrably false. (Race, age and parity have no effect on incidence of cerebral palsy; low birth weight and complications of pregnancy are associated with it: J. F. Eastman, “Obstetrical background of 753 cases of cerebral palsy,” Obstet. Gynecol. Surv. 17, 459-497, 1962.)
这个想法并非完全不合逻辑，但它不是基于现实，而且显然是错误的。(种族、年龄和胎次对脑瘫的发生率没有影响;低出生体重和妊娠并发症与之相关:J. F. Eastman，“753例脑瘫的产科背景”，Obstet。Gynecol。1962年）
Although Sigmund Freud sensibly argued in 1897 that it was more reasonable to think that an infant's cerebral palsy was caused by the same factors that caused the mother's sickness, than to think that the baby's cerebral palsy caused maternal sickness and premature labor, more than 50 years later people were still taking seriously the idea that cerebral palsy might cause maternal complications and prematurity. (A.M. Lilienfield and E. Parkhurst, “A study of the association of factors of pregnancy and parturition with the development of cerebral palsy,” Am. J. Hyg. 53, 262-282, 1951.)
尽管西格蒙德·弗洛伊德在1897年明智地提出，认为婴儿的脑瘫是由导致母亲疾病的相同因素引起的，比认为婴儿的脑瘫是导致母亲疾病和早产的原因更合理，50多年后，人们仍然严肃地认为，脑瘫可能导致孕产妇并发症和早产。(A.M. Lilienfield和E. Parkhurst，“怀孕和分娩的因素与脑瘫发展的关系的研究，”Am。J. Hyg. 53, 262-282, 1951。)
Medical textbooks and articles still commonly list the conditions that are associated with eclampsia: Very young and very old mothers, a first pregnancy or a great number of previous pregnancies, diabetes, twins, obesity, excessive weight gain, and kidney disease. Some authors, observing the high incidence of eclampsia in the deep South, among Blacks and on American Indian reservations, have suggested that it is a genetic disease because it “runs in families.” If poverty and malnutrition are also seen to “run in families,” some of these authors have argued that the bad genes which cause birth defects also cause eclampsia and poverty. (L. C. Chesley, et al., “The familial factor in toxemia of pregnancy,” Obstet. Gynec. 32, 303-311, 1968, reported that women whose mothers suffered eclampsia during their gestation were likely to have eclampsia themselves. Some “researchers” have concluded that eclampsia is good, because many of the babies die, eliminating the “genes” for eclampsia and poverty.)* Any sensible farmer knows that pregnant animals must have good food if they are to successfully bear healthy young, but of course those farmers don't have a sophisticated knowledge of genetics.
医学教科书和文章仍然普遍列出与子痫相关的条件:非常年轻和非常年老的母亲，第一次怀孕或大量的以前怀孕，糖尿病，双胞胎，肥胖，体重过度增加，和肾脏疾病。一些作者观察到在美国南部的黑人和印第安人保留区子痫的高发病率，认为这是一种遗传性疾病，因为它“在家族中遗传”。如果贫困和营养不良也被视为“家族遗传”，一些作者认为，导致出生缺陷的不良基因也会导致子痫和贫困。(L. C. Chesley, et al，“妊娠毒血症的家族因素”，Obstet。1968年的Gynec. 32,303 -311报告说，母亲在妊娠期间患子痫的妇女本身也可能患子痫。一些“研究者”认为子痫是好的,因为很多的婴儿死亡,消除“基因”子痫和贫穷。)*任何明智的农民知道怀孕动物必须有良好的食物如果他们成功地承担健康年轻,当然那些农民没有复杂的遗传学知识。
The inclusion of obesity and “excessive weight gain” among the conditions associated with eclampsia has distracted most physicians from the fact that malnutrition is the basic cause of eclampsia. The pathologist who, knowing nothing about a woman's diet, writes in his autopsy report that the subject is “a well nourished” pregnant woman, reflects a medical culture which chooses to reduce “nutritional adequacy” to a matter of gross body weight. The attempt to restrict weight gain in pregnancy has expanded the problem of eclampsia beyond its association with poverty, into the more affluent classes.
将肥胖和“体重过度增加”列入与子痫相关的疾病中，使大多数医生忽视了营养不良是子痫的基本原因这一事实。病理学家对一名妇女的饮食一无所知，却在他的尸检报告中写道，该对象是一名“营养良好”的孕妇，这反映了一种选择将“营养充足性”降低到体重的医学文化。限制怀孕期间体重增加的尝试已经将子痫的问题从贫困扩大到更富裕的阶层。
Freud wasn't the first physician who grasped the idea that the baby's health depends on the mother's, and that her health depends on good nutrition. Between 1834 and 1843, John C. W. Lever, M.D., discovered that 9 out of 10 eclamptic women had protein in their urine. He described an eclamptic woman who bore a premature, low-weight baby, as having “…been living in a state of most abject penury for two or three months, subsisting for days on a single meal of bread and tea. Her face and body were covered with cachectic sores.” (“Cases of puerperal convulsions,” Guy's Hospital Reports, Volume 1, series 2, 495-517, 1843.) S. S. Rosenstein observed that eclampsia was preceded by changes in the serum (Traite Pratique des Maladies des Reins, Paris, 1874). L. A. A. Charpentier specifically documented low serum albumin as a cause of eclampsia (A Practical Treatise on Obstetrics, Volume 2,William Wood & Co., 1887). Robert Ross, M.D., documented the role of malnutrition as the cause of proteinuria and eclampsia (Southern Medical Journal 28, 120, 1935).
