医学统计在中国的起步与发展（1840-1937）
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摘要
医学统计事业是近代公共卫生与流行病调查的重要组成部分,它在近代中国有一个漫长的起步、发展以及完善的过程,并对中国的医学科学与卫生建制产生了较大影响。与整个西方医学在华传播历程一样,医学统计事业受复杂的外来因素影响。它随着欧洲势力向中国的扩张,与殖民者操控的海关产生了密切联系。并伴随中国政治制度的变革,医学统计实践的主体、方式及原因等都发生了一系列改变。
全文由绪论、正文和结语三部分组成。正文部分主要从四点进行梳理和分析：首先是考察了1840-1911年医学统计在中国的起步过程。通过对晚清催生医学统计概念与实践的多种因素进行挖掘,发现这些因素主要包括传教士医生的医疗实践、海关统计制度的推动以及晚清社会变革的自我需求等三个方面。而晚清的医学统计活动又可划分为传教士医生的个人行为、海关主导的制度化行为、清政府的自主行为三个时期,并揭示了依据不同的时期,他们开展医学统计的目的、实施的侧重点都不尽相同。最后论述了晚清医学统计的成果与影响。基于持续的调查与研究,传教士医生与海关医务官在医学统计工作上取得了丰富成果。虽然清末政府在医学统计事业上起步较晚,但卫生行政管理机构主动参与其中也是历史的进步。
其次是探讨了1912-1927年医学统计的初步发展。在卫生行政方面,无论是从官制的设置来看,还是从卫生行政法规的颁布来看,北洋政府的卫生行政基本是处于警察制度的管辖范围。虽然强化了警政管理卫生的职能,但是实践中存在许多弊端。在卫生统计机构的建立方面,由于卫生行政沿用了清末巡警旧制,导致国家卫生机构设置不健全,把统计职能引入卫生行政中主要以北京、广州、上海等城市为代表,无法在地方普及。在统计活动的开展方面,通过对中央和代表性城市的考察,发现警察体系下传统的调查与统计方式控制着居民的生命轨迹,统计中存在许多遗报、漏报现象。在传染病调查统计方面,民国初传染病流行频繁且危害巨大,政府颁布了法定传染病条例,中央防疫机构开始对全国发生的重大传染性疾病进行常规性的信息收集和统计工作。
再次是对1928-1937年医学统计的开拓与完善进行了考察。由于南京国民政府成立了卫生部,中央和地方的卫生行政体系逐步完善,卫生法规和统计职能都得到了完善和加强。从参与主体来看,参与统计的主体除了卫生行政机构,还包括医疗服务机构、科学研究机构以及众多医务人员等。从统计方式来看,由于卫生行政职能的扩展,参与统计实践的主要以专业的卫生行政机构为主体,受过训练的稽查员或统计调查员逐步被应用其中,数据的可靠性和专业化的程度得到提升。从传染病的统计来看,民国中后期,国内传染病流行态势依然很严峻,卫生部成立后颁布了《传染病预防条例实施细则》,中央和地方卫生机构对传染病调查和统计做出多次加强与改进。
最后主要就近代医学统计实践的影响进行讨论。医学统计的实践对近代中国的影响是多方面的,如促进传染病报告、普及传染病知识；了解疫病分布、种类与伤亡；促进预防医学与疾病分类学的发展；促进公共卫生事业进步、了解入口增长态势以及引导社会福祉发展等等。
文章通过梳理和总结发现：作为始终困扰人类健康主要因素的传染病,是近现代医学统计工作的重心之一；医学统计是完善现代防疫体系、发展预防医学的关键；国家力量是推动医学统计事业进步的决定性因素；死因统计是近代医学统计的重点和难点,也是现代公共卫生行政的重要议题等几个方面。
Medical Statistics career is an important part of modern public health and epidemiological investigation; it has a long process of start, development and perfection, and has great influence on Chinese medical science and health system. As the spread course of western medicine, medical statistics activity was affected by complicated factors from the external environment. With the expansion of European powers to China, it has close contact with the customs which had been controlled by the colonists. And with China's political system reformed, the main bodies, ways and reasons of medical statistics practices had undergone a series of changes.
The article is made up of introduction, body and epilogue three parts. The body of this paper is mainly divided into four points:the first point mainly inspects the start process of medical statistics in the late Qing dynasty from1840to1911.By discussing various factors which lead to the birth of medical statistics concepts and practice, the author find that these factors include three parts:missionary doctor's practice, the customs statistics waves and self-demands of social change. What's more, the medical statistics activities of late Qing dynasty can be divide into the individual behavior of missionary doctors, the institutionalized behavior of the customs and the autonomous behavior of the Qing government. According to different times, the author reveals that the purpose and the emphasis of medical statistics are different. Finally it discusses the achievement and influence of medical statistics in late Qing dynasty. Based on the investigation and research, missionary doctors and the customs officer achieved rich results in medical statistical work. Although the Qing government started late for medical statistics career, the active participation of health administrative organization is also a history progress.
