疾病與醫療:往昔與當下

主持人:洪廣冀(國立臺灣大學地理環境資源學系 副教授)

現代臺灣漢醫的開端:日治初期鼠疫防治與臺人醫院

蔡令儀(駿琳大直中醫診所 醫師)

十九世紀末,鼠疫傳入香港,港英政府下令封港並進行隔離檢疫、清潔消毒等防疫措施,造成不小的華洋衝突。這波鼠疫大流行(pandemic)因香港疫 情爆發而有了國際關注。1896 年,正值臺灣政權轉換之際,鼠疫分別登陸臺南 與臺北,有香港作為先行者,日殖民政府在臺灣展開類似的防疫行動,並設置 隔離醫院。現代公共衛生政策同樣造成臺灣民眾不安,地方仕紳請願要求建立 使用漢醫藥專屬臺灣人的醫院。本文透過比較歷史分析,論證臺灣漢醫在日治 初期提升地位的關鍵因素在於與地方仕紳的聯盟以及透過學習新知與臨床實作 與西醫產生合作關係。在嚴峻的疫情當中,許可傳統醫學參與並非必然,甚至 可能是特例,對照東華醫院,香港中醫未能也不願意如同臺灣漢醫一般參與治 疫工作,在香港鼠疫歷史中便難以見到他們的身影。
疫情初始,染疫日人多於臺人,殖民政府認為有隱藏案例。為減少隱匿並 安撫民眾,同意成立用漢醫藥的「臺灣人黑死病治療所」,是為收治鼠疫患者 的臺人隔離醫院。因漢醫在鼠疫治療上的成功,各地仕紳紛紛請願集資成立臺 人醫院,亦獲政府許可。臺灣漢醫跟隨地方仕紳的政治參與捲入殖民政府的防 疫行動中,在治疫之外進一步成立研究會,學習現代醫學新知。隨著疫情發 展,臺灣漢醫的社會地位與專業知識也跟著提升,之後亦持續獲得臺灣民眾認 可。整體而言,透過鼠疫防疫,部分臺灣漢醫走入現代,與日治以前的傳統漢 醫區隔開來,如漢醫黃玉階,更成為臺灣文明開化的代表人物。

關鍵字:臺灣漢醫、臺人醫院、隔離醫院、鼠疫、黃玉階、香港

Tuberculosis and the Quest for Modernity in Shanghai, 1911-1928《結核病與上海的現代化》

Rachel Core(Stetson University, Sociology, Associate Professor)

The pneumonic plague, which ripped through Manchuria in 1910-11, redefined China’s quest for medical “modernity.” While there is consensus among scholars that this plague accelerated acceptance of Western medicine and laid the foundation for modern public health protocols in China, scholars have not examined how the recommendations arising from plague control directly informed policies to control a more widespread respiratory disease: tuberculosis (TB). Perhaps more than any other disease, tuberculosis has been closely aligned with the quest for modernity in nations throughout the globe. The intertwined processes of urbanization and industrialization—with crowded living and working spaces, exploitative conditions, and rampant inequality–create ample conditions for the spread of TB. After Robert Koch’s 1882 discovery of the tuberculosis bacillus and before discovery of effective antibiotics in the mid-twentieth century, several successful public health interventions were made globally to control tuberculosis. Before turning to China, this paper will review the literature on the factors contributing to the global decline of TB in the early 20th century, including labor laws and sanatoria creation. As was the case elsewhere in the world, prevalence and mortality from TB underscored a need to social change in China; however, scholars largely have not examined how tuberculosis closely aligned with China’s quest for modernity, particularly in its most industrially advanced city, Shanghai. The paper draws upon archival documents, newspaper and journal articles, and reports of the colonial Shanghai Municipal Council to investigate efforts to control TB. Despite minimal attempts to regulate labor and living conditions, TB declined in China’s largest cities in the early twentieth century. What intervention were made? The paper will examine both infrastructural and behavioral interventions informed by wider global health protocols. Among these interventions, the state and private actors built hospitals to isolate persons with infectious disease. Although the rise of hospitals had some success, attempts to develop norms regarding civilized behavior were less so. This paper demonstrates that various actors had difficulty establishing social control over TB sufferers and the authority of biomedicine in an era when the germ theory of disease was not widely accepted.

