【摘要】：公共衛(wèi)生是人類社會(huì)永恒的需求，隨著人類文明的遞嬗，公共衛(wèi)生漸由社會(huì)自發(fā)調(diào)節(jié)、隨機(jī)應(yīng)對(duì)和慈善救濟(jì)活動(dòng)，演變?yōu)橐孕l(wèi)生行政為主導(dǎo)、以科學(xué)方法為手段、以保障和增進(jìn)公眾健康為旨趣，官方與社會(huì)合作推進(jìn)的公共設(shè)施和公共事業(yè)。清末民國(guó)時(shí)期，由于近代以來西方醫(yī)學(xué)成就和租界衛(wèi)生管理制度的刺激示范，中國(guó)社會(huì)內(nèi)部對(duì)于衛(wèi)生強(qiáng)國(guó)和衛(wèi)生現(xiàn)代性的強(qiáng)烈追求，以及應(yīng)對(duì)連年疫情的現(xiàn)實(shí)需要，國(guó)家開始自上而下的衛(wèi)生行政擘畫、建構(gòu)和實(shí)施，現(xiàn)代意義上的以城市為代表的中國(guó)公共衛(wèi)生事業(yè)由此肇端。在此時(shí)代訴求和社會(huì)趨向的引領(lǐng)下，歷史悠久、文化發(fā)達(dá)、商賈輻輳的蘇省重地、江南名城——蘇州，因應(yīng)時(shí)勢(shì)，且合于地方防疫、市政建設(shè)之需要，遂在官方與社會(huì)的協(xié)作下，開啟公共衛(wèi)生之端緒，并逐漸粗成體例。 近代蘇州公共衛(wèi)生的演進(jìn)，由清末民初的萌發(fā)到南京政府十年時(shí)期的初步發(fā)展再到戰(zhàn)后的粗具體例，主要沿著三個(gè)脈絡(luò)進(jìn)行：一、公共衛(wèi)生行政管理，由衛(wèi)生行政寓于警政，走向衛(wèi)生行政與警政相對(duì)分離；二、辦理模式，由官商合辦走向以官辦為主社會(huì)協(xié)作；三、業(yè)務(wù)內(nèi)容，由清道防疫擴(kuò)及其余，粗略形成疫病防治、環(huán)境衛(wèi)生、食品衛(wèi)生、婦嬰衛(wèi)生、學(xué)校衛(wèi)生、衛(wèi)生教育等多元并進(jìn)的業(yè)務(wù)體系。蘇州公共衛(wèi)生的演進(jìn)理路，既有時(shí)代共同趨向的投射，又有過程和形式上地方樣態(tài)的呈現(xiàn)。 疫病防治是蘇城公共衛(wèi)生的中心事務(wù)，這不僅因?yàn)樗菚r(shí)代性的嚴(yán)峻課題，也是水網(wǎng)密布、氣候溫潤(rùn)的江南城市面臨的地方疫情壓力所致。近代蘇城疫病防治問題上，出現(xiàn)了二元對(duì)立的面相：一方面是驅(qū)瘟逐疫迎神賽會(huì)和挑痧等坊間防疫百態(tài)的恣肆，另一方面是官方對(duì)落后防疫行為的取締，并在與社會(huì)的互動(dòng)合作下，初步形成了一套臨時(shí)救治與常規(guī)預(yù)防相結(jié)合的急性傳染病防控機(jī)制。蘇城疫病防治上二元對(duì)立的面相，從一個(gè)側(cè)面反映了蘇城公共衛(wèi)生，實(shí)際是在與民俗傳統(tǒng)特別是迷信觀念和舉措的b^格不入中得以曲折演進(jìn)，并漸入民心的。 保障日常清潔的環(huán)境衛(wèi)生和食品衛(wèi)生被視為治疫之本，成為蘇城公共衛(wèi)生事務(wù)中的基礎(chǔ)工作�？偲浯蟾�，主要涵括街道清潔與垃圾清運(yùn)、糞穢管理與廁所改良、飲水改良、各類飲食品及其制造經(jīng)營(yíng)場(chǎng)所衛(wèi)生檢查與管理等內(nèi)容。街道清潔上日常與定期的結(jié)合，垃圾清運(yùn)上行政與市場(chǎng)的相配，糞穢運(yùn)除上加強(qiáng)時(shí)間、地點(diǎn)和面相的規(guī)范、廁所整改上的化多為少、棄舊迎新，飲水衛(wèi)生上改良與“革命”的統(tǒng)籌、食品衛(wèi)生上應(yīng)時(shí)性強(qiáng)、制度化高、消極取締與積極建設(shè)規(guī)劃的并舉，構(gòu)成了各項(xiàng)業(yè)務(wù)的典型特質(zhì)。由于經(jīng)費(fèi)的短缺、主事者和執(zhí)行者的顢頇敷塞、民的痼習(xí)、商的玩忽延宕等因素，蘇城環(huán)境衛(wèi)生和食品衛(wèi)生舉措實(shí)際成效并不甚佳，許多規(guī)劃也無果而終。然而，毫無疑義，在與社會(huì)的互動(dòng)協(xié)作乃至沖突抵牾中，官方制定了一系列的規(guī)章條例，并盡力付諸實(shí)踐，一定程度上改良了蘇州城市生態(tài)環(huán)境和日常飲食健康，并多少促進(jìn)了市民飲食住行衛(wèi)生生活方式及其觀念的形塑，更從理論和實(shí)際雙重意義上推動(dòng)了蘇州城市社會(huì)管理和公共管理的制度化進(jìn)程，加快了城市現(xiàn)代化變遷。 作為近代公共衛(wèi)生的長(zhǎng)效追求，婦嬰衛(wèi)生、學(xué)校衛(wèi)生等保健事業(yè)和衛(wèi)生教育的漸趨并進(jìn)，豐富了蘇城公共衛(wèi)生的業(yè)務(wù)內(nèi)涵。