The Vaccination and Fluctuation of the Epidemic Preventive Infrastructure in Japan-ruled Taiwan

本論文運用史學、統計與GIS繪圖法，自表至裏，自應用至體制，再至緣由，論述1895～1945年50年間臺灣預防接種史之開展、歷程與引發原因。論證臺灣人用疫苗發展歷史超過百年；日治時期臺灣住民已廣泛接種多量疫苗；臺灣諸免疫界變革不可忽視日本人事體制。 全文首先以法定之傳染病為例，論證疫苗在臺灣民間應用之普遍。首先論述最早在臺灣實施，作為全民接種開始，且採皮上切種之天花種痘，其官方制度演變、於民間推展方法、技術變革與臺日差距（少），以及從統計面所見之臺灣高接種率（社會高免疫力）、低天花感染率和死亡率，和1900年代一遇疫情風聲，即立刻實行臨時接種或擴大定期接種之防疫定制。其次論述血清型疾病預防注射。如1900年鼠疫接種，是臺灣最早由官方執行較大規模針式＼侵入性皮下預防注射之始。但1904年後因花費金額高、人體副作用大而少在臺灣實施。再如霍亂，1902年臺灣已應用霍亂血清，1916年較大規模實施＼實驗，1919～1920年國際霍亂大流行更極力推廣，兩年間，每年各有百餘萬人接種，是各地臺灣人普遍認識和接種預防注射針之始。1918～1920年流行性感冒，確切菌種和傳染原因等等均未知；但當第二波疫情較集中且嚴重時，官方已鼓勵配合副致死病因如肺炎球菌等，實施預防注射，與今日流感疫苗類似。其後，對霍亂或流感使用預防接種之防疫法，終日治結束均為常例。又如流行性腦脊髓膜炎，自1917年臺灣出現購買疫苗案例後，該疫苗自1920年代起即大量應用，1930年代後之接種人數更屢以十萬或百萬為單位。而臺灣1935年前所謂流行性腦炎或腦炎，常是指流行性腦脊髓膜炎；流行性腦炎或腦炎預防接種，實際指流行性腦脊髓膜炎接種。以上各種疫苗大量應用，至約1920年代已形成官方一遇疫情即立刻接種地積極、強力防疫定制，亦影響臺灣該等傳染病感染率和患者死亡率，以及官民對上述傳染病恐懼態度轉變。 繼應用面，本文次論人事、體制之制度面發展。首先，臺灣在1902～1905年，先後出現在臺灣設置血清藥院聲音、鼓勵細菌血清學研究、設置牛疫血清作業所、起議在臺實施全新生兒種痘和創設中央科學研究所。1916年開始製販血清疫苗，擇製本島常見菌種、強調「賣捌」非「販賣」，此後製品種類陸續增加。臺製疫苗亦供應沖繩和中國等等臺灣以外地區。1922年起，臺灣不再製造牛疫血清，改由朝鮮提供防疫之常備用品；1939年士林廠房完工，臺灣開始製造乾燥和精緻血清疫苗。另就中央衛生部人事和業績比較，細菌血清類研究和專任人力常多居各研究單位之首，1920年代達高峰；1930年代研究比重雖看似降低，然其負責人員數量、製劑內容和販賣數量，卻更深刻且快速進展，故臺灣中央一直重視免疫醫學或細菌學研究。而使臺灣於各階段發生細菌學興起、開始製販血清疫苗、研製機構體制和製品製程改變原因，首先，使細菌學、免疫學和血清研製機構在臺展開，首須歸因後藤新平和高木友枝等臺灣首長個人意識，以及其背後穩固之內務省衛生局（行政）、傳染病研究所（技術）和眾議會（審議）等人事資源和總體意向，並因人際網絡使臺灣得參酌美國作法。1916年臺灣開始製販血清疫苗，源自1914年傳研移管；擇製某類型製劑且限定專賣，則為前期人事派系延續和檢定制度便宜之計。傳承人事脈絡與社會局勢，再配合新發地政治社會需求，使1920年代後期起中央研究所人事漸變化，來自地方者再回歸地方，中央日益學術、大學化。最極致表現是1936～1939年中央研究所成為臺北帝大附屬和東大傳研化。此外，臺灣與海外各血清疫苗單位有連絡互通；臺灣是日本諸外地中最早大量製販各種血清疫苗者；也是日本國境內，極少數可以帝大附屬研究所之姿製販血清疫苗者。The dissertation aims to use historical data a long with GIS methods to explore the vaccination prevention to certain infectious diseases in colonial Taiwan (1895 – 1945). The smallpox vaccination was the earliest vaccination has been practiced in Taiwan. The change of polices and influstructure in cowpox manufacture revealed how the vaccination adminstration transformed and shaped local society. With the cowpox vaccine popularized, the immunity was gained as well as the low infection and mortality rate after 1910s implied its effectiveness. Secondly, the plague vaccination in 1900~1904 was the first big-scale preventive injection by the Taiwan official, but rarely injected after 1904 due to the high cost and side effects. following that, the cholera serum was often used in scale in 1916 which 3 million people received injecttion during 1919~1920, a period of cholera pandemic. One effective that cholera imunizationleft was that Taiwanese strated to accept needle injection a way of vaccinated prevention. The pandemic influenza invaded Taiwan in 1918~1921but the etiology was unknown currently. As the second wave of the epidemic occurred, the authorities began to pay attention and encouraged people