ヘンリー E. シゲリスト（Henry E. Sigerist)著
偉大な医師たち：伝記による医学史
The Great Doctors:A Biographical History of Medicine 1933
(Grosse Ärzte: Eine Geschichte der Heilkunde in Lebensbildern 1932 )
| 26 John Hunter (1728-1793) | 26 ハンター (1728-1793) |
|---|---|
| The scene changes, and we are back in England once more. No one who goes to London should fail to visit the museum of the Royal College of Surgeons. He will find there, in five great halls, thousands upon thousands of preparations and dissections belonging to the domains of human and comparative, of normal and pathological anatomy. But he will see there likewise objects such as are not to be found in ordinary anatomical museums. For instance he will find the skeleton of O'Bryan, the Irish giant, who was seven feet six and a half inches high, and beside it the skeleton of a Sicilian dwarf, a girl who at the age of ten was only one foot eight inches high. He will also find the skeleton of a famous racehorse, and that of a greyhound which belonged to a man of high rank. | 舞台は変わって再びイギリスに戻る。ロンドンに行ったら王立外科医協会の博物館を訪ねることを忘れてはいけない。そこには、5つの大きな広間に人間および動物、正常および病理の、何千という解剖標本がある。ここには他の解剖学の博物館には無いものが見られる。たとえば身長が7フィート6.5インチであったアイルランドの巨人オブライアンの骨格と、その脇には10歳で１フート８インチしかなかったシチリアの少女の骨格が見られる。有名な競馬ウマの骨格や高位の人が飼っていたグレーハウンドの骨格もある。 |
| At the first glance these curios show us that we are not in a typical modern collection. We become aware of the collector's spirit of the seventeenth and eighteenth centuries, when rarities and whimsicalities vied with classified scientific objects for a place in museums. The museum of the Royal College of Surgeons was, in fact, mainly grounded by the collection of an eighteenth-century surgeon named John Hunter, a Scotsman by birth. After his decease, his collection was bought by the government for 15,000 pounds. | 一見しただけで、これらは典型的な現在の収集物でないことが判る。珍しい物や奇抜なものと科学的な対象とが博物館の場所を競っていた17,18世紀の収集家の精神を知ることができる。事実、王立外科医協会博物館は主としてスコットランド生まれの18世紀外科医ジョン ハンターの収集物に基礎を置いている。彼の死後、政府は彼の収集物を15，000ポンドで購入した。 |
| Hunter, however, was no more collector. He occupies a leading place in the history of surgery and of medicine, so that it will repay us to become more closely acquainted with him. | しかしハンターは単なる収集者ではなかった。彼は外科学および医学の歴史で指導的な地位を占めているので、もっと詳しく彼のことを知る必要がある。 |
| In childhood he was the despair of the elders of his household, and no one ever anticipated for him a great career. He was the youngest of a family of ten, of whom (such mortality was characteristic of the age) three died in childhood, and four in early youth. The father, a pretty laird in Lanarkshire, was quite a veteran when John was born, and the mother spoiled her Benjamin, giving way to all his whims. At school he was an unsatisfactory pupil, so that his schooldays were short. Capricious and ill-tempered, when he could not get his own way he would howl for hours in succession. The only things he really liked doing were playing practical jokes or wandering in the woods in search of birds' eggs. He also has a way of asking inconvenient questions. "When I was a boy," he said of himself in later years, "I wanted to know all about the clouds and the grasses and why the leaves changed colour in the autumn. I watched ants, bees, birds, tadpoles, and caddisworms. I pestered people with questions about what nobody knew or cared anything about." | 子供の頃、彼は家族の年上のものにとって絶望であって大物になることを誰も期待しなかった。彼は10人の兄弟姉妹のうち最年少で、10人のうち3人は子供のときに死亡し4人は若いうちに死亡した。このような死亡率は当時は当たり前であった。父親はラナークシアの小地主でジョンが生まれたときには年をとっており母親は可愛い末子の気まぐれをそのままにしていた。学校では不出来な学生だったので学校生活は短かった。気まぐれで気むずかしく、したいように出来ないと何時間も泣き続けた。彼が本当に好きだったのは、悪戯をしたり森を彷徨って鳥の卵を探すことだった。彼はまた大人が困る質問をした。後になって彼は言った。「子供のときに、雲のこと、草のこと、および秋になぜ葉の色が変わるかを知りたかった。アリ、ミツバチ、鳥、オタマジャクシ、イサゴムシを観察した。私は誰も知らないことや興味を持たない質問をして人々を悩ました」と。 |
