日治時期砂眼調查與防治--以學校衛生為基礎的觀察

Abstract

本文探討日治時期台灣有關砂眼的調查與防治，尤其以學校衛生方面實施的砂眼對策為中心討論；主要聚焦於台灣砂眼流行的狀況、學校砂眼對策與防治、臺灣本島和日本國內制度面的差異，及在台灣實施的砂眼對策之成效等課題。 1895年以降，台灣的衛生狀態之改善是日本政府和台灣總督府重大的目標之一。日本統治台灣之初，便面臨瘧疾、鼠疫和霍亂等急性傳染病流行，因此以遏止這些致命的傳染病為首要任務。為了有效推動衛生事業的制度化，台灣總督府將日本實施的衛生制度引進台灣，作為其在台灣推動衛生行政之第一步。 儘管一開始台灣總督府的疾病防治重心並未放在砂眼上，但由於台灣早有「盲人多」的現象，因此台灣總督府自1900年代初期即開始統計盲人的數量，同時也注意到砂眼的流行。然而，因砂眼、寄生蟲等疾病較不易直接危害生命安全，因此相關制度的訂定和防治對策的提出，較日本國內晚了10年左右才制定。值得注意的是，1919年日本國內即制定「砂眼預防法」，但此法案始終未曾在台灣施行。儘管如此，從統計、報章雜誌等報導來看，很明顯地可看出砂眼曾在台灣大肆流行；而當時負責砂眼對策的最大機關就是學校，此可從1921年台灣的「學校生徒兒童身體檢查規則」中看出。 從制度面觀之，台灣的學校衛生制度並不是直接導入日本國內之學校衛生制度。在「學校生徒兒童身體檢查規則」中，也有台灣獨有性的規則項目，另一方面，也有在台灣未實行的規程。 關於在台灣負責學校衛生的「學校醫」，一開始「學校醫」通常由「臺灣公醫」兼任，直到1922年制定「關於台灣公立學校醫的聘僱及執務之規則」，「學校醫」的資格才規定為「公醫、開業醫、從事醫務的台灣總督府醫院職員」。很明顯的是，「學校衛生」與「學校醫」、「公醫」有著密切的關係。台灣的學校從1910年展開沙眼調查、統計，較日本國內還早開始，這似與「公醫」的設立與普及有相當的關係。 就學校砂眼對策的成效來看，當時並未透過學校的兒童將衛生觀念滲透到家庭，可以說學校教育對臺灣人社會的影響有限。砂眼罹患率沒有下降的原因主要是根本治療法尚未確立，砂眼的預防法沒有改善，感染源也無法斷絕。The thesis aims at investigating the prevention and cure of trachoma of Taiwan in Japanese ruled period, focusing on the epidemic of the disease and the student healthy policy at that time. While comparing and contrasting the policy against trachoma in Taiwan and in Japan, the study also summarize the result of the healthy policy. In their early ruling, the colonial government had been suffered from epidemic diseases such as malaria ,pestilence, and cholera; therefore, since 1895, the improvement of the health condition in Taiwan has been the critical administrative work of Japanese Government and Taiwan Governor. A strategically move is to introduce the health system into Taiwan. Trachoma is not the first target of the government, although the epidemic of the disease was noticed while the government collected the statistics of the people with visual impairment in 1990s. As in Japan, the Trachoma Prevention Act was established in 1919, the health policy against trachoma in Taiwan was postponed about 10 years for its emergency is less than other severe diseases. unfortunately, even the Act was introduced into Taiwan later, the government was not active in executing; an evidence is that the competent authority was the schools, not the official, regulating in the Student Health Inspection Rules. According to the news at that time, it's obvious that the epidemic is out of control. Precisely speaking, the school health system in Taiwan was not identical to that in Japan. Some articles in Student Health Inspection Rules had been adopted local features in Taiwan and few articles specialized for Japanese students were not performed in Taiwan. The School Physicians were responsible the school health in Taiwan. Not until 1922, as the School Physician Employment and Working Rules was established, the duty for school physician was on the Public Physician. However, in the said Rules, the requirements for the position were limited on personnel with qualification for "Public Physician, Operating Physician, or Medical Official in Taiwan Governing Office". Apparently, school health were related closely to public health. The establishment of Public Physician System resulted in the investigation and the data-collection on trachoma in 1910, which was earlier than that was executed in Japan. In a nutshell, the school-oriented trachoma policy was not effective enough for the influence of school was limited. The epidemic of the disease was not controlled during the whole Japanese ruled period and the reasons were the lack of ultimate treatment and prevention methods, and the source of infection were unceasingly causing the infectious disease.