청(淸) 중엽 우두법(牛痘法)의 도입과정과 광동 행상(行商)의 역할

朴基水 명청사학회 2013 명청사연구 Vol.0 No.40

在1798年鄭耐的牛痘法論文發刊之後, 新的天花預防措施在歐洲、北美和亞洲迅速得到推廣。 特別1803年西班牙國王卡洛斯四世令御醫巴爾米斯組織醫療隊, 1805年4月15日醫療隊保存着牛痘疫苗到達了小呂宋(菲律賓)。 從事菲律賓貿易的、澳門的葡萄牙商人啤道路滑, 在1805年5月17日將巴爾米斯帶來的牛痘疫苗從菲律賓帶到澳門。 英國東印度公司醫生皮爾遜拿着啤道路滑帶來的牛痘疫苗給澳門的中國人開始種痘。 這就是在中國的最初種牛痘了的。 爲了介紹新的牛痘接種術, 皮爾遜還以英文撰寫了一本小冊子, 由東印度公司翻譯嘶噹㖦將其譯成中文。(『口英咭唎國新出種痘奇書』) 最初一年之間, 皮爾遜在徒弟的幇助下給中國人數千名種了牛痘, 可是失敗了牛痘疫苗的供應, 在1806年和1808年致使牛痘接種中斷。 每中斷之時, 又他從菲律賓將牛痘疫苗收到了, 牛痘疫苗的供應不是容易的問題。 當時科學技術水平上, 牛痘疫苗的供應有各種困難的問題, 保存牛痘疫苗的技術和道具還沒發明, 在人體裏保存牛痘疫苗, 才活苗的狀態下可以種牛痘。 繼續接種者出現的話, 從他可以得到牛痘疫苗, 一旦接種者不能繼續的話, 牛痘疫苗也不能得到。 由于對於種痘醫生故意的不良的風聞, 由于對於牛痘接種術的迷信, 接種牛痘者越來越減少了。 特別由于牛痘接種法的盛行, 中國傳統的人痘接種醫生喪失了他們的工作機會, 他們決死地阻止了牛痘法。 這樣的情況下, 致力牛痘法普及的人物是邱熺, 他是向皮爾遜學習牛痘接種術的。 邱熺是廣東南海人, 在澳門生意中, 當皮爾遜的門生。 邱熺自1806年以來, 開始接種牛痘, 特別給廣東高官和著名人士的子弟接種了牛痘後, 他們常以詩文與匾額贈邱熺。 邱熺將其出版一本書(『引痘題咏』), 因此改變廣東人對於牛痘的觀念。 這本書籍成爲宣傳牛痘接種術的强力手段, 可以形成收容牛痘接種術的社會環境。 邱熺通過他著述的『引痘略』說破牛痘接種術的長處和優越性。 他借用傳統的人痘法用語, 或者利用傳統的經脈學說和男左女右理論、胎毒理論, 說明了牛痘法的諸面貌。 爲了除去一般人否定的認識(將牛膿種入人體), 他借五行思想, 主張牛畜與人脾臟都屬土行, 所以牛畜與人脾臟同屬一氣。 故用屬土的牛痘最容易將脾臟中的天花病毒引出來, 從而使全身免受其害。 這樣的理論說明致使中國士大夫和官僚, 商人表現共感對於『引痘略』, 招致依據『引痘略』編輯刊行的牛痘法書籍達到62種的情況。 這樣情況表現出邱熺的著作理論上貢獻了牛痘法在中國的普及和擴大。 在引進牛痘法的過程中, 或者在廣東地域繼續地施行牛痘法的情況中, 幷且在傳播向北京等另外地方的過程中, 行商做出了各種各樣的貢獻。 雖然在1803年失敗了接種牛痘, 東生行劉德章協助英國東印度公司的牛痘接種試圖。 在1805年會隆行鄭崇謙以他的名義下, 讓皮爾遜出刊說明牛痘法的書籍, 給皮爾遜介紹中國人徒弟, 他們學習牛痘法, 參加接種牛痘的隊伍。 行商尤其貢獻了牛痘接種術的普及和擴大, 其具體的內容是通過牛痘疫苗的供應持續牛痘接種的, 又是傳播另外地方的。 在1810年洋商伍秉鑒、潘有度、盧觀恒合捐銀3千兩, 爲痘醫之費。 通過行商捐款, 免費接種牛痘, 幷且以菓金與取漿之人, 於是種痘者源源而來, 而佳苗乃綿綿不絶。 施行傳統人痘法的時候, 種痘醫生索費, 可是接種牛痘的時候都免費, 這是成爲人們收容牛痘法的强有力的吸引方策的。 幷且以菓金與取漿之人的方法成爲貧困民衆參加牛痘接種的强有力的動因。 一部行商們的捐款行爲由于作爲紳士的行商保有的責任意識和公意識。 同時他們平常做出了對於社會各種各樣的公益活動。 伍秉鑒之子伍崇曜也捐款, 持續地運營了牛痘局, 同孚行行商的一員潘仕成爲了向北京引進牛痘法, 做出了很多的貢獻。 特別潘仕成將自身住宅捐爲番禺會館, 設置牛痘局, 從廣東邀請牛痘種痘師, 給北京兒童接種了牛痘。 伍崇曜和潘仕成都是平常做出了對於社會各種各樣的公益活動之洋商。 通過以上事例, 我們可以證明廣東行商做出了在牛痘法引進與廓張方面上貢獻的事實。

