偉大な医師たち：伝記による医学史

15 Ambroise Paré (1510-1590)	15 パレ (1510-1590)
In 1536 began the third war between Francis I and Charles V. It was on the account that Vesalius had quitted Paris. Paracelsus, who was living near Augsburg, devoted himself in the perfectionment of a vulnerary balsam. Fracastro was working at astronomy just then.	1536年にフランス王フランソワI世と皇帝カルルV世のあいだの3回目の戦争があった。ヴェサリウスがパリを離れたのはこのためであった。パラケルススはアウクスブルクの近くに住んでいて傷薬の完成に努力していた。フラカストロはそのころ天文学を研究していた。
Once more the struggle was for Milan, and it was mainly fought upon Italian soil. A French army crossed the Alps and descended by way of Susa to attack Turin. In passing, the fortress of Villine, which was held by the imperial troops, was stormed. The garrison made a desperate defence, and there were many dead and wounded. The surgeons had their hands full. Passing from case to case, they poured boiling elder oil into the wounds. The poor wretches thus treated yelled in their agony, but they had to submit, for the wounds were "poisoned with gunpowder" and in default of such cauterisation the poison would prove fatal. Such was the teaching of Giovanni de Vigo, surgeon-in-ordinary to the Pope.	今度も問題はミラノで主としてイタリアで戦闘が行われた。フランス軍はアルプスを越えスーサを通ってトリノを攻撃した。通りがかりに皇帝軍が守っていたヴィレン要砦を急襲した。守備兵は死に物狂いの防衛を行い多くが戦死したり傷ついた。外科医は手が回らないほど忙しかった。患者から患者に回り傷に沸騰したニワトコ油を注いだ。このような治療を受けた可哀想な患者は苦悶の声をあげたが仕方が無かった。傷口は火薬の毒が入っているのでこのように焼灼しないと毒によって死ぬと考えられていた。これはローマ法王の主治医ヴィゴの学説によるものであった。
The young French surgeon, Ambroise Paré, on his first campaign, was thus engaged when the elder oil ran short. What was he to do? He had with him a salve made of yolk of egg, attar of roses, and turpentine. Smearing lint with he ointment, he used it to plug the wounds. But he had an uneasy conscience. "Last night," he relates, "I could hardly sleep for continually thinking about the wounded men whose hurts I had not been able to cauterise. I expected to find them all dead next morning. With this in view, I rose early to visit them. Greatly to my surprise, I found that those whom I had treated with the salve had very little pain in their wounds, no inflammation, no swelling, and they had passed a comfortable night. The others, those whose wounds had been treated with boiling elder oil, were in high fever, while their wounds were inflamed, swollen, and acutely painful. I determined therefore, that I would no longer cauterise the unfortunate wounded in so cruel a manner."	フランスの若い外科医パレにとってこの戦闘は最初であったがニワトコ油は使い切られた。どうしたら良いのだろうか？彼は卵黄、パラ油、テレピン油からなる軟膏を持っていた。これをリント布に塗って傷に栓をした。しかし彼の良心は休まなかった。彼は述べた。「昨晩、傷口を焼灼できなかった傷兵を絶えず考えてほとんど眠れなかった。翌朝はすべて死んでいる可能性を考えた。このように考えて私は早起きして回診した。驚いたことに軟膏で治療した人たちは、ほとんど痛みが無く、炎症が無く、腫脹が無く、静かに夜を過ごしていた。ところが、沸騰したニワトコ油で傷を処置した人たちは、高熱を出し、炎症が起き、腫脹し、激しく痛んだ。したがってその後には不幸な傷をこのように残酷な方法で焼灼しないことにした。」と。
As so often happens, chance led to a discovery of prime importance, to the discovery that gunshot wounds are not poisoned wounds, and that the dominant theory was erroneous. But, as always, a man of genius was needed to grasp the significance of this chance happening, to deduce the right inferences, to elaborate and defend the new knowledge until it had become general property.	よく起こるように偶然は最重要な発見に導く。すなわち銃創の傷に毒は無く通説は誤りであることを示した。しかしこの偶然な出来事と意義を把握し正しい結論に導きこの新しい知識が共有物になるまで擁護するにはいつものことであるが天才を必要とする。