to take injection from indirect causes of death such as pneumococcal. This injection strategy was applied in the whole Japanese ruled era. The epidemic cerebrospinal meningitis, since its vaccination reported in 1917, was larger implemented in the 1920s, then greatly practiced after the 1930s. Furthermore, the epidemic encephalitis or encephalitis named after Taiwan before 1935 usually referred to the epidemic cerebrospinal meningitis. Therefore, the epidemic encephalitis or encephalitis vaccination actually meant the meningococcal meningitis vaccination. In general, most implementation of vaccination appeared around 1916 progressed in 1920s and prevalently practiced after the 1930s. The police of vaccination brought down the infection and mortality rate in Taiwan a long withthe attitude of acceptance to immunization injection among people. Furthermore, Taiwan set up a professional animal serum factory and established the Central Science Institute of Taiwan Governor in 1903. In 1916, Taiwan started to make and sell serums and vaccines to the public which indicated the vaccination were already prevalent among Taiwanese. The govenemnt monopolized the sale of vaccines and the products could however offer to China and other places. In 1939, Taiwan went a step further to manufacture the dried vaccine, toxoid, and anatoxin. The phenomenon above implied various meanings. First, the promotion of bacteriology, immunology and serum in Taiwan were based on personal commitment by Gotou Shinpei (1857-1929) and Takagi Tomoe (1858-1943). With their connection to the Bureau of Sanitation of the Ministry of Interior, the Institute of Infectious Diseases (Kitazato Shibasaburou, 1853-1931), and House of Representatives, their works might link to the Rockefeller Institute which brought strong trust to the developing of bacteriology. In 1916 the attempt to produce and sell vaccine was a side-effect deriving from the domentic friction of the Institute of Infectious Diseases in 1914. It caused by the struggle of the administrative and resources, the dispute of practical and academic, and maturates of the bacteriology; lead to the essentially open to the serums and vaccines market in Japan and its foreign lands, included Taiwan. Taiwan closed to the faction of Kitazato. Soon after, the great spread of infectious diseases in 1918-1921 bright the emergency to apply and manufacture of biologics in 1920s in Japan and all of its territories. Taken the impact, the Central Research Institute of Taiwan Governor changed its infrastructure and products in the 1930s. It is worth noting that the Central Research Institute of Taiwan Governor and the Taiwan Medical Specialized School became branches of the (Taipei and Tokyo) Imperial University in 1936-1939, for the necessity of dried vaccine, toxoid, and anatoxin