行政管理與疫情管控之歷史考察：以1918年西班牙流感與鼠疫在中國大陸流行之比較

從2019年起，新冠肺炎（COVID-19）蔓延全球，目前確診人數已破億，死亡人數達217萬人之譜，達199個國家染疫。至今研發疫苗雖有小成，但以隔離為手段的防疫措施，仍是控制疫情的方式。值此大疫流行之際，本文回顧歷史，將1918年當時於中國爆發的兩個重大疫情－鼠疫與西班牙流感進行對比，同時以《申報》為樣本，將兩個流行疫病在法定傳染病病、防疫資源與媒體報導三個面向進行分析，審視這兩個在臨床醫學上甚為相似的病症，何以在百年前，有完全截然不同的表現方式。儘管目前鼠疫與流感對人類威脅大幅度降低，但新興傳染疾病不斷產生，透過對歷史的省思，理解防疫最大的障礙－人性，在疫情爆發時對防疫工作的阻滯與反對。從未按規定配戴口罩，到隔離期間到處行走，這與百年之前，染疫居民反對進行疫調，非難疫調專家的情形並無二致。本文也從歷史文獻的檢視中瞭解，百年前資源相對匱乏的時代，如何進行防疫。鼠疫也因為其致死率高，因此針對性的研究已經有所定論；但對西班牙流感這個瘟疫族群中的新面孔，當年從致病原因、症狀判定及醫療手段，都沒有一致性的看法，以致當年，幾乎沒有記錄保留。後世的研究者僅能從不完全的記述中，追尋真相的片斷。

關鍵字

傳染病；防疫；山西

並列摘要

After the outbreak of COVID-19 in late 2019, the death toll has reached 2.17 million and the disease has spread into199 countries. By far, although there are some achievements in vaccine research and development, isolation and quarantine are still the primary measures for the control of COVID-19. This article tries to make a comparison of the outbreaks of two diseases, pneumonic plague and Spanish influenza, in China in 1918.Meanwhile,＂Shun Pao＂, a Chinese newspaper, is used as the material of research and analysis in this article. We provide in-depth analysis from three different aspects--certification of disease, preventive measures undertaken, and media coverage, to investigate how clinically similar diseases, pneumonic plague and Spanish influenza, had drastically different outcomes100 years ago in China. Although the plague and influenza are unlikely to severely threaten our public health nowadays, new infectious diseases still continue to emerge from different countries in the world. From this article, we can find that, in the beginning of the Covid-19 outbreak, there are lots of interferences with the work of prevention and control in many countries due to public resistance. For example, many people don't like to wear masks or coverings, or like to go around without any restrictions. This is comparable to the experience more than a hundred years ago, when infected patients refused to cooperate with research efforts during the outbreaks of 1918 pneumonic plague and Spanish influenza. From literature and historical documents, we also seek to understand what preventive measures were employed 100 years ago, when resources were relatively deficient. For pneumonic plague, due to its high mortality rate, many studies about this disease have been conducted and reported. However, for Spanish influenza, an unprecedented infectious disease at the time, there was no consistent view on its mechanism, clinical symptoms, and effective treatment options when it broke out; as a result, hardly any document and reports are left from that time. Researchers of Spanish flu today have to rely on limited and incomplete resources.