弗洛伊德并不是第一个明白婴儿的健康依赖于母亲，而母亲的健康依赖于良好的营养的医生。1834年至1843年间，医学博士约翰·c·w·利弗发现，90%的子痫妇女的尿液中含有蛋白质。他描述了一位患有子痫的妇女，她生下了一个早产、体重过轻的婴儿。在极度贫困的状态下生活了两三个月，几天来仅靠一顿面包和茶维持生计。她的脸上和身上都是恶病质的疮。”(《产褥期惊厥病例》，《盖伊医院报告》，第1卷，第2辑，495-517,1843年)罗森斯坦(S. S. Rosenstein)观察到，子痫是由血清的变化引起的(巴黎缰病特征性检验，巴黎，1874)。l.a.a Charpentier特别记录了低血清白蛋白作为子痫的原因(产科实用论文，第二卷，William Wood Co.， 1887)。Robert Ross，医学博士，记录了营养不良作为蛋白尿和子痫的原因(南方医学杂志28,120,1935)。
In outline, we can visualize a chain of causality beginning with a diet deficient in protein, impairing liver function, producing inability to store glycogen, to inactivate estrogen and insulin, and to activate thyroid. Low protein and high estrogen cause increased tendency of the blood to clot. High estrogen destroys the liver's ability to produce albumin (G. Belasco and G. Braverman, Control of Messenger RNA Stability, Academic Press, 1994). Low thyroid causes sodium to be lost. The loss of sodium albuminate causes tissue edema, while the blood volume is decreased. Decreased blood volume and hemoconcentration (red cells form a larger fraction of the blood) impair the circulation. Blood pressure increases. Blood sugar becomes unstable, cortisol rises, increasing the likelihood of premature labor. High estrogen, hypoglycemia, viscous blood, increased tendency of the blood to clot cause seizures. Women who die from eclampsia often have extensive intravascular clotting, and sometimes the brain and liver show evidence of earlier damage, probably from clots that have been cleared. (Sometimes prolonged clotting consumes fibrinogen, causing inability to clot, and a tendency to hemorrhage.) M. M. Singh, “Carbohydrate metabolism in pre-eclampsia,” Br. J. Obstet. Gynaecol. 83, 124-131. 1976. Sodium decrease, R. L. Searcy, Diagnostic Biochemistry, McGraw-Hill, 1969. Viscosity, L. C. Chesley, 'Hypertensive Disorders in Pregnancy, Appleton-Century-Crofts, 1978. Clotting, T. Chatterjee, et al., “Studies on plasma fibrinogen level in preeclampsia and eclampsia, Experientia 34, 562-3, 1978; D. M. Haynes, “Medical Complications During Pregnancy, McGraw-Hill Co. Blakiston Div., 1969. Progesterone decrease, G. V. Smith, et al., “Estrogen and progestin metabolism in pregnant women, with especial reference to pre-eclamptic toxemia and the effect of hormone administration,” Am. J. Obstet. Gynecol. 39, 405, 1940; R. L. Searcy, Diagnostic Biochemistry, McGraw-Hill, 1969.
粗略地说，我们可以想象一个因果关系链，从缺乏蛋白质的饮食开始，损害肝功能，导致无法储存糖原，使雌激素和胰岛素失活，并激活甲状腺。低蛋白和高雌激素会增加血液凝块的倾向。高雌激素破坏了肝脏产生白蛋白的能力(G. Belasco和G. Braverman，信使RNA稳定性的控制，学术出版社，1994)。甲状腺功能低下会导致钠流失。白蛋白钠的丢失导致组织水肿，同时血容量减少。血容量和血液浓度的降低(红细胞占血液的很大一部分)损害了循环。血压升高。血糖变得不稳定，皮质醇上升，增加早产的可能性。高雌激素，低血糖，粘稠的血液，血液凝结倾向增加会引起癫痫发作。死于子痫的妇女通常有广泛的血管内凝块，有时大脑和肝脏显示出早期损伤的证据，可能是由于已经清除的凝块。(有时长时间的凝血会消耗纤维蛋白原，导致无法凝血，并有出血的倾向。)子痫前期的碳水化合物代谢j .。。Gynaecol。83年,124 - 131。1976. 钠减少，R. L. Searcy，诊断生物化学，McGraw-Hill, 1969。《孕期高血压疾病》，Appleton-Century-Crofts出版社，1978年。凝血，T. Chatterjee等，“子痫前期和子痫患者血浆纤维蛋白原水平的研究，经验34,562-3,1978;D. M. Haynes，“怀孕期间的医疗并发症，麦格劳-希尔公司Blakiston分公司，1969。孕激素降低，G. V. Smith等，“孕妇雌激素和孕激素代谢，特别是子痫前期毒血症和激素给药的影响，”Am。j .。。妇科:39,405,1940;R. L. Searcy，诊断生物化学，McGraw-Hill, 1969。
But the simple chain of causality has many lines of feedback, exacerbating the problem, and the nutritional problem is usually worse than a simple protein deficiency. B vitamin deficiencies alone are enough to cause the liver's underactivity, and to cause estrogen dominance, and a simple vitamin A deficiency causes an inability to use protein efficiently or to make progesterone, and in itself mimics some of the effects of estrogen.
