【作者】 尹倩；

【导师】 朱英；

【作者基本信息】 华中师范大学 ， 社会史， 2008， 博士

【副题名】以上海为中心

【摘要】 本文试图在中国近代社会变迁的背景下,以上海为主要考察地区,探寻民国时期医师群体的专业化进程,以及在此过程中政府、医师群体、社会民众三者之间的互动关系,力求融合医学史与社会史的方法,展现出作为专业群体的医师在中国近代社会中特有的发展轨迹以及给近代社会带来的影响,并借此更加深入地理解中国社会的近代转型。全文共分五章:第一章主要阐述民国时期医师群体的基本情况。在近代中国社会急剧变化以及西方文化持续涌入的过程中,包括中医与西医在内的医师群体迅速发展起来。但其成员构成则由于特殊的历史、社会原因而呈现出良莠杂陈、混乱失范的状态。作为“自由职业群体”,医师群体可以采取灵活多样的执业方式,获得较富足的生活及一定的社会声望,成为都市中专业职群、中产阶层、智识阶层的一份子。第二章主要探讨民国时期医师群体的专业化过程以及在此过程中专业团体与政府力量的互动。随着医师群体职业意识的日益萌发,各种专业团体纷纷出现,成为医界主动追求专业性的重要工具。医师群体通过不断完善专业团体的组织形式和治理机制,扩展组织功能,一直力图树立其行业权威,追求着对医师群体专业化发展的主导权,同时也一直力图向政府寻求支持和保障,以推动专业医师制度的建构。政府将医师职制的设计纳入到国家的制度规范中,与医师群体在专业化诉求上达成一致,但对医师群体的监管和控制与医师群体对独立专业权威的追求不可避免地造成了利益上的冲突。各级政府、各类团体和各种社会力量的权衡和对话始终交织着,给民国时期医师群体的专业化过程打上了特有的时代烙印。第三章主要围绕在医师群体内部中西医师之间的纠葛,探讨中西医的并存对医师专业化本身及社会所带来的影响,并从中考察医师与政府、社会民众之间的微妙关系。中医和西医是民国时期医师群体的两大组成部分,他们既有着不同学术体系的医学背景,在职场上又是针锋相对的竞争对手,虽然作为医生个体他们之间的关系未必象世人所想的那样紧张,但两者的冲突和纷争却是无法忽略的事实。中西医双方从学术论争升级到政治冲突后,都力图充分利用自身的国家和社会资源以达到自身的目的。当西医界寄希望通过政府的强制力量取代中医的地位时,中医界也奋起反抗,利用其社会资源向政府施压,终于捍卫了生存的权力。而政府在仿照西方试图构建一个现代国家时,找不到将传统因素吸纳入现代国家建构的经验,其应对措施也因此显得仓促而犹豫,反而加重了中西医之间的隔阂。终民国一世,中西医界始终在相互斗争中并存和发展。在医界的纷争中,中西医双方都有意无意受到了对方的影响,西医加速了本土化的进程,而中医也力图使自己适应现代社会的专业制度。医师群体正是在内部中西文化的冲突和融合中经历了一段特殊的专业化进程。第四章主要探讨民国时期的医病关系,并以此视角进一步考察医师与社会、国家之间的关系。氏国时期医师社会地位的转变、医疗空间的转换以及医疗模式的变化,使得传统以病家为主体的医病关系开始转变,医师在医病关系中的主体性开始凸现。但医师群体经济、社会地位的提高却反衬出其社会形象的恶化。民众对医师的商业化的增强和责任感的缺乏感到普遍的失望,医师也对病家的就医观念和态度感到不满,医病关系日趋紧张。针对这一状况,医师们一方面加强现代职业道德的探讨和建设,另一方面更多地试图通过对病人的“教育”来构建现代的医病关系,但并没有取得预期的效果。没有得到有效缓解的医病矛盾导致民国时期医讼的频繁发生。而在解决医疗官司的过程中,由于缺乏权威的鉴定机构,国家的介入也很难得到医师和民众双方的满意,三方博弈的结果直接决定着医讼的结局。而紧张的医病关系也成为医师群体专业化进程中一直未能解决的难题。第五章主要考察医师群体给中国社会带来的深远影响。“上医医国”的传统和“医学救国”的思潮使得民国时期的医师群体中的精英分子并不满足于“治一病愈一人”,而是立志于振兴中华民族,摆脱“东亚病夫”的屈辱。作为专业知识分子,他们利用自身的医学背景,积极参与卫生行政,希望能推动和影响囊括医师、医疗、公共卫生在内的中国医疗卫生体系的构建,同时通过各种途径传播医学知识,并通过改良旧俗等措施力图增强整个民族的体质,达到强种强国的目的。作为新兴的中产阶级,他们在民族、政治和社会事务中都努力发出自己的声音。源于这种公共性与专业性相交织的特性,民国时期的医师群体给近代中国社会带来了独特而深远的影响。结语:医师群体在民国时期加快了其专业化进程,成为中国近代社会专业化程度最高的职群之一;他作为知识阶层的一部分,所具备的横贯中西的教育背景和知识结构给予了其推动了自身专业化的进程乃至影响社会的力量;他作为社会中产阶级的一份子,在政府和民众之间不断寻求着更大的发展空间。其专业化的进程以及与社会、政府之间的关系可以为我们展示近代社会转型的一个层面。更多还原

