Earticle

17세기와 19세기는 ‘전염병(역병)의 시대’라고 불릴 만큼 전 세계적으로 역병이 대규모 유행했던 시기였다. 당시 동아시아에서는 두창1)이 강한 역병으로 대표적이었다. 조선 후기에는 5∼6년을 주기로 한 번씩 두창이 창궐하였는데 비슷한 시기 의 청나라도 피해를 면하지 못하였다. 현재 한중 학계에서 조선 왕실의 두창 방제 조치에 대한 평가는 아직 명확히 정 립되지 않은 상태이다. 본 논문은 동아시아적 비교 시각을 도입하여, 동시대에 유 사한 위협에 직면했던 청나라 황실의 사례와 비교 분석함으로써 조선 왕실의 두창 방제 조치를 보다 체계적․객관적으로 재조명하고자 하였다. 아울러 ‘나라의 핵심 적 통치 기구’의 구성원으로서 두창 방제 책임 이행 상황을 고찰하고, 나아가 양측 의 경험과 교훈도 종합적으로 도출하였다. 더불어 조선 왕실과 청 황실의 두창 방 제 조치가 다음과 같은 유사성을 지니고 있음을 확인하였다. 첫째, 진상을 알 수 없는 공포의 질병은 인간의 본능적인 ‘피신’에서 비롯되었고 조선 왕실의 ‘피접’(避接)과 청 황실의 ‘피두’(避痘)의 행위가 나타났다. 둘째, 양측 은 모두 약물 예방과 치료법을 중시했지만, 서양 학문에 대한 거부적 태도로 인해 우두(牛痘)법이 도입된 초기 단계에서 왕실이 재빠르게 효과적으로 시행하지 못하 였다. 셋째, 약물 예방과 치료의 효과가 미미했기 때문에, 양측은 모두 두신(痘神) 에게 제사를 지내는 행위를 보였다. 이처럼 공통점을 갖고 있는 동시에 세 가지 면에서의 차이점도 존재하고 있음 을 알 수 있다. 첫째, 현재까지 조선 왕실이 대규모로 두창 환자를 추방한 사료는 확인되지 않지만, 청나라 황실은 백성들에게 ‘추두’(驅痘 두창 환자를 도성에서 몰 아냄) 정책을 여러 차례 시행한 기록이 남아 있다. 둘째, 약물 예방 및 치료 측면에 서 진료 대상의 특수성으로 인해 조선의 내의원과 청의 태의원은 모두 약물 사용 에 있어 보수적인 경향을 보였다. 그러나 태의원과 비교할 때 내의원은 왕실의 두 창 치료에 있어 인신의 원기(元氣)를 더욱 중시하였으며, 온보(溫補) 할 약을 주로 사용했다는 점에서, 태의원보다 더욱 신중했다고 평가할 수 있다. 셋째, 당시 사회 적 분위기 속에서 왕족들이 궁궐에서 무당을 불러들여 ‘두신제(痘神祭)’를 거행하 는 것을 용납하지 않은 반면에 청 황실은 그리 회피하지 않았다. 한중 양국이 이러한 차이를 보인 이유는 유교가 조선에서 절대적인 국가 통치 이념으로 자리잡았기 때문이다. 또한 조선 왕실은 의략(議藥) 정책을 통해 여러 의견을 수렴해 치료 방 안을 마련했고, 때로는 절충적 치료 방안을 취하기도 하였다. 더불어 조선은 왕권 과 신권의 권력 관계에 따라 정책 방향에도 영향을 미쳤다는 점에서 한중 양국의 차이를 설명할 수 있다.

The 17th and 19th centuries are often referred to as “the Age of Infectious Diseases.” During this period in East Asia, smallpox emerged as the most formidable and devastating disease, both in terms of its severity and societal impact. On the Korean Peninsula, during the late Joseon Dynasty, when smallpox was most rampant, outbreaks occurred approximately every five to six years. The Qing Dynasty, in a similar historical and geographical context, was also not spared. Evaluations of the smallpox prevention and control measures implemented by the royal families during the Joseon Dynasty have not yet been established in either Korean or Chinese academic circles. This study adopts an East Asian comparative perspective by analyzing the case of the royal families of the Qing Dynasty, who faced similar threats during the same era, to reexamine the smallpox prevention and control measures of the royal families of the Joseon Dynasty more systematically and objectively. Additionally, it evaluates how members of the “core governing institution of the state” fulfilled their responsibilities in smallpox prevention and systematically derives key insights and lessons from both successful and unsuccessful efforts. Moreover, it confirms that the smallpox prevention and control measures of the royal families of the Joseon and Qing dynasties shared the following similarities: Through a comprehensive comparison across four dimensions— isolation measures, medicinal treatments, vaccination techniques, and spiritual practices (i.e., religious rituals)—this study demonstrates that, within similar historical-geographical contexts and under the shared influence of traditional Korean and Chinese medical systems, the smallpox measures implemented by the royal families of Joseon and Qing exhibit three key parallels. First, in response to a terrifying and unidentifiable disease, both royal families adopted avoidance behaviors driven by the human instinct for self-preservation; the Joseon royal family adopted the practice of bijŏp (避接, contact avoidance), while the Qing Dynasty royal family employed bìdòu (避痘, smallpox avoidance) behaviors. Second, both courts significantly emphasized medicinal treatments. However, due to their resistance to Western learning, neither was able to effectively implement the cowpox vaccination method into their courts immediately after its introduction in their respective countries. Third, owing to the limited effectiveness of medicinal treatments, both sides engaged in rituals to worship the Smallpox Deity. By contrast, three notable differences emerge. First, currently no historical records are available indicating that the Joseon royal family implemented large-scale measures to expel smallpox patients. The Qing Dynasty royal family conducted multiple “Smallpox Expulsion” measures, driving patients out of the capital city. Second, in the realm of medicinal prevention and control, both the Nae-ui-won (內醫院, The Medical Dpt. of the Palace) of Joseon and the Taiyiyuan (太醫院, Imperial Academy of Medicine) of the Qing Dynasty were generally conservative in their medication choices, owing to the special status of the patients they served— members of the royal family. However, compared with Taiyiyuan, Nae-ui-won emphasized more on nurturing the vital energy of the human body when treating smallpox among the royal family members, and their medications leaned more heavily toward warming and tonifying remedies, suggesting that they were even more conservative and cautious than Taiyiyuan. Third, within the broader social context of the time, performing “Smallpox Deity Rituals” by female shamans was prohibited within the Joseon royal court. By contrast, the Qing Dynasty royal family did not observe such taboos. These differences can be attributed primarily to the absolute dominance of Confucianism as the national ideology in Joseon. The Joseon royal family adopted the measure of deliberating on medications to gather collective opinions, which sometimes led to compromises in treatment decisions. Additionally, the power dynamics between the monarchy and the bureaucracy, and the question of which held greater influence, played a significant role in shaping these divergences.