以“生”的方式嬗變、嬰兒健康比賽為主要內(nèi)容的婦嬰衛(wèi)生，以學(xué)校傳染病預(yù)防、學(xué)生健康檢查、學(xué)校衛(wèi)生教育為主要內(nèi)容的學(xué)校衛(wèi)生，以多主體、多形式、多場(chǎng)域、教育性與地方化和趣味性相結(jié)合為典型特質(zhì)的民眾（或曰社會(huì)）衛(wèi)生教育，其工作開展雖存在設(shè)施簡(jiǎn)陋、業(yè)務(wù)單一、方式粗糙甚至走過場(chǎng)、普及性不強(qiáng)等諸多局限和不足，但它們確實(shí)開啟了蘇城婦幼保健以及衛(wèi)生教育事業(yè)的端緒，積淀了一定的寶貴經(jīng)驗(yàn)。這些業(yè)務(wù)體現(xiàn)了蘇地政府維護(hù)婦嬰健康、增強(qiáng)青少年體格以及培育公眾衛(wèi)生觀念習(xí)慣的努力和自覺，更從一個(gè)側(cè)面反映了蘇州社會(huì)力量熱心公益，積極參與推進(jìn)各項(xiàng)公衛(wèi)事業(yè)，與官方互動(dòng)合作的地方風(fēng)貌。 公共衛(wèi)生是蘇城近代化變遷的產(chǎn)物，又推動(dòng)了城市社會(huì)變遷，并在變遷中曲折演進(jìn)，公共衛(wèi)生與蘇州城市社會(huì)變遷之間呈現(xiàn)出一種互動(dòng)張力。這種互動(dòng)關(guān)系可以從兩點(diǎn)得以管窺：第一，公共衛(wèi)生的舉辦推動(dòng)了市民生命狀態(tài)、生活方式和衛(wèi)生觀念的嬗變，生命、生活和觀念的嬗變又使市民增強(qiáng)了對(duì)公共衛(wèi)生的訴求，進(jìn)而推動(dòng)它的演進(jìn)；第二，公共衛(wèi)生事務(wù)引發(fā)了蘇城衛(wèi)生輿論的勃興，公共輿論又以兼具批判與啟蒙功能的蘇城特色的“公共領(lǐng)域”形式，鞭策政府、啟迪民眾、引領(lǐng)社會(huì)在公共衛(wèi)生上通力合作，增強(qiáng)當(dāng)局的行政自覺及市民的公民性和責(zé)任感，進(jìn)而推動(dòng)蘇州公共衛(wèi)生乃至整個(gè)城市近代化變遷的現(xiàn)實(shí)或可能演進(jìn)。 總之，在時(shí)代性的公共衛(wèi)生訴求和發(fā)展趨向的影響下，在蘇城地方當(dāng)局的行政努力，及民間社會(huì)的積極互動(dòng)下，時(shí)至戰(zhàn)后蘇城公共衛(wèi)生體例初具。由于眾多瓶頸因素的掣肘，蘇城公共衛(wèi)生又呈現(xiàn)出粗陋面相。且其遭遇的窒礙和困境，在全國(guó)多具一定的普遍性，因此，某種程度上可以說，，蘇城公共衛(wèi)生發(fā)展情狀是近代中國(guó)（城市）公共衛(wèi)生總體鏡像的投射，是其時(shí)代共通命運(yùn)的寫照。無論如何，近代蘇州乃至中國(guó)公共衛(wèi)生的篳路藍(lán)縷之功可圈可點(diǎn)。
[Abstract]:Public health is the eternal demand of human society. With the development of human civilization, public health has gradually evolved from social spontaneous regulation, random response and charitable relief activities to public facilities and public undertakings which are guided by health administration and promoted by scientific methods in order to protect and improve public health. In the late Qing Dynasty and the Republic of China, due to the modern western medical achievements and the stimulation and demonstration of health management system in concessions, the strong pursuit of health power and health modernity within Chinese society, and the actual needs of responding to successive epidemic situations, the state began to paint, construct and implement the top-down health administration, and in a modern sense, take the city as the city. Under the guidance of the demands of the times and the social trends, Suzhou, a famous city in the south of the Yangtze River, has a long history and a well-developed culture. Roughing up gradually.
