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 )
| 32 Jean Nicolas Corvisart (1755-1821) and Philippe Pinel (1755-1826) | 32 コルヴィザール (1755-1821) とピネル (1755-1826) |
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| Desault, as we have shown, was the founder of modern clinical study in France so far as surgery was concerned; one of Desault's pupils, Corvisart, did the same work for French clinical medicine. Just as after the extensive reorganisation that took place during the year 1794, Desault became director of the first surgical clinic, so did Corvisart become director of the first medical clinic. Like Desault, moreover, Corvisart had been actively at work as a clinician several years before this. In 1788 he had been appointed physician at the Charité, as successor to his teacher Desbois de Rochefort, organising clinical work there in an exemplary fashion and with an almost military precision. | 前に述べたように外科学に関して、ドソーはフランスにおける新しい臨床研究の創立者であった。ドソーの弟子の一人であったコルヴィザールは同じことをフランスの臨床内科学について行った。1794年に起きた広範囲にわたる組織改革でドソーが第一外科臨床の長になったと同じように、コルヴィザールは第一内科臨床の長になった。コルヴィザールはドソーと同じようにこれ以前に数年にわたって臨床家として活動していた。1788年に彼は先生のデボアの後継者としてシャリテ病院の医師に任ぜられ殆ど軍隊的な正確さで臨床研究を模範的に組織化していた。 |
| Corvisart had originally been destined for the legal profession. At school he was not only diligent at his studies, but had distinguished himself by bodily vigour. His father was solicitor to the crown, and took the lad into his own ofiice. Corvisart, however, found the copying of legal documents a tedious affair. Whenever he could, he escaped from this thraldom, made his way into the Latin Quarter, listened to one lecturer or another, visited the Hôtel-Dieu (the largest hospital in Paris), and there gave ear to what Desault had to say. He found this fascinating. At length he broke away from his father's profession, and became a medical student. Having been trained in Desault's hospital, in 1782 he qualified as a doctor and was appointed parish physician at a minimal salary. Naturally he looked out for a better post. Ere long there was a vacancy at the hospital founded by Madame Necker. He applied for it, and presented himself before the governing body, which was outraged to find that the young man wore no wig ! In other respects his qualifications and recommendations were satisfactory, but it was impossible to appoint him as hospital doctor unless he would wear a wig. Corvisart refused to give way upon this point, and, in his letter declining the post, wrote : "Respect for outward signs must not degenerate into superstition." | コルヴィザールは法律家になることになっていた。学校で勉強に熱心だっただけでなく運動が得意であった。父親は国王の法務官であり子供を事務所に連れて行った。しかしコルヴィザールは法律文書を写すのを退屈と思っていた。できるだけこの奴隷状態から逃げてカルチエラタンに行っていろいろな講義を聴き、パリ市最大の病院のオテルデュに行ってドソーの言っていることを聴いた。遂に父親の職業から離脱して医学生になった。ドソーの病院で訓練を受け、1782年に医師となり最低のサラリーで教会区医師になった。しばらくしてマダム ネッカーが創立したネッカー病院に空席があった。彼は応募し管理者の前に出た。管理者は若者がウィッグ(かつら)をしていないのを見て怒った！他の点では資格も推薦も充分であったが、ウィッグをしなければ病院医師に任命することは出来なかった。コルヴィザールはこの点で譲歩することを拒否し、就職を断って書いた。「外観を尊重して迷信に陥るべきではない」と。 |
| Now he devoted himself to anatomy and pathology. During a post-mortem examination, he pricked his finger. In those days before antiseptics had been discovered, this often meant fatal blood-poisoning. With stoical calm, watch in hand, Corvisart awaited the expected rigor, but was lucky enough to escape. Faced with the choice of devoting himself to surgery or to internal medicine, he decided in favour of the latter, and worked at the Charite, of which, a few years later, as we have learned, he became medical director. | ここで彼は解剖学と病理学に専念した。病理解剖で指を傷つけた。消毒法が発見される前にはこれによって致命的な敗血症になることが多かった。自制的な落ち着きで手に時計を持って硬直が始まるのではないか待ったが、幸いなことに起きなかった。外科と内科のどちらを専門にするかを選ぶにあたって彼は内科を選び、前に述べたようにシャリテ病院で働き、数年後には院長になった。 |
