偉大な医師たち：伝記による医学史

41 Ignaz Philipp Semmelweis (1818-1865)	41 ゼンメルワイス (1818-1865)
Now for an interlude, concerning Semmelweis and puerperal fever. His life was one of unceasing struggle: a fight against the illness he wished to make an end of; a fight to secure the acceptance of his teaching, since he was firmly convinced of its soundness; and a fight against the numerous disappointments which life brought him.	幕あいとしてゼンメルワイスと産褥熱について述べよう。彼の一生は絶え間ない苦闘であった。無くそうとした病気にたいする戦いであり、正しいと確信して自分の学説を受け入れさせるための戦いであり、世間からの数多い非難にたいする戦いであった。
Having studied medicine in Vienna and in Budapest, in 1846 he became assistant at the first Viennese Lying-in Hospital. In that same year, Skoda had been appointed professor, two years before Rokitansky. The new Viennese school stood at its climax. In the Lying-in Hospital, however, matters were at a bad pass. The mortality from puerperal fever was enormous, was terrifying. A remarkable feature of the case was that at the first Hospital, which was utilised for the instruction of medical students, the average mortality of women in childbed was 10 per cent, and in certain months was as high as 30 per cent., whereas at the second Hospital, where midwives were trained, the mortality was only 3 per cent. Doctors in those days had very vague ideas as to the nature of puerperal fever, regarding it as a peculiar form of epidemic disease. Naturally, in Vienna, there was much controversy as to what could be the cause of the differing mortality in the two hospitals. The authorities blamed all sorts of atmospheric、 cosmic, and telluric influences ; said that perhaps overcrowding was at fault; opined that the excessive mortality at the first Hospital must be due to the emotional strain to which the women in childbed there were subjected because they were examined by male students. In desperation, the foreign students were excluded from the first Hospital, on the ground that they were rougher in their examinations than the Viennese.	ウィーンとブダペストで医学を学び1846年にウィーン第一産院で助手になった。この年にスコーダが教授になり2年前にロキタンスキーが教授となっていた。新ウィーン学派は絶頂であった。しかし産院の状態は悪かった。産褥熱による死亡はすごく多く恐ろしいほどであった。学生の教育に使われている第一産院で産婦の平均死亡率は10%で月によっては30%に及んでいた。これにたいして助産婦の訓練を行う第二産院で死亡率は3%に過ぎなかった。当時の医師たちは産褥熱について漠然な考えしか持っておらず、特殊な疫病とみなしていた。もちろん、ウィーンの二つの産院で死亡率が違ふ理由について多くの議論がなされていた。権威者たちは空気、宇宙、土地のすべての種類の影響を問題にした。満員であることが理由とされたり、男性の学生が診察するので産褥の女性に感情的な緊張が与えているのに違いないとの意見が出された。ウィーン人にくらべて検査が荒いと言う理由で絶望のあげく第一産院から外国人学生が閉めだされた。
Naturally enough, the first Hospital became notorious, and it is impossible, even after the lapse of years, to read Semmelweis' description without a sense of horror: "There were heart-rending scenes when patients knelt down, wringing their hands, to beg for a transfer to the second Hospital, having, by a mistake on their part, applied for admission to the first Hospital. . . . Women recently confined, with a pulse so frequent that it could not be counted, with abdomens enormously distended with dry tonguesーーin a word, women suffering from severe puerperal feverーーwould insist, only a few hours before their death, that they were perfectly well, their object being to avoid medical treatment, since they knew that medical treatment was the immediate precursor of death." Several times a day a priest in full canonicals, preceded by a choir-boy tinkling a bell, would come to the hospital in order to give the last sacrament to the dying. We can readily imagine how distressing it must have been to a sensitive-minded physician to find himself helpless in face of such distresses. "It was a fresh shock to me every time I heard the bell as the priest passed my door, and once again I heaved a sigh for the victim who was to be destroyed by an unknowa cause. The bell, in fact, became for me an exhortation to search with all my energies in order to elucidate the cause."	