但简单的因果关系有许多反馈，加剧了问题，营养问题通常比简单的蛋白质缺乏更严重。B族维生素缺乏本身就足以导致肝脏活动不足，并导致雌激素占优势，而简单的维生素a缺乏会导致无法有效利用蛋白质或产生孕酮，本身就会产生雌激素的某些效果。
Anything that causes a thyroid deficiency will make the problem worse. Thyroid therapy alone has had spectacular success in treating and preventing eclampsia. (H. O. Nicholson, 1904, cited in Dieckman's Toxemias of Pregnancy, 1952; 1929, Barczi, of Budapest; Broda Barnes, who prescribed thyroid as needed, delivered more than 2,000 babies and never had a case of pre-eclampsia, though statistically 100 would have been expected.)
任何导致甲状腺功能不足的东西都会使问题变得更糟。甲状腺疗法在治疗和预防子痫方面取得了惊人的成功。(H. O. Nicholson, 1904年，在Dieckman 1952年的《妊娠毒血症》中被引用;1929年，布达佩斯的Barczi;布罗达·巴恩斯(Broda Barnes)在必要时开了甲状腺处方，接生了2000多名婴儿，从未出现过子痫前期病例，不过据统计，这一数字本该是100例。)
The clotting which sometimes kills women, can, if it is not so extensive, cause spotty brain damage, similar to that seen in “multiple sclerosis,” or it can occur in the liver, or other organ, or in the placenta, or in the fetus, especially in its brain and liver. Some cases of supposed “post-partum psychosis” have been the result of multiple strokes. When large clots occur in the liver or placenta, the fibrinogen which has been providing the fibrin for disseminated intravascular coagulation can appear to be consumed faster than it is produced by the liver. I think its disappearance may sometimes be the result of the liver's diminished blood supply, rather than the “consumption” which is the way this situation is usually explained. It is at this point that hemorrhages, rather than clots, become the problem. The undernourished liver can produce seizures in a variety of ways–clots, hemorrhages, hypoglycemia, and brain edema, for example, so eclampsia needn't be so carefully discriminated from “the other causes of seizures.”
凝血有时会导致妇女死亡，但如果凝血范围不太大，也会造成类似于多发性硬化症的斑点状脑损伤，也可能发生在肝脏，或其他器官，或胎盘，或胎儿，尤其是大脑和肝脏。一些被认为是“产后精神病”的病例是多次中风的结果。当肝脏或胎盘出现大凝块时，为弥散性血管内凝血提供纤维蛋白的纤维蛋白原似乎比肝脏产生的纤维蛋白原消耗得更快。我认为它的消失有时可能是肝脏供血减少的结果，而不是通常解释这种情况的“消耗”。在这一点上，出血，而不是血块，成为问题。营养不良的肝脏会以多种方式引起癫痫，比如血栓、出血、低血糖和脑水肿，所以不必把子痫和“其他癫痫病因”区别开来。
Because I had migraines as a child, I was interested in their cause. Eating certain foods, or skipping meals, seemed to be involved, but I noticed that women often had migraines premenstrually. Epilepsy too, I learned, often occurred premenstrually.
因为我小时候有过偏头痛，所以我对偏头痛的病因很感兴趣。吃某些食物或不吃饭似乎与此有关，但我注意到女性经常在月经前偏头痛。癫痫，我了解到，经常发生在月经前。
In my experience of migraine, nausea and pain followed the visual signs, which consisted of a variable progression of blind spots and lights. When I eventually learned that I could stop the progression of symptoms by quickly eating a quart of ice cream, I saw that my insight could be applied to other situations in which similar visual events played a role, especially “eclampsia” and “epilepsy.” For example, a woman who was 6 months pregnant called me around 10 o'clock one morning, to say that she had gone blind, and was alone in her country house. She said she had just eaten breakfast around 9 AM, and wasn't hungry, but I knew that the 6 month fetus has a great need for glucose, so I urged her to eat some fruit. She called me 15 minutes later to report that she had eaten a banana, and her vision had returned.
在我的偏头痛经历中，恶心和疼痛伴随着视觉信号，包括盲点和光线的变化。当我最终了解到，我可以通过快速吃一夸脱冰淇淋来阻止症状的恶化时，我看到我的洞察力可以应用到其他类似视觉事件起作用的情况下，特别是“子痫”和“癫痫”。例如，一天早上10点左右，一位怀孕6个月的妇女给我打电话，说她失明了，独自一人住在乡下的房子里。她说她早上9点左右刚吃过早餐，不饿，但我知道6个月的胎儿对葡萄糖的需求很大，所以我劝她吃点水果。15分钟后她打电话给我说她吃了一根香蕉，视力恢复了。
Early in pregnancy, “morning sickness” is a common problem, and it is seldom thought to have anything to do with eclampsia, because of the traditional medical idea that the fetus “causes” eclampsia, and in the first couple of months of pregnancy the conceptus is very small. But salty carbohydrate (soda crackers, typically) is the standard remedy for morning sickness. Some women have “morning sickness” premenstrually, and it (like the nausea of migraine) is eased by salt and carbohydrate. X-ray studies have demonstrated that there are spasms of the small intestine (near the bile duct) associated with estrogen-induced nausea.