| Now he was a clinician, but there was no clinical tradition in France. He therefore determined to get into touch with the Viennese school, since the Vienna clinic had set an example to the world. Of the three books he wrote, two were translations of those by Viennese physicians. He studied Stoll's writings, and in 1797 translated the latter's Aphorisms. Here he learned of percussion, a method of which he had never heard in Paris. "Percussion made a strong impression upon me, and I think that since then I have practised it unceasingly, whether in obscure diseases of the chest or in those that were simple and easily understood. It never led me astray if the condition of the patient was such as to allow me to make full use of it. On the other hand, I must frankly admit that I have known of many grave errors in diagnosis on the part of those who knew nothing of percussion or neglected it." For twenty years Corvisart practised percussion and developed its use. Since then it has formed an inseparable part of a clinical examination. | 今や彼は臨床家になったがフランスには臨床の習慣が無かった。従って彼はウィーン学派と連絡することにした。ウィーンの臨床は世界の手本になっていたからであった。彼が書いた3冊の本のうちで、2冊はウィーンの医師が書いたものの飜訳であった。彼はシュトールの著作を研究し、1797年に彼の「箴言」を訳した。ここで打診について学んだ。これはパリでは聴いたことが無い方法であった。「打診は私に強い感銘を与えた。胸部の稀な病気にせよ簡単で理解しやすい病気にせよ、この方法を絶えず実施するようになってから、感銘を受けている。打診法を完全に利用できるような患者の条件のときに私は迷うことがなかった。これに対して打診について何も知らなかったり無視したりする人たちは診断において多くの重大な誤りを起こしていることを率直に認めなければならない」と。20年のあいだコルヴィザールは打診を行い使用方法を開発した。それ以来、打診は臨床診断に不可分のものになった。 |
| A French translation of Auenbrugger's Inventum novum had appeared in 1770. The translation was a bad one. The translator had never practised percussion, and did not even believe in the method, which did not seem new to him for he supposed it to have been mentioned in the Hippocratic writings. In 1808, therefore, Corvisart made a fresh translation, enriched with an elaborate commentary. Auenbrugger's booklet was entirely renovated, and was expanded from 95 to 440 pages. This made it possible for the new method to bear rich fruit. Clinical medicine had advanced so far that the great majority of practitioners were thinking anatomically, and were trying in every case of illness to refer the symptoms to changes in the bodily organs. | アウエンブルッガーの「新考案」のフランス語訳は1770年に刊行されていたが、飜訳は悪かった。訳者は打診を試みたことはなかったしこの方法を信頼さえしないで、これは新しいものでなく「ヒポクラテス集典」に書いてあるものと思っていた。したがって1808年にコルヴィザールは新しく飜訳し、詳しい注釈をつけた。アウエンブルッガーの小冊子は完全に新しいものになり、95ページから440ページに広がった。これによって、この新しい方法である打診法は豊かな果実をつけるようになった。臨床医学は進歩し、大部分の臨床家たちは解剖学的に考えるようになり、病気のあらゆる例で症状を体内臓器の変化に結びつけるようになった。 |
| In the year 1797, Corvisart was appointed to a second academic post, becoming professor of practical medicine in the Collège de France. Here he shone as a teacher. A great number of physicians were trained by him. In the morning he went his round at the Charié, accompanied by a train of students as he moved from bed to bed, examining each patient with the utmost care. "The medical training of the senses" was his watchword and his program. Students must learn to use their sense-organs. Everything depended upon accurate observation. By the bedside of the sick, theory was silent, for the only thing that mattered was to see and to hear. Corvisart was himself a marvellously keen observer. We are told that one day, looking at a portrait, he said : "If this picture is a faithful one, I cannot doubt that the original must have died of heart disease." Inquiry showed that such had been the case. | 1797年にコルヴィザールは2番目の教育研究職としてコレジ・ド・フランスの臨床医学教授になった。ここで彼は教師として光った。多数の医師が彼により訓練された。朝にはシャリテ病院で回診をし、一群の学生を連れてベッドからベッドに移動し、できるだけの診療をそれぞれの患者について行った。「感覚の医学的訓練」が彼の標語でありプログラムであった。学生たちは自分の感覚器の使い方を習わなければならなかった。患者のベッドサイドで理論は表面に出ない。問題となるのは見ることと聴くことだからであった。コルヴィザール自身は素晴らしく鋭い観察者であった。ある日、肖像画を見て、次のように言ったと言われている。「もしもこの絵が信用できるなら、疑いもなくこの人は心臓病で死んでいる」と。調べたら正しかった。 |
