清代前期（1723-1820）民間傷口處理與破傷風治療－以鬥毆因風身死案為中心的分析

Abstract

依據雍正三年成立的「原毆傷輕，因風身死」例的規定，若被害人死於破傷風，犯人就有機會減刑，因此執法官必須傳喚涉案人士如家屬或醫生作證，瞭解被害人生前曾接受的治療，以評估被害人的死因，於是在鬥毆因風身死案可見到豐富的外傷醫療活動的記載。本文從334件鬥毆因風身死案例探討清代前期民間傷口處理與破傷風治療，首先，可見到由於地域與經濟等限制下，使得民眾難以順利尋醫求治，但是流行於民間的各類偏方，具有簡單易得的特性，常成為民眾處理外傷時的選擇。其次，從案件紀錄來看，醫者治療破傷風的手法相當多元，雖然以內服藥為大宗，但是外敷藥、針灸與火罐等外治法也有不少比例，可見善於手法技藝的醫者乃至遊走四方的走方醫，他們提供簡便廉速的治療，對基層民眾而言仍是不可或缺。最後，外傷治療的過程中也可見到病家換醫與群醫會診的情況。值得注意的是，部分醫者在供述時首先會表明自己是「外科」或「傷科」醫生的身分，並且他們在群醫會診中有時成為主導的角色，反映了當時的外科醫者逐漸浮現的專業自覺。

According to the legal code of ＂a minor wound in caused by the initial assault, resulting in death from tetanus＂ established by Emperor Yongzheng in 1734, if a victim died of tetanus, the convict would be considered for commutation. Therefore, the law enforcement officer must summon those who were involved in the case, such as the victim`s family or physicians, as witness to understand the treatment given to the victim in order to evaluate the cause of death The paper analyzes the civil wound treatment and tetanus treatment from 334 cases of deaths resulted from tetanus in scuffles in the early Qing Dynasty. First, it has been observed that the public often had difficulty in seeking medical treatment due to geographical or economic constraint. Under these circumstances, various folk medicine often became the choice of the public in wound treatment. Secondly, in view of the case records, physicians` treatment of tetanus was quite diverse; while internal remedies accounted for most treatment, external application, acupuncture and cupping therapy as well as other external treatment were often adopted. While there were physicians equipped with high skills, ＂wandering doctors (zou fang yi 走方醫)＂ who provided simple, affordable and fast treatment were still indispensable to the public at the bottom of the society. Finally, change of physician or diagnosis by multiple physicians was also observed in the process of wound treatment. It is worth noting that some physicians identified themselves as the members of ＂department of surgery＂ or ＂department of traumatology＂ and occasionally took the leading role in a diagnosis by multiple physicians, demonstrating an emerging professional awareness among surgeons at the time.