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香港中文大學歷史系

HIST4312F ：公眾歷史專題研究現代社會中健康與醫療：一個比較歷史學上的考察

熊秉真教授歷史系講座教授

人文學科研究所所長

2012/13 年度下學期三月七日， 10:30~12:15

李兆基樓 306 室

第八週：個人與公共衛生(Personal Hygiene, Public Health)

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現代嚴重疫症

• 中國東北鼠疫 (1910)

• 西班牙流感爆發 (Spanish flu, 1918)

• 愛滋病 (AIDS, 20 世紀至現在 )

• 非典型肺炎或「沙士」 (SARS, 2003)

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中國東北鼠疫 (1910)

伍連德醫生

• 1910 年 10 月 25 日爆發於滿洲里頭，即迅速擴散至華北地區。死者近六萬。• 1910 年 12 月清政府派伍連德往哈爾濱防疫。• 伍醫生向清廷建議使用火化屍體的方法控制疫情。由於中國人有令死者「入土為安」的思想，伍醫生只得向清廷請求皇帝頒下聖旨。• 1911 年春，疫情正式受到控制。

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焚燒屍體

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西班牙流感 (Spanish flu, 1918)

• 1918 年全球性流感爆發，至 1920疫情受控為止，約 5 億人感染，當中可能有 5 千萬至 1 億因病死去。• 由於流感爆發於第一次世界大戰期間，故此歐洲諸各一直封鎖疫情，隱瞞數據，以免影響軍心，引致疫病數據有很大偏差。由於當時西班牙為中立國，主動公開病情，加上當時連國王阿方索十三世 (Alfonso XIII) 也感染，故此有「西班牙形流感 (Spanish Flu) 」之稱。流感期間必須戴上口罩 ( 美國

西雅圖 )

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美國肯薩斯州軍營內病人

• 由於流感爆發於第一次世界大戰之中，各參戰國隱瞞疫情，沒有立即進行防疫，引致流感難以收拾。• 而第一次大戰期間，軍營的惡劣衛生環境，以及流動人口增加 ( 如軍隊移動和人民逃竄 ) ，也有助疫情擴散。• 1918 年 11 月第一次大戰結束，流感才慢慢受到控制。

西班牙流感 (Spanish flu, 1918)

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愛滋病 (AIDS, 20 世紀至現在 )• 愛滋病 (AIDS)源於在黑非州 (撒哈拉以南 ) 生長的靈長類病毒 HIV ，約在 19 至 20 世紀之交傳至人類，成為人類傳染病。• 一般認為愛滋病爆發與 19 世紀末開始受新殖民主義影響的非洲殖民風潮 (Scramble for Africa) 有非常密切關係。由於歐洲人的開發，大量沿海地區開始發展城市，而大量男性勞動人口湧入。而當地非洲女性慢慢逃離原先傳統家庭社會，在欠缺安全性行為的情況下，令愛滋病傳播。

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資料來源：

UNAIDS 2009 年報告

• 二十世紀後半，愛滋病漸漸傳到西方先進國家，加上早期欠缺安全性行為意識，以及輸血等，令 HIV 病毒散播。• 1996 年，聯合國愛滋病規劃署 (UNAIDS)成立。

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非典型肺炎或「沙士」 (SARS, 2003)• 2002 年 11 月在廣東順德爆發，估計由動物傳至人類。爆發初期，中國政府為免民眾恐慌，壓抑疫情報導。• 2003 年 2 月始中國政府才通知世界衛生組織有關疫情爆發。但病毒已經附近香港散播至越南以至全世界。而另一方面，國內春運也令病毒蔓延。• 2003 年 3 月 31 日，香港淘大花園 E 座集體感染。• 2003 年 4 月 15 日香港被世衛列為疫區，至 6月 23 日始除名。

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David R. Phillips, The Epidemiological Transition in Hong Kong: Changes in Health and Disease since the Nineteenth Century, Hong Kong: University of Hong Kong, 1988, p.31.

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David R. Phillips, The Epidemiological Transition in Hong Kong: Changes in Health and Disease since the Nineteenth Century, Hong Kong: University of Hong Kong, 1988, p.38.

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David R. Phillips, The Epidemiological Transition in Hong Kong: Changes in Health and Disease since the Nineteenth Century, Hong Kong: University of Hong Kong, 1988, p.37.