在怀孕早期，“晨吐”是一个常见的问题，很少有人认为它与子痫有关，因为传统医学认为胎儿“导致”子痫，在怀孕的头几个月，概念非常小。但咸味碳水化合物(通常是苏打饼干)是治疗晨吐的标准方法。一些女性在月经前会有“晨吐”，盐和碳水化合物可以缓解这种症状(就像偏头痛带来的恶心)。x射线研究表明，小肠(靠近胆管)的痉挛与雌激素引起的恶心有关。
Hypoglycemia is just one of the problems that develops when the liver malfunctions, but it is so important that orange juice or Coca Cola or ice cream can provide tremendous relief from symptoms. Sodium (orange juice and Pepsi provide some) helps to absorb the sugar, and–more basically–is essential for helping to restore the blood volume. Pepsi has been recommened by the World Health Organization for the rehydration of babies with diarrhea, in whom hypovolemia (thickening of the blood from loss of water) is also a problem.
低血糖只是肝脏功能失调时出现的问题之一，但它是如此重要，橙汁、可口可乐或冰淇淋可以极大地缓解症状。钠(橙汁和百事可乐提供一些钠)有助于吸收糖，更基本的是，对帮助恢复血容量至关重要。世界卫生组织(World Health Organization)推荐百事可乐(Pepsi)为腹泻婴儿补充水分，因为低血容量(因失水而导致血液增厚)也是一个问题。
The problem of refeeding starving people has many features in common with the problem of correcting the liver malfunction and hormone imbalances which follow prolonged malnutrition of a milder sort. The use of the highest quality protein (egg yolk or potato juice, or at least milk or meat) is important, but the supplementation of thyroid containing T 3 is often necessary. Intravenous albumin, hypertonic solutions of glucose and sodium, and magnesium in an effective form should be helpful (magnesium sulfate injected intramuscularly is the traditional treatment for eclampsia, since it is quickly effective in stopping convulsions). While the sodium helps to restore blood volume and to regulate glucose, under some circumstances (high aldosterone) it helps to retain magnesium;aldosterone is not necessarily high during eclampsia.. Triiodothyronine directly promotes cellular absorption of magnesium. Hypertonic glucose with minerals is known to decrease the destruction of protein during stress: M. Jeevanandam, et al., Metabolism 40, 1199-1206, 1991.
为饥饿的人提供食物与纠正长期轻度营养不良引起的肝脏功能障碍和激素失衡有许多共同的特点。使用最高质量的蛋白质(蛋黄或土豆汁，或至少牛奶或肉)是重要的，但补充含有t3的甲状腺往往是必要的。静脉注射白蛋白、有效的高渗葡萄糖和钠溶液和镁应该是有帮助的(肌肉注射硫酸镁是传统的治疗子痫的方法，因为它能迅速有效地停止抽搐)。虽然钠有助于恢复血容量和调节葡萄糖，但在某些情况下(高醛固酮)，它有助于保留镁;醛固酮在子痫期间不一定高。三碘甲状腺原氨酸直接促进细胞对镁的吸收。已知含矿物质的高渗葡萄糖可减少应激时蛋白质的破坏:M. Jeevanandam等，《新陈代谢》40,1199-1206,1991。
Katherina Dalton observed that her patients who suffered from PMS (and were benefitted by progesterone treatment) were likely to develop “toxemia” when they became pregnant, and to have problems at the time of menopause. In these women, it is common for “menstruation” to continue on the normal cycle during the first several months of pregnancy. This cyclic bleeding seems to represent times of an increased ratio of estrogen to progesterone, and during such periods of cyclic bleeding the risk of miscarriage is high. Researchers found that a single injection of progesterone could sometimes eliminate the signs of toxemia for the remainder of the pregnancy. Katherina Dalton, who continued to give her patients progesterone throughout pregnancy, later learned that the babies treated in this way were remarkably healthy and bright, while the average baby delivered after a “toxemic” pregnancy has an IQ of only 85.
凯瑟琳娜·道尔顿观察到，她的患者患有经前症候群(通过孕激素治疗获益)，在怀孕时很可能出现“毒血症”，并在绝经时出现问题。在这些女性中，在怀孕的前几个月，“月经”通常会继续正常的周期。这种周期性出血似乎代表了雌激素与孕激素比例的增加，在这种周期性出血期间流产的风险很高。研究人员发现，单次注射孕酮有时可以消除妊娠剩余时间的毒血症症状。凯瑟琳娜·道尔顿(Katherina Dalton)在整个怀孕期间继续给她的病人服用孕酮，后来发现，用这种方法治疗的婴儿非常健康和聪明，而“中毒”怀孕后出生的婴儿平均智商只有85。
Marian Diamond's work with rats clearly showed that increased exposure to estrogen during pregnancy reduced the size of the cerebral cortex and the animals' ability to learn, while progesterone increased the brain size and intelligence. Zamenhof's studies suggested that these hormones probably have their effects largely through their actions on glucose, though they also affect the availability of oxygen in the same way, and have a variety of direct effects on brain cells that would operate toward the same end.