第一産院の評判が悪くなったのは当然のことであった。年月が経った今でもゼンメルワイスの記載を読むと恐怖を覚える。「誤って第一産院に入院を希望した患者たちは固く手を握り跪いて第二産院に移らせて欲しいと願うので心が張り裂けた。....お産の床で数えることができないほど脈が速く腹部が膨満し舌が乾いたーーすなわち重篤な産褥熱のーー女性が死の数時間前に医療を受けるとすぐに死ぬことを知って、完全に健康だから医療をしないで欲しいと主張した」。毎日何回も少年聖歌隊員を先導として法衣を着た僧侶が臨終の患者に終油の秘跡を与えに来ていた。このような悲痛を目の前にして、助けることができないので、感じやすい一人の医師がどのように悲しかったか想像できる。「僧侶が部屋のドアの前を通り過ぎる鈴の音を聴くたびに、いつでも新しいショックを覚えた。不明の原因で死んで行く犠牲者のために、改めてため息をついた。事実、私にとって鈴の音は全エネルギーを捧げてこの原因を求めるようにとの励ましであった。」
Illumination came. In the spring of 1847, Semmelweis made a trip to Venice, "hoping, through the sight of the art treasures in that city, to recover the equanimity which had been so greatly shaken by the events in the lying-in hospital." Immediately after his return to Vienna he was informed of the sudden death of his intimate friend Kolletschka, professor of medical jurisprudence, whose finger had been pricked by a maladroit student during a post-mortem examination and who had died of blood-poisoning. "I was instantly struck with the close resemblance of the malady from which Kolletschka had died to that from which I had seen countless numbers of women perish after childbirth." The symptoms were, in truth, identical.	光明が得られた。1847年春にゼンメルワイスは「産院の出来事によって大きく動揺させられた平静心をこの市の美術の至宝によって快復させることを希望して」ヴェネツィアに行った。ウィーンに帰ってすぐに、親しい友達で法医学教授のコレチュカが突然に死亡したことを知らされた。屍体解剖のときに不器用な学生によって指を傷つけられて敗血症で死亡したのであった。「コレチュカが死亡した病気と出産後に死亡した無数の女性の病気とが全く似ていることに瞬間的に打たれた」。実際、症状は同じであった。
The facts were plain. Just as the post-mortem knife which had caused Kolletschka's death had been infected with materials from a dead body, so, likewise, were infected the fingers of the examining physicians and students who, in Vienna where post-mortem examinations were so frequent, continually handled the viscera of the bodies of the dead. Semmelweis himself used to make post-mortem examinations every morning. Puerperal fever, then, was not due to any peculiar "epidemic constitution," but was a decomposition of the blood just like that caused by wound-infection. It became clear why the second Hospital was much less devastated by puerperal fever, seeing that the midwives had little opportunity of getting their fingers contaminated in this particular way. It was plain, too, why women who were delivered rapidly before an examination had taken place never sickened from puerperal fever, whereas those in whom labour was tedious and in whom numerous examinations were made were almost certain to die from the disease. It was comprehensible, moreover, why the mortality was much lower during the vacation, and also why puerperal fever was comparatively rare in country districts. Taking prompt action in the light of these considerations, Semmelweis insisted that in his clinic every doctor and student must disinfect the hands with chlorine water before making an examinationーーand immediately there was a great decline in mortality.	事実は明らかであった。コレチュカの死の原因となった屍体解剖メスが屍体からの物質によって感染していたように、産院において診察をしている医師や学生の指は感染していた。ウィーンでは屍体解剖が盛んに行われ、屍体の臓器は常に取り扱われていた。ゼンメルワイス自身も屍体解剖を毎朝に行うことにしていた。従って、産褥熱は特殊な「流行性の状態」ではなくて創傷感染と同じような血液の腐敗によるものであった。助産婦たちはこのような指汚染の機会がほとんど無いので、第二産院で産褥熱が少ない理由は明らかであった。検査をする前すぐに分娩した女性は産褥熱に罹らず、陣痛が長く続いて数多くの検査を受けた女性はほとんど間違いなくこの病気で死亡することも明らかであった。さらに、休暇中には死亡率がきわめて低く田舎では産褥熱が比較的に少ないことも理解できた。これらの考えを踏まえてゼンメルワイスは検査の前に手を塩素水で洗うことを主張し、すぐに死亡率は大きく減少した。