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Notification rate of major infections diseases 1961-1985 David R. Phillips, The Epidemiological Transition in Hong Kong: Changes in Health

and Disease since the Nineteenth Century, Hong Kong: University of Hong Kong, 1988, p.33.

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The epidemiological transition in Hong Kong: proportions of mortality from different causes, 1912-1985.

David R. Phillips, The Epidemiological Transition in Hong Kong: Changes in Health and Disease since the Nineteenth Century, Hong Kong: University of Hong Kong, 1988, p.19.

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David R. Phillips, The Epidemiological Transition in Hong Kong: Changes in Health and Disease since the Nineteenth Century, Hong Kong: University of Hong Kong, 1988, p.44.

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David R. Phillips, The Epidemiological Transition in Hong Kong: Changes in Health and Disease since the Nineteenth Century, Hong Kong: University of Hong Kong, 1988, p.58.

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Tuberculosis notification rate by sex and age 1975-1985 David R. Phillips, The Epidemiological Transition in Hong Kong: Changes in Health and Disease

since the Nineteenth Century, Hong Kong: University of Hong Kong, 1988, p.59.

18 Leung Ping Chung & Ooi Eng Eong, ed., SARS War: Combating the Diseas

e, Singapore: World Scientific Publishing Co. Pte. Ltd., 2003, p.36.

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Thin section electron micrograph of infected Vero E6 cell, showing coronavirus particles within cytoplasmic membrane-bound vacules and the cisternae of the rough endoplasmic reticulum.

(Source: Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, Atlanta, USA)

Leung Ping Chung & Ooi Eng Eong, ed., SARS War: Combating the Disease, Singapore: World Scientific Publishing Co. Pte. Ltd., 2003, p.34.

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Global Outbreak: Aided by air travel, the disease spread rapidly on a global scale. Key: Country: Number of infections / Number of deaths (Figures correct as of 9 Apr 2003) Leung Ping Chung & Ooi Eng Eong, ed., SARS War: Combating the Disease, Singapor

e: World Scientific Publishing Co. Pte. Ltd., 2003, p.19.

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Hong Kong’s Industrial Production, 1993-2003 *Denotes latest data available at time of writing. Source: Hong Kong SAR Government Census and statistics Department, Hong Kong Monthly Dig

est of Statistics. Hong Kong’s index of industrial production registered a decline of nearly 9% in the first quarter of

2003 compared to the same period last year. Due to SARS, the industrial production index further fell by 13% in the second quarter.

John Wong & Zheng Yongnian, ed., The SARS Epidemic Challenges to China’s Crisis Management, Singapore: World Scientific Publishing Co. Pte. Ltd., 2004, p.43.

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Officially Confirmed SARS Patients in Hong Kong as of June 2003 Source: “SARS updated charts and figures in Hong Kong”, Hong Kong University of Sci

ence & Technology, at http://ihome.ust.hk/~bo_cckae/kivin/sars.html. John Wong & Zheng Yongnian, ed., The SARS Epidemic Challenges to China’s Crisis M

anagement, Singapore: World Scientific Publishing Co. Pte. Ltd., 2004, p.206.

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Number of Buildings with Confirmed SARS Patients by Region and Date of Posting onto the Hong Kong Department of Health Website as of June 2003

Source: Hong Kong Department of Health, at http://www.info.gov.hk/dh/diseases/ap/eng/bldgcht.htm. Information was first posted at this site on 12 Apr 2003.

John Wong & Zheng Yongnian, ed., The SARS Epidemic Challenges to China’s Crisis Management, Singapore: World Scientific Publishing Co. Pte. Ltd., 2004, p.208.

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Leung Ping Chung & Ooi Eng Eong, ed., SARS War: Combating the Disease, Singapore: World Scientific Publishing Co. Pte. Ltd., 2003, p.45.

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Leung Ping Chung & Ooi Eng Eong, ed., SARS War: Combating the Disease, Singapore: World Scientific Publishing Co. Pte. Ltd., 2003, p.48.

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Leung Ping Chung & Ooi Eng Eong, ed., SARS War: Combating the Disease, Singapore: World Scientific Publishing Co. Pte. Ltd., 2003, p.51.