The second point discusses the preliminary development of medical statistics from1912to1927. In the aspect of health administration, whether from the point of system Settings or the point of health rules and regulations, BeiYang government health administration basically falls under the jurisdiction of the police system. While strengthening the functions of the police management of health, but there are many drawbacks in practice. In terms of the establishment of health statistics institutions, because of the old patrol system used till then, the setting of national health agencies had been not perfect. Mainly Beijing, Guangzhou, Shanghai and other cities represented the statistical functions introduced in health administration, it cannot implement throughout the country. In the practices of statistical activities, based on the study of the central government and the representative cities, the author find that the life of the residents was still under the control of the traditional surveys and statistics. In statistical works, there are many omission phenomenon. In the surveys of infectious diseases, for the frequency and the great harm from Communicable diseases, government promulgated the Regulations of infectious diseases, and the central epidemic prevention agencies began to the work of infectious diseases collection and statistics across China.
The third point investigates the development and perfection of medical statistics from1928to1937. For Nanjing national government established the ministry of health, the central and local health administration system had been improve gradually; the health law and statistical functions had been improved and strengthened also. From the point of participants, in addition to the health administrative institutions, participants also include medical service agency, scientific research institutes as well as many medical personnel, etc. From the aspect of statistical way, due to the expansion of the health administrative function, participants in statistical practice mainly were professional health administrative institutions. The trained inspectors or statistical investigators had been used step by step; the reliability of data and the degree of specialization was also improved. From the point of infectious diseases statistics. Later period of the republic of China, the domestic epidemic situation of infectious diseases was still very serious. After the establishment of the ministry of health,"The implementing rules of infectious diseases prevention regulations" had been issued, and the central and local health agencies made investigations and statistics of infectious diseases improved for many times.
The last point mainly discusses the influence of the modern medical statistical practice. The influence on the modern China of medical statistics is various, such as promoting the infectious disease report, popularizing knowledge of infectious diseases Understanding the disease distribution, types and casualties; Promoting the development of preventive medicine and nosology; Promoting the progress of public health, understanding the population growth, and guiding the development of social welfare and so on.
Through reviewing and summarizing, the article finds that:Infectious disease is the main factor that harass human beings and is one of the focus of medical statistics work; Medical statistics is the key to perfect modern epidemic prevention system and to develop preventive medicine; National strength is the decisive factor for promoting medical statistics career; The cause of death statistics is the key and difficult point and also an important issue of modern public health administration.
全文由绪论、正文和结语三部分组成。正文部分主要从四点进行梳理和分析：首先是考察了1840-1911年医学统计在中国的起步过程。通过对晚清催生医学统计概念与实践的多种因素进行挖掘,发现这些因素主要包括传教士医生的医疗实践、海关统计制度的推动以及晚清社会变革的自我需求等三个方面。而晚清的医学统计活动又可划分为传教士医生的个人行为、海关主导的制度化行为、清政府的自主行为三个时期,并揭示了依据不同的时期,他们开展医学统计的目的、实施的侧重点都不尽相同。最后论述了晚清医学统计的成果与影响。基于持续的调查与研究,传教士医生与海关医务官在医学统计工作上取得了丰富成果。虽然清末政府在医学统计事业上起步较晚,但卫生行政管理机构主动参与其中也是历史的进步。
其次是探讨了1912-1927年医学统计的初步发展。在卫生行政方面,无论是从官制的设置来看,还是从卫生行政法规的颁布来看,北洋政府的卫生行政基本是处于警察制度的管辖范围。虽然强化了警政管理卫生的职能,但是实践中存在许多弊端。在卫生统计机构的建立方面,由于卫生行政沿用了清末巡警旧制,导致国家卫生机构设置不健全,把统计职能引入卫生行政中主要以北京、广州、上海等城市为代表,无法在地方普及。在统计活动的开展方面,通过对中央和代表性城市的考察,发现警察体系下传统的调查与统计方式控制着居民的生命轨迹,统计中存在许多遗报、漏报现象。在传染病调查统计方面,民国初传染病流行频繁且危害巨大,政府颁布了法定传染病条例,中央防疫机构开始对全国发生的重大传染性疾病进行常规性的信息收集和统计工作。
再次是对1928-1937年医学统计的开拓与完善进行了考察。由于南京国民政府成立了卫生部,中央和地方的卫生行政体系逐步完善,卫生法规和统计职能都得到了完善和加强。从参与主体来看,参与统计的主体除了卫生行政机构,还包括医疗服务机构、科学研究机构以及众多医务人员等。从统计方式来看,由于卫生行政职能的扩展,参与统计实践的主要以专业的卫生行政机构为主体,受过训练的稽查员或统计调查员逐步被应用其中,数据的可靠性和专业化的程度得到提升。从传染病的统计来看,民国中后期,国内传染病流行态势依然很严峻,卫生部成立后颁布了《传染病预防条例实施细则》,中央和地方卫生机构对传染病调查和统计做出多次加强与改进。
最后主要就近代医学统计实践的影响进行讨论。医学统计的实践对近代中国的影响是多方面的,如促进传染病报告、普及传染病知识；了解疫病分布、种类与伤亡；促进预防医学与疾病分类学的发展；促进公共卫生事业进步、了解入口增长态势以及引导社会福祉发展等等。
文章通过梳理和总结发现：作为始终困扰人类健康主要因素的传染病,是近现代医学统计工作的重心之一；医学统计是完善现代防疫体系、发展预防医学的关键；国家力量是推动医学统计事业进步的决定性因素；死因统计是近代医学统计的重点和难点,也是现代公共卫生行政的重要议题等几个方面。
Medical Statistics career is an important part of modern public health and epidemiological investigation; it has a long process of start, development and perfection, and has great influence on Chinese medical science and health system. As the spread course of western medicine, medical statistics activity was affected by complicated factors from the external environment. With the expansion of European powers to China, it has close contact with the customs which had been controlled by the colonists. And with China's political system reformed, the main bodies, ways and reasons of medical statistics practices had undergone a series of changes.
