偉大な医師たち：伝記による医学史

23 Hermann Boerhaave (1668-1738)	23 ブールハーフェ (1668-1738)
Albrecht von Haller writes of his teacher Boerhaave: "Communis Europae sub initio hulus saeculi magister. " In actual fact, at the beginning of the eighteenth century Boerhaave exerted an unexampled attractive force upon all young doctors and students of medicine. Thanks to him, the university of Leyden, where he worked, became the focus of medical life. In Leyden to-day we encounter his traces at every turn. His tomb is in the St. Pieterskerk. Near the old hospital is his monument. Whenever a medical congress is held in Leyden, this monument is bedecked with flowers. The magnificent new buildings in which the medical faculty is housed are known as the "Boerhaave-Kwartier." There is an active cult of his memory.	ハラーは先生であるブールハーフェについて「当代全ヨーロッパの師表」と書いた。実際ブールハーフェは18世紀の初めのすべての若い医師および医学生にとって他に例が無いほどの引力を持っていた。彼がいたライデン大学はこれによって医学の中心となった。今日でもライデンに行くとあらゆる街角で彼の跡を見ることができる。彼の墓は聖ペーテル教会にあり旧病院の近くには記念碑がある。ライデンで医学会が開かれるとこの記念碑は花で覆われる。医学部がある大きく立派な建物はブールハーフェ地区と呼ばれている。彼にたいする尊崇が生きている。
To what did he owe his extraordinary fame? His writings do not suffice to explain it. He wrote comparatively little: two rather short works; one of them entitled Institutiones medicdae (1708); and the other Aphorismi de cognoscendis et curandis morbis (1709). Apart from these, there were a few botanical and chemical papers, some clinical histories, and a number of academic orations. No doubt it is still a great pleasure to read his thoughtful speeches. His clinical histories are masterpieces. As for the two books already mentioned, their conciseness, their clarity, and their sobriety make them contrast very agreeably with much of the literature of the day, which was apt to be prolix and obscure. Sustained by their author's repute, they ran through numerous editions and were translated into various languages, even into Turkish. We see that Boerhaave's name must have been widely known in his lifetime.	彼のこのように特別な名声の理由は何であろうか？著作だけからは説明できない。彼はほんの少ししか書いていない。どちらかと言うと短い2冊の本だけであった。「医学指針」と「診断診療箴言」であった。これらの他に少数の植物および化学の論文、幾つかの臨床病歴、かなりの数の大学における講演である。もちろん、今でも彼の思慮深い講演を読むのは大きな楽しみである。彼が書いた病歴は名作である。上に述べた2冊の本は簡潔さ・明瞭さ・穏健さにおいて冗長で同時代の多くの曖昧な本に比べると極めて気持ちが良い。著者の令名に支持されて版を重ねトルコ語をはじめとして多くの言語に翻訳された。生きているときからブールハーフェは広く知られていたことが判る。
Still, when we read his writings we find nothing revolutionary in them. He made no discoveries, he did not contribute any new ideas of moment to medicine. Nor did he belong to any school, being an eclectic. Yet that was what gave him his source. He was firmly and enduringly convinced of the importance of anatomy and physiology to medicine. He knew that physics could make important contributions to medicine, and he was therefore strongly inclined towards iatromechanics. Nor was it surprising that in Leyden, where the tradition of Sylvius was still alive, he should have recognised the value of chemistry. Among more recent physicians, however, Sydenham seemed to him by far the weightiest, "I should blush to mention his name without extolling him," he said in one of his speeches.	彼の著作を読むと革命的なものは存在しない。彼は何の発見もしておらず、医学に何も新しい考えを与えなかった。彼は折衷主義者でどの学派にも所属しなかった。しかし、これこそ彼に力を与えたものであった。創始者が誰であろうと良いものを採用した。彼は医学における解剖学と生理学の重要性を堅く辛抱強く信じていた。物理学が医学へ重要な貢献をすることを知っていて、したがってイアトロ機械主義の傾向をもっていた。シルヴィウスの影響が残っているライデンで彼が化学の価値を認めていたことは驚くことではない。しかし当時の医師たちの間でシデナムをもっとも重要視していた。「賞賛せずにシデナムの名をあげるとしたら恥ずかしい」とある演説で述べた。