| What was to become of him? One of his sister had married a timber-merchant in Glasgow. Perhaps he could work in the business? But there, too, he made a poor showing. By this time he was twenty, and something must be done. For a youth of his sort it seemed that the only career open would be to enlist. However, before taking this desperate step, he would try another plan. His brother William, the pride of the family lived in London. William Hunter was about ten years older than John, had studied medicine in Glasgow, was a successful surgeon, and was devoted to anatomical studies. Perhaps William would help him, could find a use for him. John wrote to London, and William agreed to give his young brother a trial. | 彼は何になるだろうか？姉の一人はグラスゴーの材木商人と結婚した。この商売ができるだろうか？しかし、ここでも駄目だった。彼は20歳になったので、何かしなければならなかった。彼のような若者にとって唯一の経歴は兵士になることだけであった。しかし、このように絶望的な段階をとる前に彼はある計画を試すことになった。兄のウィリアムは家族の自慢の種でロンドンに住んでいた。ウィリアムはジョンより10歳上で、グラスゴーで医学を勉強し外科医として成功し解剖学の研究に打ち込んでいた。ウィリアムは彼を助け使うことが出来ると思われた。ジョンはロンドンに手紙を書きウィリアムは弟を試す承諾をした。 |
| In 1748, therefore, John Hunter journeyed to London, and became William Hunter's assistant. He arrived at a lucky moment. Since the beginning of the year, William Hunter had been giving private anatomical lectures to operative surgeons, with practical demonstrations. Wonder of wonders, the ne'er-do-well proved his mettle as William's assistant! He worked all day and far on into the night, kept the dissecting-room in good order, and showed himself an adept at securing the requisite bodies. Soon, moreover, he became a skilled dissector. | 従って1748年にジョンはロンドンに旅しウィリアム-ハンターの助手になった。彼は運良い時に到着した。その年の初めからウィリアム-ハンターは外科手術医たちに解剖学の個人講義を行い解剖教示をしていた。全く不思議なことに役立たず男はウィリアムの助手として熱情を示した！一日中、夜まで働き、解剖室を整頓して必要な死体を確保することに熟達した。さらに間もなく彼は上手な解剖師になった。 |
| He hd an excellent teacher in Brother William, who was a distinguished anatomist, surgeon, and accoucheur. William Hunter's treatise On the Human Gravid Uterus, first published in Latin in the year 1774, a huge folio enriched with thirty-four magnificent copper-plate engravings, has become a classic. William was an enthusiastic collector, not only of anatomical preparations, but also of books, manuscripts, medals, and paintings. His library and his anatomical collection are preserved in the university of Glasgow. The collector's fire is contagious passion. The younger brother was soon attacked by it, and it persisted for the rest of his life. | 兄のウィリアムはジョンにとって優れた教師であった。彼は優秀な解剖学者、外科医、そして産科医であった。ウィリアム ハンターの「人の妊娠子宮について」は最初1774年にラテン語で出版された。大きな二折判ですばらしい34枚の銅版画が含まれていて古典になった。ウィリアムは熱狂的な収集家であり、解剖標本だけでなく、書籍、原稿、メダル、絵を集めていた。この書籍および解剖標本の収集物はグラスゴー大学に保存されている。収集者の炎は伝染性の熱情である。弟のジョンもこの病気に罹り生涯続いた。 |