의학지식의 수용과 변용 ― 종두법(種痘法)의 전래와 한문 우두서(牛痘書)를 중심으로 ―

조정은 명청사학회 2018 명청사연구 Vol.0 No.49

인류의 역사는 질병과의 투쟁사이다. 그 중에서도 천연두(天然痘, smallpox)는 인류역사에 가장 큰 족적을 남긴 무서운 전염병이었다. 쉽게 전염될 뿐만 아니라 걸리면 10명 중 3명이 죽을 정도로 치사율이 높았기 때문이다. 게다가 요행이 낫더라도 얼굴에 흉한 곰보자국을 남긴다. 물론 지금의 인류에게 천연두의 공포는 더 이상 존재하지 않는다. 1980년 세계보건기구(WHO)가 천연두 바이러스의 절멸을 선언하면서 천연두는 역사 속으로 사라졌다. 인류가 천연두를 정복할 수 있게 된 것은 백신 개발을 통한 예방법이 성공한 덕분이다. 천연두 백신의 시초는 중국에서 시행된 인두법(人痘法)이다. 인두법이란 천연두 환자에게서 균을 채취하여 약하게 천연두를 앓아 면역을 만들게 하는 방법이다. 중국에서는 주로 관을 통해 코에 두가(痘痂)를 넣었다. 약 17세기부터 중국의 인두법은 러시아, 중앙아시아, 터키, 일본, 조선 등으로 전파된다. 다만 유럽에서 유행한 인두법은 중국식이 아닌 터키식 인두법으로, 팔을 째고 그 상처에 두묘를 넣는 방식이었다. 이 시기 종두법으로 대표되는 의학지식의 전파는 주로 바다를 통해 이루어졌는데, 특히 해양교통의 발전은 인두법보다 우두법(牛痘法)의 확산에 더 큰 영향을 미쳤다. 우두법의 관건은 신선한 백신의 공수에 있다. 교통이 발전하지 못한 상황에서는 인두법에 만족했을지라도 이후 신선한 우두백신의 운반이 가능해지자 종두접종의 대세는 점차 우두법으로 바뀐다. 우두법의 중국내 확산은 종두서의 번역과 출판 덕분에 가능했다. 알렉산더 피어슨(Alexander Pearson)의 『영길리국신출종두기서(咭唎國新出種痘奇書)』는 비록 적은 분량이지만 한문으로 번역되어 우두법을 알리는데 중요한 역할을 수행하였다. 구희(邱熺)의 『인두략(引痘略)』은 중의학적 지식을 이용하여 우두법을 설명함으로써 중국인들이 쉽게 우두법을 받아들일 수 있도록 도왔다. 하지만 그렇다고 해서 인두법이 곧바로 중단된 것은 아니다. 중국에서는 20세기 초까지도 여전히 인두법이 행해졌다. 우두법은 팔을 째고 그 상처에 두묘를 집어넣는 방식이기 때문에 유교적 관념에서는 받아들이기 힘들었던 것으로 보인다. 외국인이 들여온 기술에 대한 기피, 완종법을 실시할 의료종사자의 부족도 우두법 접종을 망설이게 하는 요인이 되었다. 그러나 중국과 달리 일본에서는 우두법이 들어오자 인두법을 실시하던 사람들도 곧 우두법으로 방식을 바꾸었다. 이제까지 선행연구는 우두법의 빠른 수용이 가능했던 원인으로 인두법을 통해 백신이라는 관념을 체득하고 있었다는 점, 난학의 수용으로 서양의학에 대해 거부감이 적었다는 점을 강조하였다. 그러나 한편으로 중국에서 건너온 한문 종두서의 영향력도 간과해서는 안 될 것이다. 한문이기 때문에 기본적으로 어느 정도 교육을 받은 사람이라면 문제없이 읽고 소화할 수 있었다. 또한 『신정두종기법(新訂痘種奇法)』과 『산화신서(散花新書)』에서 볼 수 있듯이 일본의 의사들은 원문 그대로 소개하는데 그치지 않고 서양의학적 지식을 이용하여 종두법을 수정, 보완하였다. 『신정두종기법』은 『영길리국신출종두기서』의 설명이 부족하다고 여겨 종두를 채취하는 모습이나 묘장의 보관법을 묘사한 그림을 추가하고 종두 접종 시 주의점을 덧붙여 독자의 이해를 도왔다. 