본고는 천연두신 무가를 ‘젠더’라는 키워드를 중심으로 하여 서사 구현 방식과 그 의미를 고찰하여 본 것이다. <손님굿> 무가는 ‘사공-각시손님’, ‘김장자-각시손님’, ‘김장자의 아들-각시손님’이 대결 혹은 갈등 양상을 보여주는데, 이 둘의 관계는 모두 ‘남-녀’라는 젠더 대결로 소급되었다. 이와 달리 ‘각시손님-사공 부인’, ‘각시손님-노고할미’, ‘각시손님-김장자 부인’, ‘각시손님-노고할미 외손주’는 모두 ‘여-여’ 관계로 우호 혹은 협조적인 젠더 양상을 보여준다. 젠더간의 상이한 관계는 전통사회에서 젠더에게 기대했던 역할이 서로 달랐기 때문이다. 천연두라는 질병을 통해 당대 사회에서 아이 양육을 전담했던 젠더는 여성이며 집안의 전권을 담당했던 젠더는 남성이었음을 확인할 수 있었다. 특히 여성이 한 가정 내의 양육과 돌봄을 전담했지만 그 역할은 남성의 전권 안에 포함된 것이었다. 이는 천연두라는 전염병을 통해 성별(Sex)이 어떻게 젠더라는 권력관계로 기능하였는가를 살펴볼 수 있게 해준다. 이와 함께 천연두라는 전염병이 아이 양육 과정에 있어서 반드시 거쳐야 하는 통과의례적인 질병이었음도 확인할 수 있었다.

This paper is a study of the narrative method and its meaning, focusing on the keywords of “gender,” in the shaman song about the Smallpox. In the <Sonnimgut> shaman song, ‘Sagong-Gaksi Sonnim’, ‘KimJangja-Gaksi Sonnim’, and ‘KimJangja’s son-Gaksi Sonnim’ show a confrontation or conflict. Both of these relationships resulted in a “male-female” gender confrontation. On the other hand, 'Gaksi Sonnim-Sagong’s wife', 'Gaksi Sonnim-Noguhalmi', 'Gaksi Sonnim-Kimjangja’s wife', and 'Gaksi Sonnim-Noguhalmi's grandchildren' were all friendly or cooperative in relation to 'female-female' . The different relationships between genders are due to the different roles expected of gender in traditional society. Through the smallpox disease, it was confirmed that in the society at that time, child rearing was dedicated to women, and that the entire household was in charge of men. In particular, even though women were dedicated to nurturing and caring for a family, that was a role in the man's whole authority. Through this epidemic of smallpox, we can see how each gender functioned as a power relationship called gender. Along with this, it was confirmed that smallpox is an epidemic that must be experienced in the child rearing process.

본고는 <마누라본풀이>에 나타난 마마신에 대한 대응 방식을 통해 신격 구성 원리를 확인하는 것을 목적으로 한다. 이를 위해 같은 마마신에 대한 신화인 동해안 <손님굿>과 <마누라본풀이>에 대한 비교 연구를 수행하였다. <마누라본풀이>와 <손님굿>은 구성과 지향에 있어 큰 차이를 보인다. <손님굿>이 마마신에 대한 철저한 복종을 통해 천연두를 피하는 신앙 체계를 마련했다면, <마누라본풀이>는 오히려 마마신을 굴복시킴으로써 천연두를 차단하는 방법을 제시했기 때문이다. 두 무가는 모두 마마신에 대한 본풀이지만, ‘복종’하는 방식과 ‘굴복’시키는 방식이라는 서로 상반된 가치를 활용하고 있다는 점에서 다른 전승 과정을 거쳤음을 알 수 있다. 이런 차이는 제주도에서 마마신에 대한 신앙이 정착하는 과정에서 지역적 특성과 깊은 관계를 맺으며 발생한 것으로 보인다. <삼승할망본풀이>의 주인공인 삼승할망과 저승할망은 당신본풀이에서도 그 연원이 확인될 정도로 오랜 토착적 신격이라 할 수 있다. 이렇게 토착적으로 신격의 체제를 이미 마련한 제주 지역에서 마마신이라는 외래적 신격을 수용했기 때문에 동해안과는 다른 방식으로 신화를 구성할 수밖에 없었던 것이다. 특히 불도맞이를 통해 산육신에 대한 분명한 신앙 체계가 마련된 상태였기에 마마신의 수용을 신과 신의 관계 속에서 맞이하게 되었고, 이 과정에서 선신의 위력을 통해 악신을 제압하는 서사가 구성될 수 있었다고 할 수 있다 이와 달리 동해안에서는 마마신과 산육신을 직접적으로 대응시키지 않고 독립된 거리로 구성하면서 무당과 신의 관계 속에서 신화가 제시된다. 때문에 무당과 신앙민들이 신에 복종하고 모시는 형태로 신화가 구성된 것이다. 이렇게 볼 때, 동해안과 제주도는 기존의 신앙 체계에 대한 고려를 통해 새로운 신격에 대응하는 모습을 보였다고 하겠다. 이와 같은 마마신에 대한 수용 방법의 차이를 통해 우리 무속이 외부의 충격에 대응하는 방법들에 대한 이해를 넓힐 수 있으리라 생각한다.