| Anatomy is not an easy profession for a young man who has had a poor education. As we have seen he had had very little schooling, and had never been at a university. Still, in those days it was possible for him to become a surgeon, so, on apprentice at Chelsea Hospital, transferring later St. Bartholomew's and to St. George's. In Cheselden and Pott he has excellent teachers, and after a few years he had mastered his craft. William wanted John to make up for the defects of his general education, so he sent the young man to Oxford, but John stayed only a few months, saying when returned: "They wanted to make an old woman of me, or that I should stuff Latin at the University; but these schemes I cracked like so many vermin as they came before me." | 殆ど教育の無い若い男にとって解剖学は容易な専門職業ではない。既に見たようにジョンは学校に少ししか行かなかったし大学に入ったことはなかった。しかし、この頃には外科医になることが出来た。従って、チェルシー病院で徒弟になり後に聖バーソロミュー病院および聖ジョージ病院に移った。チェゼルデンとポットは彼にとって素晴らしい教師であり彼は数年後には外科に精通した。ウィリアムはジョンが一般教育の欠けているのを補うためにオクスフォードに行かせたが数月で帰ってきて、「彼らは私を服従させ、私はこの大学でラテン語を詰め込まなければならなかった。しかし彼らが私の前に来たときに沢山の害虫と同じようにその計画を潰した。」と。 |
| His interests were in a very different field. With the utmost zeal, he now devoted himself once more to anatomical studies, realising that one who wishes, not merely to describe but also to understand the organs of the human being must make himself acquainted with the organs of the lower animals as well. He must dissect as many different kinds of animals as possible. Anatomy must be comparative anatomy. Only through a comparison of the organs of men and those of other animals is it possible to understand the general functions of life, whether normal or pathological. To comparative anatomy, therefore, he turned. He was not an anatomist of the ordinary sense. He never wrote a text-book of anatomy. How easy it would have been for him to engage a copper-plate engraver and, getting prints made of his numerous preparations, to produce monumental illustrated works. He had no thought, however, of doing anything of the kind. In fact he wrote very little upon anatomy; no more than a work upon the natural history of the teeth and a few minor essays -- parerga. For him, anatomy was not an end in itself, but a means to an end; especially comparative anatomy and embryology. The latter, likewise, could help him to answer the various questions in which he was interested. Was it not true that animals in the early stages of their development exhibited forms which reminded the observer of the structure of other and simpler animals? | 彼の興味は大きく違う分野にあった。最大限の熱心さで再び解剖学の研究に専念し、人間の臓器を単に記載するだけでなく理解するには下等動物の臓器にも精通しなければならないことを理解した。彼は出来るだけ多くの他の種類の動物を解剖した。解剖学は比較解剖学でなければならなかった。人間とその他の動物の臓器を比較することによって始めて正常にせよ病的状態にせよ生命の一般機能を理解することができる。従って彼は比較解剖学に転向した。彼は普通の意味の解剖学者ではなかった。彼は解剖学の教科書を書いたことはなかった。銅版画を作り彼自身が作った数多くの標本を印刷して不朽の図解本を作ることは彼にとって容易なことであった。しかし、このようなことをする意志は無かった。彼は解剖学について少ししか著述しなかった。歯の自然誌など小編の幾つかだけであり副業であった。解剖学は彼にとって目的ではなく主目的である比較解剖学と発生学への手段であった。発生学は彼が同じように興味を持っていた種々の問題に答えるのを助けることが出来た。動物は発生の初期段階において他のより簡単な動物で見られる形を示すのではないだろうか？ |
