日治時期臺灣地方病的調查與防治--以肺吸蟲病為中心

Abstract

日本明治維新後，受歐美近代化的影響甚深。在疾病的防治上，以預防和治療作為兩大核心。政府當局透過全面的調查來掌握疾病傳染的情形，再由學界投入研究、了解病因，最後由政府制定相關防治政策。官學互動密切，實為一大特色。同時，強調公共衛生的重要性，重視預防勝於治療，因此透過改善衛生，來降低疾病傳染的可能。為了有效落實衛生政策，而展開全面的衛生教育，透過各種方式影響民眾，以建立現代衛生觀念為主要目標。這樣的模式，成為日本醫療衛生近代化的主軸。 日本統治下的臺灣，亦受到日本近代化的影響。在面對臺灣未知的風土疾病上，臺灣總督府極為倚重醫學研究者，透過各式的調查、實驗與研究，充分了解各疾病的病因、病源與傳染方式，以求快速地掌握病情，展開對策，遏止疫病的擴大傳染。 本論文以肺吸蟲病（Paragonimiasis）作為探討主題，以其作為代表來觀察臺灣地方病調查與防治的過程及其成效，藉以凸顯地方病防治對策上因地制宜之特性。由於肺吸蟲病是日治時期少數因確切掌握感染原因與傳染途徑而有明確防治對策之疾病，因此從肺吸蟲病罹患的消長進行分析，有助於瞭解官方、民間、醫學界在臺灣衛生改善與疾病防治事業上，各自扮演的角色及他們的互動關係。 在疾病防治上，總督府極重視基礎醫學的研究，並且與研究者保持良好的互動關係，使雙方能夠針對不同疾病，有效率地展開行動，加以預防、治療及撲滅該疾病。在肺吸蟲病的調查上，研究者很早就指出新竹地區是肺吸蟲病的主要流行區，研究者以新竹為主要研究地點，積極地展開肺吸蟲的發育史及傳染途徑研究。在經過一連串的調查、假設、實驗與研究後，1915年中川幸庵終於解開謎團，找到肺吸蟲的第二中間宿主。由於寄生蟲病防治上，釐清傳染途徑是有效預防的關鍵要素，因此這項發現對於爾後的肺吸蟲防治實有莫大貢獻；此舉大大振奮臺灣研究群，因而展開臺灣肺吸蟲研究熱潮。在更加積極的調查與研究下，很快的肺吸蟲的發育史與感染途徑便被醫學界掌握。肺吸蟲病的預防對策就此被確立：禁止生食淡水蟹，同時禁止飲用生水。 台灣總督府除了用政府強制力來使民眾遵守相關對策外，亦透過各種方式來推廣衛生教育，強化民眾衛生觀念。《臺灣日日新報》積極的報導刊載各項肺吸蟲研究的新成果，使民眾對肺吸蟲病有相當的熟悉，並且能在第一時間掌握預防要點。而流行地中心的新竹，更是透過衛生講話或學校教師推廣，來強化當地民眾衛生概念。透過這些努力，肺吸蟲病的感染率有效地逐年下降，大部分地區的感染率都能控制到1%以下；少部分地區仍舊流行的原因，是因為沒有徹底落實禁食生蟹的預防方法，其中又以住在新竹山地的原住民族感染較為嚴重。可見民眾衛生思想的與時俱進，是疾病能否有效防遏的主要關鍵。 在學術研究上，1920年代以後參與研究肺吸蟲的人數大幅增加。研究者紛紛以自身熟悉的學科背景切入，針對肺吸蟲所引起的各式症狀展開實驗，尋求治療方式；同時不同學科的攜手合作，也使這段時間的研究成果有更豐富的面貌。可以說，日治時期臺灣的肺吸蟲研究不管在基礎研究或應用上，都有其重要性。 此外，由教授指導學生共同完成論文，也是此一時期研究上的一個特色，顯見臺灣醫學界已有能力培育新生代研究者，並且發展出有影響力的學術社群，使相關研究得以蓬勃發展；而這些人才，恰恰成為戰後台灣寄生蟲學病防治上的生力軍。Japan modernized very well after the Meiji Restoration, influenced by European and American systems. The Imperial Japanese focused on prevention and treatment of disease. Comprehensive government programs sought to stop the spread of diseases through research and understanding etiology, and as well as the implementation of related prevention policies. Government officials and medical professionals worked closely together. In order to improve public health, it was determined that preventative measures would best help reduce the spread of disease. In order to promote these policies, health education through various means was used to achieve the goal of modernizing medical and sanitary standards, this was the centerpiece of Japanese modernization of the medical system. Taiwan under the rule of Imperial Japan benefited from this modernization process. In order to face endemic diseases, Taiwan’s governing body relied heavily on medical professionals, who then went through all sorts of research and experiments to fully understand the etiology of various diseases, pathogens, and mode of transmission. This would help quickly grasp the severity of health issues, and to come up with quick countermeasures in order to curb infection. This thesis focuses Paragonimiasis to highlight Taiwan’s local endemic diseases and the process to control outbreaks and its outcome, so as to highlight the characteristics of endemic disease prevention measures accordingly. In terms of disease prevention and control, the Governor of Taiwan attached great importance to basic medical research and maintained good interaction with researchers, enabling both sides to work efficiently together to prevent, treat, and combat the disease. On the research of Paragonimiasis, researchers long noticed that the endemic centered around Hsinchu. They used Hsinchu as a main study site and in 1915 Nakagawa（中川幸庵）finally solved the secondary alternate life cycle of Paragonimus parasite which enabled a way to stop the disease. Prevention measures were established; the eating of certain freshwater crabs became prohibited, and drinking unboiled water was banned. The Governor of Taiwan not only used force to get the populace to follow the new rules, but also through health education through various means in order to strengthen the public awareness. Taiwan Nichinichi newspaper reported positive developments in Paragonimus and so the parasite became quite familiar to people, and for the first time helped prevent the growth of the disease. Given that the Paragonimus disease centered in Hsinchu, announcements at schools and public spaces reinforced public health concepts in the area. Through these efforts, Paragonimus infection effectively decreased in most areas to below 1% of the populace. There was an exception in mountainous regions among Hsinchu Aborigines, where prevention methods, such as to not eat raw crab, was not fully implemented for various reasons. The system’s key was making the disease aware in the public mind andto have the public active in preventing the disease. In the 1920’s, significant strides were made on the research of Paragonimus. Like its namesake, Paragonimus covered so many medical areas so medical researchers of various differentiating fields and disciplines collaborated to combat this disease. During the Japanese administration era, whether it was basic research to the application of cures, the entire process was treated importantly. Professors of the time would co-author their papers alongside the students who they trained, and this brought a lot more people into the fold of researching Paragonimus. The result was clear; it nurtured a new generation of local Taiwanese medical researchers, who after World War II, became the forefront of parasitological disease prevention in Taiwan.