The purpose of this article is to confirm principle of God in <Manurabonpuri>. Through coping with the Mamasin. For this purpose, <Manurabonpuri> was compared with <Sonnimguk> of the East Coast. <Manurabonpuri> and <Sonnimguk> show a large difference in composition. <Sonnimguk> is a way of submitting to Mamasin. In contrast, In Hamlet, Mamasin gives in to ‘the God’s birth’. This is because the two myths have different transmission environments. This difference is deeply related to regional characteristics. The protagonists of <Samseunghalmangbonpuri> are indigenous Gods. Because of this Jeju environment, it is different from the east coast. In Jeju, faith was accepted in the relationship between God and God. So it is a form of suppressing Evil God with Good God. On the other hand, on the east coast was the relationship between God and shaman. So it is a form submitting to God. In this way, Hawaii and Guam responded to their existing faith. On the influx of new gods. The difference between these methods makes us aware of our shamanism culture.

본고는 의료 선교사 에비슨(Oliver R. Avision)과 그의 제자들에 의해 발간된 제중원 한글 의학 교과서를 대상으로, 전염병 관련 어휘를 고찰하는 데 목적이 있다. 의료 기 술이 발달했으나, 여전히 질병은 인류에게 두려움의 대상이라 할 수 있다. 전염병은 “만 가지 병 즁에  쟝 만코도  쟝 위험 병(병리통론, 1907: 182)”에 해당한다. 이 중, ‘두창(痘瘡)’과 ‘콜레라’는 오래전부터 한국인이 겪어야 했던 질병으로 그 명칭도 매우 다양하게 나타난다. 선교사 알렌(Horace N. Allen)의 건의로 1885년 최초의 근대식 병원 ‘제중원’이 설 립되었다. 이후 세브란스 병원 의학교에서 활용된 『진단학』1․2(1906, 1907), 『병리통론』(1907), 『외과춍론』(1910) 등은 전문적인 내용을 담은 한글 의학 교과서라 할 수 있다. 이에 본고에서는 20세기 초 전염병 관련 어휘를 살피되, 동시대, 전후 시대에 쓰인 어휘와의 관련성도 함께 고찰하고자 하였다.

This study aims to examine the epidemiological vocabulary of Korean medical textbooks published by medical missionary Oliver R. Avision and his disciples in Widespread Relief House(Jejungwon). Disease can still be said to be the object of fear for mankind. Although medical technology has developed, disease is still a fear of mankind. Epidemics is “the most common and most dangerous of all 10,000 diseases(Pathology and Pain Theory(Byeongritongron:182).” Among them, ‘Smallpox(Duchang)’ and ‘Cholera’ are diseases that Koreans have had to suffer for a long time and the names of them were also appeared in diverse. In 1885, the first modern hospital, ‘Jejungwon(Widespread Relief House)’, was founded by missionary Horace N. Allen’s suggestion. Afterwards, Diagnostics 1․ 2(1906, 1907), Pathology and Pain Theory(1907), and General Theory of Surgery (1910), which were used at Severance Hospital Medical School, are Korean medical textbooks with specialized contents. Therefore, in this study, it intends to examined the vocabulary related to epidemics in the early 20th century and also to research the relevance of vocabulary used in the contemporary and postwar periods.

미국의 역사학자 엘리자베스 A. 펜(Elizabeth A. Fenn)은 2001년에 출판된 자신의 저서 『폭스 아메리카나: 1775-82 두창 대유행』에서 18세기 미국독립전쟁 동안 유행한 두창이 실질적으로 전 북미를 휩쓴 팬데믹이 있었다는 것을 밝혀냈다. 펜의책은 국지적이라고 생각되었던 두창 발발 케이스 간의 연관성을 추적해 거시적 관점에서 북미 두창 유행의 규모를 밝히고, 독립전쟁 기간 동안 두창 유행의 정치적, 군사적, 그리고 의학적 함의를 연구한 저작으로 18세기 미국사에 기여한 바가 크다. 본 연구는 펜의 사학사적 공헌에 더해, 그러나 펜의 거시적 관점에서 미시적 접근으로 그 방법을 달리해 18세기 북미 두창 유행의 시대를 재조명한다. 이를 위해 본 논문에서는 전쟁기 영국군에서 의료인으로 활동한 미국인 충성파 의사 존 제프리의 기록을 중심으로 영국군 주둔지에서 두창 통제에 대해 살펴본다. 본 연구는 독립전쟁 기간 동안 제프리의 충성파로서의 여정과 그가 남긴 군사 및 의료 기록을 통해 봉쇄된 보스턴과 캐나다 노바스코샤에 위치한 영국군 주둔지에서 두창 유행의 양상과 인두접종 실시 방법을 재구성한다. 특히 본 논문은 영국군 내 전투요원뿐만 아니라 기존에 다루어지지 않았던 피난민, 종군민간인, 그리고 전쟁포로에 대한 영국군의 두창 통제 정책과 인두접종의 사례를 발굴하는 것을 통해 전쟁기 군에 의한 두창 통제와 인두접종에 대한 논의가 전투요원과 비전투요원(특히 아동)을 포함하는 포괄적 관점에서 논의되는 것이 중요함을 역설한다.