The article is made up of introduction, body and epilogue three parts. The body of this paper is mainly divided into four points:the first point mainly inspects the start process of medical statistics in the late Qing dynasty from1840to1911.By discussing various factors which lead to the birth of medical statistics concepts and practice, the author find that these factors include three parts:missionary doctor's practice, the customs statistics waves and self-demands of social change. What's more, the medical statistics activities of late Qing dynasty can be divide into the individual behavior of missionary doctors, the institutionalized behavior of the customs and the autonomous behavior of the Qing government. According to different times, the author reveals that the purpose and the emphasis of medical statistics are different. Finally it discusses the achievement and influence of medical statistics in late Qing dynasty. Based on the investigation and research, missionary doctors and the customs officer achieved rich results in medical statistical work. Although the Qing government started late for medical statistics career, the active participation of health administrative organization is also a history progress.
The second point discusses the preliminary development of medical statistics from1912to1927. In the aspect of health administration, whether from the point of system Settings or the point of health rules and regulations, BeiYang government health administration basically falls under the jurisdiction of the police system. While strengthening the functions of the police management of health, but there are many drawbacks in practice. In terms of the establishment of health statistics institutions, because of the old patrol system used till then, the setting of national health agencies had been not perfect. Mainly Beijing, Guangzhou, Shanghai and other cities represented the statistical functions introduced in health administration, it cannot implement throughout the country. In the practices of statistical activities, based on the study of the central government and the representative cities, the author find that the life of the residents was still under the control of the traditional surveys and statistics. In statistical works, there are many omission phenomenon. In the surveys of infectious diseases, for the frequency and the great harm from Communicable diseases, government promulgated the Regulations of infectious diseases, and the central epidemic prevention agencies began to the work of infectious diseases collection and statistics across China.
The third point investigates the development and perfection of medical statistics from1928to1937. For Nanjing national government established the ministry of health, the central and local health administration system had been improve gradually; the health law and statistical functions had been improved and strengthened also. From the point of participants, in addition to the health administrative institutions, participants also include medical service agency, scientific research institutes as well as many medical personnel, etc. From the aspect of statistical way, due to the expansion of the health administrative function, participants in statistical practice mainly were professional health administrative institutions. The trained inspectors or statistical investigators had been used step by step; the reliability of data and the degree of specialization was also improved. From the point of infectious diseases statistics. Later period of the republic of China, the domestic epidemic situation of infectious diseases was still very serious. After the establishment of the ministry of health,"The implementing rules of infectious diseases prevention regulations" had been issued, and the central and local health agencies made investigations and statistics of infectious diseases improved for many times.
The last point mainly discusses the influence of the modern medical statistical practice. The influence on the modern China of medical statistics is various, such as promoting the infectious disease report, popularizing knowledge of infectious diseases Understanding the disease distribution, types and casualties; Promoting the development of preventive medicine and nosology; Promoting the progress of public health, understanding the population growth, and guiding the development of social welfare and so on.
Through reviewing and summarizing, the article finds that:Infectious disease is the main factor that harass human beings and is one of the focus of medical statistics work; Medical statistics is the key to perfect modern epidemic prevention system and to develop preventive medicine; National strength is the decisive factor for promoting medical statistics career; The cause of death statistics is the key and difficult point and also an important issue of modern public health administration.
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