The evolution of modern Suzhou public health, from the germination of the late Qing Dynasty and the early Republic of China to the preliminary development of the Nanjing government in the ten-year period and then to the rough and concrete cases after the war, mainly follows three lines: first, public health administration, from health administration in police administration, to health administration and police administration relatively separated; second, the mode of management, from the co-operation of government and business to move towards. Third, the development of Suzhou public health is characterized by both the projection of the common trend of the times and the local forms and processes. The presentation.
Disease prevention and control is the central task of public health in Suzhou, not only because it is a serious issue of the times, but also because of the local epidemic pressure faced by the cities in the south of the Yangtze River with dense water network and warm climate. On the other hand, the government banned backward epidemic prevention activities and, under the interaction and cooperation with the society, initially formed a set of acute infectious disease prevention and control mechanism combining temporary treatment with routine prevention. Popular traditions, especially superstitions and practices, have evolved in a tortuous way and gradually become popular.
Safeguarding the daily clean environment and food hygiene is regarded as the basis of epidemic prevention and treatment, and has become the basic work of public health affairs in Suzhou. Daily and regular combination of garbage clearance and transportation administration and market matching, waste removal to strengthen the time, place and appearance of the norms, toilet rectification and transformation of more than a few, abandon the old and welcome the new, drinking water hygiene improvement and "revolution" of the unified, food hygiene should be timely, highly institutionalized, passive ban and active construction planning of the simultaneous, constitute. Owing to the shortage of funds, the carelessness of the principals and executives, the habits of the people, the negligence of the merchants and other factors, the actual results of the environmental hygiene and food hygiene initiatives in Suzhou have not been very good, and many of the plans have been fruitless. A series of rules and regulations have been formulated and put into practice to a certain extent, which has improved the ecological environment and daily dietary health of Suzhou, and promoted the formation of the public's dietary, living and hygienic life style and their concept to some extent, and promoted the institutionalization of Suzhou's urban social management and public management in both theoretical and practical aspects. The process accelerated the change of urban modernization.
As a long-term pursuit of modern public health, health care undertakings such as maternal and child health, school health and health education are gradually advancing, enriching the business connotation of public health in Suzhou. The contents of school hygiene, with multi-subject, multi-form, multi-field, education and localization and interesting combination as the typical characteristics of public (or social) health education, although there are many limitations and shortcomings in its work, such as poor facilities, single business, rough way or even walk through the stage, not strong popularity, but they really opened up the city of Suzhou. Maternal and child health care and health education have accumulated valuable experience, which reflects the efforts and consciousness of the Soviet government in safeguarding maternal and child health, strengthening the physique of young people and cultivating public health concepts and habits, and reflects from one side the enthusiasm of Suzhou social forces for public welfare, and actively participate in promoting various public health undertakings. The interaction with the government.
Public health is the product of the modernization of Suzhou, it also promotes the social change of the city, and in the twists and turns of the evolution, there is an interactive tension between public health and the social change of Suzhou. This interactive relationship can be seen from two aspects: first, the holding of public health promotes the state of life, life style and social change of the citizens. The evolution of health concept, life, life and concept makes the public demand for public health enhanced, and then promotes its evolution. Secondly, public health affairs caused the vigorous development of health public opinion in Suzhou, and public opinion spurred the government and enlightened the people in the form of "public sphere" with both critical and enlightening functions. The public should lead the society to cooperate with each other in public health, enhance the administrative consciousness of the authorities and the citizenship and sense of responsibility of the citizens, so as to promote the reality or possible evolution of Suzhou public health and even the modernization of the whole city.
In a word, under the influence of the public health demand and development trend of the times, with the administrative efforts of the local authorities and the active interaction of civil society in Suzhou, the public health style of Suzhou began to take shape after the war. Therefore, to some extent, it can be said that the development of public health in Suzhou is a reflection of the general image of public health in modern China and a portrayal of the common destiny of the times.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R-09

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