In her distinguished book Pox Americana: The Great Smallpox Epidemic of 1775-82 (2001), American historian Elizabeth A. Fenn gauged the scale of the eighteenth century smallpox epidemic by seeing individual outbreaks as linked events and examining the political, military, and medical implications of an epidemic during the Revolutionary War. Benefiting from her contribution, but switching from a macro perspective to a micro approach, this article addresses underexamined or undiscussed issues regarding smallpox inoculation during the eighteenth century smallpox pandemic through the records of Dr. John Jeffries, an American loyalist doctor who served in the British Army as medical personnel. His odyssey as a loyalist during the Revolutionary War and the military and medical records left by him allow us to visit different times and locations where smallpox was spreading and inoculation was practiced. Based on these materials, this study illuminates the British Army’s policies and practices concerning smallpox inoculation for loyalist refugees, camp followers, and prisoners of war in sieged Boston and in Halifax, a British garrison town in Nova Scotia, Canada. In doing so, this article argues the importance of understanding wartime smallpox inoculation as a method of disease prevention and control from a more comprehensive and complex perspective that includes not only the immunization of combat soldiers but also that of noncombatants, especially children.

This research explores the case of the 1903 smallpox outbreak on the SS Korea, a transpacific carrier making runs between Southeast Asia, East Asia, Hawaii, and the United States. These regions were connected to a degree that no one had ever imagined through the SS Korea. Honolulu, Hawaii, was one of the most important territories in US maritime history and served as a waypoint from Asia to San Francisco on the mainland. As increasing numbers of people traveled by sea, various microbes were communicated across the Pacific. International tourists traveling across the ocean to Hawaii and the United States were alerted infectious disease, one of the most significant being smallpox. The story of the SS Korea serves as an important lens through which to explore the early twentieth century transpacific world connected through Honolulu. Focusing on the spread of smallpox via international travelers, this research studies aspects of the public health system that were developed to contain smallpox infection on international ships and the application of smallpox vaccination as a method for infectious disease control. More importantly, in bringing attention to the uncertainty surrounding the diagnosis of smallpox, this research argues for the necessity of historians to build a more comprehensive medical historical context for disease control systems that includes the limits of medical science in making diagnoses of infectious diseases, the uncertainties arising from a lack of this component, and the implementation of health policies and preventative medical technologies.

By the early eighteenth century, quantification had been integrated as a useful method for analyzing medical questions in England and America. After the introduction of smallpox inoculation in the early 1720s, physicians and intellectuals assessed smallpox and inoculation data. This article explores how numeric data and quantitative analysis were used in the discussion of smallpox and inoculation during the several decades following the introduction of inoculation. It focuses on Boston, the historic site where inoculation unfolded for the first time in American history. Bostonians quantified the mortalities of community-acquired smallpox and inoculated smallpox. They defended inoculation, arguing that it was less risky than natural exposure. In a nutshell, this argument based on risk calculation did not convince everyone. Statistical data show that by the 1764 epidemic, the proportion of the inoculated to the entire population was quite low. Reports in local newspapers also proved that fear of inoculation persisted, and supporters of inoculation were not able to quell the outcry from anti-inoculators. Furthermore, the Boston public health authority resisted embracing inoculation as an ordinary medical practice. In spite of these limitations, assessment of numeric data reached to population levels in 1752. The compiled data helped Bostonians examine their current practice of inoculation from a new perspective. Analyzing and discussing numbers enabled them to ask meaningful questions about the management of inoculation in practice and differences in environmental practice settings.

This article explores the relationship between Boston’s public health policy and law and changes in the practice of smallpox inoculation from 1753 up to the 1764 smallpox epidemic. In concentrating on the lack of change in public health policy and methodological development, historians have dismissed the importance of nearly a decade of these inter-epidemic interval years and the changes that did occur during the 1764 epidemic. This study attempts to examine how inoculation hospitals were adopted in Boston and how these new clinical settings influenced the change of inoculation practices. In delving into these questions, this article will have focused examination on the following three points: First, this study examines the transformation of inoculation sites from private spaces to public spaces. It argues that the public profile of inoculation was important in stimulating physicians’ and patients’ comparisons of different inoculation methods and treatment. Secondly, it shows that Boston’s public health decisions were not necessarily an accurate manifestation of individual decisions. Despite the town’s collective decision for rigid regulation of inoculation methods and rejection of the proactive use of inoculation technology, the majority of Bostonians welcomed smallpox inoculation. Thirdly, it hopes to connect local medical history to a larger political context; it argues that the French and Indian War and the emergence of revolutionary conflict between American colonies and Britain partly impacted the dynamic tension in Boston between public health concerns, private practice, inoculation technologies, and inoculation hospitals.

OBJECTIVES: The aim of this study was to estimate the medical surge capacity required for mass prophylaxis based on a hypothetical outbreak of smallpox. METHODS: We performed a simulation using the Bioterrorism and Epidemic Outbreak Response Model and varied some important parameters, such as the number of core medical personnel and the number of dispensing clinics. RESULTS: Gaps were identified in the medical surge capacity of the Korean government, especially in the number of medical personnel who could respond to the need for mass prophylaxis against smallpox. CONCLUSIONS: The Korean government will need to train 1,000 or more medical personnel for such an event, and will need to prepare many more dispensing centers than are currently available.

