中国麻醉周科普 第一位全职麻醉学家

图片由马里兰州Bethcsda国家医学图书馆提供，源于米勒麻醉学。

    1846年后，William T.G. Morton的很多精力被牵扯到申请专利和相关的经济补偿上，因此他不能全身心地投身于麻醉专业的研究。大多数历史学家认为John Snow是首位全职麻醉学家，他通过自己的榜样作用，使麻醉学科作为科学学科，成为一个有重要价值的学科。

    1813年6月15日，John Snow出生于英格兰的约克城。他是一个农民家庭的长子，早年就读于约克的一所私立学校，同时也在家中务农。14岁时，他成为了纽卡斯尔的外科医生William Hardcastle的助手。4年后，纽卡斯尔暴发霍乱，Snow在当时做了许多后来被证明是很有价值的研究。23岁时，他于伦敦的 Hunterian医学学校开始了正规的医学学习。这个时期很短，1年后他通过了考试，成为英格兰皇家外科学院的一员。

   Benjamin Ward Richardson是 Snow的好友，他写了一篇关于Snow的简短传记，认为他是一个追求“只是真理，无任何功利目的、赤裸真理”的人。Snow最初试图建立私人全科医疗计划，但最终由于吸引不了付费病人而失败。他不愿只从事神经科病人的日常处理，因此将时间用于在Charing Cross医院做义工及用于阅读医学资料。1841年30多岁时，他在伦敦医学学会宣读了他的第一篇论文《新生儿窒息及复苏》。这篇论文描述了新生儿呼吸抑制的正压通气复苏，显示出他对麻醉专业的兴趣。当乙醚吸入实施无痛手术的消息从美国传到德国后，他对麻醉的兴趣日益浓厚。

    Snow专门从事乙醚麻醉的研究，1年后撰写了2本关于吸入麻醉的划时代著作。1847年10月，James Simpson医生介绍了氯仿后，他积极地将这种药物也包括进来。他的氯仿吸入器更加先进，使用一个活瓣防止重复吸入。他将麻醉深度进行分级，并研究了乙醚、氯仿在人及动物的麻醉作用，以了解各个麻醉阶段所需的浓度。他的这项工作的精确和详细程度是后人在近100年间都是难以达到的，直到可以测定吸入麻醉药的蒸发压。由于他的临床技能在同时期的医师中最为娴熟，因此他被推荐为维多利亚女王的两个孩子的出生实施麻醉。Snow为1853年Leopold王子及 1857年Beatride公主的出生实施了氯仿麻醉。

    1854年Charing Cross区霍乱大流行，Snow基于先前的经验分析了传播的病因。他怀疑霍乱是通过供水系统传播，因此建议去除Brosdstreet水泵的把手，流行很快平息下来。他的霍乱传播理论后来发表于《伦敦医学公报》(London Medical Gazette)。他最后一篇论文《关于氯仿及其他麻醉药的研究》记录了他最后的研究成果。1858年7月14日Snow死于肾病，享年45岁。

（参考文献：米勒麻醉学）

A STORY OF JOHN SNOW

John Snow defeats “king cholera”

John Snow was afamous doctor in London-so expert,indeed,that he attended Queen Victoria as herpersonal physician.But he became inspired when he thought about helpingordinary people exposed to cholera.This was the deadly disease of its day.Neitherits cause nor its cure was understood.So many thousands of terrified peopledied every time there was an outbreak.John Snow wanted to face the challengeand solve this problem.He knew that cholera would never be controlled until its cause was found.

He became interested in two theories that possibly explained

how cholera killed people.The first suggested that cholera multiplied in the air.A cloud of dangerous gas floated around until it found its victims.The second suggested that people absorbed this disease into their bodies with their meals.From thestomach the disease quickly attacked the body and soon the affected persondied.

John Snow suspected that the second theory was correct but he needed evidence.So when another outbreak hit London in 1854,he was ready to begin his enquiry.As the disease spread quickly through poor neighbourhoods,he began to gather information.In two particular streets,the cholera outbreak was so severe thatmore than 500 people died in ten days. He was determined to find out why.

First he mark edon a map the exact places where all the dead people had lived. This gave him avaluable clue about the cause of the disease.Many of the deaths were near thewater pump in Broad Street(especially numbers 16,37,38and40).He also noticedthat some houses(such as 20 and 21 Broad Street and 8and 9 Cambridge Street)had had no deaths.He had not foreseen this,so he made further investigations.Hediscovered that these people worked in the pub at 7 Cambridge Street.They hadbeen given free beer and so had not drunk the water from the pump.It seemed that the water was to blame.

Next,John Snow looked into the source of the water for these two streets.He found that it camefrom the river polluted by the dirty water from London.He immediately told theastonished people in Broad Street to remove the handle from the pump so that itcould not be used.Soon afterwards the disease slowed down.He had shown thatcholera was spread by germs and not in a cloud of gas.

In another part of London,he found supporting evidence from two other deaths that were linkedto the Broad Street outbreak.A woman,who had moved away from Broad Street,liked the water from the pump so much that she had it delivered to her house everyday. Both she and her daughter died of cholera after drinking the water.Withthis extra evidence John Snow was able to announce with certainty that polluted water carried the virus.

To prevent this from happening again,John Snow suggested that the source of all the water suppliesbe examined.The water companies were instructed not to expose people topolluted water any more.Finally "King Cholera"was defeated.

来源：麻醉科普