| While he was thus busily at work, in the year 1761 he had a severe attack of pneumonia. One of his brothers had died of consumption. His life in hospital wards and in the dissecting-room was not one to be recommended to a man with such morbid tendencies. He was advised to be as much in the open air as possible. For a time he became army surgeon, and then naval surgeon. England was at war with France and Spain. Hunter was present at several engagements, and acquired a great deal of experience. His mental outlook was essentially contrasted to that of the ordinary army surgeon. He was a man of science; his mind was keenly occupied with the problems of general pathology; and every injury he had to treat was for him an experiment. It was during this period of active service that were laid the foundations of a book which was to take decades to mature, and was not to be published until after his death. It is accounted his most important work, and it will be considered presently. | このように忙しく研究していた間の1761年に彼は重篤な肺炎に罹った。兄の一人は肺結核で死んでいた。彼の病棟および解剖室における生活はこのように病気に罹りやすい男に推薦できないものであった。彼は出来るだけ戸外に居るように勧告された。しばらくの間、彼は陸軍外科医になり次に海軍外科医になった。イギリスはフランスおよびスペインと戦争をしていた。ハンターは幾つかの戦闘に従事して多くの経験を積んだ。彼の心の構造は基本的に普通の軍医とは違っていた。彼は科学者で心は病理学総論の問題で完全に占領されていた。治療しなければならない傷は彼にとっては実験であった。成熟させるのに数十年かかり死後になって始めて出版された本(＊「血液、炎症および銃創について」)の基礎はこの時期における軍医としての任務であった。これは彼の最も重要な研究であり、それについては後で述べる。 |
| In 1763 the war came to an end with the Peace of Paris, by which France ceded Canada to England. The army was disbanded. Hunter returned to London and settled down as a surgeon. At first his practice grew slowly, for he had no hospital, and a surgeon without a hospital is like a captain without a ship. Well, he had all the more time for his studies and his collection. | 1763年に戦争はパリ平和条約で終了しフランスはカナダをイギリスに譲った。軍隊は解散された。ハンターはロンドンに帰り外科医として落ち着いた。最初に彼の開業は思い通りには流行らなかった。彼に病院が無く、病院が無い外科医は船の無い船長のようなものであった。それで彼はそれだけ研究や収集のための時間を持った。 |
| He bought a country-house at Earl's Court -- for Earl's Court was in the country a hundred and seventy years ago. It was a very original country-house, one which no one could pass without standing at gaze. Never before had so many kinds of animals been seen in the grounds of a country mansion. Behind it was a meadow where birds of all sorts were walking about, especially a great number of geese, whose eggs Hunter wanted for his embryological studies; but there were also pigs, goats, dangerous beasts -- leopards, jackals, serpents -- were kept in cages. Many of the birds were rare specimens. There was a dissecting-rooms for physiological experiments, and rooms for the storage of collections. | 彼はアールズコート(＊ロンドン西部)に大地主の邸宅を買った。18世紀にはアールズコートは田舎だったからである。これは非常に変わった邸宅で誰でも立ち止まって眺めずに通り過ごすことはできなかった。邸宅の庭にこんなに多くの種類の動物が居ることはなかった。建物の後ろは草地で、いろいろな種類の鳥が歩いていた。とくに沢山のガチョウが居てハンターはその卵を発生学の研究に使っていた。さらにブタ、ヤギが居り、ヒョウ、ジャッカル、ヘビのような危険な野獣は檻の中に居た。多くの鳥は珍しい見本であった。生理学実験のための解剖室があり収集品を保存するための部屋があった。 |
| Hunter was perpetually on the look-out for rare beasts. If a gipsy passed by with a dancing bear, Hunter would make a bargain with the man to bring the creature for dissection when it died. The Irish giant cost him much labour and a great deal of money. He was absolutely determined to have O'Bryan's skeleton for his collection. When the giant fell sick, Hunter had him kept under observation. But the Irishman scented danger, and, regarding with horror the thought that his body would be cut up, he made his friends promise that when he died they would never lose sight of his corpse until it had been sealed up in a leaden coffin and sunk in the sea. We are told before that bribery and corruption to the tune of 500 pounds were needed before Hunter could get his way. The upshot was that the skeleton is in the Royal College of Surgeons' museum, and that O'Bryan's name has become immortal. | ハンターは絶えず珍しい動物を探していた。踊る熊を連れてジプシーが通ると、この動物が死んだら解剖するために持ってくるようにと取引をした。アイルランド巨人について、彼は大変な骨折りと沢山の金を使った。彼はオブライアンの骨格を何としてでも収集に加えたかった。巨人が病気になったときにハンターは巨人をずっと診察していた。しかし、このアイルランド人は危険を感じ身体が切り刻まれることを恐れ、死んだら鉛の棺に入れて海に沈めるまで眼を離さないことを友達に誓わせた。以前に我々が聞いた所によると、思い通りにするためにハンターは賄賂と買収に大枚500ポンドを使ったとのことであった。その結末は骨格が王立外科医協会の博物館に存在しオブライアンの名前は不死となった。 |
