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.