【Abstract】 This thesis mainly examines medical practitioners in Shanghai and probes the process of their professionalization and the interplay among the government, medical practitioners, and the public in he period of the republic of China under the background of the development of Chinese modem society. It employs approaches of the medical history and social history to unfolds the unique professionalization of medical practitioners, as professionals, in Chinese modem society, and thereby its influence on the modem society so that we can have more thorough understanding of the social transformation during modern times. The thesis is divided into the following five parts.First, the thesis makes a general description of medical practitioners in he period of the republic of China. When the Chinese society experienced drastic changes and was flooded with western culture, medical practitioners, including traditional Chinese and foreign doctors were developing rapidly. However, not all of them were qualified and licensed because of some special historical and social factors. As professionals, they had flexible ways of practicing medicine, got rich and social prestige, and became a part of professionals, the middle-class, and intelligentsia in the municipalities.Second, the thesis discusses the professionalization process of medical practitioners and the interplay between medical association and the government. With the arising of professional awareness among medical practitioners, all kinds of associations came into being and became significant channels to pursue professionalization. They continued to perfect their professional organizations and administrative mechanisms, expanded working functions to build up authoritative position in the field, so as to seize the leading of the professionalization, as well as gained the support and safeguard from the government to promote the establishment of professional doctors system. The government put the medical register system in the systems and regulations of the nation to reach an agreement on the demand of professionalization. However, there were obvious conflicts between the government’s supervision and control of medical practitioners and their pursuing of the authoritative position. The balancing and dialogues were tangling episodes among, different levels of governments, associations and social powers, which characterized the professionalization process of medical practitioners in the period of the republic of China.Third, the thesis revolves around the conflicts among native medical and western medical practitioners, discusses the co-existence of native medical and western medical practitioners and its influence on their professionalization and the society, and examines the subtle relationship among medical practitioners, the government and the public, native medical practitioners and western medical practitioners were the two main parts of doctors in the period of the republic of China. They had different medical background which fell into different academic systems. They were competing rivals in the medical field. Although their relationship was not so tense as expected, their conflicts and disputes couldn’t be ignored. From academic arguments to political clashes, they attempted to make full use of their nations and social resources to achieve their own goals. When western medical practitioners hoped to substitute native medical practitioners with the help of the government, traditional Chinese doctors rose and resisted, put pressure on the government and finally safeguarded their right of existence. While the government was imitating the western countries to establish a modern country, they couldn’t find the ways to absorb the traditional factors into the construction of a modem society. It hesitated to take measures so that the situation was deteriorating, native medical and western medical practitioners coexisted and developed in their conflicting during the whole period of the republic of China. In this process, both parties were unconsciously influenced by their rivals respectively. For one thing, Western medical practitioners were more and more localized. For another, native medical practitioners attempted to adapt to the professional system in the modern society. It was in the conflicting and integration of Chinese and western culture that the medical practitioners went through very special professionalization process.Fourth, the thesis discusses the doctor-patient relationship and furthermore examines the relation of medical practitioners, the society and the nation from this perspective. The social position of medical practitioners improved, and the changes of iatrical space and modes of practicing medicine began to change the traditional doctor-patient relationship, in which patients were the main concern, and the Subjective role of medical practitioners was highlighted. However, the enhancing of their economic, and social positions made a sharp contrast to the deterioration of their social images. People were widely disappointed at their commercialization and their lack of responsibility while medical practitioners were dissatisfied with patients’ attitude and ideas of treatment and their relation became more and more tense. In order to solve the problem, on the one hand, medical practitioners reinforced the discussion and construction of the modem professional morals. On the other hand, they attempted to educate patients to establish the modem doctor-patient relationship, but in vain. The conflicts which couldn’t be effectively mitigated led to the frequent occurrences of medical lawsuit. However, in the process of dealing with these cases, the intervention of the government couldn’t satisfy both sides, and gambling of three sides directly determined the results of these medical cases because of the lack of authoritative evaluation organization. And the tense relation was an issue which failed to be resolved in the professionalization of medical practitioners.Lastly, the thesis examines the profound influences of medical practitioners on the Chinese society. Influenced by the tradition of "an outstanding doctor be able to work with hope of doing for his country ", which became a trade in modern china, the elites of medical practitioners were no longer satisfied with curing patients. They were ambitious to make our nation more prosperous and get rid of the insult of Sick Man of East Asia. As professional literates, they exploited their medical background and participated administration of sanitation actively in the hope to promote and influence the Chinese medical sanitary system which includes doctors, medical practice and public sanitation. At the same time, they took measures such ad spread the medical knowledge, reformed old customs to strengthen the quality of the whole nation to empower the country and its people. As the new middle-class, they had their voices in the national, political and social affairs. The medical practitioners in he period of the republic of China brought about profound and unique influences on the Chinese modern society because of the combination of publicity and speciality.Conclusion: In he period of the republic of China, the medical practitioners accelerated the professionalization process and became one of the most professionalized lines of work. As a part of the literate class, their educational background and knowledge, in which the Chinese and western parts were perfectly integrated, made them the force to push forward the professionalization and to have impact on the society. As the element in the middle-class, they looked for a larger place to develop between the government and the public. Their professionalization process and their relation with the government and the society can be a facet to exhibit the modern social transformation.更多还原