In Italy during the thirteenth century there had been a great development of surgery, which had spread thence to the adjoining land of France. Surgery must always keep in close touch with life, and can never be so theoretical as internal medicine. Only by practice does a man learn how to operates. A suture holds the edges of a wound together, or it fails to do so. One thing or the other; there can be no dispute about the matter. That was why, even during the heyday of scholasticism, there had been noted practitioners of surgery. Indeed, the prevailing interest in classical and Arabic medical literature was most advantageous to them. They could try this, that, and the other, and hold fast to what was good. Tradition was sifted by practice and could prove fruitful instead of sterile.	イタリアでは13世紀に外科学が発達し隣のフランスに広がった。外科学は生命と密接な関係があり内科学のように理論的ではあり得なかった。実行によってのみ手術は学ばれる。縫合は傷口を保持する。そうでなければ失敗する。成功するか失敗するか。このことは議論ではない。スコラ学の最盛期にも有名な外科医が居たのはこのためであった。実際、古典医学やアラビア医学文献が広く行われるようになったことは彼らにもっとも有利であった。彼らはこの方法、あの方法、または他の方法を試して良い方法を採用した。伝統は実行によって変更され不毛なものではなく収穫が多いものになった。
To the surgeons of those days, when most wounds were made with cold steel, "healing by first intention,: that is to say a primary, non-suppurative growing together of the edges of a wound, seemed the most desirable ideal. A change came, however, during the fourteenth and fifteenth centuries, when the increasing use of firearms imposed new tasks upon army surgeons. Even "small arms" were then of large calibre, their bullets ranging up to nearly an inch in diameter. These projectiles must have inflicted horrible wounds, most of which, doubtless, were infected from the outset. We can hardly be surprised, therefore, that by degrees the idea gained ground that suppuration was a normal stage in the healing of wounds, and that gunshot wounds were poisoned by the gunpowder. As for suppuration, you may still hear the expression "laudable pus."	大部分の傷は刃物によった時代の外科医にとって傷は一次治癒すなわち化膿しないで傷口の閉じるのが理想であった。しかし14世紀から15世紀になって火器が使われるようになると軍外科医たちに新しい任務が課せられるようになった。「小火器」と言っても当時の弾丸の直径は約1インチに及んでいた。これらの弾丸はひどい傷を負わせ多くが最初から感染していたことは疑いの余地が無い。従って化膿は傷の治癒における正常の段階であり銃創は火薬の毒で汚染されている、とする考えが次第に勢力を得てきた。化膿について今でも「歓迎すべき膿」(＊古代ギリシアから盛んに使われたが現在は死語)という言葉を聞くことがあるだろう。
Time was needed, however, before Paré's discovery could take effect. Paré was not a man of learning, was not a writer as well as a surgeon. His instrument was the bistoury, not the pen. He sprang from the common people, being a handicraftsman (as were most surgeons in those days) and devoid of humanist culture. Born in 1510 at Bourg-Hersent near Laval in Maine, he had for a time been a barber's apprentice. Then, going to Paris, he spent several years working at surgery in the Hôtel-Dieu. When the war broke out he was considered sufficiently expert to accompany Marshal Montejan as regiment surgeon. His scientific equipment was in considerable. Since he had never learned Latin, the writings of the ancients were closed books. But he was endowed with great surgical skill, was a good observer, and was so eager to learn that he would try the recipes of old wives and would pay court to obscure surgeons in order to learn the secrets of their practice. Like Paracelsus, he did not disdain to study the therapeutic lore of the common folk.	しかしパレの発見が功を奏するには時間が必要であった。パレは学者ではなかった。外科医ではあったが著作者ではなかった。道具は柳葉刀(細身のメス)であってペンではなかった。彼はふつうの人間であって当時の大部分の外科医と同じように手職人(床屋)であり人文学者としての教養は無かった。1510年にメーヌ(フランス北西部)のラヴァル市の近く(現在はラヴァル市内)に生まれ、しばらくの間は床屋の徒弟であった。次いでパリに行きオテル-ディユ病院の外科で数年のあいだ働いた。戦争が始まったときに彼は連隊付き外科医としてモントジャン元帥に従うのに適当な専門家であると認められた。科学の知識はかなりのものであった。ラテン語を学んだことがなかったので古代の著書を読むことはできなかった。しかし彼は外科手術が巧みであり良い観察者であり学ぶのに熱心であって、老婆たちの処方を確かめ無名の外科医たちのご機嫌をとって彼らの秘術を学んだ。パラケルススと同じように大衆の治療知識を軽蔑しなかった。
