2015年6月13日 星期六

百年前台灣的疾病概況

A Selected Abstract from "The Diseases of China Including Formosa and Korea"  by W.H. Jefferys and J.L. Maxwell; 1911.

譯者龔飛濤前言: 英國蘇格蘭人James Laidlaw Maxwell(馬雅各)於1865~1871年及1883年在台灣傳教及行醫。他是第一位將近代醫學引進台灣的醫生。步其後塵,又有幾位外籍醫生來台。到了1900年日治初期,馬雅各的次子,同名的James Laidlaw Maxwell (Jr.) - 馬雅各二世,到台南新樓醫院執業。他在台行醫23年後,轉往中國。

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)。格主希望醫療人員及一般大眾都能對百年前台灣的疾病衛生概況有所瞭解,因此挑出其中特別論及台灣的部分,摘譯如下:


Leprosy 麻風、痲瘋、癩病
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.
麻風病遍及中國全境,而福建和南台灣較多,但最高頻率則出現在北台灣和雲南。根據Maxwell,在台南,每450人有1人得此病。全台而言,大約400個漢人中有1人。

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."
在中國許多地方,這種病被認為頗具傳染性,因此大眾對患者常避之唯恐不及。可是其他地區如台灣,痲瘋病人除非已屆末期,否則仍與常人混居。 其實,台灣有句俗語:「寧可與麻風者睡同床,也不願跟搔癢者住對街。」可見,此地漢人並不以為此疾的傳染性有多高。

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.
麻風可於任何年齡發病,但最常見的是在12歲至30歲之間。小孩子當中罕見此病。不過,我們曾經在台灣看到一個6個月大的嬰孩,有明顯的麻風症狀。

The macular variety, when of a pure type, is a very mild form of the disease. We meet with it not uncommonly in Formosa.
純粹斑點性麻風是一種非常溫和的病型。這種病型,在台灣並非罕見。

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...
單純的麻木性麻風通常是非常溫和。在台灣我們發覺有兩種主要類型。一種是手尺骨型,這一型手尺骨神經特別會受侵害,而變得粗厚。另一型是腳底會有穿透性的潰瘍,潰瘍通常是對稱的。

The Tubercular Variety.- It is to this variety that we owe the mental picture which the word "leper" calls up...
結核性麻風,給我們的印象,就是造成此疾被稱做"leper"的原因。

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。

譯者補充:
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〉。

2. 從前台灣民間迷信,認為麻風患者亡故後,帶著病原的蚜蟲就會從死者的鼻孔爬出,飛向空中,然後為炊煙所吸引,進入煙囪、爐灶、食物,而感染他人。因此,古早台灣人不怕活癩者;卻懼癩者死。

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。至今猶耿耿於懷。


Goiter 甲狀腺腫 

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.
在台灣的中心地帶、即台南的內山邊區,得此疾的人數,多到常會自動向台南的馬雅各醫師報到。因此他認為,此疾患者必然充斥著某些村落。
(譯者按:後人發現是缺碘所致)


Plague 鼠疫
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...
大體而言,鼠疫在中國,從北緯28度以南,不是地方風土病就是流行性疾病。在台灣及法屬印度支那亦然...

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.
在台灣,每當一年的首次颱風暴雨之後,台南市內的鼠疫流行就會突然停止,但在鄉下可就沒有那麼明顯。

(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.
腺型鼠疫: 我們在台灣見到的這型鼠疫都是身體上稀疏的分佈著出血性大皰。這些病患很快就死亡。

(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 rales 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%。


Dengue 登革熱
In Formosa an epidemic may be expected  once in 10 years.
在台灣,每十年會有一次登革熱流行。


Malta fever 馬爾他熱
It is probable that fever formerly called by local names (..., Tamsui fever, etc.) are manifestations of this disease.
先前一些以地方命名的熱病(如淡水熱等),可能就是馬爾他熱。


Enteric or typhoid fever 傷寒或腸熱病
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.
中國大部分的住民只喝熱飲,這無疑是一項防止腸熱病的良策。可是,我們發現在台灣,漢人們正快速興起對"剉冰"及瓶裝檸檬水(汽水)的喜愛。我們覺得喝熱飲以防腸傷寒的良策,恐怕維持不久了。


