日常遭遇する消化管の医原性疾患

COMMON IATROGENIC DESEASES OF THE DIGESTIVE ORGANS

Ⅰ．まえがき

　Iatrogenic disease（医原性疾患）という言葉が1930年代Sir Arthur Hurstによって用いられて以来，いろいろな用語が似たような意味合いで使用されてきた．しかしその概念は入により多少の相違があり，今にしてなお若干の混乱がある．ことにわが国では，これについて注目され出した歴史が浅いためか，この言葉の用い方，含まれる内容に一層の曖昧さがめだつ．

　本来は，平易ないいかたをすれば，主に医者の言動によってひきおこされた不利な患者の状態，すなわち医者，患者間の心理的交互作用によってつくり出された病的状態といった意味合いであるが，その後だんだんと投与した薬剤，手術などの医療行為そのものによってひきおこされる障害もこれに含まれるようになってきた．いわば医原性心理障害と医原性身体障害を含めた広い意味で医原性疾患という言葉を使っている人が最近では多いようである．しかし人によっては，あくまでも医者の言動によって惹起される医師原性のものを医原性疾患の本来のかたちとみるのが妥当であるといっており，わが国の日野などもその見解を主張し，治療により当然おこることが予想されるものは，むしろMoserがいったようにdisease of medical progressとして別に考えるほうが混乱をきたさないであろうとしている．

　There still exist some confusions about the concept of iatrogenic desease. Originally the iatrogenic desease meant the disadvantageous state of the patient which was produced by the doctor's behaviour. In other words, it was the morbid state which was produced by psychological interaction between the doctor and the patient. It is a recent tendency, however, that the sense of the word has been widen and many people use the word in the sence indicated: the disturbances which are produced by the medical acts (the administered drugs and operation etc.), the original meaning heeing included. In daily consultation and treatment, it is necessary to be careful both about the psychological interaction between the doctor and the patient, and the medical deeds mentioned above. But the cases of the category, namely neurotic reaction, neurosis, and psychosomatic reaction which were developed by the psychological mechanism between the doctor and the patient induced by the doctor's careless behaviour are more important. From this view point, the iatrogenic desease was analized in this paper. As the actual instances, the cases were presented in which they are treated as deseases but without necessarily making the patients notice them as deseases, and actually, gastroptosis and chronic gastritis were discussed. Also the case of iatrogenic abdominal neurosis which was caused by the doctor's carelessness of telling the patient that he had the adhesion of intestine was studied How to avoid iatrogenic desease was also discussed.