『산화신서』 또한 『인두략』의 번역에 그치지 않고 본 ... The purpose of this paper is to clarify How medical knowledge was Accepted and Transformed in East Asia, the propagation of Variolation(人痘法) and Vaccination(牛痘法) as an example. Variolation was the first method used to immunize an individual against smallpox(Variola) with material taken from a patient. Smallpox was a devastating infectious disease in former times. On average, 3 out of every 10 people who got it died. Those who survived were usually left with scars. It is unclear when the variolation began in China, but at least it was generally practiced in the Ming and Qing Dynasties. This method was introduced in Japan and other countries by sea until 1720s. In Japan, a Chinese inoculator Li Jen-Shan(李仁山) proposed the method of Chinese style variolation after a severe smallpox outbreak in Nagasaki in 1744, but it was not popular except for some areas. On the other hand, vaccination with cowpox developed from an experiment carried out by an English country doctor, Edward Jenner in 1796. Unlike the old Chinese style variolation, Jenner’s vaccine quickly spread throughout Asia, including China and Japan. Alexander Pearson’s small book was translated into Chinese YingjiliguoXinchuZhongdouQishu(咭唎國新出種痘奇書) and played an important role in informing the Jenner’s vaccine in China. But the Chinese doctors understood that Jenner’s vaccine was based on the Chinese traditional medicine, for example YindouLue(引痘略). Japanese doctors were relatively tolerant of Jenner’s vaccine acceptance. Previous studies have emphasized that they had learned the concept of vaccines through the Chinese Variolation and the acceptance of Rangaku has made it less resistant to Western medicine. But the influence of Chinese Vaccination Books should not be overlooked, because it is a Chinese character, and Japanese was able to understand it without problems. In addition, Japanese doctors not only introduced the original texts, but also revised and supplemented them with western medical knowledge, as can be seen in the "Sinteitousyukihou(新訂痘種奇法)" and "Sankasinsyo(散花新書)". Here we can see how medical knowledge continues to build vitality and develop.

