A Cultural History of the Fever 發燒文化史

阿德里安娜·拉弗朗斯

For most of human history， an unusually high body temperature was a sign of the supernatural. Fevers were sinister1 but common， unnatural but real.

Ancient Romans had at least three temples dedicated to worshipping a god of fever. According to a 1918 issue of The Classical Weekly， Romans would leave amulets2 in these structures of febris3， hoping to placate the deities who made them sick.

In the Middle Ages， fever treatments included incantations4， elixirs5， charms6， and exorcisms7. Avicenna， the influential Persian scholar， described the condition as “extraneous heat， kindled in the heart， from which it is diffused to the whole body through the arteries and veins.” In the centuries that followed， fevers retained an air of mysticism.

Fevers were mysterious largely because people didnt understand they were a symptom rather than a disease in their own right—but also because of their seemingly paradoxical8 qualities. A person who is febrile feels hot to the touch， but experiences bouts9 of shivering cold. Someone with a very high temperature can get well without intervention， whereas the condition of a person with milder fever can seem to suddenly deteriorate.

“Going back to Hippocrates， people—doctors and their patients—had the conception that fever was the disease itself rather than， say， caused by salmonella， or influenza， or some microbial organism，” said Howard Markel， the director of the Center for the History of Medicine and a professor of pediatrics10 and communicable diseases at the University of Michigan. “Nobody knew about microbes， so fever was considered a disease.”

Generations of doctors tried to treat fevers themselves， not their underlying causes， often with gruesome outcomes. “Particularly with febrile diseases， one of the ideas was that you had unbalanced humors11，” said David Morens， a senior scientific advisor at the National Institute of Allergy and Infectious Diseases. “The idea was that bad humors were causing the disease， or at least the fever， and you had to get rid of the poison.” In the 1700s， patients with febrile diseases were bled， sometimes to death， in an attempt to get rid of toxicity.

Even into the 20th century， as people began to understand that fever was the symptom and not the disease， fever was explicitly connected to how illnesses were described： yellow fever， typhoid12 fever， scarlet fever.

Today， doctors dont treat fevers as much as they attempt to treat a fevers underlying cause， but philosophies on fevers are evolving. As recently as the 1970s， doctors still wondered if inciting fever might help kill off an actual infection. Theres little scientific evidence that a fever can stop a virus， but that idea has persisted， highlighting the sometimes bizarre manifestations of fevers cultural standing.

What， then， is the evolutionary purpose of a fever？

It may simply be a way for humans to know that theyre sick—which is useful not just for the person suffering， but for the community around that person. Consider， for example， what happened during the catastrophic measles epidemic in Fiji in 1875. “These people had never seen an epidemic fever—not ever，” Morens said. “This is a group of people who lived for over 1，000 years on a group of islands. There had never been an epidemic febrile disease there.” And yet they knew how to protect themselves right away.

“First of all， they were terrified—all of the sudden their bodies were turning hot and cold，” Morens said. “They didnt know what it was or why. They thought theyd been bewitched13 by spirits... But they immediately understood the concept of contagion and they started isolating themselves. Theyd never seen a fever before but they immediately recognized it was contagious. Groups of people ran to the highlands and hid until the epidemic went away. In some cases， where people were sick， they locked them up in a village and burned them down and killed them.”

Doctors now know that， with the exception of ultra-high fevers of 10514 or more， a higher temperature does not necessarily mean a person is sicker. Most cultures have abandoned theologic15 interpretations—like the idea that a fever was a sign of the gods striking you down， as ancient Egyptians believed. But a deep-rooted fear of fevers remains， passed down from generations of people who lived with a different understanding of their bodies and their vulnerabilities.

“The idea that fever was a big deal has been around for thousands of years，” Morens said. “Fever was a real disease to people， and we carry that legacy forward.”