Upon this first campaign, his abilities attracted attention. A physician of Turin, who saw him at work, said to Marshal Montejan: "Sir, you have with you a surgeon who, though young in years, is old in knowledge and experience. Take great care of him, for he will do you good service and bring you honour."	この最初の戦闘において彼の能力は注目された。トリノの医師は彼の仕事を見てモントジャン元帥に言った。「閣下、貴方のところには若いけれど知識と経験に富んだ外科医が居ます。大事になさい。彼は貴方に貢献し役に立つでしょう。」と。
After the Peace of Nice in 1538, Paré returned to Paris. He married, and devoted his energies to practice. A few years later, war broke out again between the two monarchs, and Paré was eager to march with the French army. The methodical efficacy of his new way of treating wounds, his marked operative skill, and his successful dealing with the wounds of persons of importance, made him more and more widely known. His colleagues recognised his superiority, and begged him to put his ideas concerning the principles of wound surgery upon written record.	1538年のニース講和の後でパレはパリに戻った。結婚し臨床に専念した。数年後に戦争は再び２つの君主国のあいだで戦争が始まり、パレはフランス軍と一緒に進軍することを希望した。傷を処理する彼の新しい方法の理論的な有効性、彼のすばらしい手術能力、および重要な人物の傷を治したこと、によって彼は広く知られるようになった。同僚たちは彼の能力を認め外傷外科についての原理を記録に残すようにと彼に頼んだ。
After the peace of Crespy in 1544, Paré was again in Paris. His fame had reached the ears of Jaques Dubois, whose acquaintance we have already made as one of Vesalius' teachers.Dubois invited Paré to Dinner. The two men had a talk about gunshot wounds. Paré warmed to the subject, related his experience, and explained his reasons for believing that gunshot wounds were not necessarily poisoned wounds. Dubois, recognising the outstanding intelligence of his guest, likewise urged him to publish his experiences, in order to counteract Vigo's disastrous teaching. It was under these auspices that, in 1545, was published Paré's first literary work, the little manual upon the treatment of gunshot wounds which has become a classic. This was the first of a long series of valuable monographs.	1544年のクレスピ講和の後にパレは再びパリに居た。彼の令名はデュボアの耳に入った。デュボアはヴェサリウスの先生の一人としてすでに述べた。彼はパレを夕食に招待した。2人は銃創について話した。パレはこの問題に熱中して経験を話し銃創には必ずしも毒が入ってはいないと信ずる理由を説明した。デュボアはこの客の知性が優れていることを認めてパレの同僚と同じようにヴィゴの有害な学説に対抗するためにこの経験の出版を勧めた。このような後援の下にパレの最初の著作が刊行された。銃創の治療についての小さな手引きであったが古典となっている。これは価値ある長いシリーズのモノグラフの最初のものである。
If anywhere, it was in the field of surgery that the new science of anatomy was to come into its own. Paré had from the first recognised the great importance of anatomy. Even when on active service, he made dissections whenever opportunity offered; and he relates having dissected the left side of a body while leaving the right side intact as a guide to operate work -- a specimen which he took home with him. The years 1545 to 1550 were mainly devoted to anatomical study, with two interruptions for field surgery connected with the siege of Boulogne. Dubois appointed him prosector. Dubois was firmly convinced of the soundness of Galen's teaching, and it was not until the professor died that Paré ventured to acknowledge his acceptance of the new Vesalian anatomy. Then several anatomical works of his own were published. Although they did not contain any new discoveries, we have to remember, when considering them, that theyt were composed exclusively for practical purposes, were guide for surgeons who needed topographical rather than systematic knowledge.	