玛丽安·戴蒙德(Marian Diamond)对老鼠的研究清楚地表明，怀孕期间增加雌激素的接触会减少大脑皮层的大小和动物的学习能力，而孕酮则会增加大脑的大小和智力。Zamenhof的研究表明，这些激素可能主要通过它们对葡萄糖的作用来发挥作用，尽管它们也以同样的方式影响氧气的供应，并对脑细胞有各种各样的直接影响，这些影响将朝着同一个方向运行。
If Katherina Dalton's patients' IQs averaged 130, instead of the expected 85, the potential social effects of proper health care during pregnancy are enormous.
如果凯瑟琳娜·道尔顿的病人平均智商为130，而不是预期的85，那么孕期适当的医疗保健的潜在社会影响是巨大的。
But there is evidence that healthy gestation affects more than just the IQ. Strength of character, ability to reason abstractly, and the absence of physical defects, for example, are strongly associated with weight at birth.
但有证据表明，健康的妊娠期影响的不仅仅是智商。例如，性格的力量，抽象推理的能力，以及没有身体缺陷，都与出生时的体重密切相关。
Government studies and Social Security statistics suggest the size of the problem. The National Institute of Neurological Diseases and Stroke found that birth weight was directly related to IQ at age four, and that up to half of all children who were underweight at birth have an IQ under 70.(Chase.) According to standard definitions, about 8% of babies in the U.S. have low birth weight.
政府研究和社会保障统计数据表明了问题的严重性。美国国家神经疾病和中风研究所发现，出生体重与4岁时的智商直接相关，在所有出生时体重不足的儿童中，有多达一半的人智商低于70。根据标准定义，美国约有8%的婴儿出生时体重偏低。
Among people receiving Social Security income because of disability that existed at the age of 18, 75% were disabled before birth. In 94% of these cases, the abnormality was neurological. (HEW.)
A study of 8 to 10-year-old children found that abstract verbal reasoning and perceptual/motor integration are more closely related to birth weight than they are to IQ. (Wiener.)
在18岁时因残疾而获得社会保障收入的人群中，75%的人在出生前残疾。94%的病例中，神经系统异常。(坚持)。
一项针对8至10岁儿童的研究发现，抽象语言推理和知觉/运动整合与出生体重的关系比与智商的关系更密切。(香肠)。
National nutritional data show that in the U.S. the development of at least a million babies a year is “substantially compromised” by prenatal malnutrition. Miscarriages, which are also causally related to poor nutrition, occur at a rate of a few hundred thousand per year. (Williams.)
国家营养数据显示，在美国，每年至少有100万婴儿的发育受到产前营养不良的“严重影响”。流产，也与营养不良有因果关系，每年以几十万的速度发生。(威廉姆斯)。
When a muscle is fatigued, it swells, taking up sodium and water, and it is likely to become sore. Energy depletion causes any cell to take up water and sodium, and to lose potassium. An abnormal excess of potassium in the blood, especially when sodium is low, affects nerve, muscle, and secretory cells; a high level of potassium can stop the heart, for example. Cellular energy can be depleted by a combination of work, insufficient food or oxygen, or a deficiency of the hormones needed for energy production. When the swelling happens suddenly, the movement of water and sodium from the blood plasma into cells decreases the volume of blood, while the quantity of red cells remains the same, making the blood more viscous.
当肌肉疲劳时，它会肿胀，吸收钠和水，很可能会变得疼痛。能量消耗会导致任何细胞吸收水和钠，而失去钾。血液中钾的异常过量，特别是当钠含量低时，会影响神经、肌肉和分泌细胞;例如，高水平的钾可以使心脏停止跳动。由于工作、食物或氧气不足，或缺乏产生能量所需的激素，细胞能量会被耗尽。当肿胀突然发生时，水和钠从血浆进入细胞的运动减少了血液的体积，而红细胞的数量保持不变，使血液更加粘稠。
During the night, as adrenalin, cortisol, and other stress hormones rise, our blood becomes more viscous and clots more easily. In rats, it has been found that the concentration of serum proteins increases significantly during the night, presumably because water is moving out of the circulatory system. Even moderate stress causes some loss of water from the blood.
在夜间，随着肾上腺素、皮质醇和其他压力荷尔蒙的增加，我们的血液变得更粘稠，更容易凝结。在老鼠身上，已经发现血清蛋白的浓度在夜间显著增加，大概是因为水从循环系统中流出。即使是适度的压力也会导致血液中的水分流失。
If a person is malnourished, a moderate stress can overcome the body's regulatory capacity. If tissue damage is extreme, or blood loss is great, even a healthy person experiences hypovolemia and shock.
