A Selected Abstract
"The Diseases of China Including Formosa and Korea, 1911"
W. Hamilton. Jefferys, M.D. and James L. Maxwell, M.D.
"The Diseases of China Including Formosa and Korea, 1911"
W. Hamilton. Jefferys, M.D. and James L. Maxwell, M.D.
馬雅各二世，對台灣醫療貢獻極大，對醫學研究也很用心。1911年他和W.Hamilton Jefferys 合著了這本 - "The diseases of China, including Formosa and Korea"。 (按:當時台灣與朝鮮剛納入日本帝國不久，兩地的衛生及"病情"依然較近清帝國，故與之相提並論)。格主心想或許有人對百年前台灣的疾病及衛生概況會感興趣，因此特別挑出其中論及台灣的部分，摘譯如下:
Leprosy is smeared over the face of China as butter on bread - not in spots, but found just about everywhere...Fukien and South Formosa are given a still higher degree, and North Formosa and Yunnan the highest degree of prevalence... Tainan, South Formosa, one in 450 of population (Maxwell)...
In Formosa we estimate its incidence among the Chinese at roughly 1 in 400 of the general population.
In many parts of China the disease is believed to be infectious, and leper shunned... In other places, as in Formosa, the leper, except in the last stages of the disease, mixes with the ordinary population. Indeed, in Formosa, we have a proverb which shows very plainly how little importance the Chinese put on the infectiveness of leprosy: "Sleep in the same bed with a leper, but do not be neighbour across the street to a man with itch."
Leprosy attacks every age, but is commonest between twelve and thirty; it is rare in very young children, but we have seen one case in Formosa of well-marked leprosy in an infant of six months.
The macular variety, when of a pure type, is a very mild form of the disease. We meet with it not uncommonly in Formosa.
The anaesthetic variety when pure is often of a very mild type... We recognise it in Formosa in its pure form in two principal varieties. An ulnar form, where the ulnar nerve is especially affected, and may be felt to be greatly thickened...The other form is characterized by perforating ulcers of the soles of the feet; the ulcers are usually symmetrical...
The Tubercular Variety - It is to this variety that we owe the mental picture which the word "leper" calls up...
Mixed Cases -These are very common. Perhaps the most common of all are the first two types combined, the macular-anaesthetic variety...
混合性麻風，非常普遍，其中以頭兩種的綜合 - 即斑點麻木型最多。
1. 麻風，台語叫 t'ai ko。許成章的台灣漢語辭典如是說: t'ai ko 相當於 "癩可"，〈西清詩話:詩僧祖可，身被惡疾，人號癩可〉。〈楊萬里過烏沙望大唐石峰詩: 山如可師癩滿項，石如陳三癭聯頭〉。
3. 日治時代，發生了一件駭人聽聞的事件: 台灣北部某地，有位病人，麻風已至末期，不知道是不是因為上述迷信的緣故，竟然決意未死先葬。於是家人為他舉行葬禮。他向親友一一道別後，即入棺出殯。在被掩埋直前，他還叩棺詢問家人，風水方位是否精確...。數日後，消息傳到日警那裏，日警趕緊帶人，到現場挖開墳棺，但事主早已氣絕。後來，有數位家人受到刑罰。這件事記載於日本時代的台灣醫學會雜誌上，譯者三十多年前在紐奧良(New Orleans)的杜蘭大學醫學院(Tulane Medical School)圖書館中，無意間讀到。
The center of Formosa, in the mountains back of Tainan, is prolific in goiter cases which report themselves frequently to Maxwell in Tainan, and he judges that certain villages must be full of it.
Generally speaking, plague may be considered endemic and epidemic to the south of 28th parallel of north latitude in China, including Formosa and French Indo-China...
In Formosa we have repeatedly observed that the first torrential typhoon rains have at once put an end to an epidemic in the city of Tainan, but the same has not been as apparent in the country villages.
(For bubonic plague), the only ones we have ourselves seen in Formosa have consisted of hemorrhagic bullae scattered very sparsely over the body; cases with these are very rapidly fatal.