목 적 : 두창백신 접종 후 일반적으로 접종 부위에 거즈를 먼저 덮고, 그 위에 반투과막을 덮어주는 드레싱을 권장하고 있다. 저자들은 이러한 드레싱 방법의 효율성을 알아보기 위해서 두창백신 접종 후 접종 부위, 거즈 바깥부위, 반투과막 바깥부위에서 각각 분비되는 바이러스양을 정량적으로 비교하였다. 재료 및 방법 : Lancy-Vaxina (Berna Biotech, Swiss) 두창백신 1:10 희석연구에 참여한 자원자들 중에서 접종부위에 정해진 기간에 검체 채취에 동의한 40명을 대상으로 연구를 진행하였다. 참가자들은 두창백신 접종 후 6, 8, 10, 13, 15일에 각각 방문하여 드레싱을 교체하였다. 드레싱을 교체하면서 두창백신 접종 부위, 거즈 바깥부위, 반투과막 바깥부위에 면봉을 이용해서 각각 검체를 채취하였다. 검체는 냉동 보관한 후 plaque assay를 통하여 정량적으로 바이러스 역가를 측정하였다. 결 과 : 총 40명의 자원자가 본 연구에 참가하였다. 백신 접종 부위에서 채취한 156 검체 중 126건(81%)에서 백시니아바이러스가 검출되었다. 백신 접종 부위에서 접종 8일째 바이러스 역가의 평균(geometric mean titer (log10))은 3.91 pfu/mL이었다. 거즈 바깥부위에서 총 39 검체가 얻어졌고, 이 중 16건(41%)에서 백시니아바이러스가 검출되었다. 거즈 바깥부위에서 접종 8일째 바이러스 역가의 평균은 0.91 pfu/mL이었다. 반투과막 바깥부위에서 총 133 검체가 얻어졌고, 이 중 1건(0.8%)에서 백시니아바이러스가 검출되었다. 접종 8일째 거즈 바깥부위에서는 바이러스가 검출되지 않았다. 결 론 : 두창백신 접종 후에 거즈를 덮고 그 위에 반투과막을 덮어주는 드레싱 방법은 백시니아바이러스 배출을 효과적으로 줄여줄 수 있음을 확인하였다.

Background : We compared vaccinia virus shedding from the vaccine inoculation site (vaccination lesion) and two sites of a dressing covering the vaccination site; the outer surface of the semipermeable dressing (outer surface) and the inner surface of the semipermeable dressing, that is, the surface of a folded gauze under the semipermeable membrane (gauze surface) Material and Methods : Subjects were recruited from the volunteers who participated in a clinical trial of the efficacy of a 1:10 dilution of Lancy-Vaxina (Berna Biotech, Switzerland), and were seen every 2-3 days (days 6, 8, 10, 13, and 15 after smallpox vaccination) for scheduled dressing changes. Swab specimens were obtained from the vaccination lesion, the outer surface, and the gauze surface. Quantitative viral culture assays for these specimens were done. Results : Vaccinia virus was recovered from 126 (81%) of the 156 vaccination lesion samples collected from the 40 participants. A high virus titer was recovered from the vaccination lesion (geometric mean titer (log10)=3.91 on day 8). Of the 39 swab samples obtained from the gauze surface of the gauze, 16 (41%) were positive for virus. An intermediate titer was recovered from the gauze surface (geometric mean titer (log10)=0.91 on day 8). Of the 133 swab samples obtained from the outer surface, only one (0.8%) was positive for vaccinia. No virus was recovered from the outer surface on day 8. Conclusion : Our findings suggest that the addition of a semipermeable dressing to the folded gauze further reduces viral shedding and therefore increases protection.

A comparison of the publication history of Dugwa hwipyeon (痘科彙編) with that of smallpox texts in China reveals that, in Joseon Korea, the central government and government officials often took the lead in publishing such works. Moreover, the publication of smallpox texts and the broader response to smallpox in Joseon were closely intertwined with relief and welfare policies (guhyul, 救恤), giving these efforts a distinctly policy-oriented character. This stood in stark contrast to China, where most smallpox texts, including Dugwa hwipyeon, were published and distributed by specialized private booksellers and merchants, leaving individual consumers to choose which texts to purchase. In China, the coexistence and intermingling of diverse approaches to smallpox prevention and treatment also contributed to the expansion of the profession of smallpox physicians (duui, 痘醫). In Joseon, by contrast, the emphasis on practical efficacy under real-world conditions fostered the development of smallpox-related medical knowledge focused on treatment methods that could be applied without specialized skills.

This study focuses on the 1908 outbreak of foot-and-mouth disease (FMD) in the United States to investigate the relationship between this epizootic disease and the production and circulation of the smallpox vaccine. It further explores how the search for the origin of the 1908 FMD outbreak contributed to the eventual enactment of federal legislation regulating animal biologics in 1913. The investigation into FMD drew both public and scientific attention to the interconnectedness of human and animal health and raised broader concerns about the safety of biologics used in veterinary medicine. In response, Progressive Era reformers in the United States moved toward centralized, government-led regulation grounded in scientific oversight. Both the 1902 Biologics Control Act and the 1913 Virus-Serum-Toxin Act are widely recognized for their roles in advancing the safety and efficacy of biologics. Nevertheless, despite these regulatory efforts, FMD outbreaks persisted in the United States until 1929, demonstrating that legal and institutional reforms alone were insufficient to alleviate public anxiety over zoonotic infections or to restore trust in biologics.

Beijing and Shanghai, representative modern cities in China, witnessed the development of various urban infrastructures and quarantine systems in the 1920s and 1930s. Both cities established Health Demonstration Stations in the 1930s, as part of their implementation of modern health administration. This foundation played a pivotal role for making health administration more practical. Huang Zi-fang (1899-1940) and Hu Hung-ji (1894-1932), the inaugural directors of the health bureau in the respective cities, were both graduates of the Johns Hopkins University School of Public Health in the United States. They shared a similar view of public health. Active exchanges occurred between the heads of the health administration in the two cities who were the leading forces in the health reform, encompassing various health experiments including the Health Demonstration Station. During the 1930s in China, state medicine gained prominence as the most ideal medical model for constructing a modern state. As such, the quarantine activities they promoted were also considered the most ideal model. The public health care centered on Health Demonstration Stations in the 1920s and 1930s that developed in large Chinese cities such as Beijing and Shanghai pursued similar goals by strengthening quarantine administration through free medical treatment and modern spatial control. Nonetheless, each city exhibited differences in terms of the subjects and targets of quarantine, as well as the primary bases of quarantine, which were either Health Demonstration Stations or hospitals. Both municipal governments and the civilian sector led the sanitary infrastructure development. While Shanghai showed stronger development in terms of the number of vaccinations, Shanghai’s dualized quarantine system did not necessarily create a better health environment than Beijing in terms of spatial control. In the 1940s, the Japanese occupation government implemented measures to inherit and further develop existing health administrations in Beijing and Shanghai. Existing international settlements were incorporated into the Japanese occupation government, and the occupation government pursued homogenization of urban space and tried to maintain the existing urban policy as much as possible to preserve the status quo. However, the intensification of the Anti-Japanese War and the Chinese Civil War brought an end to the health experiment centered around the Health Demonstration Station in China in the first half of the twentieth century.

