十九世紀後期英國醫學界對中國痲瘋病情的調查研究

British Medical Research on Leprosy in Late Nineteenth-Century China

本文探討十九世紀後期英國醫學界對中國痲瘋病情的調查研究，並分析當時關於痲瘋病困和傳播方式的醫學爭論。自十六世紀以來，痲瘋在歐洲大多數地區已消失無蹤。然而，十九世紀隨著歐洲的帝國主義擴張以及勞動移民的增加，使得歐洲人接觸痲瘋病患的機會大增。十九世紀初，歐洲醫界大致認為痲瘋是遺傳病，並不會對歐洲造成太大威脅。然而，一八六○年代在夏威夷出現多起痲瘋病例，使得西方再度出現對痲瘋的恐懼。由於夏威夷過去並沒有痲瘋病例，此一事件令不少人懷疑痲瘋可能會傳染，而且是由中國苦力帶入當地的。擁有龐大殖民地的美國政府相當注意夏威夷痲瘋事件，而這也促使了英國醫界加強海外的痲瘋研究。十九世紀歐洲醫界認為中國是痲瘋主要盛行區域之一，許多來華的醫療傳教士以及在中國海關擔任醫官的美籍醫師，對痲瘋研究相當有興趣。一八六○年代和一八七○年代，大多數來華美國醫師認為痲瘋是遺傳病。儘管中國人普遍相信痲瘋會經由性行為傳染，美國醫師卻對此存疑。到了一八九○年代，痲瘋傳染說逐漸成為美國醫界的主流意見；也有越來越多的醫師認為中國移民將痲瘋散播到世界各地。美國醫師康德黎在香港行醫、教學多年，他獲得英國國家痲瘋基金會論文獎的研究著作，就是此一論點的重要代表。此外，康德黎也主張痲瘋會透過性行為傳染。本文指出，新興的細菌學說雖然促使美國醫界接受痲瘋傳染說，這段期間它在中國的痲瘋研究卻沒有扮演任何實質的角色。事實上這些研究主要仍依賴舊式的疾病問卷調查，而這正是十九世紀英國殖民科學與醫學常用的研究方法。本文進一步指出，英國痲瘋醫學研究之轉折和西方種族主義的高張以及熱帶醫學的專科化，有著密切的關係。

This paper investigates nineteenth-century British medical research on leprosy in China. Since the sixteenth century leprosy had disappeared from most part of Europe. In the early nineteenth century most European medical men held that leprosy was a hereditary disease that no longer posed serious threats to Europe. However, in the 1860s the appearance of leprosy in Hawaii aroused the fear of leprosy in the West again: Leprosy had not appeared in Hawaii before, and the incident raised the possibility that it was contagious. The immigrant Chinese coolies were blamed for bringing the disease to Hawaii. The event prompted British medical men to conduct several investigations of leprosy in the colonies and the periphery of the Empire. In the nineteenth century, European medical men considered China as a major source of leprosy. Western medical missionaries to China and the Medical Service of the Chinese Imperial Maritime Customs staffed mainly by British medical men were interested in studying leprosy. In the 1860s and 1870s most British medical men in China still held that leprosy was hereditary, and they were sceptical about the Chinese belief that leprosy could be transmitted sexually. However, in the 1890s the idea that leprosy was contagious and the Chinese immigrants were largely responsible for its spread, as represented by James Cantlie 's prize essay, became the mainstream in British medicine. Moreover, the view that it could infect people by means of sexual intercourse accrued credibility. This paper analyzes the relation between British medical men's change of view with racism, the rise of germ theory of disease, and the establishment of tropical medicine as a specialty. It argues that although the ascendance of bacteriology in the late nineteenth century helped sway medical opinions with regard to the issue of the contagiousness of leprosy, bacteriology did not play a substantial role in research on leprosy in China. Most of the research in China still relied on the 'old-fashioned' survey, a method central to nineteenth-century British colonial science and medicine.