One might suppose that so epoch-making a discovery would speedily have achieved general recognition. This was far from being the case. Semmelweis declared: "It is owing to the doctors that there is so high a mortality in childbed." He himself frankly acknowledged : "As a logical outcome of my conviction I have to acknowledge that God only knows how many women I have prematurely brought down into the grave." Others were less frank. No doubt such men as Skoda and Hebra were quick to appreciate the value of Semmelweis' work and to proclaim the importance of his discovery. His fiercest adversaries, however, were his own immediate colleagues, the professors of midwifery, who regarded themselves as affronted. There ensued a deplorable and long-1asting controversy between Semmelweis and the most noted accoucheurs of the day. On the one side there was a sincere conviction, which often enough found expression in bitter phraseology ; and on the other side there was scorn and cold rejection. "Murder must cease," wrote Semmelweis ; "and I shall do my utmost to ensure the cessation of murder, for everyone who dares to disseminate dangerous fallacies concerning puerperal fever will find in me an extremely active opponent. I am firmly convinced that there is no other way of putting a stop to these murders than the ruthless exposure of my adversaries, and no one whose heart is in the right place will blame me for the means I use."	このように画期的な発見は一般に急速に認められるに違いないと思われるであろう。そうではなかった。ゼンメルワイスは宣言した。「産褥でこのように死亡率が高いのは医師の責任である」と。彼自身は「私の信念の論理的な結果として私がいかに多くの女性を時期尚早に墓に送ったかは神のみが知っている」と率直に認めた。他の人たちは率直でなかった。シュコーダやヘブラのような人たちはゼンメルワイスの研究の価値を認めて発見の重要性を賛美した。しかし、もっとも激しい反対者は同僚の助産学教授たちであった。彼らは侮辱されたと感じていた。ゼンメルワイスと当時の有名な産科医のあいだに嘆かわしく長いあいだ続いた討論が行われた。一方は真面目な信念でしばしば激しい言葉で表現した。他方は嘲笑と冷たい拒否であった。ゼンメルワイスは書いた。「殺人は終わらせなければならない。殺人を終わらせるためなら私は出来ることを何でもしよう。産褥熱について危険な誤った考えをまき散らす人にとって私は強力な反対者であろう。これらの殺人者に中止させるためには反対者を残酷に摘発する以外に方法は無いと私は固く信じていて、心臓が正しい位置にある人なら誰も私が採用する方法を非難しないであろう。」
Writing to Scanzoni, the famous Würzburg accoucheur, he said : "If, Sir, without having refuted my doctrine, you continue to teach the students and the midwives you train that puerperal fever is an ordinary epidemic disease, I proclaim you before God and the world to be an assassin, and the history of puerperal fever would not do you an injustice were it, on the grounds that you were the first to set yourself in opposition to my life-saving discovery, to immortalise you as a medical Nero."	ヴュルツブルクの有名な産科医スカンツォニに書いた。「枢密顧問官閣下。私の学説を論破しないで引き連れている学生や助産婦たちに産褥熱はふつうの疫病であると教え続けるなら、神および世界に貴方は暗殺者である、と宣言する。生命を救う私の発見に貴方が第一に反対した理由によって産褥熱の歴史が貴方を医学のネロとして不滅な存在にしたとしても不当ではない」と。
It will readily be understood that such language as this did not make Semmelweis popular. There was no chance of promotion for him at the university of Vienna. His request to be allowed to lecture there was at first bluntly rejected, and was in the end granted only on the condition that he might demonstrate operations upon the model exclusively. Naturally he would not be content with this grudging concession. Five days after his appointment as instructor, he shook the dust of Vienna off his feet, and in 1851 returned to his native city of Budapest, where he was able to work as honorary physician to the St. Rochus Hospital under the most unhygienic conditions imaginable. At length, after four years, he became ordinary professor of midwifery at the University of Budapest. He refused a call to Zürich, though made in gratifying terms, for he felt more at home in Buda.	