It is out of these elements that modern medicine has been upbuilded. But in the opening of the eighteenth century, considering how elementary as yet were the science named, it would have been overbold to attempt a synthesis of these elements, and would merely have led to the construction of an artificial system. Boerhaave, therefore, wisely renounced the idea of establishing a circumscribed system. He made no attempt to explain all morbid phenomena. He was much less interested in theory than in the patient and the cure -- in medical practice.	現代の医学はこれらの要素から作られている。しかしここに挙げた科学は18世紀の初めにはまだ初歩的の状態だったことを考えると、これらの要素を総合しようとする試みは軽率であり人工的な体系を形成するに過ぎなかった。従ってブールハーフェは賢いことに境界のある体系の作成を放棄した。彼はすべての病的現象を説明しようとは試みなかった。患者と治療、すなわち臨床、に比べて理論に興味を持たなかった。
The secret of Boerhaave's success is to be found, not so much in his scientific writings, as in his personality, in his alluring personality as physician and clinical teacher. Any one who had come into close contact with him, any one who had seen and listened to him at the bedside, would never be able to shake off his influence, would burn for the rest of life with sacred fire, and would persistently have the picture of an ideal physician before his eyes. All Boerhaave's pupils were at one upon this matter; they were grateful to him and remained deeply attached to him, describing him as extraordinarily kindhearted, and ever ready to give help. Haller writes of him: "In respect of learning he had equals, though perhaps not many; but hardly any one was worthy to rank with him in his truly divine character, in his goodness to all, ever heard him say a disparaging word."	ブールハーフェ成功の秘密は彼の科学的著作によるのではなく彼の個性、医師および臨床教師としての魅力ある個性、によるものである。親しく接触した人、ベッドサイドで彼を見て話を聴いた人は誰でもその影響を振り切ることはできず、神聖な火が一生のあいだ燃え続けて理想的な医師像を目の前に持つことになったであろう。この点でブールハーフェの弟子たちは一致していた。感謝し深く傾倒し続け、心優しくて何時でも助けてくれようとしている、と語った。ハラーは次のように書いた。「学識については、たぶん多くはないかも知れないが同等の人は居る。しかし、真に神のような性質、すべての人にたいする親切心、嫉妬深い人たちや競争相手にたいする慈悲心、において彼とならぶ人は居ない。他人をさげすむ言葉を彼が発しているのを聞いたものは居ない。」と。
Boerhaave was the son of an impecunious country clergyman, and was himself destined for the Church. In Leyden he was, to begin with a student of theology. Soon, however, he found that mathematics, chemistry, botany, and medicine were far to his taste, and in the end he made up his mind to transfer to the medical faculty. Not wishing to attract attention to this change of plan, he removed to another university and took his degree in medicine at Harderweijk. Then returning to Leyden, he settled down there as a doctor. Not having many patients to begin with, he had plenty of time for wider education, especially in mahematics. In 1701 he was appointed lector of theoretical medicine, and was so successful in this post that two years later he received a call Gröningen. Leyden, however, did not want to lose him. The university raised his salary, and promised him the next vacant chair. Even in those days professors were long-lived men, and Boerhaave had to wait six years for his promotion. When Hotton died in 1709, Boerhaave became professor of botany, and the post carried with the direction of botanical gardens. "No explorer," writes Haller, "ever made his way into more unknown country than this new professor, who knew almost nothing abut plants, however much he might have excelled in other departments of knowledge. He applied himself so diligently, however, that, in spite of the severe winter of 1709, in 1710 he was able to publish a list of his plants which excelled that of any of his predecessors." Haller makes repeated mention of Boerhaave's devotion to the botanical gardens. Every morning at seven o'clock he demonstrated plants to the students, "generally pointing out to them on each day hundreds of plants and giving supplementary names without making use of notes." The botanical gardens of Leyden soon became among the finest in the world, for Boerhaave, corresponding freely with men in similar positions, secured seeds from far and wide. "The finest feature of the place is," writes Haller, "that everything is purposively arranged, so that a stranger with Boerhaave's list in his and can recognise all the plants in accordance with their serial order and by means of the ticketed staves."	