從天理到手技：清末西醫婦產科譯書與知識傳遞

From Heavenly Principle to Hands-on Technique: Medical Translations and the Transmission of Western Obstetrics and Gynecology into Late Qing China

本文以清末醫療傳教士所翻譯之醫書—合信（Benjamin Hobson, 1816-1873）的《婦嬰新說》（1858）及嘉約翰（John G. Kerr, 1824-1901）的《胎產舉要》（1893）—為核心，重構西醫婦產醫療傳入中國的過程，並探討書籍及文本知識在其中扮演的角色。《婦嬰新說》與《胎產舉要》分別代表譯書兩種不同的功能：前者的出現是傳教士試圖與中國本土掌握文本知識的醫者對話，進一步建立「西醫婦產科」學說的過程，具體表現在合信試圖融合中西方的觀察與天理，並省略文人醫者所不能接受的骨盆解剖及接生器械操作的內容。後者則更像是在醫院內部使用的醫療操作手冊，預設的讀者是實習的學生或助手，具體表現在嘉約翰對於接生器具和手法的強調，並以簡明的問答形式與大量圖例，有效快速地將接生之「技」傳達給在醫院的習醫者。此二譯書在文類上的演變，亦體現了西醫傳入中國的歷史進程：醫療活動從「文人交往」的一部分演變為在醫院對學生實施的「手做教學」。誠然，本文無意截然劃分文人與行醫者、學理與技術|事實上，「醫」同時作為一門學說與診療技術，兩股力量是相互流動、辯證的。然而，若將西醫婦產書籍翻譯與其醫療實踐放在歷史的時間軸下分析，會發現隨著時間的演進，「醫」的意義也有所不同，呈現出多元交織的不同面向。

This article investigates the relations between medical texts and the practice of Protestant medical missionaries in transmitting Western obstetrics and gynecology into nineteenth-century China. It focuses on two different genres of medical translations, seen in Benjamin Hobson's Treatise on Midwifery and Diseases of Children (Fuying xinshuo, 1858) and John G. Kerr's technical manual, Essentials of Obstetrics (Taichan juyao, 1893), respectively. Whereas Hobson situated his text on ''specialist methods'' in the realm of scholarly knowledge that was informed by, and in turn contributed to, Chinese classical scholarship, Kerr, who worked closely with his non-elite students and assistants, promoted ''hands-on techniques'' exclusively generated in the clinical setting. The evolution of the two translations in their distinct genres also reflects the historical process of the introduction of Western medicine into China: medical activities evolved from communication among literati to an emphasis on ''hands-on learning'' in hospitals for educating pupil-practitioners. To be sure, this article does not intend to dichotomize a chasm between academic knowledge valued by literati and craft skills possessed by medical practitioners| instead, I argue that we should maintain a keen historical perspective on the concept of ''Western medicine,'' particularly as its practices developed across diverse time and space before extending to a host of even more starkly different cultures, including those found in China. Such historicity bears witness to the fact that medicine is a uniquely hybrid and malleable sort of science and socio-cultural practice.