| When a patient died in the clinic, a careful examination of the intact body was first made. Then came the autopsy, and immense was the delight of the doctor and his pupils if this confirmed the diagnosis. Still more instructive, however, were instances in which discrepancies arose. They gave Corvisart an opportunity of showing in masterly fashion how and why he had erred, and, of explaining what was to be learned from these new observations. In the evenings he delivered theoretical addresses at the Collège de France, speaking extempore as a rule, and discussing cases which had been treated in the morning. | 臨床で患者が死ぬとまず死体そのままを注意深く検査した。次に死体解剖を行い、診断がこれによって確認されると医師および学生たちは喜んだ。しかし、もっと教育的であったのは診断と解剖結果に違いの起きたときであった。この場合は、なぜ間違えたか、この新しい結果から何を学ぶことができるかの説明を、医師たちはコルヴィザールに大家にふさわしく述べる機会を与えた。夕方に彼は朝に行ったことについて、ふつう準備無しにコレジ・ド・フランスで理論的な講義を行った。 |
| Thus in the Paris clinic the road entered upon by Morgagni was systematically followed. Patients were examined with the utmost thoroughness ; if they died, their bodies were subjected to post-mortem examination ; then the clinical history and the report of the autopsy were mutually confronted. For the time being, so Corvisart thought, theory was of minor importance. The first essential was, in the then state of medical knowledge, to collect an abundance of accurate observations, to make precise pictures of diseases. Still, the outlook was not one-sidedly anatomical. Physiology, too, was given due weight. "The physician who fails to combine pathological physiology with his anatomy will never be anything more than a more or less adroit, diligent, and patient prosector. In practice he will be vacillating, unstable -- especially as far as the treatment of organic lesions is concerned." | このようにパリの臨床ではモルガーニが着手した路を体系的に進んだ。患者は全く細かく検査された。死亡すると病理解剖が行われた。続いて、病歴と剖検報告は互いに付き合わされた。コルヴィザールの考えで理論はさしあたって大きな意味が無かった。最初に必要なのは当時の医学知識において正しい観察を充分に集め病気の精確な像を作る、ことであった。このさい、考え方は解剖学一辺倒ではなかった。生理学にも当然の重点が置かれた。「病理生理学を自分の解剖学と結びつけることができない医師は器用で勤勉で辛抱強い解剖師以上の何ものでもない。臨床の実際において気迷いし不安だろう。特に器質的な傷害の治療にあたっては。」 |
| What loomed before Corvisart as destined to be his opus magnum was a work which, following Morgagni's example, he would call De sedibus et causis morborum per signa diagnostica investigatis et per anatomen confirmatis -- that is to say "Concerning the Seats and Causes of Diseases, as studied in accordance with Diagnostic Signs and confirmed by Anatomy." But for this a new Morgagni would have been needed ! Corvisart felt unequal to so mighty an undertaking, which would, moreover, have been premature. There had not as yet been collected a sufficiency of material. The book, therefore, would have been a mere fragment. Corvisart devoted himself to and finished a portion of the task ; an extremely important part, namely that of diseases of the heart. In 1806 he published his Essai sur les maladies et les lesions organiques du coeur et des gros vaisseaux. Hitherto, doctors had been unable to cope with diseases of the heart. Corvisart, applying his method to their study, achieved