ブールハーフェは貧しい田舎牧師の息子であり聖職に進むはずであった。ライデン大学で最初は神学部の学生となった。しかし間もなく数学、化学、植物学、医学に興味を持ち、医学部に移る決心をした。この計画変更を知られることを好まないので他の大学に移ってハルデルウェイク大学で医学の学位を得た。次いでライデンに戻り、医師として落ち着いた。最初には多くの患者が得られなかったので、広範な学問とくに数学を学ぶ十分な時間を持った。1701年に彼は理論医学の講師となり、ここで成功して2年後にはフローニンゲンに招聘された。しかしライデンは彼を失うことを好まなかった。大学は彼のサラリーを上げて次の空席を約束した。この頃も教授は長命でブールハーフェは昇進に6年待たなければならなかった。1709年にホットンが死亡したときにブールハーフェは植物学の教授となり、この職は植物園長も兼ねることになっていた。ハラーは書いた。「どんな探険家もこの新しい教授のように知らない国に行くことはなかったろう。彼は他の知識分野では有能かも知れないが植物については何も知らなかった。しかし1709年の冬はひどく寒かったが、熱心に仕事をして1710年には先任者の誰よりも優れた植物リストを刊行した。」と。ハラーはブールハーフェの植物園への貢献を繰り返し述べている。毎朝7時に学生たちに植物を見せて「毎日ふつう数百の植物を示し、メモさえ見ないで補足的な名前を与えた。」と。ライデンの植物園は世界最良のものとなった。同じ立場の人たちと自由に交流して広範囲に遠くからも種子を入手していたからであった。「この場所の最良の点はすべての植物が目的別に配置されていて、外来者でもブールハーフェのリストを手にしていると番号に従い名札を見てすべての植物を知ることができる」とハラーは書いている。
In the winter Boerhaave lectured on chemistry. His importance in the specialty is for the most part over-estimated, for indeed there is a tendency to describe him in somewhat exaggerated terms as a man of overwhelming ability in all the fields he tilled. No doubt he was a brilliant experimenter, and his marked capacity as a teacher did not fail him in the chemical laboratory or lecture-theatre; but he was not an originator here, being content to follow in the footsteps of his predecessors, especially those of Robert Boyle.	ブールハーフェは冬には化学の講義を行った。この学問における彼の重要性は多くのばあい過大評価されていた。実際、関連したすべての領域で彼は圧倒的な能力を持っていたと誇張して書かれる傾向がある。彼が優秀な実験家であり教師としての優秀な能力は実験室でも講堂でも他人にひけを取らなかったことは疑いもない。しかしこの領域で彼は独創的な研究をしておらず以前の人たち特にボイルの足跡に従っていた。
Where Boerhaave was incomparable was in the domain of clinical instruction, which he took over in 1714 after the death of Bidloo. At the bedside of the sick, the full powers of his personality were unfolded. Here he was not a mere iatromechanical theoretician, but a great physician in the profoundest sense of the term. He approached his patients with the keen insight of the born diagnostician, treated them with affection as well as with medicine and good advice, and carried his hearers with him, when lecturing or demonstrating, by the rigorousness of his logic. In the hospital behind the Vrouwen Kerk there were two rooms, each containing six beds -- a ward for men and a ward for women available for clinical instruction. Half the doctors of Europe were trained beside these twelve beds! Day after day, Boerhaave went from case to case, explaining them to his students. The senior students were asked to give practical advice just as they are in our modern hospitals. If we wish to form an idea of the abundance of material dealt with by Boerhaave in his clinical demonstration, we must turn to the editions of the Institutiones and Aphorismi that were edited with commentaries by his pupils van Swieten and von Haller, for the commentaries consist mainly of Boerhaave's own observation, as noted down by these two students. Van Swieten, whose acquaintance we shall make in the next chapter but one as the reformer of medicine in Vienna, was a good shorthand writer. His notebooks are extant. They have been deciphered, and show us in the liveliest possible way how clinical instruction was given by Boerhaave.	ブールハーフェに比肩するものが他にいないのは臨床教育の領域であった。1714年にビドローの死後になって臨床教育を行うようになった。病人のベッドサイドで彼の個性はすべて示された。彼はイアトロ機械主義の単なる理論家であるだけではなく言葉の深い意味における偉大な医師であった。生まれつきの診断者として鋭い洞察をもって患者に接し医薬や正しい助言だけでなく親しみを患者に与え講義や臨床教示にさいして厳しい論理を聴講者と共有した。フラウヴェン教会の裏にある病院には２部屋があり、それぞれに６床のベッドがあって、臨床教育のための男子病棟と女子病棟であった。ヨーロッパの医師の半分はこの12床で教育された！毎日ブールハーフェはベッドからベッドに進んで学生たちに説明した。我々の現代の病院におけると同様に年長の学生は実際の説明をするよう要求された。もしもブールハーフェが行った臨床教示の豊富な材料を知りたかったら、「医学指針」と「診断診療箴言」を読むとよい。それぞれ2人の弟子スヴィーテンおよびハラーによって注釈を付けて編集されたものであり、注釈は主としてブールハーフェ本人の観察を2人が記録したものであった。ハラーについては次章で述べる。スヴィーテンについては後の章でウィーンにおける医療改革者として述べるが、スヴィーテンは有能な速記者でもあった。彼のノートは現存して読解されていて、ブールハーフェがどのように臨床教育を行ったか生き生きと示している。
