Glisson與佝僂病— 一段不廣為人知的故事

原創 Hewie Jiang 阿爾法醫學英語 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年出生於英國的多塞特郡。他20歲進入劍橋大學的岡維爾凱斯學院學習，37歲時被授予醫學博士學位。兩年後，他被任命為劍橋大學的皇家御用醫學教授。大家對Glisson這個名字熟悉應該都是因為肝臟的一種解剖結構-Glisson’s capsule/Glissonian sheath,即格林森鞘。Glisson在對牛進行解剖中發現肝臟內的肝動脈、門靜脈和膽管周圍有一層將三者都包裹在其中的結締組織。1654年，他將這一發現記錄在自己關於肝臟解剖結構的著作Anatomia hepatis中。後人為了紀念他，就將這層門靜脈纖維鞘稱為Glisson’s capsule。

Anatomia hepatis的第292頁，來源：劍橋大學圖書館網站

今天我們並不是來給大家介紹格林森鞘，而是說說一個不廣為人知的故事，Glisson與佝僂病的聯繫。

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發表了題為《佝僂病，一種兒童常見疾病》的論文。Glisson稱自己研究佝僂病已經有五年了。他認為佝僂病是一種古今醫學家都未描述過的全新兒童疾病。格裡森強調了病理解剖學在此疾病研究中的重要性。Glisson認識到佝僂病既不是先天遺傳性的，也不是傳染性的，更不是由梅毒引起的。他認為佝僂病是過度餵養導致的消化不良引起。

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.

事實上，Glisson關於佝僂病的研究成果被英國的另一位醫生丹尼爾·惠斯勒（Daniel Whistler）於1645年搶先發表。惠斯勒發表的關於佝僂病的博士學位論文時只有25歲，很多人猜測（但沒有直接證據）他可能事先接觸過Glisson的研究成果。（像極了最近的付向東與楊輝的學術糾紛）

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.

惠斯勒對佝僂病的臨床表現進行了出色描述。他提到佝僂病患者有頭部、骨骺和腹部的膨大；整個骨骼系統就像未凝固的液體蠟一樣柔軟；松垮沒有力氣的腿無法承受身體的重量；脊椎和脛骨都在從上往下應力的作用下而彎曲。限於當時的醫學水平，惠斯勒對佝僂病病因的研究也是不準確的。他認為兒童患佝僂病是由於母親飲酒過多造成的。

Glisson因在解剖學領域的成就而被世人銘記，卻因研究成果被搶先發表而導致在佝僂病方面的貢獻不廣為人知。這也啟示著我們年輕醫學生在潛心研究的同時也需要注意保護自己的學術成果。Anyway, 選擇了醫學，就好好熱愛它吧，共勉！

詞彙複習

1. microscopy /maɪˈkrɑːskəpi/ n. 顯微鏡檢查，顯微鏡學

2.bile duct n. 肝膽管

3. portal vein n. 門靜脈

4. hepatic artery n. 肝動脈

Hepatitis /ˌhepəˈtaɪtɪs/ n. 肝炎

5. rickets /ˈrɪkɪts/ n.佝僂病

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

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

8. syphilis /ˈsɪfɪlɪs/ n.梅毒

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

10. epiphyses /ɪ&39;tɪbɪiː/ n. 脛骨

Fibula /ˈfɪbjələ/ n. 腓骨

12. spine /spaɪn/ n. 脊柱

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

Antenatal examination n. 產前檢查

Reference:

1.Van Gulik TM. From the archives of hepato-biliary and pancreatic disease--Francis Glisson&34;discovery&39;s capsule of the liver. Gastroenterology. 2001;120(6):1362. doi:10.1016/s0016-5085(01)87930-0