このような言葉がゼンメルワイスの評判を落としたことは容易に理解できる。ウィーン大学では昇進の機会が無かった。講義をさせて欲しいという要請は最初にべもなく拒否されたが人体モデル実習だけの条件で許可された。もちろん、このような悪意をもった譲歩は不満であった。任命の5日後にウィーンの埃を脚から払って1851年に故郷ブダペストに戻り、考えられるもっとも非衛生的な聖ロクス病院の名誉医師となった。最後には4年後にブダペスト大学の助産学の正教授となった。条件は良かったがチューリッヒからの招聘を断った。ブダ(＊ブダペストの城側の部分)が好きだったからであった。
His end was tragical. The joy of life, the exuberant cheer-fulness, which, during the years when he was an assistant physician, had enabled him to divert himself many an evening in the Prater, and there to forget the troubles with which he was environed, had long since been damped by struggle and bitterness. His memory began to fail. His mind became clouded. At length he had to be put under restraint in an asylum. As a culmination of tragedy, he died when only forty-seven years of age of the very disease which had given him the hint needed for his discovery. He injured himself while performing an operation, and, like his friend Kolletscnka long before, died of blood-poisoning.	彼の最期は悲劇的であった。助手時代にはウィーンのプラター遊園地で夕を過ごして身の回りの困難を忘れていたが、そのような楽しい生活は争いや苦痛によって失われた。記憶が無くなり精神は濁り、ついには精神病院に入れられた。もっとも悲劇的なことに、産褥熱発見の端緒となった病気によって彼は47歳の若さで死亡した。すなわち、手術にさいして自分を傷つけて以前に起きた友人コレチュカの場合と同じように敗血症で死亡した。
Semmelweis wrote little, having no taste for it, as he himself declared. Apart from a few lectures and his notorious Open Letters, he published only one book of note, the Aetiologie, Begriff und Prophylaxis des Kindbettfiebers, which appeared in the year 1861. It is a small volume, simple and unadorned, but cogent through its presentation of hard facts and through its inexorable consistency-being a work which was intended to overcome the last resistance to his teaching. Semmelweis made his discovery empirically. He recognised that puerperal fever was a form of wound-infection. The post-partum uterus is like a huge wound, and can, like any other open wound, be readily contaminated by decomposing organic substances, with the result that a deadly form of blood-poisoning arises. He showed that certain chemicals could make these poisonous substances harmless. Thus he was a pioneer in the realisation of the modern notion of antisepsis. But he had no clear notion as to the nature of the virus He was not aware that living organisms were at work in producing wound-infection and puerperal fever. His doctrine lacked convincing force until these organisms had been discovered, but as soon as they had been discovered it became part of the general theory of infectious disorders. The actual discovery and demonstration of the contagia viva was the work of the men to whom we shall now turn.	自分で言っているようにゼンメルワイスは書くことを好まず著作は少ない。幾つかの講義と評判が悪い公開書簡の他には1861年に刊行した著名な一冊の本「産褥熱の原因、概念および予防」だけしか書かなかった。この本は簡単で飾り気の無い小さなものであったが、事実の表示および容赦なく矛盾の無い議論は説得力があり、彼の教えにたいする最終的な反撃を目的とするものであった。ゼンメルワイスは経験によってこの発見を行った。彼は産褥熱を創傷感染の一種と考えていた。出産後の子宮は大きな傷のようなもので他の開放傷と同じように腐敗した有機物質で汚染され致死的な敗血症が起きる、とした。ある種の化学物質はこれらの有毒物質を無毒化することを彼は示した。この意味で彼は消毒の現在の概念を示した先駆者であった。彼の学説は微生物の発見までは説得力を持たなかったが、微生物が発見されるや否や感染症の一般理論の一部となった。生きている感染体の実際の発見と証明はこの後に述べる人たちによって為された。

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