Drugs and narcotics in history
Drugs and narcotics in history
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历史上的毒品和麻醉品
DOI：
10.1017/s0025727300061391
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发表时间：
1996
期刊：
影响因子：
1.4
通讯作者：
P. Bartrip
中科院分区：
文献类型：
--
作者：
P. Bartrip
在病人的家里或住处，外科医生和牙医的私人诊室，伦敦的大医院，时髦的伦敦西区旅馆，以及白金汉宫，实施麻醉也是引人注目的。在这种社会空间和社会地位的范围内，人们不禁要问，根据个体患者在阶级、种族和性别等级中的地位，对麻醉的不同需求的期望是否可以从斯诺的记录中剔除出来。马丁·佩米克（Martin Pemick）在《痛苦的计算》（A calculus of suffering，1985）中优雅地从美国案例书籍中提取了这种期望。等待仔细分析的是斯诺对麻醉的不断变化的评价以及病人的期望、选择和经历。我们听说，在圣乔治医院，一个“工人”在氯仿下拔牙，用斯诺的话说，“他说，这几乎和他没有吃东西一样疼”（第70页），而另一个在他的查林十字架住所接受治疗的病人报告说，“他不记得手术的任何事情，但梦见他在地中海航行”（第70页）。105-6）。有些病人迫切希望麻醉，而另一些病人则抵制或拒绝。一般来说，斯诺似乎是应外科医生或牙医的要求进行麻醉的，但在少数情况下，病人不顾自己的医疗顾问，寻求斯诺的帮助。这些记录为研究疼痛史提供了一个有希望的切入点。斯诺没有记录的东西很难衡量，尽管埃利斯提请注意一些重大的遗漏。他推测斯诺在每天结束时都会写下条目，这是有道理的，并强调这种书面记录是选择性的产物，而且正如明显的失误所表明的那样，有时是不可靠的记忆。不仅如此，斯诺发表的几个特别重要的案例的报告在这些案例书中没有出现。其他的沉默也同样令人困惑。例如，每天的第一个条目包括对患者尿液比重的测量，但在随后的数百页中只有少数进一步的报告。尿液分析的例子是罕见的，还是在斯诺的实践中这种测试如此不起眼，以至于他认为没有特别的理由去记录它？我们没有办法告诉，使用案例书作为历史来源的固有局限性。这卷发出邀请调查进一步雪的做法在早年麻醉。与此同时，它应该提醒我们，私人诊所的病例簿有更广泛的可能性，既可以作为关于床边行为的信息来源，也可以作为探索历史学家最忽视的医疗实践之一的工具，即记录保存的实践。
administered anaesthesia also was remarkable: in patients' houses or lodgings, the private consulting rooms of surgeons and dentists, the great London hospitals, fashionable West End hotels, and Buckingham Palace. Presented with this range in social space and social position, one wonders whether the expectations about differential need for anaesthesia according to the individual sufferer's place in class, ethnic, and gender hierarchies that Martin Pemick, in A calculus ofsuffering (1985), elegantly extracted from American case books, might be teased out of Snow's records. Awaiting careful analysis are Snow's changing appraisals of anaesthesia and the expectations, choices, and experiences of patients. We hear of the tooth extraction under chloroform of a "working man" at St George's Hospital who, in Snow's words, "said that it hurt him nearly as much as if he had not had the stuff' (p. 70), while another patient treated at his Charing Cross lodgings reported "he did not remember anything of the operation, but dreamed that he had been sailing in the Mediterranean" (pp. 105-6). Some patients were desperately eager to be anaesthetized, while others resisted or refused. Generally, Snow seems to have administered anaesthesia at the request of the surgeon or dentist performing the operation, but in a few instances patients sought out Snow's aid in defiance of their own medical advisors. Such records offer a promising wedge into the history of pain. What Snow did not record is difficult to gauge, though Ellis draws attention to some significant omissions. His conjecture that Snow inscribed entries at the end of each day makes sense, and emphasizes that this written record is the product of selective and-as evident slips make clear-sometimes unreliable memory. More than this, reports on several particularly important cases that Snow published appear nowhere in these case books. Other silences are equally perplexing. The very first daily entry includes a measurement of the specific gravity of a patient's urine, for example, yet only a few further reports appear in the hundreds of pages that follow. Were instances of urinanalysis rare, or was the test so unremarkable in Snow's practice that he saw no particular reason to make note of it? We have no way of telling, an inbuilt limitation of using case books as an historical source. This volume issues an invitation to investigate further Snow's practice during the early years of anaesthesia. At the same time, it should remind us of the wider possibilities of private practice case books both as a source of information about behaviour at the bedside and as a vehicle for exploring one of the medical practices most neglected by historians, namely, the practice of record keeping.