| Manifestly such studies must have cost a great deal of money. His practice had to supply the necessary funds. Frequently quoted is the anecdote that when on one occasion Hunter was called away from his work to see a patient he said to one of his freiends: "Well, Lynn, I must go and earn this damned guinea, or I shall be sure to want it tomorrow." It was a lucky day for him when, in 1768, he was appointed surgeon to St. George's Hospital, where, years before, he had been a student. Thenceforward his practice rapidly increased. In 1775 he was earning a thousand pounds a year, and in 1783 five thousand a year -- an enormous sum for those days. Enormous though it may have been, it did not suffice his needs. His household had gradually increased to forty-five persons: children, a tutor, assistants, servants, gardeners, keepers for the animals. Above all, his collection swallowed huge amounts, so that when Hunter died he left nothing but his collection and debts. | このような研究には莫大な金が必要なことは明らかである。必要な資金は開業によって得なければならなかった。しばしば次のアネクドートが引用される。患者を診察するのに研究を離れるときに彼は友達に言った。「さてリン、この忌まわしいギニーを儲けるためには行かなければならない。そうしないと明日には足りないだろう」と。1768年に聖ジョージ病院の外科医に任ぜられた。この病院は数年前に学生だった所であり彼にとって幸福な日であった。1775年には1年に千ポンド稼ぎ、1783年には5千ポンド稼いだ。これは当時には莫大なものであった。高額ではあったが必要とするのに比べて充分でなかった。彼の世帯は徐々に増えて45人になった。子供たち、助手、召使い、庭師、動物飼育掛、であった。とくに収集には莫大な金額が必要で、ハンターが死んだときには収集品と借金しか残って居なかった。 |
| Being now a hospital surgeon, he had pupils, some of whom lived with him and were his constant companions. Among them was a young man with whom he became peculiarly intimate, and with whom in subsequent years he kept up a correspondence. This was Edward Jenner. | 今度は病院外科医になったので弟子たちが居るようになり、一部のものは一緒に住んでいて毎日の話し相手であった。その中には特に親しい者が居て、その後も常に手紙のやり取りをしていた。これはジェンナーである。 |
| Just as his brother William had given courses of private lectures on anatomy, so in the autumn of 1773 John Hunter began to give private lectures upon the theory and practice of surgery. The course lasted from October to April, three lectures every week, the fee for the whole being four guineas. Hunter was not a good lecturer. He could only read from his manuscript, and before every lecture he was extremely nervous, so that sometimes he had to take thirty drops of laudanum in order to compose himself. Nevertheless, his lectures were of the utmost interest to those competent to understand them. He conveyed much more information than had been promised in the prospectus. What he discoursed upon was not the theory of operative surgery, but rather that which today we call "general surgery," a domain which had not hitherto been segregated. Nor indeed did Hunter call it by that name. It comprised general surgery, and more, namely anatomy, physiology, and pathology. In all these fields he put forward original ideas, the result of prolonged observations and experiments. Hunter was not a qualified physician, had not been trained in any academic faculty. He was an empiric in the best sense of the term, and approached the problems of pathology from the practical aspect, in a mood quite free from prejudice. | 兄のウィリアムが解剖学の個人講義を行っていたようにジョン ハンターは1773年秋に外科学の理論および実際についての個人講義を始めた。