『ヒポクラテス全集』における排尿障害の記述について

Abstract

Hippocrates was a famous physician of Kos in ancient Greece (c. 460 B.C.). His works were later described in the Hippocratic Collection, in which I studied disorders of urination. I collected mentions of disorders of urination in the Hippocratic Collection (Roeb, Otsuki and Kon editions) to compared description of disorders of urination between the Kos and Knidos Schools. Disorders of urination were mentioned in 67 parts (sentences or sections): difficult urination in 50, retention of urine in 15 and urinary incontinence in two or three (presumably complicated by difficult urination in one). sigmastrangourih (strangourih) and deltadusourih (dusourih) were counted in 20 and 30 parts, respectively. sigmastrangourih was used in 12 (60%), 5 (25%) and 3 (15%) respective descriptions by Kos, Knidos, and unspecified School, while deltadusourih was used in 13 (43%), 17 (57%), and no descriptions; the correlation was not significant, (chi-squared test, p > 0.05). Descriptions of "stoppage of the urine or bladder", "blockage of the urine", "inability to pass urine", and "check" in classic Greek may mean retention of urine, which also is suspected in the case of severe deltadusourih and sigmastrangourih. Retention of urine only appeared in descriptions by the Kos School, except for one of origin not specified between the Kos and Knidos Schools. The terms "deltadusourih" and "sigmastrangourih" are the origins of the English terms "dysuria" and "strangury". Dysuria ("dys + urine + ia") denotes painful or difficult urination, while strangury ("drop + urine") denotes slow and painful discharge of urine. Deltadusourih and sigmastrangourih with severe pain appear in descriptions by the Kos School. However, in classic Greek, these words by no means always meant painful urination, which differed partially from present-day meanings of dysuria and strangury. There were deltadusourih, sigmastrangourih, and retention of urine accompanied by severe, slight or no pain. The former degree of pain may have included urinary tract infection and/or prostatitis, with the latter, including prolape of uterus or bladder. Sigmastrangourih was a chronic disease of a nonfatal natures, unless complications occurred. "Unconsciously passed a copious discharge of urine" may refer to urinary incontinence, which was seen in one description by Kos and two by Knidos. Two types of urinary incontinence were described, copious and drop urine wise urinary incontinence; the former may represent neurogenic bladder caused by brain dysfunctions, while the latter may represent overflow incontinence. Urethral catheterization and diuretics already were mentioned in the Hippocratic Collection. Bleeding and anodyne were used in treatment of deltadusourih and sigmastrangourih. Disorders of urination appeared in four categories, namely difficult urination or dysuria: dropwise urine or strangury; urinary retention : and urinary incontinence. Severe disorders of urination appear frequently in descriptions by the Kos School.