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 c...

근대 상하이에서 두창은 치사율 30%에 이르는 가장 위협적인 질병 중 하나였다. 그러나 한편으로는 백신으로 충분히 막을 수 있는, 비교적 방역책이 확실한 전염병이기도 했다. 종두법에는 인두법과 우두법이 있는데, 각기 장단점이 있으나 인두법보다 우두법이 더 간단하고 안전하다고 여겨졌다. 따라서 서양에서 건너온 의료선교사들은 전통적인 중국식 인두법 대신 제너가 개발한 우두법을 알리고자 노력했다. 현재 상하이교통대학 의학부 부속 종합병원으로 유명한 인제의원은 1844년 영국인 의료선교사 윌리엄 록하트가 세운 자그마한 진료소에서 시작했다. 그는 상하이에서 최초로 우두접종을 실시한 인물이기도 하다. 마카오에서 들여온 신선한 우두묘를 사용하여 1845년 우두접종에 성공한 것이다. 한편 화계에서 우두접종을 주도한 인물은 바로 인제의원의 중국인 의사 황춘푸이다. 1850년 상하이 도대의 지원을 받아 화계의 성황묘에 인제의원 분원을 설립하고, 무료로 우두를 접종하여 우두법이 확대되는데 크게 기여하였다. 황춘푸와 같은 중국의 지식인들은 인두법을 통해 이미 면역이라는 개념을 알고 있었기 때문에, 같은 원리인 우두법을 수월하게 받아들일 수 있었을 것으로 짐작된다. 또한 그는 독실한 기독교 신자였는데, 기독교에 대한 믿음이 서양의학에 대한 믿음으로 이어졌을 가능성이 있다. 마지막으로 황춘푸는 인두보다 우두가 더 안전하며 맞는 사람의 고통도 덜하다는 사실도 잘 알고 있었다. 한편 우두법을 널리 알리기 위해서는 신선한 우두묘와 함께 제도적인 뒷받침도 필요했다. 1869년 공부국 의관 에드워드 핸더슨은 공부국 이사회에 종래의 인두법을 금지하고 우두법을 시행해야 한다고 건의하였다. 인두법은 다른 사람에게 두창을 전염시킬 우려가 있기 때문이다. 그리고 안전이 보장되는 장소에서 우두를 접종하기 위해 우두접종소를 설립해야 한다고 주장하였다. 의료위생 전반을 담당하는 공부국 위생처에서는 각 지구별로 우두접종소를 운영하는 한편, 병원이나 진료소뿐만 아니라 감옥에서도 백신접종을 시행했다. 또한 중국인들이 자주 모이는 성황묘나 천단에 우두접종소를 설치하여 접근성을 높였다. 이 과정에서 조계지의 주민들은 근대화된 도시위생체제의 이점을 충분히 누렸다. 공공조계에서는 우두제조소를 설립하여 직접 백신을 생산함으로써 무료접종이 원활히 진행될 수 있었기 때문이다. 실험실에서는 중국의 자선기관에 무료로 대량의 백신을 제공하였을 뿐만 아니라, 아직 실험실이 갖춰지지 않은 다른 지역에까지 백신을 공급하였다. 한편 공부국의 주도하에 체계적인 우두접종이 실시된 조계와는 달리, 화계는 1900년대 초에도 여전히 성황묘 우두접종소와 같은 자선기관 중심으로 접종이 이루어졌다. 이러한 차이는 조계와 화계로 나뉜 상하이의 특수한 정치적 상황에서 비롯되었다. 외국인 거주지인 조계는 외국 정부의 영향력이 강했고, 외국인 의사들은 우두법의 필요성을 잘 인식하고 있었다. 한편 화계는 중국인 거주지로 여전히 청나라의 전통적 지배체제 아래에 놓여있었다. 한편으로 백신을 접종받지 않은 중국인이 계속해서 조계로 밀려들었기 때문에 조계 당국은 우두접종에 더 심혈을 기울일 수밖에 없었다. 그러나 우두법이 소개된 후에도 인두법은 사라지지 않았다. 오래된 관념은 여전히 중국인들 마음속에 강하게 자리 잡고 있었다. ...

옛 사람들의 기록에서 천연두는 너무나 일상적이고 치명적인 질병이었다. 일단 발병 기간이 짧아 대처하기 어려웠고, 뚜렷한 증후가 나타날 때까지 다른 병으로 오진한 확률도 높았다. 천연두로 확진된다 해도 마땅한 치료법이 있는 것도 아닌데다가, 주로 어린 자식들이 발병해서 그 안타까움은 더할 수밖에 없었다. 천행(天幸)으로 회복이 된다면 그보다 좋을 수 없겠지만, 만일 잘못되면 부모는 곰보보다 더 깊은 마음의 상흔을 짊어져야만 했다. 그래서 천연두는 금기(禁忌)나 기원(祈願)에 몸을 맡길 수밖에 없는 슬픈 병이었다. 장혼의 「기척」은 천연두의 실질적인 처방을 매우 상세하게 기록하고 있어, 실제 어떻게 천연두에 대응했는지 살펴보기에 소중한 자료이다. 손자의 천연두 발병 초기부터 사망에 이르기까지 전 과정을 소상히 보여준다. 「기척」은 온 가족이 어린 아이를 구명하기 위한 눈물겨운 노력을 담고 있다. 자칫 슬픔 자체에 매몰되어 격정적으로 감정을 토해내거나, 몇 가지 단편적인 에피소드에 의존하는 여타의 글과는 상당한 차이를 보인다. 투병의 전 과정을 일기식으로 상세히 기록하면서 의원과의 갈등, 아이의 증세, 처방과 대처까지 객관적이고 냉정하게 적어내려 갔다. 백방의 노력은 모두 무의로 돌아가고, 치열했던 투병의 끝에 깊은 회한만 남았다. 글의 후반부는 아이를 잃은 상실감과 회한이 주를 이룬다. 손자를 잃지 않으려는 할아버지의 눈물겨운 노력과 손자를 잃은 뒤 가슴 찢어지는 슬픔이 생생히 전해져서 애도(哀悼) 문학의 명편(名篇)으로 꼽기에도 충분해 보인다.