在人類歷史的大部分時間里，體溫異常高都被視為一種超自然現象。發燒雖兇險但卻常見，雖反常但卻真實存在。

古羅馬人至少設有三座神殿專門供奉發燒神。據1918年某期《古典周刊》的文章，羅馬人會把護身符放置在這些發燒神殿內，希望能讓致病的神靈息怒。

中世紀，治療發燒的手段包括咒語、丹藥、符咒和驅邪術。頗具影響力的波斯學者阿維森納將發燒描述為“外熱在心臟內受激發后，通過動脈和靜脈蔓延至全身”。嗣后的幾個世紀，發燒一直給人一種神秘莫測的感覺。

過去發燒之所以玄秘難解，很大程度上是因為那時人們不知道發燒本身是癥狀而非疾病——而另一部分原因是發燒有一些看似自相矛盾的特征：發燒之人體表摸著很熱，但卻一陣陣打寒戰;高燒者可能不治而愈，低燒者病情卻似乎會突然惡化。

密歇根大學醫學史中心主任、兒科學和傳染病學教授霍華德·馬克爾說：“回想希波克拉底的時代，那時人們——醫生及其病人——認為發燒本身是疾病，而不知道是由沙門氏菌、流感或某種微生物引起的。無人知曉微生物，因此發燒被視為一種疾病。”

一代代醫生試圖治療發燒，但都是治標不治本，結果往往很糟。美國國家過敏和傳染病研究所高級科學顧問戴維·莫倫斯說：“特別針對發熱性疾病，有一種觀點認為病因是體液失調：不良體液引發疾病或至少導致發燒，因此必須祛除毒素。”18世紀，為祛除體液中的毒素，醫生會給熱病患者放血，此舉有時導致病人死亡。

即使到了20世紀，人們開始認識到發燒是癥狀而不是疾病，但描述疾病時還是明確與發燒相關聯，例如黃熱病、傷寒熱、猩紅熱。

如今，醫生對發燒治本重于治標，而關于發燒的觀念也在不斷嬗變。直到20世紀70年代，醫生們還在琢磨讓病人發燒是否可能有助于消除真正的感染。幾乎沒有科學證據證明發燒可遏制病毒，但這種觀點一直延續至今，凸顯出發燒有時在文化地位上的怪異表現。

那么，從進化角度看，發燒的目的是什么呢？

這或許只是一種讓人類知曉自己生病的方法——不僅對病人有用，對他所在的社群也有用。例如1875年斐濟的災難性麻疹疫情，想想當時發生的一切吧。“當地人從未見過流行性發燒——從來沒有。”莫倫斯說，“這個族群在群島上生活了1000多年。當地此前從未發生過流行性熱病。”但他們立時就知道了如何保護自己。

莫倫斯說：“他們起初極度驚恐——身體突然忽冷忽熱。他們不知道是怎么一回事，也不清楚為什么會這樣，還以為自己中邪著魔了……但他們旋即意會到‘傳染這一概念，開始自我隔離。他們以前從未見過發燒，卻即刻認識到發燒會傳染。人們成群結隊跑到高地躲藏起來，直到疫情消退。在某些情況下，發現有人生病時，他們會將病人關押在村子里，將其燒死。”

現在，醫生們知道，除105華氏度或以上的超高燒以外，體溫更高未必意味著病情更重。古埃及人認為發燒是被神靈擊倒的征象，諸如此類的神學詮釋已被大多數文化所擯棄。然而，對發燒根深蒂固的恐懼依舊存在，這是對自己的身體和弱點有著不同理解的先人一代代流傳下來的。

莫倫斯說：“發燒非同小可，這一觀點已流傳幾千年。對人們來說，發燒曾是一種實實在在的疾病，而我們現在要把這種認識向前推進。”

（譯者為“《英語世界》杯”翻譯大賽獲獎者）

1 sinister險惡的，不祥的。? ?2 amulet護身符，驅邪物。? 3 febri熱，燒。? 4 incantation咒語。? 5 elixir靈丹妙藥。? 6 charm咒文，符咒。? 7 exorcism驅邪儀式或法術。

8 paradoxical自相矛盾的。? 9 bout發作。? 10 pediatrics兒科，兒科學。? 11 humor體液。

12 typhoid傷寒的。

13 bewitch使著魔，蠱惑。? 14約等于40.5攝氏度。? 15 theologic神學的。