Although the roots of the new method reach as far as Padua, it was Leyden, it was Boerhaave's hospital, which was the cradle of modern clinical methods. Here a sound method for the examination of the sick was first worked out. To begin with, the anamnesis (clinical history) was fully recorded; and then the present condition of the patient was ascertained. The investigation was not as yet anatomical. The doctor did no ascertain the condition of the organs, but that of the malady. Thereafter a diagnosis and a prognosis were made, and a course of treatment was laid down. The seed sown in this way at Leyden was soon to sprout in many other places.	新しい臨床教育方法の起源はパドヴァに遡るものであるが、現代の臨床教育方法の揺りかごはライデンであり、ブールハーフェの病院であった。病人を診察する健全な方法は最初にここで行われた。まず、既往症(臨床歴)を完全に記録する。ついで患者の現症を確かめる。検査はまだ解剖学的ではなかった。医師は臓器を調べることはなく病気を調べた。続いて診断と予後が決定され治療過程が工夫された。ライデンで蒔かれた種は多くの場所で発芽した。
Students at Leyden in Boerhaave's day had the advantage of learning, not only from that famous clinician, but also from a distinguished anatomist, Bernhard Siegfried Weiss, who Latinized his name as Albinus.	ブールハーフェの時代の学生たちはこの有名な臨床家から学ぶ利点だけでなく優れた解剖学者ワイスからも学ぶことができた。彼は自分の名前をラテン語化してアルビヌスと称していた。
Boerhaave's practice increased from year to year. Haller writes: "From ten till twelve his consulting-room was thronged by those who sought his advice, for pressure of work now made it impossible for him to visit patients in their homes. Often enough the morning consultations outlasted the fixed hours, so that lecture time had come before he had had a moment in which to eat hi dinner. At three in the afternoon additional patients began to arrive. What remained of his day was spent in an extensive correspondence and in his long-continued labours upon the writings of the Greek physicians -- unless some distinguished patient dragged him away from his work." Elsewhere in Haller's journal we read: "So widely known did Boerhaave's name become, that students from all lands assembled to hear him, and there was no patient of high degree who did not seek his advice. I have myself seen Monsieur Fenelon, ambassador at the Hague, waiting to catch him as he came out of the lecture-theatre. We students numbered about 120, half of whom were from foreign lands. I doubt if any medical professor's lecture-room was ever before so well-attended as Boerhaave's. Wealth flowed to him from all parts, and it was supposed that his only daughter would inherit a few tons of it. In 1725, not long before my arrival, he had suffered from severe inflammation of the joints, which deprived him completely of sleep."	年を追ってブールハーフェは臨床で忙しくなった。ハラーは書いている。「10時から12時にかけて彼の診察室は診察を希望する人たちで一杯になり、ついには患者を往診することが出来なくなった。朝の診察が規定時間を過ぎてしまって、しばしば昼食を取る前に講義時間になった。3時になると新しい患者たちが到着した。1日の残った時間は高貴な患者に邪魔されないときには、詳細な文通および、長期にわたって行ってきたギリシアの医師たちの著作についての研究に費やされた」と。ハラーの日記の別の所で読むことができる。「ブールハーフェの名前は広く知られるようになり、あらゆる所の学生たちは彼に習うことを希望し、高貴な人たちで診察を希望しないものはいなかった。ハーグの大使であるムシュー　フェネロンが講堂から出てくる彼を捕まえようとしているのを私自身が見た。我々学生の数は約120人で、そのうち半分は外国から来ていた。学生がこのように多く出席している医学部教授の講義室があるかどうか私は知らない。礼金はあらゆる方向から流れ込み、彼の唯一の娘はかなりの財産を相続しただろう。私が到着する少し前の1725年に彼は激しい関節の炎症で苦しみ、これによって殆ど眠ることができなかった。」と。
These attacks of gout became so violent and so frequent that Boerhaave had to cut down his work, and in 1729 he resigned the professorships of chemistry and botany. He continued, however, to give clinical instruction until in 1738, in the seventieth year of his life, he was finally relieved of his sufferings.	痛風発作は激しくしかも回数が多かったのでブールハーフェは業務を減らさなければならず1729年には化学と植物学の教授を辞任した。しかし臨床は70歳になった1738年まで続け、ここで彼は苦しみから解放された。

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