(For pneumonic plague), the importance of the disease can, perhaps, be best exemplified by a concrete case: a Chinaman of 35 years of age presented himself at Tainan Hospital, asking admission for blood-spitting. As there were a large number of cases seeking admission, we examined him cursorily and found him to be spitting up blood-stained sputa and to have scattered râles over his chest. Temperature about 100 F., and patient did not appear very ill. He was admitted to general ward and the pathological clerk told to examine the sputa for tubercle bacilli. The clerk came to us an hour later, saying that he could find no tubercle bacilli, but that the sputum was crowded with germs, staining like plague bacilli. On examination this was found to correct. The patient was removed and died two days later. This man, whom no one would have suspected of suffering from plague, was, as a matter of fact, expectorating enormous quantities of plague bacilli in all directions.
肺型鼠疫: 此型鼠疫的重要性，看了下面的病例就會瞭解 - 一名35歲的漢人男子因為咯血而要求住院。當時因為要求入院的病人很多，我們只是大略的檢查他一下，發現他吐的痰帶有血絲，聽診時全胸散佈著囉音。體溫是華氏100度。病人看起來並不很嚴重的樣子。他住進普通病房，病理檢驗師為他檢查痰，看有否結核桿菌。一小時後，檢驗師來告訴我們，痰中沒有結核桿菌，但卻充滿疑似鼠疫桿菌。複檢證實結果正確。病人移出(普通病房)，兩天後病歿。這位男子，原先沒人會猜想他患了鼠疫，其實他卻是向著四方，咳出大量的鼠疫桿菌啊!
Prophylactic treatment: The result of inoculations, as shown in the epidemic of 1901 in Formosa, was to reduce the number of attacks of plague in the inoculated to 0.19 % as compared with 2.80% in the non-inoculated, and the deaths of those attacked to 56% in the inoculated as compared with 84% in the non-inoculated.
預防性療法: 預防接種的結果如何，可從1901年台灣的鼠疫流行中得到答案。當時，有接種疫苗的人口中，其得病率是0.19%；而未接種疫苗者，得病率是2.80%。又，接種疫苗後，還得病的，其死亡率是56%；未接種疫苗而得病的，死亡率是84%。(現今已不再做普遍性的預防接種，而只對高風險的人員才施打疫苗。詳見CDC 網頁)
In Formosa an epidemic may be expected once in 10 years.
Malta fever 馬爾他熱
It is probable that fever formerly called by local names (..., Tamsui fever, etc.) are manifestations of this disease.
Enteric or typhoid fever 腸熱病或傷寒
Over a large part of China the inhabitants will drink nothing but hot fluids and these very sparingly,and this no doubt is another safeguard against enteric fever. Having, however, ourselves watched the very rapid growth in Formosa of a taste among the Chinese for shaved ice and bottled lemonade we feel that this latter safeguard is not likely to last.
Beri-beri (Syn. Kakke.) 腳氣病
... It is quite common in Formosa.
1. The disease is a peripheral neuritis,...
2. The disease is one associated with the collection of people together, whether in gangs, prisons, asylums, schools, or on shipboard...
Some races are more susceptible than others, though Bradden denies this. This is very clearly brought out in our own experience in Formosa, where Japanese, who are fewer in number and better fed than the Chinese, fall much more frequent victims to the disease, and acquire it in a more severe form, on the whole, than do the Chinese...
雖然 Bradden 否認這種說法，但似乎有些種族比其他較容易得此病。我們在台灣的經驗很明確的顯出這個現象- 在台日本人雖然人數較少，而且營養較佳，但卻遠比漢人更常得此病；而且一得此病，其病況也較嚴重。(譯者註:後人發現此病是維他命B1缺乏所致。而當時日本人較易得病，是因為其食米較精白，含維他命B1的米粒外層幾乎被去除淨盡。)
... we append here the figures showing the results of mosquito protection of the soldiers of the Japanese garrison in Formosa. Percentage of deaths of Japanese soldiers in Formosa from malaria, 1897-1900, before any of the barracks were mosquito-screened, 17 to 20 %; in 1901, when screening was only in very partial use, 11.19%; 1902, 7.32%; 1903, screening thoroughly effected, 0.7%.