notable results. First of all he was able to show how common are organic diseases of the heart. He also insisted upon the need for distinguishing functional from organic heart diseases. With the help of percussion he tried to form a clinical picture of the particular diseases of the heart. He was further able to distinguish between hypertrophy and dilatation of the heart, and made a thorough study of the course of cardiac insufficiency or, as we now call it, failure of compensation. | コルヴィザールは自分の主著をモルガーニの例にならって「診断徴候によって研究し解剖学によって確認した病気の座ならびに原因について」と命名したかった。しかし、このためには新しいモルガーニが必要だったろう！コルヴィザールはこのように大きな仕事に自分が不適と感じていたし、さらにこの仕事は時期尚早であった。まだ充分の材料が集められていなかった。その一部であるが極めて重要な部分すなわち心臓病にコルヴィザールは専念し終了した。1806年に「心臓および大血管の病気ならびに器質的障害についての論文」を刊行した。まず、心臓の器質的な病気が如何に普通であるかを示すことができた。また機能的および器質的な心臓病の区別が必要なことを主張した。打診の助けによって彼は個々の心臓病の臨床像の作成を試みた。さらに彼は心臓の肥大と拡張を区別することが可能になり現在は心臓の代償不全と呼ばれるような機能不全の経過を細かく研究した。 |
| Thus Corvisart's clinic served, not only to train more competent physicians, but also to advance research by a long stride. His study of heart diseases showed what the new method could effect. | このようにコルヴィザールの臨床は有能な医師を訓練するだけでなく長期の見通しで研究を進めた。彼の心臓病研究は新しい方法によって得られる成果を示した。 |
| In 1807 Corvisart became physician-in-ordinary to Napoleon, and his new duties tended more and more to withdraw him from his work as a clinical teacher. His practice increased from day to day, and his social obligations became more comprehensive. Napoleon was a difficult and exacting patient, but Corvisart got on with him very well. It is recorded that the Emperor once said he had no faith in medicine, but he had faith in Corvisart. | 1807年にコルヴィザールはナポレオンの主治医になり、新しい義務は臨床医学教師としての仕事からますます手を引くようになった。彼の患者の数は毎日のように増加し、社会的な責任はもっと総合的になった。ナポレオンは困難で厳しい患者であったが、コルヴィザールは巧みに取り扱っていた。医学は信用しないがコルヴィザールを信用している、と皇帝がある時に言ったと記録されている。 |
| After the fall of the Empire in 1815, Corvisart likewise vanished from the stage. He had been paralysed by an apoplectic seizure, and retired to his country estate. He was not the founder of a school, but he had trained many distinguished pupils, among them such men as Laennec, Bayle, Dupuytren, and Bretonneau, who worked along his lines, and continued his labours. | 1815年にナポレオンの帝国が没落した後、コルヴィザールも舞台から消えた。彼は中風発作で麻痺し、田園別荘に隠退した。学派の創立者ではなかったが、多くの優れた弟子を訓練し、その中にはラエンネック、ベイル、デュピュイトラン、ブルトノーが居て、彼らはコルヴィザールの方針に沿って研究を行い、彼の仕事を続けた。 |
| A contemporary and associate of Corvisart was Pinel. Corvisart was medical director of the Charité, Pinel that of the Salpêtriere where women suffering from mental and nervous disorders were cared for. Corvisart was professor of practical medicine at the Collège de France, and Pinel was professor of hygiene and subsequently of internal pathology at the Ecole de Medécine. Though belonging to the same epoch, and indeed born in the same year, the two men were radically different. Look at their portraits, Corvisart has the aspect of a self-confident man of the world, and we know that he was not afraid to express his views to Napoleon frankly. Pinel's countenance betrays his character, shows him to have been retiring, reserved, timid. Fundamentally different, likewise, were Corvisart and Pinel in their medical outlook and in their whole way of thinking. [Extrovert and introvert, pyknic and asthenic, respectively !] | ピネルはコルヴィザールと同時代人で同僚だった。コルヴィザールはパリのシャリテ病院の院長で、ピネルはサルペトリエール病院の院長であった。サルペトリエール病院は精神および神経を病む婦人のための病院であった。コルヴィザールはコレジ・ド・フランスの臨床医学の教授で、ピネルはエコール・ド・メドシンの衛生学教授で後に内科病理学教授になった。同じ時代であり、実際に同年生まれであったが2人は全く違っていた。肖像画を見てみなさい。コルヴィザールは自信を持つ世慣れた男の顔つきをしていて、ナポレオンにたいして自分の見解を率直に言うことを恐れなかった。ピネルの顔つきは性格を洩らしている。引っ込み勝ち、控えめ、臆病なことを示している。コルヴィザールとピネルの医学的な見通しも考え方全体も同じように根本的に違っていた。 [それぞれ外向的と内向的、肥満型と無気力、と違っていた！] |