如果一个人营养不良，适度的压力可以克服身体的调节能力。如果组织损伤严重，或者失血过多，即使是健康人也会出现低血容量和休克。
C.A. Crenshaw, who was a member of the trauma team at Parkland Hospital in Dallas that worked on Kennedy and Oswald, had been involved in research with G. T. Shires on traumatic shock. In his words, “we made medical history by discovering that death from hemorrhagic shock (blood loss) can be due primarily to the body's adjunctive depletion of internal salt water into the cells.” (Shires' work involved isotopes of sodium to show that sodium seems to be taken up by cells during shock.)
c·a·克伦肖(C.A. Crenshaw)是达拉斯帕克兰医院(Parkland Hospital)创伤小组的一员，该小组曾为肯尼迪和奥斯瓦尔德做过治疗。克伦肖曾参与夏尔(g.t. Shires)对创伤性休克的研究。用他的话来说，“我们创造了医学史，因为我们发现，失血性休克(失血)的死亡主要是由于体内的盐水进入细胞的补充耗竭。”(夏尔的研究涉及到钠的同位素，表明钠似乎在休克时被细胞吸收。)
According to Crenshaw, “Oswald did not die from damaged internal organs. He died from the chemical imbalances of hemorrhagic shock. From the time he was shot…until the moment fluids were introduced into the body…” [19 minutes] “there was very little blood circulating in Oswald's body. As a result, he was not getting oxygen, and waste built up in his cells. Then, when the fluids were started, the collection of waste from the cells was dumped into the bloodstream, suddenly increasing the acid level, and delivering these impurities to his heart. When the contaminated blood reached the heart, it went into arrest….” The “waste” he refers to includes potassium and lactic acid. Crenshaw advocates the use of Ringer's lactate to replace some of the lost fluid. Since the blood already contains a large amount of lactate because the body is unable to consume it, this doesn't seem reasonable. I think a hypertonic version of Locke's solution, containing glucose and sodium bicarbonate as well as sodium chloride, would be better, though I think the potassium should be omitted too, and extra magnesium would seem desirable. Triiodothyronine, I suspect, would help tremendously to deal with the problems of shock, causing potassium, magnesium, and phosphate to move back into cells, and sodium to move out, helping to restore blood volume and reduce the wasteful conversion of glucose to lactic acid..
据克伦肖说，“奥斯瓦尔德不是死于内脏受损。他死于失血性休克的化学失衡。从他被枪击的那一刻起直到液体进入身体的那一刻……”[19分钟]“奥斯瓦尔德体内的血液循环非常少。结果，他得不到氧气，细胞内废物堆积。然后，当液体开始的时候，从细胞收集的废物被倾倒到血液中，突然增加了酸的水平，并把这些杂质输送到他的心脏。当被污染的血液到达心脏时，它就停止了活动….”他所指的“废物”包括钾和乳酸。克伦肖提倡使用林格氏乳酸盐来补充一些流失的液体。由于血液中已经含有大量的乳酸盐，因为身体不能消耗它，这似乎是不合理的。我认为洛克溶液的高渗版本，包括葡萄糖、碳酸氢钠和氯化钠，会更好，尽管我认为钾也应该被省略，而额外的镁似乎是可取的。我认为，三碘甲状腺原氨酸将极大地帮助处理休克的问题，导致钾、镁和磷酸盐回到细胞中，而钠则移出细胞，帮助恢复血容量，减少葡萄糖转化为乳酸的浪费。
Albumin has been used therapeutically in preeclampsia (Kelman), to restore blood volume. Synthetic polymers with similar osmotic properties are sometimes used in shock, and might also be useful in eclampsia, but simply eating extra protein quickly restores blood albumin. For example, in a group of women who were in their seventh month of pregnancy, the normal women's serum osmotic pressure was 247 mm. of water, that of the women with nonconvulsive toxemia was 215 mm., and in the women with eclampsia, the albumin and osmotic pressure were lowest, with a pressure of 175 mm. In the eighth month, the toxemic women who ate 260 grams of protein daily had a 7% increase in osmotic pressure, and a group who ate 20 grams had a decline of 9%.(Strauss) In a group of preeclamptics, plasma volume was 39% below that of normal pregnant women.
白蛋白已被用于治疗子痫前期(Kelman)，以恢复血容量。具有类似渗透性的合成聚合物有时用于休克，也可能用于子痫，但简单地吃额外的蛋白质可以迅速恢复血白蛋白。例如,在一群妇女在怀孕第七个月,正常妇女血清渗透压是247 mm.水,女性的nonconvulsive毒血症是215毫米,女性子痫,白蛋白和渗透压最低,175毫米的压力。在第8个月里，每天摄入260克蛋白质的中毒妇女的渗透压增加了7%，而一组每天摄入20克蛋白质的妇女渗透压下降了9%。
If the physiology of shock has some relevance for eclampsia, so does the physiology of heart failure, since Meerson has shown that it is a consequence of uncompensated stress. The failing heart shifts from mainly glucose oxidation to the inefficient use of fatty acids, which are mobilized during stress, and with its decreased energy supply, it is unable to beat efficiently, since it remains in a partly contracted state. Estrogen (which is increased in men who have had heart attacks) is another factor which decreases the heart's stroke volume, and estrogen is closely associated with the physiology of the free unsaturated fatty acids. The partly contracted state of the heart is effectively a continuation of the partly contracted state of the blood vessels that causes the hypertension, and reduced tissue perfusion seen in shock and eclampsia. Since shock can be seen as a generalized inflammatory state, and since aspirin has been helpful in protecting against heart disease, it's reasonable that aspirin has been tried as a treatment in pre-eclampsia. It seems to protect the fetus against intrauterine growth retardation, an effect that I think relates to aspirin's ability to protect in several ways against excesses of uunsaturated fatty acids and of estrogen. But, since aspirin can interfere with blood clotting, its use around the time of childbirth can be risky, and it is best to correct the problem early enough that aspirin isn't needed.