新しい解剖学を自己のものにしたのは他の領域ではなく外科学であった。パレは最初から解剖学の重要性を認めていた。従軍しているときでも可能なときには解剖を行っていた。彼は人体の左側を解剖し右側を手術の役に立つようにそのまま残して標本として持ち帰った。ブローニュ包囲のさいに戦陣外科を行った以外は1545年から1550年に主として解剖学の研究を行っていた。デュボアはパレを解剖従事者に任命した。デュボアはガレノスの教えが正しいとする信念を持っていて、パレはデュボアが死亡するまでは新しいヴェサリウスの解剖学を敢えて受け入れなかった。その後に何冊かの彼自身の解剖学書を出版した。新しい発見は無いがこれらの本はもっぱら実用的なもので、体系解剖学ではなく外科医が必要とする局所解剖学であったことを忘れてはならない。
In 1552 war broke out again. This campaign was of the utmost importance to Paré, for it was now he became aware that, in amputation, ligature was preferable to cauterisation for the arrest of haemorrhage. The ligature was not a novelty, but an old device which had passed into oblivion, and upon whose advantages it was needful to insist once more. The same year, under order from the king (whose surgeon-in-ordinary he had become), he managed to make his way into the beleaguered city of Metz, to help the wounded there. When next year he was taken prisoner at Hesdin, he bought his freedom by amazingly successful operations, without disclosing his identity to the enemy. Fresh honours were awaiting him in Paris. In 1554 he was appointed maitre-chirurgien at the Collège Saint-Côme -- an unprecedent honour for a sometime barber's assistant who had no Latin.	1552年に戦争が再び始まった。この軍事行動はパレにとって最も重要であった。何故かというと手足切断には血管結紮が焼灼よりも止血に役立つことに気付いたからであった。血管結紮は決して新しいことではなく忘れられていた古い方法であったが有効なので改めて強調する必要があった。彼は王の主治医になっていて王の命令によって、包囲された都市メス(フランス北東部)にその年に何とか入って傷ついた人々を助けることができた。翌年エスダンで捕虜になったときに多くの手術に成功したので身分を敵に知られずに釈放された。パリには新しい名誉が待っていた。1554年に彼はコレージュ-ド-サン-コムの外科医長に任じられた。これはラテン語を知らない理髪師徒弟であったものにとって特例であった。
The ensuing years were spent in war service, in accompanying the king upon journeys, and in Parisian practice. In the army, Paré's popularity was unbounded; and after the death of Henry II, Francis II, and then Charles IX, continued to place the utmost confidence in him. He wrote many more books. Whenever a question was topical, he was moved to record his experiences upon the matter. Sometimes these concerned purely medical and surgical matters, but sometimes led him father afield, and then brought him into conflict with the faculty. He died on December 20, 1590, when eighty years of age.	続く年々は、戦争、王の旅行のお供、パリにおける臨床、に費やされた。軍隊でパレの令名は高かった。アンリII世の死去に続いて、フランソワII世、シャルルIX世は彼を心から信頼した。彼は多くの本を書いた。何か重要な問題が起きると彼は自分の経験を書き記させられた。これらは純粋に医学や外科学のこともあったが戦場に行くこともあったので教授会と軋轢を生ずることがあった。彼は1590年12月20日に80歳で死亡した。
Paré, also, was a man of the Renaissance, although of a very different type from the physicians studied above. Like them, however, he was a discoverer of new territory and a conquistador. Unencumbered by tradition, he followed his sound instinct. Many of the operations he introduced into daily practice were not new but had been forgotten, and were revived through his authority.	パレはこれまで述べた医師たちとは大きく違うが、やはりルネッサンス人であった。違うとは言っても新しい領域の発見者であり征服者であった。慣習には邪魔されずに健全な本能に従った。毎日の臨床で使った手術は新しいものではなく忘れられていたもので、彼の一存で復活させたものであった。