| Pinel had entered the medical profession by a devious route. The son of a country practitioner in poor circumstances, he had begun his career as a divinity student, but subsequently transferred from this branch of study to philosophy, upon which topic his doctrines were akin to those of the sensualists, the followers of Condillac. For a while he was engaged in the pursuit of natural science, and did not begin his medical studies until he was thirty years of age. Having worked at Toulouse, Montpellier, and Paris, in 1798 he published his opus magnum, Nosographie philosophique, ou la méthode de l'analyse appliqude à la médecine. In two decades the book ran through six editions, and secured for Pinel a large following. | ピネルは回り道をして医師になった。貧乏な田舎医師の息子で、まず神学生になったが哲学の研究に移り、感覚論者の学説に近い考えを持っていてコンディヤクの信奉者であった。しばらくして自然科学の研究を行い、医学の勉強を始めたのは30歳になってからのことであった。トゥールーズ、モンペリエおよびパリで学び、1798年には主著である「哲学的疾病論」を刊行した。この本は20年のあいだに6版を重ね多くの信奉者が得られた。 |
| Pinel was both philosopher and scientist, but especially the latter. For him medicine was one branch of the natural sciences, and must be studied in exactly the same way as botany, zoology, or mineralogy. Diseases were entities, just like the species of plants and animals. Every illness had its natural course, with which it behoved the doctor to become acquainted. Pinel, like Corvisart, greatly esteemed the Viennese school, more especially because the clinical teachers in the Austrian capital had studied the course of so many diseases. A doctor, when consulted by a patient, should first decide the true nature of the malady, and thereafter must pigeon-hole it in its proper place in a natural system. Pinel's work revolved round this attempt to formulate a natural system of diseases. | ピネルは哲学者であるととも科学者であり、特に科学者であった。彼にとって医学は科学の一分野であり、植物学、動物学、鉱物学と全く同じように研究すべきものであった。病気は植物や動物の種と同じように存在物(エンティティ)であった。すべての病気はそれぞれ自然の経過を持ち、医師はこれをよく知る義務があった。ピネルはコルヴィザールと同じようにウィーン学派を高く評価していた。特にオーストリアの首都の臨床教師たちは非常に多くの病気の経過を研究していたからであった。医師は患者を診察したときには、まずその病気の本性を決定し、その後でそれを自然体系のうちの適した場所に分類整理すべきであった。ピネルの研究は病気の自然体系を創る試みの周りを回転していた。 |
| We see that Pinel worked along the lines which had come down from Sydenham. One who holds that there are ("species morborum") will necessarily endeavour to classify these species systematically, just as a botanist classifies plants and a zoologist classifies animals. Linnaeus (a qualified medical man as well as a botanist) had written a work entitled "Genera morborum." One of his contemporaries, the French physician and botanist Boissier de Sauvages, had in the middle of the eighteenth century penned a Nosologia methodica, and in the subtitle of this classification of diseases he declared that his works were conceived in the spirit of Sydenham and constructed in accordance with the method employed in botanical science. He distinguished one from another 2,700 types of disease, which he arranged in species, orders, and families. The Linnaean system exercised a contagious influence, so that many doctors of that date were convinced of the need for a tabular classification of maladies resembling the tabular classification of plants. | ピネルはシデナムに始まった方針に従って研究した。「病気の種」があると考える人は、植物学者が植物を分類し動物学者が動物を分類するように、病気の種を体系的に分類する努力をした。植物学者であるとともに医師であったリンネは「病気の属」と題した著作を書いた。同時代人でフランスの医師で植物学者のソヴァージュは18世紀の中葉(1768)に「疾病分類論」を書き、副題に「シデナムの精神に従って植物学で使われた方法で分類した」ことを宣言した。彼は2700種の病気を区別し、科、属、種に並べた。リンネの体系は伝染的な影響を持ち、当時の多くの医師たちは植物の分類表に似た病気の分類表の必要性を感じていた。 |
