日據前的西方醫療及其對台灣醫學之影響

本文所論及日據前的西方醫療橫跨瘴氣醫學時期與教會醫學時期，直至日治醫學時期之前，即西方殖民台灣，讓台灣首度接觸西方醫療的時代。明清西方勢力進入前，臺灣煙瘴甚厲，牟勇多病，苦無良醫。直至1887年初設官醫局，雇用西醫診療官吏。軍隊設官藥局，後改養病院，另外為民眾設官立的醫療機構，有養濟院、普濟堂、及留養局；而私人機構則靠私家周藥、善堂、藥簽與民間避瘟儀式。在西方醫療進入前的台灣醫療狀況值得一提的包括王船信仰與宗教醫療、原住民醫療與巫醫、本地醫生及漢藥方與土方。荷蘭時期的醫療檔案資料為荷文，保存在荷蘭。當時的醫療制度與人員以商務或軍人為主，間或有傳教士醫師，但仍未完全脫離官方色彩。早期荷蘭佔領時期臺灣居民絕大多數仍為原住民，西部以平埔族居多，醫療服務對象應為原住民，相關資料除非漢譯或精於羅馬拼音恐難窺究。目前僅能從歷史上的蛛絲馬跡去推測，是以名之為史前史。十九世紀之前，即在日據前橫跨三百年，在台灣的外國醫療活動以荷蘭與英國為主，特別以東印度公司、醫療傳教活動以及日殖之前海關醫官的活動為重點。在1860年英法聯軍之役之後，簽訂了天津條約，允許外國人在中國居留與旅行，這為傳教士的進入台灣打開了門戶。隨著傳教活動而來的許多醫療傳教士。此外英國在「天津條約」簽訂後接掌中國海關，並在通商港埠設立海關醫療勤務，由英國醫師擔任醫官，但薪資由滿清政府負責。他們除了主管港口防疫工作之外，也為當地歐洲人與本地人提供醫療服務。部份海關醫官還從事研究當地的風土病與盛行的疾病，並記錄當地所面臨的醫療問題。在台灣打狗(Takow)與淡水(Tamsui)這兩個港口都設有海關醫官，直到甲午戰後日本殖民台灣為止。海關有出版“海關醫報”(Medical Reports, In China Imperial Maritime Customs)，而醫療傳教士也留下許多報告、出版品與書信。目前這段歷史在荷蘭與英國有著豐富且重要的史料，迄今仍尚未被史學界充分整理與利用。十九世紀前荷蘭與英國人在台灣的醫學研究與醫療活動值得我們探討；特別是荷蘭與大英帝國在台灣的政經利益與其醫學活動之關係、及西方醫學在台灣的傳播過程及其與台灣人的互動。目前已部份整理的資料包括衛康醫學史圖書館、倫敦熱帶醫學校、倫敦大學亞非學院、與部份在台灣可尋得各教會醫院的組織資料，其中包括在長榮中學的長老教會文物館、新樓醫院馬雅各文物館、彰化基督教醫院文物館及馬偕醫院文物館。

關鍵字

日據前台灣的西方醫療；台灣醫療史；海關醫療；教會醫療

並列摘要

This paper discussed the western medical history in Taiwan from the primitive medical stage till the period under Japanese occupation, that means until the christian medical mission was popular. In Ming and Chin Dynasty, before the colonialism power entered Taiwan, people in Taiwan suffered from the local tropical diseases of unknown etiologies without good medical care. Till 1887, public health bureau was founded hiring doctors and using western medicine. Later, public health bureau was founded in larger number in the army and were rebuilt as chronic care center. In addition, public health agencies such as nursing home, chronic care center, and health care center were built for the people; private agencies were often seen as pharmacy, drug store, or herb-drug health center. Before the introduction of western medicine to Taiwan, belief of religion, aboriginal medicine, local way of treatment and herb doctor, and traditional Chinese medicine deserve our attention. During the Dutch occupation period, medical files were recorded in Dutch and conserved in the Netherlands. At that period, medical system and personnels were mainly engaged in commerce and the army. Few were missionaries and there were mostly official. In the early stage, the majority of residents in Taiwan were aborigines and many of them were Ping-pu gathered in west coast. Since Medical service was offered for aborigines, it was difficult to collect relevant data for lack of Chinese translation. Even till now, we can only infer based on the fragment of data, we call it is pre-historical history. Before the 19(superscript th) Century, about three hundred years before Japanese occupation in Taiwan, western medicine was conducted by English and Dutch, in particular, East Indian Corporation, christian medical missionaries, and customer official medical personnels. After the war with Britain and France in Chin Dynasty, Tienchin Treaty was signed which allowed foreigners to travel and inhabit in China and opened the gateway for missionaries to enter territory of China. After the treaty, Britain took over Chinese customs and set up agencies to take in charge of medical works in customs. British doctors were hired as custom officials though salaries were provided by Chin government. These officials took charge of the preventive medical work and provided medical service to both European and local residents. Some even were engaged in the studies of local or tropical and endemic diseases and recorded the medical challenges they were facing. Custom medical officials stationed in Takow and Tamsui habours from Chiawu War till Japanese occupation period. The customs even published ”Medical Reports in China Imperial Maritime Customs” and many reports, publishing, and correspondence were left by the missionaries also. Data of this period of history were conserved in the Netherlands and Britain, butthey have not been well compiled and filly used for the study of medical history in Taiwan. There is a need for us to explore medical history and activities in Taiwan before the 19(superscript th) Century, especially in the fields of the political and commerce interest, medical interactive relations, and the medical education among Taiwan, the Netherlands, and Britain. Some compiled data can be found in museum, hospital, and university libraries in Britain, such as Wellcome Institute of Medical History, School of Hygience and Tropical Medicine, and School of Oriental and African Studies; and also in Taiwan including museums of Changjung High School, Hsinlou Hospital, Chuanghua Christian Hospital, and Mackay Memorial Hospital.