疾病、文化與社會變遷─由結核病流行觀點探究二次世界大戰前後的臺灣社會

Disease, Culture and Social Transition - Delving into Taiwan Society Before and After World War Two from Epidemic of Tuberculosis

李政益(LEE CHENG YI)

指導教授 ： 侯文詠

臺北醫學大學/醫學院/醫學科學研究所/碩士(2001年)

摘要

本研究試著利用文獻回顧法與田野調查法，觀察結核病這個傳染病史上最為普遍與嚴重的慢性疾病，以其在臺灣流行、死亡率、治療以及防疫的觀點，來探究社會變遷與其深層所反映出來的文化意涵。 臺灣曾被日本統治五十年，其所帶來之物質上的建設與行政、衛生制度，對臺灣有廣大的影響。以公衛政策為例，自一八九五年日人剛開始到臺灣考察時所稱的「瘴煙蠻雨、惡疫流行」，到一九一○年之後相關衛生制度漸漸的發揮預期功效，臺灣地區各種衛生指標已漸趨於和日本一致化；就在日本即將把臺灣建設完成為一個「南進之地」的同時，二次大戰的亞洲戰區開打，起初臺灣處於「西線無戰事」的狀態，公衛指標顯示臺灣社會各種民生情況明顯優於當時的殖民母國日本，當時台灣結核病死亡率還甚至低於日本二點五倍，可是到了一九四七年，台灣結核病死亡率急轉直上，反而比日本高出了一點五倍以上。 相對於結核病死亡率的變動，臺灣的統治權也由於日本戰敗，政權轉移到來自中國大陸國民黨政權的手上。這期間台灣經歷了截然不同的兩種政權，人口更是因為軍隊的遷徙，而有了更多樣化的組成份子。經歷了不同的政權以及人口變遷，同樣的疾病在台灣，表現出不同的死亡率，對照之下，反映出許多相當有趣而深刻的文化意涵。 本研究試圖從歷史文獻、報紙、文學作品與口述歷史的訪談中，去尋找傳染病與社會、文化變遷之間的關係，並且藉由這些資料的整理與交叉比對、分析，論述結核病與臺灣相關的文化脈絡之間的交互影響。從各地方對於結核病的不同認知開始為起點，再比較臺灣民眾對於結核病的觀點與想法，試著以各種不同的政治、經濟與公共衛生等層面建構與解構這些想法的來源，進而瞭解形成如此認知的主要原因與時空背景。 在這個研究中，我們發現當時台灣民眾的結核病認知明顯與世界各地的認知不同，其對於結核病的認知常是一種「恐懼的」、「注意疾病外緣的」、與「重視現實狀況遠大於想像的」，和國外的「浪漫意象的表徵」有著顯著的差異性；此外，我們也觀察到傳染病與文化之間的關係，傳染病的防治造成人民對疾病認知與求醫行為的轉變，更造成了對傳染病的一種特殊態度；而傳染病對於產業經濟的影響更是不在話下，傳染病的控制成功使得人口大量增加，勞動生產力的品質與穩定性也因而提高，造成了經濟的發展與繁榮，使得日本本土對於台灣經濟與米糖等民生物資的依存度大幅增加，使得傳染病控制似乎成為國家機器有效的控制人民方法之一，也因而鞏固其政權。我們研究的目的在於瞭解結核病作為一廣泛的傳染性流行病與社會變遷的關係，並發掘其間展現出來的重要文化因素，以便對將來更多傳染性疾病的防疫上與治療上，尋求出屬於臺灣自身的方法與途徑。

關鍵字

肺結核病 ； 疾病 ； 文化與社會變遷 ； 日據時代 ； 日據時期 ； 日治時期 ； 國民黨政權 ； 第二次世界大戰 ； 公共衛生 ； 疾病意象 ； 醫學人文

並列摘要

By reviewing the historic records and field study, this research observes TB is the most commonplace and serious chronic disease in history, of which the epidemic, the dying rate, the treatment and the prevention can delve into the social transition and the deep cultural meaning as reflected. Taiwan being ruled by Japan for 50 years widely influenced the material establishment, the administration, sanitary systems in Taiwan. For the example of the policy of the public sanitation, in 1895, the Japanese started to survey in Taiwan, so-called "miasma with torrential rain, epidemics rampant", and in 1910 the related sanitation rules gradually took effect as expected, falling in line with the Japanese standards. As the Jap was about to establish Taiwan into "Moving-South Base",the World War Two in Asia began: In the beginning, Taiwan was placed in “non-war zone”, of which the sanitary index registered even better than Japan with the TB dying rate 2.5 times lower than Japan. But in 1947, the TB dying rate spiraled, even 1.5 times higher than Japan then. In relation to the change of the TB dying rate, the rule of Taiwan was transferred to the Kuomintang from the mainland China. During this period, Taiwan had going thru two different regimes. The populace comprised of more complex members due to the relocation of the army. Experiencing the different regimes and populace relocation, the same disease in Taiwan showed different dying rate, and that reflects a lot of interesting and profound cultural meanings. Based on the historic records, newspaper, literature and the oral interview, this research tries to find out the revelation among the contagion / epidemic, the society and the culture and by means of the data-sourcing, intercrossing, contrasting, analyzing, theorizes on the interacting influence between the TB and the Taiwan culture. Starting with the local different knowledge of the TB, compared with the points of views of the TB by the masses, and what generated such thoughts can be traced and analyzed in relation to politics, economics and the public sanitation etc, in order to further understand the main causes and the backgrounds. In this research, we find that the popular recognition of the TB widely differed from that of the world, which is "a panic", "a caution for outside contagion", "emphasis on the current status a lot more than imagination", -obviously different from the foreign "romantic symbol (image)". Besides, we also observe the relation between the epidemic and the culture: the prevent of the epidemic leads the populace to recognize the TB and change of the medication, further forming a special attitude toward epidemic. Needless to say how epidemic affects the industry. The successful check of epidemic diseases increases the populace, upgrades the quality and the stability of life, thus contributing to the economic development and prosperity, highly interdependent between Taiwan and Japan in economy, rice and sugar etc the people’s livelihood. Then we can find that it seems to be the efficient way for state apparatus to control the people is to control the epidemic first, that the regime can also be more secure. The purpose of this research is by understanding of TB, we can know the relation between the epidemic and the social transition, also dig out the key cultural elements in order to seek out our own Taiwanese ways and methods in dealing with the epidemic prevention and medication.

並列關鍵字

Tuberculosis ； Disease ； Culture and Social Change ； colonial period ( Japanese Occupied Period) ； Kuomintang ； World War Two ； Public Health ； Disease Image ； Medical Humanities

參考文獻

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