| Pinel's book was an expression of this trend, though he worked with different instruments. He knew the writings of his forerunners well enough, but regarded their systems as erroneous, as unduly artificial and too complicated. Their mistake had been that they were ready to regard mere symptom-complexes and complications as distinct diseases. That is why they had established such a multiplicity of species, which did not correspond to anything actually existing in nature. A particular disease must be analysed until its essential form came to light, and this must be the basis of classification. The lines of classification must be determined (herein we recognise the gulf between Pinel and his precursors) by physiological and anatomical considerations. Pinel was continually regarding anatomical fundamentals. How, for instance, were inflammations to be classified? In accordance with the tissues affected by it. There were, for instance, inflammations of the skin, of the mucous membranes, of the serous membranes, of the parenchyma or functional elements of the various organs, of the muscular tissue, and so on. | 方法は違ったが、ピネルの本はこの傾向の表現であった。彼は先人たちの仕事をよく知っていたが、彼らのシステムは不適当に人工的であまりにも複雑であり誤っているとみなしていた。彼らの誤りは、単なる症候群や合併症を独立の病気とみなすことにあった。このことによって彼らは自然には実際に存在していないこんなに多くの病気種を確立した。個々の病気はその本質的な形が明らかになるまで充分に分析しなければならない。これこそ分類の基礎でなければならない。分類の方針は生理学的および解剖学的な考えによって決められるべきである。ここにピネルと先人たちのあいだの隔たりのあることが判る。ピネルは絶えず解剖学的な基本を考えていた。例えば皮膚の炎症、粘膜の炎症、漿膜の炎症、実質すなわち種々の臓器の基本的な成分の炎症、筋の炎症、その他。 |
| It is easy to understand why Pinel's books had so striking a success. He wanted, as practical-minded doctors had again and again wanted before his day, to extricate medical science from uncertainty, so that it should no longer grope in the dark. His contemporary Corvisart had revived the old saying that medicine was an "ars conjecturalis," an art guided by guesses . For Pinel, however, medicine was one of the natural sciences, and must be made as exact a science as botany or mineralogy. A doctor at the bedside of his patient must observe all that was going on as accurately as Hippocrates (whom Pinel greatly esteemed) had observed. Then, proceeding analytically, he must decide the true character of the malady with which he had to deal and ascertain its place in the classificatory system. That was the purpose of diagnosis. In fact, the doctor's duty was almost finished when he had made an accurate diagnosis. Who could be bold enough to maintain that he had ever really cured a disease? | 何故ピネルの本が驚くべく成功したかは容易に理解できる。実際的な考えをする医師たちが繰り返して要求したように、ピネルは医学を不確かさから解放し暗闇で模索しないようにすることを要求した。彼の同時代人であるコルヴィザールは、医学は「推測の術」であるという古い格言を生き返らせていた。しかしピネルにとって医学は自然科学の一つであり、植物学や鉱物学のように精確な科学でなければならなかった。患者のベッドサイドの医師はそこで進行していることをヒポクラテスが観察したように出来るだけ精確に観察するべきであった。ピネルはヒポクラテスを非常に尊敬していた。医師は分析を進め取り扱っている病気の真の性質を決定し、それの分類上の場所を確かめなければならない。これが診断の目的であった。事実、医師は精確な診断を行ったら任務は殆ど終わったことになる。病気を治したと主張する勇気が誰にあるだろうか？ |
| Attractive though Pinel's Nosographie was, it was a premature and fallacious attempt. In his day the knowledge of pathological anatomy was not sufficiently far advanced to warrant such far-reaching inferences. Nay more, it was to become manifest in the sequel that no such system as he aimed at establishing is possible. The strength of our contemporary theories of disease lies in the fact that we have renounced any idea of complete systematisation and are content to define as best we may certain groups of illnesses. | ピネルの「疾病論」は魅力があったが時期尚早であり誤った試みであった。当時は病理解剖学の知識がこのような遠大な推理をするほどまだ進歩していなかった。いやもっと言うと、彼の確立しようとしたシステムは結局のところ不可能であることが明らかになった。現在のわれわれの疾病論の利点は完全な体系化を放棄し或るグループの病気を可能なかぎり定義することだけで満足していることにある。 |