關鍵字:tuberculosis, Shanghai, public health, modernity/modernization, China

明清時期大風子的醫療文化史試探

官柏勳(國立臺灣大學歷史學系 碩士班學生)

梁其姿反省回溯診斷(retrospective diagnosis),重建大風、癘(癩)、麻風的命名過程、疾病分類與醫療史,也指出南宋以降的傳染概念影響明清以降的麻風隔離院。她檢視大風子(大楓子)的相關文獻,指出元明以降醫者愛用大風子治療大風、癩。本文從貿易網絡、本草知識和醫療實作的角度,進一步分析大風子從南海輸入明清中國的過程。傳統中國對於外來醫藥並非一無所知,第三章綜覽歷代外來醫藥入華的主要媒介,說明中外本草與醫療知識的相遇。
第四章聚焦本草知識。傳統中國據藥物的作用、外形和陰陽五行屬性等原則命名和分類。明清許多本草學者據療效(治大風與風)和形狀(高大楓樹)解釋大風子的命名由來,並參考其在文本中的大樹形象分類。明末少數本草學者對於海外某種「不結毬而結子」的大楓樹感到疑惑,清代本草學者卻無回應此難題,亦無重新定義楓樹。明末以降大風子圖繪者多彰顯常見的藥用部位,很少考證其他部位形狀,也有人仿照楓葉繪製其葉子,反映大楓子與楓的模糊關係。明清本草學者和繪圖者對於海外大楓樹的掌握有限。當時醫者和本草學者對於大風子的產地環境亦缺乏深刻認識,很少連結其藥性與方土。
傳統中國的藥物性質基本上與方土、氣味、炮製有關。明代印刷出版及尚醫文人風氣促進朱震亨(1281-1358)醫療文本傳播,該文本社群依託朱氏,批評「粗工」不懂大風子性(大)熱而誤用。明末江南本草學者的師友社群據陰陽五行、佛教四大學說、「風動蟲生」等文化資源,賦予大風子多元藥味。大風子的性質猛烈,許多醫藥學者或因此視其為毒藥,又以炮製、配伍方法減少大風子對人體的傷害。明末沈之問運用炮製,在跨文化與多元醫療市場中建立權威感。
第五章透過大風子的相關藥方配伍,分析多重藥物實作和藥性網絡的互動與摩擦,進而重建病因、疾病分類與醫藥知識變遷。梁其姿指出,宋代以降醫者不再以風為大風、癩的重要病因,因而將這類病放入外科(皮膚病)。筆者指出,明清醫者援引風、蟲致病論,並融入內熱(火)、情志、傳染、南方風土等較新病因。大風子散風、殺蟲的療效顯示外科病因並非與風、蟲毫無關係,學者不能以邊緣的風致病論解釋大風、癩有時屬於外科的現象。皮膚麻木成為大風、癩、麻風的主要特徵,才能解釋疾病分類史。
要言之,本文藉由大風子入華的過程及媒介,探討明清本草知識、醫療實作與疾病知識的交織,並重建中外文化相遇的特色。

關鍵字:大風子、文化交流、本草知識、醫療實作、中國麻風史、楊梅瘡

英屬馬來亞瘧疾研究的國際網絡:以金雞納生物鹼和合成藥物測試為例

洪均燊(國立臺灣大學歷史學系 博士生)

本文以吉隆坡醫學研究所(Institute for Medical Research, IMR)以及國聯衛生組織瘧疾委員會的檔案等史料,以英屬馬來亞的金雞納生物鹼和其他化學合成藥物的人體測試,了解英屬馬來亞瘧疾研究的國際網絡。

