Various reports have appeared on the favorable effect of vitamin E (alphatocopherol) in peripheral vascular diseases." 2 , 3 9The list of diseases includes thrombophlebitis, phlebothrombosjs, indolent varicose ulcers, early gangrene, thromboangiitis obliterans, arteriosclerotic gangrene, sclerosis of legs with ulcers, and noduloulcerative granuloma of the legs.In view of these reports, a series of cases under our personal supervision in a hospital were given a preparation of alpha-tocopherol in varying doses. Oral therapy consisted of 200 to 600 mg. daily. Intramuscular therapy varied from 200 to 400 mg. daily. These doses are considered adequate both by the manufacturer and in the published reports. Clinical Studies Thromboaragiitis Oblileraias. Case 1. L. R. G.: a 29 year-old white male with onset, 5 years ago, of intermittent claudication and pahs in the soles of his feet. He developed infection and gangrene in his right first toe in 1944 and had an amputation of the terminal phalanx of this toe that year. In 1945, infection and gangrene occurred in the left first toe. Amputation of this toe failed to heal and a below knee amputation was done in 1945.With an artificial limb, he continued to work, driving a truck. I n October, 1948, he injured the stump, developed a painful ulcer, and was admitted to the hospital in November, 1948. Despite advice to the contrary, he has persisted in smoking off and on.The dorsalis pedis and posterior tibia1 pulsations were absent in the right foot. The Alien test indicated partial occlusion of the right radial and ulna. He was started on vitamin E, 300 mg., later 600 mg., orally plus 200 mg. intramuscularly daily. Local wet dressings were used. The pain became increasingly severe and could not be controlled with demerol, barbiturates, or nerve block for any length of time. Relief was finally obtained by spinal anesthesia and ice packs. Amputation above the knee was done 10 days after start of tocopherol therapy. Healing was uneventful, without any E medication, but the patient has stopped smoking again.M. Mc. 0.: a 54 year-old white male with onset, 10 years ago, of intermittent claudication, ulcers of left first toe, right second toe, andsev-era1 fingers of both hands. These healed spontaneously. Six weeks before admission, he developed an ulcer of the right second toe which failed to heal. He has never stopped smoking.Examination showed cyanosis of right second, third, and fourth toes, with an ulcer on second toe. The dorsalis pedis was absent bilaterally.Examination showed a deep draining ulcer of the stump.
Case 2.The vitamin E was supplied by VCA Laboratoriea in capsules containing 100 mg. of alpha-tocopherol for oral use and in sesame oil for intramuscular use.
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