近代苏州公共卫生研究（1906-1949）

发布时间：2018-08-11 20:19

【摘要】：公共卫生是人类社会永恒的需求，随着人类文明的递嬗，公共卫生渐由社会自发调节、随机应对和慈善救济活动，演变为以卫生行政为主导、以科学方法为手段、以保障和增进公众健康为旨趣，官方与社会合作推进的公共设施和公共事业。清末民国时期，由于近代以来西方医学成就和租界卫生管理制度的刺激示范，中国社会内部对于卫生强国和卫生现代性的强烈追求，以及应对连年疫情的现实需要，国家开始自上而下的卫生行政擘画、建构和实施，现代意义上的以城市为代表的中国公共卫生事业由此肇端。在此时代诉求和社会趋向的引领下，历史悠久、文化发达、商贾辐辏的苏省重地、江南名城——苏州，因应时势，且合于地方防疫、市政建设之需要，遂在官方与社会的协作下，开启公共卫生之端绪，并逐渐粗成体例。近代苏州公共卫生的演进，由清末民初的萌发到南京政府十年时期的初步发展再到战后的粗具体例，主要沿着三个脉络进行：一、公共卫生行政管理，由卫生行政寓于警政，走向卫生行政与警政相对分离；二、办理模式，由官商合办走向以官办为主社会协作；三、业务内容，由清道防疫扩及其余，粗略形成疫病防治、环境卫生、食品卫生、妇婴卫生、学校卫生、卫生教育等多元并进的业务体系。苏州公共卫生的演进理路，既有时代共同趋向的投射，又有过程和形式上地方样态的呈现。疫病防治是苏城公共卫生的中心事务，这不仅因为它是时代性的严峻课题，也是水网密布、气候温润的江南城市面临的地方疫情压力所致。近代苏城疫病防治问题上，出现了二元对立的面相：一方面是驱瘟逐疫迎神赛会和挑痧等坊间防疫百态的恣肆，另一方面是官方对落后防疫行为的取缔，并在与社会的互动合作下，初步形成了一套临时救治与常规预防相结合的急性传染病防控机制。苏城疫病防治上二元对立的面相，从一个侧面反映了苏城公共卫生，实际是在与民俗传统特别是迷信观念和举措的b^格不入中得以曲折演进，并渐入民心的。保障日常清洁的环境卫生和食品卫生被视为治疫之本，成为苏城公共卫生事务中的基础工作。总其大概，主要涵括街道清洁与垃圾清运、粪秽管理与厕所改良、饮水改良、各类饮食品及其制造经营场所卫生检查与管理等内容。街道清洁上日常与定期的结合，垃圾清运上行政与市场的相配，粪秽运除上加强时间、地点和面相的规范、厕所整改上的化多为少、弃旧迎新，饮水卫生上改良与“革命”的统筹、食品卫生上应时性强、制度化高、消极取缔与积极建设规划的并举，构成了各项业务的典型特质。由于经费的短缺、主事者和执行者的颟顸敷塞、民的痼习、商的玩忽延宕等因素，苏城环境卫生和食品卫生举措实际成效并不甚佳，许多规划也无果而终。然而，毫无疑义，在与社会的互动协作乃至冲突抵牾中，官方制定了一系列的规章条例，并尽力付诸实践，一定程度上改良了苏州城市生态环境和日常饮食健康，并多少促进了市民饮食住行卫生生活方式及其观念的形塑，更从理论和实际双重意义上推动了苏州城市社会管理和公共管理的制度化进程，加快了城市现代化变迁。作为近代公共卫生的长效追求，妇婴卫生、学校卫生等保健事业和卫生教育的渐趋并进，丰富了苏城公共卫生的业务内涵。以“生”的方式嬗变、婴儿健康比赛为主要内容的妇婴卫生，以学校传染病预防、学生健康检查、学校卫生教育为主要内容的学校卫生，以多主体、多形式、多场域、教育性与地方化和趣味性相结合为典型特质的民众（或曰社会）卫生教育，其工作开展虽存在设施简陋、业务单一、方式粗糙甚至走过场、普及性不强等诸多局限和不足，但它们确实开启了苏城妇幼保健以及卫生教育事业的端绪，积淀了一定的宝贵经验。这些业务体现了苏地政府维护妇婴健康、增强青少年体格以及培育公众卫生观念习惯的努力和自觉，更从一个侧面反映了苏州社会力量热心公益，积极参与推进各项公卫事业，与官方互动合作的地方风貌。公共卫生是苏城近代化变迁的产物，又推动了城市社会变迁，并在变迁中曲折演进，公共卫生与苏州城市社会变迁之间呈现出一种互动张力。这种互动关系可以从两点得以管窥：第一，公共卫生的举办推动了市民生命状态、生活方式和卫生观念的嬗变，生命、生活和观念的嬗变又使市民增强了对公共卫生的诉求，进而推动它的演进；第二，公共卫生事务引发了苏城卫生舆论的勃兴，公共舆论又以兼具批判与启蒙功能的苏城特色的“公共领域”形式，鞭策政府、启迪民众、引领社会在公共卫生上通力合作，增强当局的行政自觉及市民的公民性和责任感，进而推动苏州公共卫生乃至整个城市近代化变迁的现实或可能演进。总之，在时代性的公共卫生诉求和发展趋向的影响下，在苏城地方当局的行政努力，及民间社会的积极互动下，时至战后苏城公共卫生体例初具。由于众多瓶颈因素的掣肘，苏城公共卫生又呈现出粗陋面相。且其遭遇的窒碍和困境，在全国多具一定的普遍性，因此，某种程度上可以说，，苏城公共卫生发展情状是近代中国（城市）公共卫生总体镜像的投射，是其时代共通命运的写照。无论如何，近代苏州乃至中国公共卫生的筚路蓝缕之功可圈可点。
[Abstract]:Public health is the eternal demand of human society. With the development of human civilization, public health has gradually evolved from social spontaneous regulation, random response and charitable relief activities to public facilities and public undertakings which are guided by health administration and promoted by scientific methods in order to protect and improve public health. In the late Qing Dynasty and the Republic of China, due to the modern western medical achievements and the stimulation and demonstration of health management system in concessions, the strong pursuit of health power and health modernity within Chinese society, and the actual needs of responding to successive epidemic situations, the state began to paint, construct and implement the top-down health administration, and in a modern sense, take the city as the city. Under the guidance of the demands of the times and the social trends, Suzhou, a famous city in the south of the Yangtze River, has a long history and a well-developed culture. Roughing up gradually.
The evolution of modern Suzhou public health, from the germination of the late Qing Dynasty and the early Republic of China to the preliminary development of the Nanjing government in the ten-year period and then to the rough and concrete cases after the war, mainly follows three lines: first, public health administration, from health administration in police administration, to health administration and police administration relatively separated; second, the mode of management, from the co-operation of government and business to move towards. Third, the development of Suzhou public health is characterized by both the projection of the common trend of the times and the local forms and processes. The presentation.
Disease prevention and control is the central task of public health in Suzhou, not only because it is a serious issue of the times, but also because of the local epidemic pressure faced by the cities in the south of the Yangtze River with dense water network and warm climate. On the other hand, the government banned backward epidemic prevention activities and, under the interaction and cooperation with the society, initially formed a set of acute infectious disease prevention and control mechanism combining temporary treatment with routine prevention. Popular traditions, especially superstitions and practices, have evolved in a tortuous way and gradually become popular.
