清季臺灣地區疾病的治療與觀察 ──外國海關醫員的觀點

Treatment and Observations of Diseases in Taiwan in Qing Dynasty─from the Point View of Medical Staffs of the Customs

清季臺灣開港通商之後，西式醫療亦隨之進入臺灣，以長老教會醫療傳教士與海關醫員為兩大管道，而在觀察與解讀本地傳統醫療上留下極有意義的史料。過去對於長老教會為主的西式醫療已有若干研究，但對於外籍海關醫員了解不多，故本文探討進駐臺灣關（含臺灣府與打狗）與淡水關（含淡水與雞籠）的外籍海關醫員對駐紮地的疾病觀察及其醫療行為，以促進對清季臺灣疾病與西式醫療的了解。首先值得注意的，就是海關醫員多以環境因素或生活習慣來解釋致病原因。此因十九世紀的英國醫生受到整體論的環境醫學（environmental medicine）影響，普遍以之說明疾病的產生，而不太能接受疾病是由特定微生物引起的這種簡單看法。在他們留下的史料中，亦針對氣候地理環境、衛生習慣與疾病之關聯性，提出相關之醫療衛生建議。海關醫員對於台灣民眾的求醫與民俗醫療亦加以注意。由於西式醫療與當時臺灣傳統疾病治療大為不同，他們注意到本地人對西式醫療的看法，發現本地人尋求西醫診治的病症以瘧疾、皮膚病及外科病症較多，此可能與西醫具有中醫或民俗療法所缺乏的診治技術或藥物，甚至與看病費用低廉或免費有關。雖然多數醫員認為本地療法是迷信的，但也有一些醫員承認本地藥物在治療皮膚等疾病也能發揮功效而採用。這些醫員亦呼籲反對屍體解剖的本地人能接受驗屍，以查驗死因與增進病理上的醫學知識。

After Taiwan opened trade in Qing Dynasty, Western medicine was also brought into Taiwan by the medical missionaries of Presbyterian Church and by foreign medical staffs of the customs. It not only made a great impact on Taiwan, but also left very meaningful historical materials relevant to the observation and interpretation of local traditional medicine. There were a number of Western medical researches based on the Presbyterian Church, but only a few about the foreign medical staffs of the customs. Therefore, this article aims to discuss the observations of diseases and medical treatment of the foreign medical staffs in Taiwan-fu customs (included Taiwan-fu and Takow) and Tamsui customs (included Tamsui and Kelung) and tries to promote the research of diseases and Western medicine in Taiwan in Qing Dynasty. First of all, it is worth noting that the medical staffs often used the environmental factors or living habits to explain the emergence of diseases. This was because in the nineteenth century, British doctors were influenced by the environmental medicine and tended to explain the emergence of diseases with this theory. They disagreed with the simple idea that diseases were caused by specific micro-organisms. In the historical materials they left, they proposed related medical advice according to the relevance of climate, geographical environment, health habits to disease. Medical staffs of the customs had paid attention to the local people’s treatment and folk treatment. Since Western medicine was very different from the traditional treatment of diseases in Taiwan at that time, they also observed the local people’s viewpoints about western medicine and found that the local people turned to western medicine and treatment in malaria, skin diseases and surgical cases. This maybe has to do with the western medical treatment technology or medicine, which Chinese medicine or folk remedies lacked, or has to do with free or low cost medical treatment. Although most of the medical staffs thought that the local therapy was superstitious, interestingly, some of them recognized that the local medicine did show effectiveness in the treatment of skin diseases and started to use it. These medical staffs also urged those local people who opposed the autopsy to accept post-mortem so that they could enhance Pathological medical knowledge by examining the cause of death.