この講義は10月から4月まで毎週3回あり、全体で4ギニーであった。ハンターは講義が得意ではなかった。彼は原稿を読むだけであり講義の前に著しく神経質になり時には落ち着くために30滴のアヘンチンキを摂らなければならなかった。しかし理解できる者にとって講義は非常に面白いものであった。紹介文で約束した以上のものを伝えた。講義の内容は外科手術の理論ではなく、今日ではむしろ「外科学総論」と呼ぶものであって、その頃まで分かれていない分野であった。実際、ハンターはそのようには呼んでいなかった。講義には外科学総論だけでなく、解剖学、生理学、病理学が含まれていた。これらすべての分野で彼は独自の考えや長期にわたる観察や実験の結果を進めていた。ハンターは医師の資格を持っていなかったし大学教育を受けていなかった。彼は正しい言葉の意味で経験主義者であり、病理学の問題に実際面から取り組んでいて全く偏見を持っていなかった。 |
| One of the illnesses which in the eighteenth century was left entirely to the surgeons for treatment was syphilis. Hunter attacked this difficult problem, and wrote a great work upon it, On the Venereal Disease, published in 1786, which remained a standard text-book well on into the nineteenth century. Valuable as this treatise is in many respects, it contains serious errors, and errors which are all the more instructive because they were originated by experiment. In his day there was much dispute as to whether gonorrhoea and syphilis were but two manifestations of one disease. Hunter inoculated himself with what he believed to be gonorrhoeal pus, with the result that a chancre formed at the site of inoculation. The identity of gonorrhoea and syphilis seemed to have been proved. Just as in former days people had believed in the infallibility of logical deduction, so now were experimenters inclined to put blind faith in the results of experiment. What we have to learn is that one experiment, taken by itself, proves nothing, and that the correct interpretation of experiment is more important than the experiment itself. [The presumption is that the pus with which Hunter inoculated himself, the pus from a urethral discharge, was derived -- in part at least -- from an intraurethral syphilitic chancre.] | 18世紀に外科医に治療を任せられていた病気の一つは梅毒であった。ハンターはこの難しい問題に取り組み、大作「性病について」を書いた。これは1786年に出版され、19世紀に至るまで標準教科書として使われた。この本は多くの点で価値の高いものであったが、重大な誤りがあった。この誤りは実験をもとにしているだけ、より教訓的である。この頃、淋病と梅毒は１つの病気が２つの現れ方をしたに過ぎないかどうか、と言う議論が激しく行われていた。ハンターは淋病の膿と思ったものを自分に接種し、その場所に下疳が出来た。淋病と梅毒の同一であることの証明とみなされた。嘗て人々は論理的な推理には誤りが無いと思ったように、この頃の実験者たちは実験結果に絶対的な信頼を持っていた。我々が学ばなければならないのは一回の実験だけでは何も証明できず、実験の正しい解釈は実験そのものよりも重要なことである。[ハンターが自分への接種に使った尿道分泌物は、少なくとも一部は尿道内にできた梅毒下疳からのものであったと推定される。] |
| The closing years of Hunter's life were years of unceasing toil. He was up before six in the morning, and worked until nine in his dissecting room. Until noon he saw patients at home, and then went on his rounds. At four in the afternoon he had his principal meal, after which he slept for an hour. Then he gave lectures. After that his secretary took down from his dictation what he had observed during the day. At midnight the family went to bed. The footman brought his master a freshly trimmed lamp, and Hunter remained at work till one, two, or even later in the morning. He quarrelled with his brother William, to whom he had owed so much at the outset of his career. He suffered much and for several years from angina pectoris, which ultimately proved fatal. | 晩年のハンターは間断ない労苦の年月であった。彼は朝6時に起き9時まで解剖室で働いた。正午まで家で患者を診療し、次いで回診をした。午後4時に正餐をとり、その後で1時間寝た。次いで講義を行った。その後で秘書がその日に彼が観察したことを口述筆記した。夜半に家族は就寝した。下男は芯を揃えたランプを主人に持ってきてハンターは未明の1時、2時、ときにはもっと遅くまで仕事をした。彼の経歴の初期に大きな世話をしてくれた兄ウィリアムと仲が悪くなった。数年のあいだ狭心症で苦しみ、この病気で彼は死去した。 |