| Clinicians of Corvisart's type worked causally. They tried to discover the pathogenesis of a disease, to throw light upon the causal chain, link by link, from the first appearance of a morbific cause until the disappearance of the last symptom. It was a long and tedious road they had to tread. Much remained obscure, much was still inexplicable. But it is the road along which we are still advancing to-day. Moreover, it is the road whose goal is treatment, is the cure of the patient. Pinel's method, on the other hand, was descriptive. Just as, for Condillac, the understanding was nothing more than the capacity for speech, nothing more than the power of expressing sensation in linguistic symbols, so, likewise, for Pinel, the only thing that it behoved the doctor to do was to discover a suitable denomination for the disease with which he was confronted. The manifest outcome of such views was his therapeutic nihilism. | コルヴィザールの型の医師は病気の原因を求めて仕事をしていた。原因の鎖に光を当てて鎖の環を一つづつ病気の最初の出現から最後の症状が無くなるまで病気の病因を発見しようとした。彼らが歩かなければならない路は長く辛かった。多くのことは不明で多くのことは説明できなかった。しかし、これは我々が今でも進んでいる路である。さらに、この路の終点は治療であり、患者の治癒であった。これに対して、ピネルの方法は記載的であった。コンディアックにとって認識は話す能力以上のものではなく感覚を言語記号で表現する能力以上ではなかったのと同じように、ピネルにとって医師が行わなければならないことは当面した病気にたいして適した名前を見つけることであった。このような考えの明らかな結果は治療虚無主義であった。 |
| All the same, there were various fields of medicine in which the descriptive and analytic method proved extremely fruitful, especially where no clear images1 of disease had hitherto existed and where pathological anatomy was still at fault. These two reservations applied, in particular, to psychiatry and dermatology. For thousands of years, diseases of the skin had been regarded as disturbances of the body-juices ; as "eruptions," as outbreaks, of peccant humours . Very little attention had been paid to typical forms, colours, and changes in these eruptions, since such matters were regarded as of secondary importance. It was time, and more than time, for doctors to undertake precise descriptions of specific eruptions, just as a botanist describes plants. In the year 1806, one of Pinel's pupils, Jean Louis Alibert, began the publication of a great work, enriched by magnificent coloured plates, on morbid manifestations in the skin, and attempting to construct a natural system of skin diseases classified in families, orders, and species. A classification of such diseases from the pathologico-anatomical outlook was not yet possible, owing to the lack of sufficient knowledge of the local changes. It was not until 1845 that the famous Viennese dermatologist Ferdinand Hebra was able to attempt this. | それでも記載的、分析的方法が著しく成果をあげる医学分野があった。とくに、明らかな病像がそれまで存在しない分野および病理解剖学がまだ不明瞭な分野であった。この２つの保留条件は、とくに精神病学および皮膚病学に適合した。数千年にわたって皮膚病は体液の障害、たとえば「発疹」は病的な体液の出現と、とみられてきた。これらの発疹の典型的な形、色、経過、は殆ど注目されなかった。二次的な重要性しか無いとみなされたからであった。植物学者が植物を記載するように個々の発疹を精確に記載する時代になった。1806年にピネルの弟子アリベールは素晴らしい着色図の多い皮膚疾患についての大作の出版を始め、科、目、種に分類した皮膚疾患の自然体系の製作を試みた。これらの病気の病理解剖的見地による分類は、局所変化についての充分な知識が得られていないのでまだ可能でなかった。ようやく1842年になってウィーンの有名な皮膚科学者ヘブラはこのことを試みた。 |