我們附上台灣日軍營區防蚊措施的結果數據如下: 1897-1900年蚊帳紗窗啟用前，台灣日軍死亡人數中，17-20% 肇因於瘧疾；防蚊措施部分啟用時期，1901年死亡人數中，11.19%死於瘧疾，1902年是7.32%；而1903年全面實施防蚊措施後，死於瘧疾的只佔死亡總人數的0.7%。
金雞納樹(Cinchona ledgeriana) 譯者攝自溪頭台大實驗林；
Blackwater fever (Syn.- Hemoglobinuric fever) 黑水熱
...It is still a matter of fierce dispute whether the disease is a result of malaria pure and simple or of the same aggravated by the improper use of quinine or whether it is caused by some organism resembling the piroplasma of cattle but not yet discovered...
The disease has been said to be found in Formosa; we have never ourselves seen a case, and despite diligent enquiries have failed even to hear of one.
We have ourselves failed to discover the parasite in spleen punctures from several likely patients in Formosa.
Parasites of lungs. Paragonimus Westermani 肺吸蟲。衛氏並殖腺吸蟲
A trematode worm found in the lungs of inhabitants of certain localities in Formosa, Korea, Japan and the Philippines.
Formosa: Northern end, villages inland from Tainan (abundant).
It is prevalent in central Formosa, and found in the north of Formosa; and it has been reported three times from Fukien. In each of the Fukien reports there are was but one patient, and certainly two, probably all three, were imported from Formosa.
The worm was first described by Manson from a specimen of Ringer's from North Formosa.
首次描述這寄生蟲的是Manson醫生，而該標本則來自北台灣的 Ringer 醫生。
This parasite is the cause of a disease known as endemic haemoptysis, an extremely common but not very serious ailment in the regions where the worm is found. Indeed it would seem in some of the villages in Central Formosa the large majority of the inhabitants harbour the parasite.
Parasites of circulatory and lymphatic systems. Filaria Bancrofti 循環-淋巴系統寄生蟲。班克羅夫氏絲蟲
The distribution of the disease is in some cases very peculiar, and not at all easy of explanation. For example, while it appears to be most prevalent in coast regions (of China), islands such as Hainan and Formosa are left practically untouched.
Whereas in Formosa filariasis is rare, elephantiasis is practically absent.
Nematodes. Ascaris lumbricoides 線蟲屬。蛔蟲
Landsborough, Formosa tells us of a case of intestinal obstruction in a boy in which the intestine was blocked with round worms.
Strongyloides intestinalis 腸性類圓蟲
We believe we have seen the embryo in a series of faecal examinations in Tainan, Formosa.
Strongylidae. (Ankylostomum duodenale. Necator americanus) 圓蟲屬。(十二指腸鉤蟲. 美洲鉤蟲)
..., and is extremely prevalent in Formosa, 44% in a series of 1,000 male patients.
Ankylostomiasis.- In Formosa nearly 40% of inhabitants harbour the parasite, but probably not more than 20% of the infected persons show any ill effects.
The blood picture in ankylostomiasis is one approaching, sometimes very closely, that of pernicious anemia. We are aware that often a very different type of blood picture, viz., that of chlorosis, is given, but in our own experience in Formosa, which has been a very considerable one, the type in advanced cases has always resembled that of pernicious anemia.
鉤蟲病的的血液接近甚至有時很像惡性貧血的型態。我們知道有時它也會顯現不同的型態如萎黃症(即hypochromic microcytic anemia 淺色小血球貧血)，不過，根據我們眾多的經驗，重症病例的血液型態總是類似惡性貧血。
To the ordinary farmer, the risk of infection through the skin, though considerable, are not as great as in another class we shall name. We find in Formosa that about 50% of the farming classes (males) are infected. The full effect of the use of human manure is, however, felt by the vegetable and flower gardeners. These men use the manure in a fresh form,...the legs of the workers being constantly splashed by the manure. In this class of men, infection is extreme, practically 100% harbouring the worm, and nearly all suffering from the disease.