| In 1794, a year after his death, appeared the ripest fruit of his life-work, 'A Treatise on the Blood, Inflammation, and Gunshot Wounds' -- a work which is a milestone in the development of general pathology. The theory of inflammation was the wrestling ground of speculation. Each school, every trend, had its own theory. Practice brought a wholesome corrective, holding fast as it did to well-tried methods of treatment, regardless of theory. As late as 1822, C.H.M.Langenbeck, the Göttingen anatomist and surgeon, wrote: "If we compare the theories concerning inflammation, but genuine practitioners treat the disease in the same way." | 彼の死後1年にあたる1794年に生涯の大作「血液、炎症および銃創について」が刊行された。これは病理学総論の進歩の道程であった。炎症の理論は推測の取っ組み合いの場所であった。個々の学派や流れはそれぞれの理論を持っていた。理論とは無関係に臨床はよく行われている治療法に沿って慎重な調整案を提出していた。その後1822年になってゲッチンゲンの解剖学者で外科医のランゲンベックは書いた。「炎症の理論を比較すると真の臨床家だけはこの病気を同じように取り扱っている。」と。 |
| Hunter was the first investigator since the days of antiquity to advance the theory of inflammation a stage. By simple observations and lucid experiments he was able to interpret processes of inflammation more clearly than they had ever been interpreted before. He recognised that inflammation is a reaction of the organism to any kind of noxious influence. Determinative of the type and the course of any particular inflammation, he said, were the exciting cause, the constitution of the body, and the peculiarities of the affected part. He was well acquainted with the three main types of inflammation: alterative, secretive, and regenerative. "Inflammation in itself is not to be considered as a disease, but as a salutary operation, consequent either to some violence or some disease. .... Inflammation is not only occasionally the cause of diseases, but it is often a mode of cure, since it frequently produce a resolution of indurated parts, by changing the diseased action into a salutary one, if capable of resolution." Thus the curative value of inflammation was plainly recognised. | ハンターは炎症理論を古代の理論から１段階進めた最初の研究者であった。簡単な観察と判りやすい実験で炎症過程をそれまでに解釈されていたよりもずっと明白に解釈した。彼は炎症をある種の傷害にたいする生体の反応である、とみなした。ある特定の炎症の型と経過を決定するのは、刺激する原因、身体の健康状態、および傷害を受ける部分の特性、であると彼は言った。彼は主な3種の型の炎症をよく知っていた。退行性、分泌性、および再生性、の3種の炎症であった。「炎症そのものは病気とみなすべきではなく、ある暴力またはある病気の結果に起きる有益な作用である......炎症は時に病気の原因であるだけでなく、しばしば治癒の形式である。消散できるときには病気の作用を有益な作用に変えて、しばしば硬化部分の消散を起こすからである」と。このように炎症の治癒価値が明白に理解された。 |
| Wherein does Hunter's historical significance lie? He worked at anatomy all his life, and yet his true field of work was not anatomy pure and simple. He was one of the most successful surgeons of his time, but many another surgeon among his contemporaries did more than he to promote the advance of operative surgery. His position in the history of the healing art must be sought elsewhere. In the eighteenth century, medicine and surgery were two distinct provinces. At the university the physician received instruction in surgery, but usually from anatomical specialists not one of whom had ever done so much as lance a boil. No scientific