Smallpox was too general and fatal disease in accordance with the ancient records. It was difficult to treat smallpox because of short period of outbreak. Moreover, the probability of misdiagnosis to other diseases was very high until the definite symptoms appeared. Thus, smallpox was the sad disease which people couldn't help staking their destiny to taboo or pray. “Gicheok” by Janghon described the actual prescription on smallpox in very details. It is the important data to examine the actual treatment on smallpox. He described the entire process from the first stage of smallpox observed in his grandson to his death in detail. Gicheok is significantly different from other records presenting several fragmentary episodes or furiously expressing emotions as being indulged into sorrow itself. As detailing the whole process of struggle against the disease, he objectively and cold-heartedly described the conflicts with a doctor, symptoms of the grandson, prescription and treatment. All endeavors were meaningless and only regret remained at the end of fierce struggle against the disease. The latter half of the records comprised mainly sense of loss and regret from the death of the grandson. Gicheok is enough to be the masterpiece in the literature of mourning because of the vivid description on the piercing sorrow after losing the grandson as well as on the pathetical endeavor of the grandfather who strived not to lose the grandson.

The First Health Demonstration Station (第一衛生區事務所) in Beijing has conducted local-based quarantine since 1925. This method, centered on local bases such as Health Demonstration Stations, enabled a wide range of vaccinations for residents moving between local communities. Health Demonstration Stations set up a network of vaccination points, which provided an opportunity for the municipal power to penetrate the daily space of residents. This method had a great effect on preventing smallpox by increasing the number of inoculators, but there was a risk of missing those who were not so mobile, such as newborns and infants. In fact, the outbreak of smallpox in 1926, 1932, and 1936 revealed the limitations of the local-based quarantine method. To overcome its shortcomings, the visiting vaccination was introduced in 1937 as a new spatial control system. Health Demonstration Stations conducted prenatal and postpartum care for mothers, and nurses visiting the home were in charge of vaccinations of infants. This method increased the vaccination rate of Health Demonstration Stations from 59.4% to 79.0%. Thus the visiting vaccination system could have a significant preventive effect for smallpox.

이 연구는 전근대 사회의 재난 인식과 대응 방식을 보여주는 문화적 자료로서, 조선시대 야담에 수록된 천연두 귀신담을 분석한다. 천연두는 조선시대 전반에 걸쳐 높은 전염성을 지닌 위험한 질병이었으나, 반복적 유행을 통해 경험적 지식이 축적되면서 다른 전염병과 구별되는 질병 특징이 인식되었다. 당대 사람들은 천연두의 상대적으로 낮은 치사율, 제한적인 감염 범위, 병의 경과 과정 등을 인식하게 되었으며, 이는 인간의 행위가 병의 치유에 영향을 미칠 수 있다는 믿음을 형성하는 데 일정한 영향을 미쳤다. 이러한 인식과 믿음은 야담 속에서 천연두 귀신을 인간과 유사한 소속이나 신분, 이성과 감정을 지닌 존재로 구체화하는 동시에, 귀신을 달래고 대응하는 인간의 행동 지침과 윤리를 강조한 서사를 형성하게 했다. 나아가 천연두의 질병 특성은 천연두 귀신을 공경과 제의의 대상인 신적 존재로 재구성하는 조건 가운데 하나로 작용했으며, 이러한 재구성은 유학자 지식인이 천연두를 유교적 윤리 질서 속에서 이해하고 그 정당성을 논의하는 담론으로까지 확장되었다. 이러한 점에서 천연두 귀신담은 조선 사회의 조건 속에서 형성된 질병 경험과 서사 형성 방식 사이의 긴밀한 연관성을 보여주는 사례로 이해할 수 있다.

This study examines smallpox ghost narratives in Joseon yadam collections. While previous studies have primarily interpreted such narratives as products of collective anxiety caused by highly contagious and lethal diseases, this study argues that smallpox narratives display distinctive features shaped by the specific characteristics of the disease. Although smallpox was a life-threatening epidemic, its repeated outbreaks allowed for the accumulation of empirical knowledge regarding its transmission, symptoms, and prognosis. This relative familiarity is reflected in narrative form. Unlike other epidemic ghosts, which often appear as anonymous and incomprehensible external forces, smallpox ghosts are frequently depicted as identifiable figures with prior social identities, emotions, and moral dispositions. The ghosts are capable of communication, negotiation, and response to human actions such as ritual offerings, taboos, and acts of hospitality. These narrative features transform the disease from an uncontrollable catastrophe into a condition that can be understood, anticipated, and partially managed. At the same time, the narratives reveal a complex way of understanding in which belief, skepticism, and denial coexist. Confucian literati neither fully accepted nor completely rejected the existence of disease-related spirits, resulting in narratives that simultaneously affirm and question their agency. In this regard, smallpox ghost narratives function not only as representations of fear but also as cultural mechanisms that organize and mediate fear.