Clonorchis sinensis 中華肝蛭
It is very common in Korea, the Swatow region, and Hong-kong, but appear to be absent from Formosa...
We have never met with a case in Formosa.
Epidemic stomatitis 流行性口腔炎
We have ourselves met with in Formosa a form of stomatitis not mentioned in books on tropical medicine... It is a disease which is specially prevalent in schools and institutions, often affecting a large proportion of the inmates, and spreading with great rapidity.
Aetiology.- Of the ultimate cause we can say but little, as we have not yet had time to investigate the bacteriological factors. The affection appears to be spread by the careless use of common chopsticks and bowls among patients, especially children eating at the same table.
病因 - 對真正的致病原因我們知道很少，因為我們還沒有時間作細菌學方面的調查。這種疾病好像是藉由與患者隨意共用碗筷而傳播出去，尤其是小孩子們同桌吃飯者。
Symtoms.- The patients all complain of soreness of the mouth. On examination the tongue and sometimes the palate are found to be brightly red in colour, the papillae of the tongue, especially at the base, are swollen and prominent. There is slight salivation... In many cases superficial ulcers of tongue, lips, or gums appear.
症狀 - 病人都有口腔疼痛的的主訴。檢查發現舌頭，有時甚至腭部會呈鮮紅色；舌頭尤其基部附近的小乳頭變得腫脹而突顯；有一些口水；許多人在舌頭、嘴唇、及齒齦還會出現淺潰瘍。
Treatment.- The disease, if no re-infection occur, is quickly cured by a mouth wash of pot. chlorate with tinct. myrrhae and glycerine. Ulcers should be touched with silver nitrate caustic...
治療 - 這種病如果沒有二度(細菌)感染，只要用氯酸鉀加上沒藥酊及甘油漱口就可迅速治癒。而對潰瘍，可塗以硝酸銀。
Scorbutic stomatitis 壞血性口腔炎
A form of scurvy of very mild type is common in Formosa and in parts of south China.
It is, as a rule, in South China and Formosa that we see dysentery at its worst.
Subacute dysentery is the commonest of the three forms of the disease and the one most frequently seen in Formosa and South China. In origin it may be either bacillary or amoebic, and we know nothing but microscopic examination that will settle this point as a general rule.
Stricture of the rectum 直腸狹窄症
...In some parts of South China and Formosa this disease is common. Among the first thousand inpatients admitted to Tainan Hospital, Formosa, during the current year, no fewer than eight were suffering from this complaint, and we operate on an average nearly twenty times a year for this condition.
...But the pathology of the majority of the cases remains doubtful.
Both sexes are equally liable to the disease. The most common age affected is that of the middle period of life.
Cirrhosis of liver 肝硬化
This is a subject of great importance in China and Formosa...
Tropical abscess of the spleen 熱帶性脾膿瘍
Abscess of the spleen is far more common than the text-books on surgery or tropical medicine would lead one to suppose. We have ourselves seen three cases in Formosa..., and probably the large majority of cases are never reported at all.
Landry's paralysis 蘭兌氏麻痺
Quite a number of cases have been reported, and we have seen three ourselves in Formosa.
這種病已經有不少病例報告了。我們在台灣看過三例。(譯者註:今稱 Guillain-Barre-Landry Syndrome，可能是與免疫有關的急性多數神經及神經根的病變)
Locomotor ataxia (Tabes dorsalis) 脊髓後索癆 - 運動共濟失調病
Syphilis is one of the commonest diseases of China and ... transverse myelitis of an almost certainly syphilitic origin is relatively common. We therefore find is difficult to account for the absence, we believe the total absence, of true locomotor ataxia. among some 12,000 in-patients and more than four times that number of out-patients seen by us in Formosa, we have not yet come across a single case which in any way could be mistaken for tabes dorsalis, and the same is the experience of our colleague in Shanghai, nor do we know of any well-authenticated case reported in China.