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...
這種病在台灣很常見。
1. 它是一種末梢神經疾病...
2. 它與群居有關,比如幫會、監獄、收容所、學校、或船上。

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:在台灣的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。)


Malaria 瘧疾
... 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0.7%。

奎寧(Quinine) 譯者提供 
金雞納樹(Cinchona ledgeriana) 譯者攝自溪頭台大實驗林;
其樹皮可萃取奎寧(Quinine),用以治瘧疾。




















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...
此疾的本質為何,仍在熱烈爭論中,有人認為純粹是瘧疾所導致;有人認為是奎寧使用不當引起;也有人認為是其病原體是一種尚未發現,但類似牛隻焦蟲的東西。

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.
這種病,有人說曾經在台灣發現。可是我們沒看過。而且即使努力打聽也無所獲。


Kala-azar 黑熱病
We have ourselves failed to discover the parasite in spleen punctures from several likely patients in Formosa.
在台灣,我們曾經對幾個可能病例做脾臟穿刺,但沒有找到寄生蟲。


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.
這種吸蟲存在於台灣、朝鮮、日本及菲律賓的某些地方的民眾的肺裏。

Formosa: Northern end, villages inland from Tainan (abundant).
台灣: 北端及台南內陸村落(很多)。

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.
這種病在台灣中部相當普遍,北台灣也有。在福建有報告過三次,每次只有一個病例,當中確定兩例,或許三例全都來自台灣。

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.
這種寄生蟲是所謂"地區性咯血症"的病源。這種病在該蟲出現的地域極為常見,但它並不是很嚴重的疾病。事實上,在中台灣的一些村莊裏,似乎大多數的居民的體內都有這種寄生蟲。


Parasites of circulatory and lymphatic systems. Filaria Bancrofti 循環及淋巴系統寄生蟲。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.
這種疾病的分佈比較特殊,且難解釋。比如這病在中國沿海地區最為普遍,但(鄰近的)海南、台灣兩島卻幾乎未被波及。

Whereas in Formosa filariasis is rare, elephantiasis is practically absent.
絲蟲病在台灣很稀罕,其所導致的象皮症則幾乎不存在。


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.
台灣的Landsborough(彰化蘭大衛醫生)告訴我們,有個男孩,他的腸子被蛔蟲堵住,而引起腸阻塞。


Strongyloides intestinalis  腸性類圓蟲
We believe we have seen the embryo in a series of faecal examinations in Tainan, Formosa.
我們相信在台灣台南的一系列糞便檢查中曾經看到這種蟲的胚胎。


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.
這在台灣極為普遍,在一千名男性的調查系列中,44%有這種寄生蟲。

Ankylostomiasis.In Formosa nearly 40% of inhabitants harbour the parasite, but probably not more than 20% of the infected persons show any ill effects.
鉤蟲病在台灣,近四成的住民身藏這種寄生蟲,但感染者中出現病徵的大概不超過20%。

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.
一般農民經由皮膚感染此疾的風險雖然相當可觀,但還有一種業者,其風險更高。我們發現在台灣男性農民感染鉤蟲的機率是50%。可是,受到施灑人肥影響最為極致的,卻是菜園和花圃的園丁。這些人使用"新鮮"的人肥,他們的腳足經常灑有人肥,結果可以說100%體內藏有鉤蟲,且幾乎每個人都發病。


Clonorchis Sinensis 支那肝胵
It is very common in Korea, the Swatow region, and Hong-kong, but appear to be absent from Formosa...
這種病在朝鮮、汕頭地區及香港很普遍;但顯然在台灣闕如。


Cestodes 條蟲
We have never met with a case in Formosa.
在台灣我們連一個病例也沒見過。


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.
我們在台灣見到一種熱帶醫學書籍未曾提到的口腔炎。這種疾病在學校和公共團體設施特別普遍,常感染大部分的囚犯或被收容者,且傳播得很快。

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.
這一種輕微的壞血病在台灣及華南部分地區常見。
(譯者註:後人發現壞血病是維他命C缺乏所致。)