A practitioner above all, nevertheless as a writer he felt the need to provide theoretical grounds for his contentions. He did this with the aid of the medical ideas of Galen, some of whose writings -- and especially the Methodus medendi -- had been translated into French. He was far from being opposed to Galen, as Paracelsus and Vesalius had been. How could he, a mere barber by training, venture to contradict the great master? All the same, the most characteristic feature of Paré's work was that when he found a disharmony between theory and experiment he gave theory the go-by. Experience took the lead; "ratio" and "auctoritas" must bow to it, and were only valid when they confirmed it.	彼は何よりも臨床家であったが著作にあたっては自分の主張に理論的な基礎を準備する必要を感じていた。彼はガレノスの医学的な考えに助けを求めた。ガレノスの著書とくに「治療の方法」はフランス語に訳されていた。彼はパラケルススやヴェサリウスのようにガレノスに反対するどころではなかった。単なる理髪師として訓練されたのにどうして偉大な学者に反対できるだろうか？何にもせよパレの研究の特徴は理論と実際が矛盾したら理論を見て見ぬふりをしたことであった。経験が主導し、「理性」と「権威」は頭を下げるべきであり、もしもそれらが経験を確認するならば正しい、と考えた。(＊スコラ学は「理性」と「権威」を基礎とした)
Paré's ways of thinking are admirably illustrated by the following anecdote. When he was on his first campaign, a scullion fell into a cauldron of boiling oil and was horribly scalded. Paré having been summoned, he ran off to the apothecary to fetch the customary cooling applications There he encountered an old woman who advised him to apply raw onion. chopped and sprinkled with a little salt, for this, she said, as experience had shown her again and again, would prevent the formation of blebs. True to his principles to make trial of every remedy from which good might be expected, Paré followed the old woman's counsel, and the result was satisfactory. He continued experimenting in this direction. A German soldier had his face badly burned, and Paré treated half the face with chopped onion and the other with one of the usual remedies. The result was that on the former half no blebs formed whereas the other half was thickly covered with them. Soon afterwards a number of soldiers, while storming a fortress, were burned by the ignition of a train of gunpowder. Paré seized the opportunity to try the method once more, treating some of the patients with onions and the rest of them otherwise -- with the same result as before. These experimental data convinced Paré that the application of raw onion was of great value in the treatment of burns and scalds. But what had theory to say about it? According to Galen, onions are warm in the fourth degree, and are therefore strongly contra-indicated in burns and scalds. Paré did not venture to infer that Galen had been wrong. Yet it never occurred to him to doubt the accuracy of his own observations, and since it was necessary to confirm them "ratione et auctoritate," theory must be adapted to experience. Well, every one knew that it was with Galen as with the Bible. By searching diligently, you could find a text to support whatever you pleased -- or you could modify the text to suit your wishes. Paré discovered that onions are indeed potentially, that is to say metaphorically, warm in their effect; but that actually, that is to say as made know to us by our sense, they are damp. By their warm temperament they thin the integument, and by their moistness they loosen its structure. We should infer from this that they would promote the formation of the blebs. Paré, however, argued that, thanks to the aforesaid