이 글은 최근에 새롭게 번역이 이루어진 19세기 야담자료인 《용창총설(榕牕叢說)》의 유혁연 일화를 주요 텍스트로 삼아 서울굿에 나타난 천연두신 즉 별성신(別星神)과 별상신(別上神)에 관한 논의를 재고찰하는 것을 목적으로 한다. 야담자료가 새롭게 번역된 것에 힘입어 유혁연이라는 역사적 실존 인물이 어떻게 신격화되고 어떠한 과정에 의해 천연두신으로 좌정하는지 알아보고자 한다. 심원열은 무속에 굉장히 관심을 드러내며 개방된 태도를 보였다. 따라서 유혁연을 단순하게 천연두신에 상정하지는 않았을 것이다. 유혁연 일화와 관련된 천연두신 이야기는 《용창총설》에서만 발견되며 천연두신의 이야기가 확장되는 특별한 사례로 독자적인 가치가 있다. 유혁연 일화는 여러 의미를 환기한다. 역사적 인물을 천연두신으로써 형상화하면서 천연두신의 정체성을 중첩적으로 보여준다는 점에서 소중한 전거다.

The purpose of this article is to reconsider the discussion of the smallpox gods, the ByeolSung gods, and the ByeolSang gods, which appeared in Seoul Gut, using Yoo Hyuk-yeon's anecdote of "Yongchangchongseol,”a recently translated 19th-century Yadam material, as the main text. Thanks to the new translation of the Yadam material, we want to find out how a historical real person named Yoo Hyuk-yeon is deified and how he is ruled as a smallpox god. Shim Won-yeol showed great interest in shamanism and showed an open attitude. Therefore, Yoo Hyuk-yeon would not have been simply assumed to be the smallpox god. The story of smallpox related to the Yoo Hyuk-yeon anecdote is only found in Yongchang Chongseol and has its own value as a special example of expanding the story of smallpox. The Yoo Hyuk-yeon anecdote evokes many meanings. It is a valuable Sources in that it superimposes the identity of smallpox while embodying historical figures as smallpox. Shim Won-yeol showed great interest in shamanism and showed an open attitude. Therefore, it would not have simply assumed Yoo Hyuk-yeon as a small pox. The story of the small pox related to the Yoo Hyuk-yeon anecdote is found only in "Yongchang Chongseol" and is a special case in which the story of the small pox is expanded and has its own value. The Yoo Hyuk-yeon anecdote evokes many meanings. It is a valuable story in that it shows the identity of the small pox in layers while embodying historical figures as small pox. In general, smallpox was referred to in various terms such as Mama-god, Byeol-Sung-god, Hokoo-Byeol-seong-god, Byeol-Sang-god, the god of the west, and guest of Du-god. Conventional shamanic studies generally pointed out the viewpoint of recognizing Byeol-Sung-god and Byeol-Sang-god as the same god without distinguishing between Byeol-Sung-god and Byeol-Sang-god, and identified that Byeol-Sung-god and Byeol-Sang-god are strictly different gods. In other words, it is idealized that Byeol-Sung-god and Byeol-Sang-god have become distinguished and have been dualized. Although these studies have certain validity, this study attempted to re-establish a basis point and study because it secured new data that can recognize the conceptual problem of Byeol-Sung-god and Byeol-Sang-god as a unification. In particular, when looking at the anecdote that Yoo Hyuk-yeon, a general, appeared as a smallpox, that is, a Byeol-Sung-god, we could put weight on the possibility that Byeol-Sung-god was a Byeol-Sang-god. It could also be revealed that the confusion between Byeol-Sung-god and Byeol-Sang-god was not simply a problem caused by the similar names.

This paper examines how smallpox vaccination has been implemented in China from a technological perspective. It is an attempt not only to investigate the impact of technology and instruments on medical advances, but also to deepen the understanding of modern Chinese society through smallpox vaccination. Smallpox vaccination helps people develop immunity to smallpox by inoculating into them pus from cowpox which is an infectious disease that affects cows. In 1805, Alexander Pearson succeeded in smallpox vaccination using the arm-to-arm transfer method for the first time in China thanks to the arrival of the vaccine in Macao. As Pearson and Quixi, who followed in the footsteps of Pearson, used the arm-to-arm method, they did not have much interest in vaccine containers. However, the vaccine administration technique changed: the vaccine obtained from people was inoculated into cows, and then again, into people. It thus resulted in the manufacturing of various vaccine containers including glass vials and tubes. The development of tools contributed to the expansion of cowpox vaccination. In addition, cowpox vaccines were imported directly from foreign countries. Advertisements which remain to date indicate that vaccines were widely imported. Pharmacies promoted vaccines, contending that the sale and import of vaccines was for the Chinese people. On the other hand, there were voices against imported vaccines, saying that they were expensive and foreign-made. Under the banner of patriotism and nationalism, people demanded that vaccines be made in China, which led to the production of vaccines in large cities such as Shanghai and Beijing. Along with the aforementioned efforts to obtain vaccines, techniques for smallpox vaccination can also be understood in the Chinese context. For example, traditional Chinese medicine maintains that acupuncture can be used as a vaccination lancet. Since traditional Chinese medicine already embraced the use of cowpox for protection against smallpox, they advocated using acupuncture instead of western instruments in order to expand the influence of traditional Chinese medicine. The belief that inoculation should be done into acupuncture points in the upper arms shows the significant influence of traditional Chinese medicine. On the other hand, Chinese people being reluctant to leave vaccine marks show the general view of what was considered as beautiful at the time, rather than the Chinese traditional perspective. Consequently, smallpox vaccine techniques in China, while following the technological advancement in general, could not help but be adapted to the Chinese context under the influence of modern Chinese society. Thus, smallpox vaccine techniques provide clues for understanding modern Chinese society. As such, historians who conduct research mainly with literature should also take interest in medical technology and instruments as well.