如果说休克的生理学与子痫有某种关联，那么心衰的生理学也有某种关联，因为Meerson已经表明，它是未补偿应激的结果。衰竭的心脏从主要的葡萄糖氧化转变为脂肪酸的低效使用，这些脂肪酸在压力下被调动，随着能量供应的减少，它不能有效地跳动，因为它仍然处于部分收缩状态。雌激素(在心脏病发作的男性中增加)是另一个降低心脏搏出量的因素，而雌激素与游离不饱和脂肪酸的生理特性密切相关。心脏的部分收缩状态实际上是引起高血压的血管的部分收缩状态的延续，休克和子痫所见的组织灌注减少。由于休克可以被视为一种广泛性炎症状态，由于阿司匹林有助于预防心脏病，因此阿司匹林作为先兆子痫的治疗尝试是合理的。它似乎可以保护胎儿不受宫内发育迟缓的影响，我认为这与阿司匹林在几个方面保护胎儿不受不饱和脂肪酸和雌激素过多的影响有关。但是，由于阿司匹林会影响血液凝固，在分娩前后使用它是有风险的，最好尽早纠正这个问题，这样就不需要阿司匹林了。
Besides protein deficiency and other nutritional deficiencies, excess estrogen and low thyroid can also limit the liver's ability to produce albumin. Hypovolemia reduces liver function, and (like hepatic infarcts) will reduce its ability to maintain albumin production..
除了蛋白质缺乏和其他营养不足，雌激素过多和甲状腺功能低下也会限制肝脏产生白蛋白的能力。低血容量会降低肝功能，(如肝梗死)会降低其维持白蛋白生成的能力。
The studies which have found that hospitalized patients with the lowest albumin are the least likely to survive suggest that the hypovolemia resulting from hepatic inefficiency is a problem of general importance, and that it probably relates to the multiple organ failure which is an extremely common form of death among hospitalized patients. A diet low in sodium and protein probably kills many more people than has been documented. If old age is commonly a hypovolemic condition, then the common salt restriction for old-age hypertension is just as irrational as is salt-restriction in pregnancy or in shock. Thyroid (T 3), glucose, sodium, magnesium and protein should be considered in any state in which weakened homeostatic control of the composition of plasma is evident.
的研究发现,住院病人白蛋白是最不容易生存最低的建议导致血容量减少肝效率低下是一个普遍存在的问题的重要性,而且它可能与多器官功能衰竭死亡这是一个非常常见的住院病人。低钠和低蛋白饮食可能会导致比文献记载更多的人死亡。如果老年通常是低血容量的情况，那么常见的盐限制老年高血压就像怀孕或休克时的盐限制一样不合理。甲状腺(t3)，葡萄糖，钠，镁和蛋白质应考虑在任何状态，在体内平衡控制减弱的血浆成分明显。
*Note: Although Konrad Lorenz (who later received the Nobel Prize) was the architect of the Nazi's policy of “racial hygiene” (extermination of those with unwanted physical, cultural, or political traits which were supposedly determined by “genes”) he took his ideas from the leading U.S. geneticists, whose works were published in the main genetics journals. Following the Nazis' defeat, some of these journals were renamed, and the materials on eugenics were often removed from libraries, so that a new historical resume could be presented by the profession.
*注意:虽然康拉德·洛伦茨(他后来获得了诺贝尔奖)是纳粹“种族卫生”政策的设计者(即消灭那些被认为是由“基因”决定的身体、文化或政治特征的人)，但他的想法来自美国领先的遗传学家，他的作品发表在主要的遗传学杂志上。在纳粹战败后，其中一些期刊被重新命名，有关优生学的材料经常从图书馆中删除，这样该专业就可以提交一份新的历史简历。
ADDITIONAL REFERENCES
其他引用
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C. Muller, et al., “Reversible bilateral cerebral changes on magnetic resonance imaging during eclampsia,” Deutsche Medizinische Wochenschrift 121(39), 1184-1188, 1996. (Brain edema was demonstrated.)
Uzan S; Merviel P; Beaufils M; Breart G; Salat-Baroux J. [Aspirin during pregnancy. Indications and modalities of prescription after the publication of the later trials]. Presse Medicale, 1996 Jan 6-13, 25(1):31-6. Aspirin, an inhibitor of cyclo-oxygenase, is prescribed in a number of conditions related to abnormal production of prostaglandins including gravidic hypertension. Results of the most recent trials demonstrate that in patients with a past history of pre-eclampsia or intra-uterine growth retardation, a pathological Doppler examination of the uterus, a pathological angiotensin test or an antiphospholipid syndrome, prescription of aspirin at the dose of 100 mg/day can prevent recurrence or development of pre-eclampsia or intra-uterine growth retardation. Treatment should begin as soon as possible during pregnancy, certainly before development of clinical manifestations. After history taking and identification of possible contraindications, bleeding time (Ivy method) is recorded before and after prescription and should be lower than 8 minutes. In case bleeding time exceeds 10 minutes 10 to 15 days after initiating aspirin, doses may be reduced to 50 mg per day or even 50 mg every two or three days to reach the target level. Treatment should generally be continued up to 36 weeks gestation.