Dysentery 赤痢
It is, as a rule, in South China and Formosa that we see dysentery at its worst.
在華南和台灣看到的赤痢通常是最嚴重的。

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.
赤痢的三型當中,以亞急性型最為普遍。而在台灣和華南,也以此型最常見。其病源則或為桿菌、或為阿米巴原蟲。


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.
在華南及台灣的一些地方,這種病常見。在台南病院,今年的頭一千個住院病患中,至少八個有此問題,而我們平均一年做近20次的手術。

...But the pathology of the majority of the cases remains doubtful.
大部分的病例,其病理不明。

Both sexes are equally liable to the disease. The  most common age affected is that of the middle period of life.
此症的男女得病率是一樣的。患者最常見的年齡是中年。


Cirrhosis of Liver 肝硬化
This is a subject of great importance in China and Formosa...
此病在中國和台灣都是重要的問題。


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.
脾膿瘍的存在遠比外科醫學或熱帶醫學教科書所述更常見。我們本身在台灣就見過三個病例...,而大多數的病例大概都不曾被提報出來。


Landry's Paralysis 
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感受 ,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.
一次相當嚴重的流行病曾於1905年侵襲台灣。


Artificial Deformities 人工畸形
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.
在台灣,一些原住民會將大塊異物(鵝卵石?)塞入耳垂,讓耳垂變得很大。


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.
1910年2月14日,有三位病人住進台南病院。他們的訴苦相同,只是程度有異。他們求治的症狀是四肢顫抖。這三人來自同一村鎮,且在同一家"打銀舖"工作。他們還說:同一村鎮裏,另有兩個人,同是銀匠,也患有同樣病症。

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。他的顫抖非常嚴重,走路困難,發聲也受影響。

Tremors affect especially the arms, only these were affected in our Case No.1.
顫抖在手部尤其明顯,而病例1則是只有手有顫抖。

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.
這種病,有些極度重症的病患,顫抖的程度會嚴重到像在激烈的跳舞似的。病例3.就是如此,他寧願躺在地板上,因為他會從床上摔下。他無法自己進食,也無法自己穿衣。說話、咬嚼、和走路的能力都受到影響。這三個病人都有口腔炎,但不很嚴重。顫抖在用力時比較顯著,睡覺時就消失。事實上,病例1.的顫抖只有在肌肉使勁時,才較明顯。三個病人的手力都明顯衰弱,這點我們在教科書上沒發現有提及。

In Case No. 3, the memory was affected and the mental balance easily upset...
病例3.的記憶力也受影響,而且情緒容易失控...

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.
進一步詢問後,我們發現雖然這種病不是由銀所引起,但在銀匠界卻眾所周知。預防方面,據說只要工作場所通風、常洗手就會大大減少此疾的發生。
譯者按: 以前從銀礦石提取純銀的過程中,會用到汞(水銀)。


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.
在台灣到底有多少人得這種病? 我們無法提出確切的數字來。但,我們常常碰到這類病例。


Maclean-Maxwell Disease 馬克林 - 馬雅各病

Maclean-Maxwell disease (箭頭,係譯者的標示)
Chronic Enlargement of the Os Calcis- Under this heading Maxwell, of Tainan, Formosa reports with illustrative cases a condition which he described as follows:
台灣台南的Maxwell(馬雅各)用"慢性跟骨增大"的標題報告並描述了一種病症如下:

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;...
1905年,我們描述了一種地區性跟骨增大的情形,它與先前Maclean所述存在於西非的病症有些類似...

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 rarification 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...
在台灣,這種病是跟骨的後1/3呈現慢性增大且伴有壓痛,其疼痛往往造成行走困難。所附照片清楚顯示腳跟變大。這種病只出現在20至30歲的年青男性。它不僅有骨膜炎,而且骨頭疏鬆並實際增大。密質骨的外殼變得很薄;鬆質骨組織的空間變大且有脂肪變性。有些病例可以排除性病的可能性。我們對這種病症的原因毫無所知...

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.
治療非常簡單有效。就是在跟骨的外側切入,分開骨膜,用起子撬抬骨膜,然後再以小環鋸從骨的一邊推進到另一邊。術後,疼痛和壓痛立刻消失,復原很快。