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Leung Ping Chung & Ooi Eng Eong, ed., SARS War: Combating the Disease, Singapore: World Scientific Publishing Co. Pte. Ltd., 2003, p.53.

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Leung Ping Chung & Ooi Eng Eong, ed., SARS War: Combating the Disease, Singapore: World Scientific Publishing Co. Pte. Ltd., 2003, p.54.

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Leung Ping Chung & Ooi Eng Eong, ed., SARS War: Combating the Disease, Singapore: World Scientific Publishing Co. Pte. Ltd., 2003, p.56.

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Leung Ping Chung & Ooi Eng Eong, ed., SARS War: Combating the Disease, Singapore: World Scientific Publishing Co. Pte. Ltd., 2003, p.57.

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Visits between PRC and Taiwan, 1988-2003 Source: http://www.chinabiz.org.tw/chang/Eco/136-2003-12/136-20.xls Migration into Taiwan from China was not trivial, but it was the relocation of appro

ximately half a million Taiwanese business investors and their families to China, in addition to seasonal tourists, that made Taiwan uniquely vulnerable to China’s initial disregard of public health measures. The dramatic rise and fall in the number of annual visists, however, also attest to the fragility of current interdependence.

Deborah Davis & Helen Siu, ed., SARS: Reception and Interpretations in Three Chinese Cities, London: Routledge, 2007, p.13.

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Visits between Hong Kong and PRC, 1994-2004 Source: Hong Kong Tourism Board In the context of the SARS outbreak the fissures of international politics and the eve

ryday interdependence of trade, investment, and family ties therefore defined the reception and interpretation of the disease in Taiwan far more than it did in Hong Kong.

Deborah Davis & Helen Siu, ed., SARS: Reception and Interpretations in Three Chinese Cities, London: Routledge, 2007, p.9.

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Masked! Face masks quickly became sold out as more and more people take personal preventive measure.

Leung Ping Chung & Ooi Eng Eong, ed., SARS War: Combating the Disease, Singapore: World Scientific Publishing Co. Pte. Ltd., 2003, p.22.

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Hong Kong residents combating the SARS outbreak (Source: Strategic Business World Monthly) Leung Ping Chung & Ooi Eng Eong, ed., SARS War: Combating the Disease, Si

ngapore: World Scientific Publishing Co. Pte. Ltd., 2003, p.44.

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Protected: Air crew operating in affected countries wear face masks to protect themselves.

Leung Ping Chung & Ooi Eng Eong, ed., SARS War: Combating the Disease, Singapore: World Scientific Publishing Co. Pte. Ltd., 2003, p.71.

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Amoy Gardens Block E: An alarming number of residents in this apartment contracted the disease, prompting the authorities to quarantine the entire building.

(Source: Mingpao, Hong Kong) Leung Ping Chung & Ooi Eng Eong, ed., SARS War: Combating the Disease, Singa

pore: World Scientific Publishing Co. Pte. Ltd., 2003, p.132.

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Increased Hygiene The management of many workplaces as well as government ministries have steppe

d up their level of hygiene. Here, a janitor is shown disinfecting and cleaning the entrance of an office building. Lifts should be cleaned regularly and thoroughly, with special attention being paid to the panel buttons.

Leung Ping Chung & Ooi Eng Eong, ed., SARS War: Combating the Disease, Singapore: World Scientific Publishing Co. Pte. Ltd., 2003, p.67, 98, 99.

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Stepping Up Cleanliness: Singapore and Hong Kong have stepped up on the level of hygiene at public places. Here, a cleaner is shown cleaning a subway station.

Leung Ping Chung & Ooi Eng Eong, ed., SARS War: Combating the Disease, Singapore: World Scientific Publishing Co. Pte. Ltd., 2003, p.71.

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Traditional Remedy: Many people turn to Chinese herbs to strengthen their immune system. Demand for certain herbs surged dramatically, resulting in some herbs being sold out in many places.

Leung Ping Chung & Ooi Eng Eong, ed., SARS War: Combating the Disease, Singapore: World Scientific Publishing Co. Pte. Ltd., 2003, p.103.

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Developing diagnostic kits to ascertain that patients have SARS is pertinent. (Source: Straits Times) Leung Ping Chung & Ooi Eng Eong, ed., SARS War: Combating the Disease, Si

ngapore: World Scientific Publishing Co. Pte. Ltd., 2003, p.127.