四岁阿斯伯格症的儿童表现（Glisson与佝偻病一段不广为人知的故事）

四岁阿斯伯格症的儿童表现（Glisson与佝偻病一段不广为人知的故事）In fact Glisson’s text had been pre-empted by a slim thesis on rickets for the degree of MD in Leyden delivered by Daniel Whistler in 1645. As he was only 25 years old when it was originally presented in Leyden there was speculation (but no evidence) that he may have had prior access to Glisson’s studies on this disease.在1651年，Glisson发表了题为《佝偻病，一种儿童常见疾病》的论文。Glisson称自己研究佝偻病已经有五年了。他认为佝偻病是一种古今医学家都未

原创 Hewie Jiang 阿尔法医学英语 昨天

Francis Glisson (1597-1677) was born in Rampisham Dorsetshire England. Although not an indolent student he waited until age 20 before enrolling in Gonville and Caius College Cambridge. He was awarded his M.D. degree at age 37. Two years later he was appointed Regius professor of medicine at Cambridge. His description of the capsule of the liver in 1654 was derived from gross anatomic studies of the ox unaided by microscopy. The fibrous sheath of the portal tracts identified in Anatomia hepatis was named Glisson’s capsule.

Glisson 1597年出生于英国的多塞特郡。他20岁进入剑桥大学的冈维尔凯斯学院学习，37岁时被授予医学博士学位。两年后，他被任命为剑桥大学的皇家御用医学教授。大家对Glisson这个名字熟悉应该都是因为肝脏的一种解剖结构-Glisson’s capsule/Glissonian sheath 即格林森鞘。Glisson在对牛进行解剖中发现肝脏内的肝动脉、门静脉和胆管周围有一层将三者都包裹在其中的结缔组织。1654年，他将这一发现记录在自己关于肝脏解剖结构的著作Anatomia hepatis中。后人为了纪念他，就将这层门静脉纤维鞘称为Glisson’s capsule。

Anatomia hepatis的第292页，来源：剑桥大学图书馆网站

今天我们并不是来给大家介绍格林森鞘，而是说说一个不广为人知的故事，Glisson与佝偻病的联系。

An English edition edited by Nicholas Culpeper with the title A treatise of the rickets being a disease common to children appeared in 1651. Glisson stated that he had been studying rickets for five years and that it was an “...absolutely new disease and never described by any ancient or modern writers in their practical books which are extant at this day of the diseases of children.”

Glisson emphasized the importance of morbid anatomy in the study of this disease. Glisson recognized too that rickets were neither congenital nor inherited were not contagious nor caused by syphilis. The nearest he came to a nutritional cause was to blame excessive feeding with its resulting indigestion.

在1651年，Glisson发表了题为《佝偻病，一种儿童常见疾病》的论文。Glisson称自己研究佝偻病已经有五年了。他认为佝偻病是一种古今医学家都未描述过的全新儿童疾病。格里森强调了病理解剖学在此疾病研究中的重要性。Glisson认识到佝偻病既不是先天遗传性的，也不是传染性的，更不是由梅毒引起的。他认为佝偻病是过度喂养导致的消化不良引起。

In fact Glisson’s text had been pre-empted by a slim thesis on rickets for the degree of MD in Leyden delivered by Daniel Whistler in 1645. As he was only 25 years old when it was originally presented in Leyden there was speculation (but no evidence) that he may have had prior access to Glisson’s studies on this disease.

事实上，Glisson关于佝偻病的研究成果被英国的另一位医生丹尼尔·惠斯勒（Daniel Whistler）于1645年抢先发表。惠斯勒发表的关于佝偻病的博士学位论文时只有25岁，很多人猜测（但没有直接证据）他可能事先接触过Glisson的研究成果。（像极了最近的付向东与杨辉的学术纠纷）

He gave an excellent clinical description of the disease mentioning the enlargement of the head the epiphyses and the abdomen the rickety rosary and “the whole bony system ... flexible like wax that is rather liquid so that the flabby and toneless legs scarcely sustain the weight of the superimposed body 　so that the tibiae yield to the weight of the fabric pressing down on them from above and become bent; and for the same reason the thighs above are curved and the back through the bending of the spine. Whistler believed that rickets had an antenatal origin due to the mother drinking too　much alcohol.

惠斯勒对佝偻病的临床表现进行了出色描述。他提到佝偻病患者有头部、骨骺和腹部的膨大；整个骨骼系统就像未凝固的液体蜡一样柔软；松垮没有力气的腿无法承受身体的重量；脊椎和胫骨都在从上往下应力的作用下而弯曲。限于当时的医学水平，惠斯勒对佝偻病病因的研究也是不准确的。他认为儿童患佝偻病是由于母亲饮酒过多造成的。

Glisson因在解剖学领域的成就而被世人铭记，却因研究成果被抢先发表而导致在佝偻病方面的贡献不广为人知。这也启示着我们年轻医学生在潜心研究的同时也需要注意保护自己的学术成果。Anyway 选择了医学，就好好热爱它吧，共勉！

词汇复习

1. microscopy /maɪˈkrɑːskəpi/ n. 显微镜检查，显微镜学

2.bile duct n. 肝胆管

3. portal vein n. 门静脉

4. hepatic artery n. 肝动脉

Hepatitis /ˌhepəˈtaɪtɪs/ n. 肝炎

5. rickets /ˈrɪkɪts/ n.佝偻病

6. congenital /kənˈdʒenɪtl/ adj. 先天的，天生的

7. contagious /kənˈteɪdʒəs/ adj. 感染性的；会蔓延的

8. syphilis /ˈsɪfɪlɪs/ n.梅毒

9. indigestion /ˌɪndɪˈdʒestʃən/ n. 消化不良；不消化

10. epiphyses /ɪ'pɪfɪsiːz/ n. 骨骺

11. tibiae /'tɪbɪiː/ n. 胫骨

Fibula /ˈfɪbjələ/ n. 腓骨

12. spine /spaɪn/ n. 脊柱

13. antenatal /ˌæntiˈneɪtl/ adj. 产前的；生前的

Antenatal examination n. 产前检查

Reference:

1.Van Gulik TM. From the archives of hepato-biliary and pancreatic disease--Francis Glisson's Anatomy of the Liver and Biliary Tract. Hepatogastroenterology. 1990;37(5):530-531.

2. Walker RM. Francis Glisson and his capsule. Ann R Coll Surg Engl. 1966;38(2):71-91.

3. Dunn PM. Francis Glisson (1597-1677) and the "discovery" of rickets. Arch Dis Child Fetal Neonatal Ed. 1998;78(2):F154-F155. doi:10.1136/fn.78.2.f154

4. Haubrich WS. Glisson of Glisson's capsule of the liver. Gastroenterology. 2001;120(6):1362. doi:10.1016/s0016-5085(01)87930-0