progress in surgery was to be expected from such quarters. The practising surgeon, on the other hand, was as a rule a rather imperfectly educated handicraftsman. Even though surgery was steadily advancing and such institutions as the Académie Royal de Chirurgie founded in Paris in the year 1731 had had a valuable influence, the interest of surgeons was concentrated upon practice. When a surgeon, here and there, felt impelled to engage in scientific work, his main concern was likely to be to effect an improvement in operative technique. Very rigid limits were imposed upon operative surgery in those days, owing to the impossibility of producing general anaesthesia, and owing to the almost universal prevalence of the various forms of wound infection. Surgeons, therefore, kept their minds fixed upon particular and very narrowly defined groups of maladies. Their thoughts turned in a circle round the disease due to "external injuries," as they phrased it; and such maladies as stone in the bladder, rupture, fistula, etc., whose treatment they tried to improve. | どこにハンターの歴史的な意義があるのか？彼は生涯にわたり解剖学を研究した。しかし、彼の真の研究分野は純粋な解剖学ではなかった。彼は当時の有名な外科医であったが同時代の多くの外科医は外科手術の進歩にもっと貢献した。医術の歴史における彼の地位は別に求めなければならない。18世紀に医学と外科学は２つの異なる分野であった。大学で医師は外科学の教育を受けたが、おできを切開する程度も行ったことがないような解剖学専門家から習っていた。このような場所では外科学の科学的な進歩は期待できなかった。これに対して外科の臨床家は、ふつう不完全な教育しか受けていない手職人であった。外科学は絶えず進歩しており1731年にパリに作られた「王立外科学アカデミー」は価値の高い影響力を持っていたが外科医たちの興味は患者の診療だけに集中していた。ある外科医が科学的研究を行わなければならないと感じたら興味は手術技法の改良に向けられたであろう。全身麻酔が出来ないし種々の創傷感染があるために当時の外科手術には極めて厳しい制限があった。従って外科医たちは狭い範囲の特定の病気だけに注目していた。彼らの考えは「外傷」と呼んでいたものを原因とする病気の周りを回っていた。そして、膀胱の石、ヘルニア、瘻孔など、の病気であって、その治療法を改良しようとした。 |
| It seems to me, then, that Hunter's main significance was that he threw open the field of surgical observation and experiment to general medicine, enabling all doctors to turn it to account. He was a working surgeon like the rest of them; but he was also a man of science. For him a wound was something more than a practical problem. He was not content to ask, "How can I best heal this wound?" He inquired: "What does the wound signify to the organism? By what mechanisms does the organism safeguard itself against the effects of the wound, immediate and remote?" In this way, almost imperceptibly, he passed from the domain of surgery into that of pathology. His anatomical and physiological studies safeguarded him against getting lost in a maze of speculation. As a practitioner, he advanced by practical measures, set the organism tasks, made experiments. Not having been trained as a physician, approaching the problems devoid of preconceptions and from without, he saw much which had remained hidden from the doctors. | ハンターの主な意義は外科的な観察および実験の分野を一般医学に開きすべての医師に注目させたことにあると私は考えている。ハンターは他の人たちと同じように外科医として働いていたが、それと同時に科学者であった。彼にとって傷は臨床的な問題以上のものであった。「どうしたら、この傷を良く治せるか？」だけで彼は満足しなかった。「この傷は生体にどんな意味があるか？直接にせよ間接にせよ、この傷の効果に対して生体はどのように防禦するか？」、と彼は問いかけた。このようにして殆ど気がつかないで彼は外科学の領域から病理学の領域に入り込んだ。解剖学および生理学の研究は憶測の迷路で行き先を失わないように彼を守った。臨床実際家として実際的な基準で進み、生体に課題を与え、実験を行った。医師としての訓練を受けて居なかったので、偏見無しに外から問題に近づき医師たちには隠されていたものを見ることができた。 |
| Along this path he was a pioneer hastening greatly in advance of his time, and he constructed the first bridge between surgery and medicine. | 彼は時代に大きく先んじてこの路を急ぎ、外科学と医学の間に最初の橋を架けた先駆者であった。 |