從觀測到監控－近代東亞疾病地圖之研究

Abstract

本文旨在分析比較西方、中國、日本製作之近代東亞疾病地圖，探討疾病地圖生成之歷史背景和構成要素、製圖者身份與社群網絡、圖像內容及具體影響。

疾病地圖是將疾病的空間資訊予以量化和視覺化，與近代地圖測繪、醫學統計學、醫學製圖學的發展息息相關。然而一幅疾病地圖的完成，從病名的診斷分類、統計調查到地圖的標記與劃界，無時無刻不參雜人為考量與技術限制在內。因此本文並不將疾病地圖視為科學進步史觀下的產物，而是希望藉由該課題的深掘，探究十九世紀以前東西方如何去思考瘟疫傳播之於地理環境；帶出十九世紀以後東亞疾病地圖與公共衛生制度化，以及民族國家形成之間的連動關係；進而讓早已被地圖思維制約化的我們，重新檢視COVID–19流行至今各種滲透進日常的疫情地圖。

研究時空集中在十九世紀末東亞第一張疾病地圖的出現，到二次世界大戰以前的中國、日本、英領殖民地香港、日領殖民地朝鮮和臺灣。結構上以個案方式呈現，除了討論人類史上的重大傳染病─霍亂和鼠疫，也處理到深具地方時代意義的腳氣病與傷寒。貫穿本文主軸的是「觀測」（空間展示）與「監控」（空間管制）兩種性質，這兩種性質並非對立或者分割的概念，時常是並存或為因果關係。例如，早期西方國家製作的東亞疾病地圖，多是為了保護西方人的健康與利益，繪製各式各樣具有觀測性質的傳染病與非傳染病地圖。受到西方勢力和傳染病威脅的中國與日本，因為防疫的迫切性而開始自製具有監控目的之傳染病地圖。

透過以上討論，本文將論證利用地圖去思考和呈現疾病的空間概念，是在何時、以什麼樣的形式出現在中國與日本，以及它對於防疫官員、學術社群和普羅大眾的意義，從而賦予疾病地圖豐富多元的歷史內涵。

This study aims to analyze and compare modern East Asian disease maps produced by the West, China, and Japan, and discuss the historical background and components of disease maps, the identity and social network of mapmakers, and the image content and specific influences of disease maps.

As a way to quantify and visualize the spatial information of diseases, disease maps are closely related to the development of modern map surveying, medical statistics, and medical cartography. However, the completion of a disease map involves human considerations and technical limitations, including the diagnosis and classification of diseases, statistical investigation, and the marking and demarcation of the map. Therefore, this study does not treat disease maps as products of scientific progress, but intends to (1) explore how the East and the West thought about the spread of plagues in geographical environments before the nineteenth century; (2) indicate the connection between East Asian disease maps, public health institutionalization, and the formation of nation-states in the nineteenth century and beyond; (3) and remind those who have long been accustomed to thinking in terms of maps to re-examine the various epidemic maps that have penetrated into our daily life since the outbreak of the COVID-19 pandemic.

The temporal and spatial scope of this study focuses on the emergence of the first disease map in East Asia at the end of the nineteenth century, to China, Japan, the British colony of Hong Kong, the Japanese colonies of Korea and Taiwan before World War II. This study is presented by a combination of case studies. In addition to discussing the major infectious diseases in human history, including cholera and pestis, it also deals with beriberi and typhoid with profound local and historical significance. Constituting the main axis of this study are maps with the two purposes of “observation” (spatial display) and “monitoring” (spatial control). These two purposes are not antitheses or discrete concepts, but often coexist or have a causal relationship. For example, early disease maps of East Asia produced by Western countries were mostly to protect the health and interests of Westerners, and include maps of various infectious and non-infectious diseases with observational purpose. China and Japan, threatened by Western forces and infectious diseases, began to make their own infectious disease maps for monitoring purposes because of the urgency of epidemic prevention.

Through the above discussion, this study will demonstrate in what time and in what form the spatial concept of using maps to think about and present diseases appeared in China and Japan, and its significance to epidemic prevention officials, the academic community and the general public, thus enriching and diversifying the historical significance of disease maps.