청말 의료선교사의 눈으로 본 두창과 종두법

曺貞恩 ( Jo¸ Jeong-eun ) 명청사학회 2021 명청사연구 Vol.- No.56

This paper comparatively analyzes Chinese people's and foreign medical missionaries' perceptions on vaccination and their effects on the transmission of Jenner's vaccine, from the records of Chinese smallpox and vaccination in the late Qing dynasty, which medical missionaries left. Furthermore, it also examines how the traditional knowledge system interacted with the modern one, by exploring medical missionaries, Chinese people, vaccination and variolation. The Jenner's vaccine is a vaccination method for preventing smallpox by using the smallpox virus extracted from cows. Chinese people already knew the concept of vaccination through variolation, so Jenner's vaccine was the best method for introducing the modern medicine. Medical missionaries who first introduced the modern medicine into China also intended to demonstrate the superiority of the modern medicine and show Christian mercy to Chinese people, by using Jenner's vaccine. Medical missionaries left a variety of records regarding the prevalence of smallpox and vaccination. In China, smallpox was an infectious disease that was always prevalent in all areas. Chinese people believed that they could not but experience smallpox once at least in their life. In addition, it can be found that vaccination and re-vaccination for missionaries were emphasized, since smallpox was a disease which also seriously threatened foreigners. Medical missionaries made various efforts to extend Jenner's vaccine, by publicizing it through a variety of media and freely vaccinating people in vaccine stations or mission hospitals constructed in cooperation with local merchants, elites and officials. In addition, medical missionaries and mission hospitals secured vaccine lymph, by using their domestic and foreign networks and contributed to extending Jenner's vaccine by instructing Chinese physicians about how to use Jenners' vaccine. On the other hand, an aspect of East-West cultural exchange can be observed, in that vaccine stations were built in the traditional Chinese temples and Chinese people and foreign medical missionaries performed vaccination together. Jenner's vaccine was, however, not easily practiced. At the initial stage, medical missionaries also experienced many difficulties. The vaccination was often failed, due to corruption of vaccine lymph and lack of knowledge and experience about native vaccinators and use of unhygienic tools. Medical missionaries made efforts to increase the success rate of Jenner's vaccine, by continuously investigating why the vaccination was failed and exchanging information with each other. Chinese people's high reliability of variolation was an obstacle to the extension of Jenner's vaccine. Medical missionaries introduced various cases of variolation, indicating that variolation was generally conducted at that time. In such record, they emphasized the advantage of vaccination, listing the cases of victims who were dead or lost their eyesight due to variolation. Different from them who recognized that the variolation and the traditional notions about it should be abandoned, however, Chinese people who learned Jenner's vaccine from them attempted to accept it within the traditional notions which they had long trusted and preserved. In particular, YindouLue(引痘略) applied the taidu (胎毒) theory, the Yin-Yang theory, periods of vaccination and the restriction on foods after vaccination to Jenners' vaccine. Medical missionaries, however, could not understand such a restriction and explained Chinese people that Jenner's vaccine, different from variolation, could be applied to them regardless of any seasons and it was not necessary to choose foods after vaccination. On the other hand, xieqi(邪氣), a traditional medical concept was also used to explain the causes of smallpox, where the germ theory did not still appear. In order to extend the use of Jenner's vaccine, medical missionaries thus criticized variolation, while using the traditional concept. In spite of such an effort, however, it was not easy to help Chinese people understand the Western way of thinking, since there was a cultural gap which could not be narrowed, between medical missionaries and Chinese people, as in the case of perceptions on re-vaccination and pockmarks. The issue of how to narrow the cultural gap between them is directly related with the localization of the Western modern medicine with the main focus on Jenner's vaccine.