qualities of onions, the inflamed humours were drawn forth, consumed, and dried, with the result that no blebs were formed -- this being a sign that Galenic doctrine is extensible, and must not be interpreted too rigidly. Here he had the proof "ratione"; and as for the proof of "auctoritate," Galen was himself the required authority. After all, Galen admitted numerous instances in which it was necessary to treat, not contraria contrariis, but similia similibus. For instance, vivper's flesh (in theriac) was an antidote to a viper's bite.	パレの考え方は次の逸話でみごとに示される。最初の従軍のときに台所下働きの男が沸き立つ油の大釜に落ちてひどい熱傷になった。パレは呼ばれ薬屋に行ってふつうの冷却剤を求めた。そこで彼は老婆に出会い細かく刻んで少量の塩を加えた生タマネギを使うのが良いと話かけられた。彼女はこの方法によって火ぶくれにならないでも済んだ経験を何度も持っているとのことであった。良い結果が得られるかもしれない方法を試すことにしていたのでパレは老婆の忠告に従ったところ満足すべき結果が得られた。彼はこの方向を試しつづけた。ドイツ軍の兵隊の一人が顔にひどい火傷をしていてパレは顔の半分を刻みタマネギで治療し他の半分にはふつうの治療を行った。この結果、最初の半分に火ぶくれはできず他の半分は火ぶくれで厚く覆われた。すぐ後でかなりの数の兵士が要塞の攻撃にさいして火薬の口火点火で火傷をした。パレはこの機会をとらえてこの治療法を再び試みた。半分の患者は刻み生タマネギで治療し他の半分の患者には他の方法を用い結果は前と同じであった。これらの実験結果によって生タマネギは火傷や熱傷に有効であることをパレは確信した。しかし理論はこれについてどう言っているだろうか？ガレノスによるとタマネギは4度の熱であるので火傷、熱傷に禁忌のものであった。パレはガレノスが誤りであるとは敢えて言わなかった。しかし自分自身による観察の正確さを疑うことはなかった。これらは「理性と権威により」確かめる必要があるので理論は経験に適合しなければならないものであった。だれでも知っているようにガレノスについても聖書についても言うことができる。熱心に探すと自分が好きな文章が見つかるし、もしも見つからなかったら希望に合うように文章を変えることができる。タマネギは潜在的すなわち比喩的には熱の効果を持つが、実際的すなわち我々の感覚では湿であることを、パレは見出した。この熱の性質は皮膚を薄くし湿の性質は構造をゆるくする。これによるとタマネギは火ぶくれを促進すると考えるべきである。しかし上に述べたタマネギの性質によって炎症体液が流れ出て消費され乾くことによって、火ぶくれはできない、とパレは論じた。このことはガレノスの学説は拡張性があり、あまり厳密に解釈すべきではないことを示すものとされた。ここでパレは「理性により」の証明とした。「権威により」としてガレノス自身は必然的な権威を持っていた。何にせよ病気は「正反対の薬で治る」でなく「似たものは似たもので治る」数多くの例があることをガレノスは認めていた。例えばテリアカ(万能の抗毒剤)中の毒ヘビの肉は毒ヘビに噛まれたときの抗毒剤であった。
Paré's commanding figure stands upon the threshold of modern surgery. It was thanks to him, in the main, that for several centuries France took the leadership in this field.	パレは新しい外科学の始めにあたって堂々と立っている。フランスがこの領域において数世紀にわたって指導的な役割をはたしたのは主として彼に負っている。
I must allude to one of his character traits which makes him more congenial than the majority of medical notabilities, one which distinguished him from many of his contemporaries. He was extremely modest, this modesty being the outcome of a profound piety which was untinged by bigotry. For him, as for Paracelsus, the foundation of the healing art must be love. Again and again we find him adjuring young surgeons not to work for the sake of menetary reward, and to do their duty to the last even in hopeless cases or cases that appeared hopeless. "for nature often brings things to pass which seem impossible to the surgeon." If the surgeon was successful in bringing about a cure, he must not plume himself on this, but must ascribe the happy result to God's grace. The oft-quoted saying of his, "je le pensai, Dieu le guarist," is the most signal of the great French surgeon's titles to honour, superadding to his manifold services the atmosphere of all that was best in humanism.	パレを同時代人と区別させるもの、すなわち当時の有名な医学者の多くに比べて親しみを持たせる性格について述べなければならない。彼は著しく慎み深かった。この慎み深さは偏狭さで影響されない敬虔の結果であった。彼にとって医術の基本はパラケルススと同じように愛でなければならなかった。金のために仕事をしてはいけない、希望が無いように見える例においても最後まで任務を果たすように、と若い外科医に繰り返して厳命した。「自然は外科医に不可能に見える例を与えることがあるから。」と。もしも外科医が治療に成功したら自慢してはいけない。幸福な結果は神の恵みと思わなければならない。彼の言葉で良く引用される「私は包帯し、神が治した」は偉大なフランス外科医の名誉の称号であり、彼の多くの貢献の上にヒューマニズム最高の雰囲気を加えたものである。

< 前へ目次次へ >

ComeJisyo Project

ComeJisyo Project