Safeguarding the daily clean environment and food hygiene is regarded as the basis of epidemic prevention and treatment, and has become the basic work of public health affairs in Suzhou. Daily and regular combination of garbage clearance and transportation administration and market matching, waste removal to strengthen the time, place and appearance of the norms, toilet rectification and transformation of more than a few, abandon the old and welcome the new, drinking water hygiene improvement and "revolution" of the unified, food hygiene should be timely, highly institutionalized, passive ban and active construction planning of the simultaneous, constitute. Owing to the shortage of funds, the carelessness of the principals and executives, the habits of the people, the negligence of the merchants and other factors, the actual results of the environmental hygiene and food hygiene initiatives in Suzhou have not been very good, and many of the plans have been fruitless. A series of rules and regulations have been formulated and put into practice to a certain extent, which has improved the ecological environment and daily dietary health of Suzhou, and promoted the formation of the public's dietary, living and hygienic life style and their concept to some extent, and promoted the institutionalization of Suzhou's urban social management and public management in both theoretical and practical aspects. The process accelerated the change of urban modernization.
As a long-term pursuit of modern public health, health care undertakings such as maternal and child health, school health and health education are gradually advancing, enriching the business connotation of public health in Suzhou. The contents of school hygiene, with multi-subject, multi-form, multi-field, education and localization and interesting combination as the typical characteristics of public (or social) health education, although there are many limitations and shortcomings in its work, such as poor facilities, single business, rough way or even walk through the stage, not strong popularity, but they really opened up the city of Suzhou. Maternal and child health care and health education have accumulated valuable experience, which reflects the efforts and consciousness of the Soviet government in safeguarding maternal and child health, strengthening the physique of young people and cultivating public health concepts and habits, and reflects from one side the enthusiasm of Suzhou social forces for public welfare, and actively participate in promoting various public health undertakings. The interaction with the government.
Public health is the product of the modernization of Suzhou, it also promotes the social change of the city, and in the twists and turns of the evolution, there is an interactive tension between public health and the social change of Suzhou. This interactive relationship can be seen from two aspects: first, the holding of public health promotes the state of life, life style and social change of the citizens. The evolution of health concept, life, life and concept makes the public demand for public health enhanced, and then promotes its evolution. Secondly, public health affairs caused the vigorous development of health public opinion in Suzhou, and public opinion spurred the government and enlightened the people in the form of "public sphere" with both critical and enlightening functions. The public should lead the society to cooperate with each other in public health, enhance the administrative consciousness of the authorities and the citizenship and sense of responsibility of the citizens, so as to promote the reality or possible evolution of Suzhou public health and even the modernization of the whole city.
In a word, under the influence of the public health demand and development trend of the times, with the administrative efforts of the local authorities and the active interaction of civil society in Suzhou, the public health style of Suzhou began to take shape after the war. Therefore, to some extent, it can be said that the development of public health in Suzhou is a reflection of the general image of public health in modern China and a portrayal of the common destiny of the times.
【学位授予单位】：苏州大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R-09

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