梅毒是中國最常見的疾病之一，...梅毒性橫貫脊髓炎應該也會相當普遍才對。因此，我們很難解釋為什麼在台灣，12000名住院病患，還有四倍多的門診病人中竟然找不到 - 完全找不到一個侵犯脊髓導致運動共濟失調的病例。而且，連誤診成這種病的也沒有。我們在上海的同事也有同樣體驗 ，而且就我們所知，在中國尚無一個真正確認的病例。
Epidemic cerebrospinal meningitis 流行性腦脊隨腦膜炎
An epidemic of some severity visited Formosa in 1905.
Artificial deformities 人為畸形
In Formosa some of the aboriginal tribes introduce large foreign bodies (pebbles?) into the lobe of the ear and so make the lobe of enormous size.
Chronic mercury poisoning 慢性汞中毒
On February 14, 1910, three patients were admitted to the Tainan Hospital suffering from the same complaint in varying degrees. The symptoms for which they sought relief was that of marked tremors of the limbs. All three came from the same town, and worked in the same silversmith's shop. further, they stated that two other people in the same town, also silver workers, were suffering from the same disease.
Case No. 1.- The youngest, a lad of fifteen, had worked in silver for less than one year. He had been ill for two months, and suffered from slight tremors, the exact nature of which will be described later.
Case No. 2.- A young man of twenty-three had worked from three years and had been ill for one month. The tremors in his case were more marked.
Case No. 3.- Father of the first was thirty-nine years of age, had worked twelve years as a silversmith, and then had to give up his employment seven years ago owing to this illness. The tremors in his case were very severe, walking was difficult, and the voice was affected.
病例1. - 最年輕。是個15歲的"少年家"，在銀舖工作不滿一年。生病已有兩個月。他有輕微顫抖。詳後。
病例2. - 是位23歲的青年，已經在那兒工作3年。生病已有一個月。他的顫抖比較明顯。
病例3. - 乃病例1.之父，年39。曾當銀匠12年。7年前因此疾而棄職。他的顫抖非常厲害，走路困難，發聲也受影響。
Tremors affect especially the arms, only these were affected in our Case No.1.
In some of the very severe cases, the tremors were so severe as to resemble violent chorea. This was so in Case No. 3. The patient prefers to lie on the floor. Case No. 3 tumbled out of his bed. He could neither feed nor clothe himself. The power of speaking, chewing, and walking were affected. Stomatitis was present in all three cases, but not very severe. Tremors were more marked during exertion, and disappeared during sleep. Indeed, in Case No. 1 they were only marked on muscular exertion; there was distinct loss of muscular power in the arms in all three cases; we have not seen this mentioned in the text-books.
In Case No. 3, the memory was affected and the mental balance easily upset...
On further inquiry we find that the disease, though not its cause, is well known among silversmiths in this island. For prophylaxis, it is stated that free ventilation of the workshops and frequent washing of the mouth greatly lessen the incidence of the disease.
Stricture of the oesophagus 食道狹窄症
We are unable to give the exact figures in Formosa, but we have met cases of this nature with very considerable frequency.
Maclean-Maxwell disease 馬克林 - 馬雅各病
|Maclean-Maxwell disease (箭頭，係譯者的標示)|
In 1905, we described a condition of endemic enlargement of the Os calcis, somewhat similar to a condition formerly described by Maclean as present in West Africa;...
The disease as seen in Formosa consists in a chronic enlargement of the posterior third of the os calcis with tenderness to pressure and pain often of a quite disabling nature on walking. The enlargement of the heel is well shown in the accompanying photograph. The disease has only been observed in young men between twenty and thirty years of age and consists not merely in a periostitis, but in an actual enlargement with rarefaction of the bone, the outer shell of compact bone being very thin and the spaces in the cancellous tissue enlarged and showing fatty changes. Several cases have been observed where venereal diseases could be excluded and we have no knowledge of the cause of the condition...
The treatment is simple and satisfactory. An incision is made over the outer side of the os calcis dividing the periosteum. The periosteum is raised with an elevator and a small trephine driven through the bone from side to side. The pain and tenderness is at once relieved and convalescence is very speedy.