英國與國聯瘧疾委員會於1920-30年代尋找比奎寧更便宜但同樣有效的抗瘧製劑,並研究生物鹼混合物與奎寧相比之下的效力,如Cinchona febrifuge,撲瘧母星(Plasmoquine),阿的平(Atebrin)等,以用於治療各國的瘧疾。IMR於1921年開始受到英國Medical Research Council的委託進行了金雞納生物鹼(Cinchona Alkaloids)如奎寧丁(Quinidine)、辛可寧(Cinchonine)以及Cinchona febrifuge對各種瘧原蟲作用的差異,評估在人體的有效劑量及副作用。德國藥廠拜耳(Bayer)先後於1926年及1930年製造出化學合成藥物撲瘧母星與阿的平,在國聯瘧疾委員會的支援下,相關藥物的測試在阿爾及利亞、撒丁島、羅馬尼亞、蘇聯與馬來亞等地進行。馬來亞部分的藥物測試由IMR執行,以確認預防性投藥的劑量、間隔時間與長效性。
本研究認為IMR藉由馬來聯邦各地醫院及種植園區的瘧疾患者,為上述各種藥物的測試提供充足的病患來源,同時產生具有實驗有效性的實驗成果,為英國及國聯衛生組織所接受,成為藥效評估的依據。此外,在馬來亞的生物鹼藥物研究中,種植園區成為可以操作實驗變相,藉由控制種植園區的病媒蚊以及最終宿主等瘧疾傳播途徑,能夠確保種植園區具有穩定的病患自然產生, 並進一步對病患進行生物鹼藥效測試,這樣的研究方法也被國聯衛生組織選為藥物測試的區域,成為東南亞乃至於世界各地茶園、橡膠等重要經濟作物種植園區的藥物測試代表。
既有國際衛生史論點認為,國際組織如國聯、洛克菲勒基金會等透過資金與技術援助對殖民地或第三世界發揮影響力,卻少有研究從東南亞國家的角度出發,討論這些國家扮演的積極角色,形成區域聯盟進行醫療知識與技術交流。本文探討英屬馬來亞時期生物鹼藥物療效的測試,認為英屬馬來亞的瘧疾研究應被視為全球瘧疾研究與防治網絡中的重要樞紐之一。

關鍵字:馬來亞、瘧疾、奎寧、藥物測試

Bricolage for a Troubled World: Chinese medicine and the Response to COVID 19

Eric I. Karchmer(中國醫藥大學 訪問學者、助理教授)、賴立里(北京大學醫學人文學院)、楊慧宇宙(南京信息工程大學)、趙笑芃(北京中醫藥大學)

One of the surprising developments in the COVID 19 pandemic response in mainland China was that doctors of Chinese medicine were given a sizeable role in the clinical management of COVID 19 patients. Perhaps even more unexpected, given the historical ambivalence of the Chinese Communist Party (CCP) towards traditional healing, has been the numerous official announcements trumpeting the clinical successes of Chinese medicine therapies. What can we learn from doctors of Chinese medicine working to treat a newly emergent disease about indigenous forms of knowledge? If the claims of the CCP are correct, how is it possible that these traditional therapies were effective in treating a disease caused by a virus that had never existed before? In this paper, I will argue that the answers to these questions will push us to think more deeply about how to “indigenize” science and technology studies and reconceptualize the relationship between alternative knowledges and the more established field of science and technology studies. To outline a tentative response to this important theoretical work, I want to propose a return to Claude Levi-Strauss’s Savage Mind and his concept of bricolage. Levi-Strauss famously defined bricolage as the practice of making do with whatever is at hand, and he contrasted it to the work of the engineer, who supposedly is liberated from the constraints of the moment. Although Jacques Derrida later critiqued this opposition between bricoleur and engineer, we should not abandon many of the other rich insights to be found in Levi-Strauss’ work. By examining the clinical work of Chinese medicine doctors in the bewildering, early days of the pandemic, I will show how bricolage allows for efficacious action in moments of instability and dislocation, for pragmatic solutions that do not require a privileged claim to truth and total knowledge.

關鍵字:Chinese medicine, bricolage, COVID 19, indigenous knowledge