Randall, C L; Anton, R F; Becker, H C; Hale, R L; Ekblad, U. Aspirin dose-dependently reduces alcohol-induced birth defects and prostaglandin E levels in mice. Teratology, v.44, n.5, (1991): 521-530. The purpose of the present study was threefold. The first purpose was to determine if aspirin (ASA) decreases alcohol-induced birth defects in mice in a dose-dependent fashion. The second purpose was to see if the antagonism of alcohol-induced birth defects afforded by ASA pretreatment was related to dose-dependent decreases in prostaglandin E (PGE) levels in uterine/embryo tissue. The third purpose was to determine if ASA pretreatment altered maternal blood alcohol level.” In experiments 1 and 2, pregnant C57BL/6J mice were administered ASA (0, 18.75, 37.5, 75, 150, or 300 mg/kg) on gestation day 10. One hour following the subcutaneous injection of ASA, mice received alcohol (5.8 g/kg) or an isocaloric sucrose solution intragastrically. In experiment 1 the incidence of birth defects was assessed in fetuses delivered by caesarean section on gestation day 19. In experiment 2 uterine/embryo tissue samples were collected on gestation day 10 1 hr following alcohol intubation for subsequent PGE analysis. In experiment 3 blood samples were taken at five time points following alcohol intubation from separate groups of alcohol-treated pregnant mice pretreated with 150 mg/kg ASA or vehicle The results from the three experiments indicated that ASA dose-dependently reduced the frequency of alcohol-induced birth defects in fetuses examined at gestation day 19, ASA decreased the levels of PGE in gestation day 10 uterine/embryo tissue in a similar dose-dependentfashion, and ASA pretreatment did not significantly influence maternalblood alcohol levels. These results provide additional support for the hypothesis that PGs may play an important role in mediating the teratogenic actions of alcohol.
Prevention of fetal growth retardation with low-dose aspirin: findings of the EPREDA trial [see comments] Uzan S; Beaufils M; Breart G; Bazin B; Capitant C; Paris J. Lancet, 1991 Jun 15, 337:8755, 1427-31 The efficacy of low-dose aspirin in preventing fetal growth retardation was tested in a randomised, placebo-controlled, double-blind trial. A secondary aim was to find out whether dipyridamole improves the efficacy of aspirin. 323 women at 15-18 weeks' amenorrhoea were selected at twenty-five participating centres on the basis of fetal growth retardation and/or fetal death or abruptio placentae in at least one previous pregnancy. They were randomly allocated to groups receiving placebo, 150 mg/day aspirin, or 150 mg/day aspirin plus 225 mg/day dipyridamole, for the remainder of the pregnancy. In the first phase of the trial all actively treated patients (n = 156) were compared with the placebo group (n = 73). Mean birthweight was significantly higher in the treated than in the placebo group (2751 [SD 670] vs 2526 [848] g; difference 225 g [95% CI 129-321 g], p = 0.029) and the frequency of fetal growth retardation in the placebo group was twice that in the treated group (19 [26%] vs 20 [13%]; p less than 0.02). The frequencies of stillbirth (4 [5%] vs 2 [1%]) and abruptio placentae (6 [8%] vs 7 [5%]) were also higher in the placebo than in the treated group. The benefits of aspirin treatment were greater in patients with two or more previous poor outcomes than in those with only one. In the second analysis, of aspirin only (n = 127) vs aspirin plus dipyridamole (n = 119), no significant differences were found. There was no excess of maternal or neonatal side-effects in the aspirin-treated patients.
An aspirin a day to prevent prematurity. Sibai BM. Clin Perinatol, 1992 Jun, 19:2, 305-17. Intrauterine fetal growth retardation and preeclampsia remain a substantial cause of preterm birth world wide. There is evidence to suggest that a functional imbalance between vascular prostacyclin and platelet-derived thromboxane A2 production plays a central role in the pathogenesis of these disorders. Low-dose aspirin appears to reverse the above functional balance resulting in increased prostacyclin to thromboxane ratio. The efficacy and safety of low-dose aspirin in preventing preeclampsia and fetal growth retardation were tested in several randomized and uncontrolled trials. The data in the literature suggest that low-dose aspirin is effective in reducing preterm birth due to the above complications in selected high-risk pregnant women.
Rosental, D G; Machiavelli, G A; Chernavsky, A C; Speziale, N S; Burdman, J A. Indomethacin inhibits the effects of estrogen in the anterior pituitary gland of the rat. Journal of Endocrinology, v.121, n.3, (1989): 513-520. Two inhibitors of prostaglandin synthesis, indomethacin and aspirin, blocked the increase of oestrogen-binding sites in the nuclear subcellular fraction, an increase which occurs after the administration of oestradiol.
Zanagnolo, V; Dharmarajan, A M; Endo, K; Wallach, E E. Effects of acetylsalicylic acid (aspirin) and naproxen sodium (naproxen) on ovulation, prostaglandin, and progesterone production in the rabbit. Fertility and Sterility, v.65, n.5, (1996): 1036-1043.