| In psychiatry, too, all that was practicable was a purely descriptive account of the various disorders of the mind, since their pathologico-anatomical explanation was not yet possible -- and, indeed, as regards many types of mental disorders, is still impossible to-day. It was, doubtless, known that bodily conditions, various kinds of intoxication, infectious disorders, and diseases of the brain could give rise to mental disorders. In 1793 an Italian physician, Vincenzo Chiarugi by name, published at Florence a book containing sixty-two reports of post-mortem examinations made on patients who had died of mental disorders. Speaking generally, however, the autopsy on one who had perished while suffering from mental disorder rarely disclosed any changes in the brain, and it was therefore a long stride in advance when the descriptive method was applied to reduce the symptomatology of diseases of the mind to some sort of order. | 精神病学でもまた実際に行われたのは種々の心の病について単に記載することだけであった。病理解剖学的な説明はまだ不可能だったからであり、このことは実際のところ多くの精神障害について今日でも不可能である。疑いも無く、身体の状態、種々な中毒、感染、脳の病気によって、精神障碍の起きることが知られていた。1793年にイタリアの医師キアルジは精神障害で死亡した62人の病理解剖の報告を含んでいる本をフィレンツェで発行した。しかし、一般に言って精神障害に罹っているあいだに死亡した患者の死体解剖では脳にほとんど変化は無く、従って記載的な方法によって精神障害の症状学をある程度整頓することは遠い将来のことであった。 |
| Here Pinel himself led the way. He was superintendent of an asylum, and had a vast amount of material under observation. He wrote a book on mental disorders. But his greatest service in the domain, perhaps the most important outcome of his life-work, was that he alleviated the unhappy lot of the insane. Personal experience had made him a psychiatrist. One of his friends had gone mad, had run away into the woods, and had been devoured by wolves. In 1792, Pinel was appointed superintendent at Bicêtre. The conditions there were horrible. The patients were kept in chains, were treated worse than wild beasts. In 1788, Mirabeau had written a pamphlet describing the horrors that went on at Bicêtre. The sick, he said, had not even a doctor to look after them. "The new inmates are heedlessly flung into this wild rabble of lunatics, and any ragamuffin who comes along with a few sous in his pocket can be gratified by the sight of the menagerie." When the Revolution came, it brought freedom of a kind even for the insane. They, too, were entitled to the "Rights of Man." But the change for the better did not come of itself. Pinel had to work hard for his reforms. He went in person to the Convention, was able to make the deputies agree that the chains should be removed, and that henceforward the insane should be regarded and treated as ordinary invalids. He worked for many years to improve things, first at Bicêtre and subsequently at the Salpêtriere. What had been penitentiaries were transformed into hospitals. | 精神病学においてはピネル自身が先頭を切った。彼は精神病院の院長であり、非常に多くの患者を観察していた。彼は精神障碍についての本を書いた。しかし、この領域における彼の貢献、たぶん生涯における最も重要な成果は精神障害者の不幸な運命を楽にしたことであった。個人的な経験が彼を精神病学者にした。彼の友達の一人が狂気になって森に逃げ込みオオカミに食い殺された。1792年にピネルはビセートル病院の院長に任命された。この場所の状態は恐ろしいものであった。患者たちは鎖で繋がれ、野獣よりも酷い取り扱いを受けていた。1788年にミラボーはビセートル病院で起きている恐怖を書いたパンフレットを出した。病人には世話をする医者さえ居ない、と彼は書いた。「新しい入院患者は考え無しに狂人の群に投げ込まれ、不作法な若者たちは数スーの小銭を払って野獣のように見物した」と。大革命が始まったときに、精神障害者にも自由がもたらされた。彼らにも「人権宣言」が適用された。しかし、それだけでは良くならなかった。ピネルは改革に全力をあげた。彼は個人的に国民公会に行き、鎖を除くことを代議士に納得させ、その後、精神障害者は普通の病人と同じように見做され取り扱われるようになった。最初はビセートル病院において続いてサルペトリエール病院において彼は何年も改革に努力した。狂人収容所だったものが病院になった。 |
| In 1822 anti-clerical disturbances broke out at the Ecole de Médecine, which had once more become a faculty and was affiliated to the university of Paris. For a few months the faculty was closed. When it was reopened, some of the members of the professorial stuff failed to secure reappointment. One of these was Pinel. | 1822年に聖職者介入反対の騒動が医学校(エコール・ド・メドシン)で起き、医学校は再びパリ大学所属の医学部になった。学部は数月のあいだ閉鎖された。再開されたときに教授の一部は再任されなかった。ピネルは再任されない一人であった。 |