Leprosy Through the Ages歷史上的麻風(fēng)病

Among the diseases and afflictions encountered throughout history， leprosy is perhaps second only to plague in its association with suffering， disfigurement and death. Images of sufferers cast out from society， forced to live in leprosy colonies and advertise their condition with a bell， have become clichéd portrayals of medieval leprosy—but they are far from the whole accurate picture.

在歷史上人類所遭遇的病痛中，麻風(fēng)病或許在痛楚、毀形和致死方面僅次于瘟疫。患者被社會(huì)所拋棄、被迫住在麻風(fēng)村并在脖子上掛鈴鐺以示患病的形象是對(duì)中世紀(jì)麻風(fēng)病的老套描繪，但與整個(gè)實(shí)際情況相去甚遠(yuǎn)。

The chronic illness known today as Hansen’s disease is a bacterial infection that causes skin sores and ultimately， if untreated， damage to the bones of the face， hands and feet， as well as breathing difficulties and blindness. Unlike plague victims， sufferers can live with their symptoms for several years or even decades， so leprosy patients have constituted a recognizable component in past societies， probably present in Britain from the fourth century AD or earlier. Until very recently， there has been no effective treatment for leprosy; past therapies have been palliative rather than curative， including medical baths， bandaging and dietary regulation.

麻風(fēng)病如今被稱為漢森病。它是一種慢性疾病，由細(xì)菌感染引起，會(huì)造成皮膚疼痛，如果不及時(shí)治療，最終會(huì)導(dǎo)致面部和手足骨骼損壞，呼吸困難以及失明。與瘟疫患者不同，麻風(fēng)病人可能帶病生存幾年甚至幾十年。因此，在過(guò)去的社會(huì)中，這些患者一直以來(lái)數(shù)量可觀，他們可能在公元四世紀(jì)或更早就在英國(guó)出現(xiàn)了。直到近期以前，針對(duì)麻風(fēng)病都沒有有效的治療手段。過(guò)去的治療方法，如藥浴、包扎以及飲食調(diào)理等都旨在緩解而非根治。

The history of leprosy and its sufferers is complex and sometimes ambiguous. The disease is mentioned in several passages of the Bible. It affected people in Europe in the Middle Ages， when numerous leprosy hospitals were founded， but declined across most of the continent from the 16th century， though it continues to occur in Africa， Asia and South America.

麻風(fēng)病及其患者的歷史復(fù)雜且有時(shí)很模糊。《圣經(jīng)》有好幾個(gè)章節(jié)都提及這種頑疾。中世紀(jì)的歐洲曾受到麻風(fēng)病影響，那時(shí)建了好多麻風(fēng)病醫(yī)院。到了16世紀(jì)，病情在歐洲大部分地區(qū)得以緩解；但在非洲、亞洲以及南美洲依然不斷暴發(fā)。

Colonial encounters with sufferers in other parts of the world in the 19th century caused Europeans to reflect upon the presence of leprosy in the medieval west， and to contrast a narrative of a stigmatised， excluded group. This narrative has been questioned in recent decades; historians now emphasize the fact that leprosy patients were viewed as a special religious group， selected by God to suffer on earth and attain salvation， and were a major focus of Christian charity. Furthermore， although leprosy hospitals were located outside towns and cities， their residents remained connected with mainstream society， and received spiritual as well as bodily care—they were not shunned.

19世紀(jì)，殖民者在世界其他地方遇到麻風(fēng)病人，這使歐洲社會(huì)反思中世紀(jì)西方的麻風(fēng)病，并發(fā)現(xiàn)對(duì)受到污名化和排擠的麻風(fēng)病群體的描述與現(xiàn)實(shí)有明顯差異。最近幾十年來(lái)，這類描述一直遭到質(zhì)疑。歷史學(xué)家現(xiàn)在強(qiáng)調(diào)這樣一個(gè)事實(shí)，即麻風(fēng)病人曾被視為一個(gè)特殊的宗教群體，受上帝甄選，到人間遭受苦難并獲得解救，而且他們是基督教慈善事業(yè)的重點(diǎn)關(guān)注對(duì)象。不僅如此，盡管麻風(fēng)病醫(yī)院都建在城鎮(zhèn)之外，其病人與主流社會(huì)保持著聯(lián)系，得到身心上的照料。主流社會(huì)并非對(duì)他們避之唯恐不及。

Our understanding of past views of leprosy is also complicated by ambiguity in the disease’s identity in historical sources. From antiquity until 1873， when the bacterium Mycobacterium leprae was identified by Gerhard Henrik Armauer Hansen， the word leprosy did not necessarily signify one single disease. Indeed， in the ancient Greek texts attributed to Hippocrates， lepra described a range of different skin disorders. Similarly， in the Latin Vulgate Bible lepra was not clearly associated with a single medical condition. In fact， in the ancient world the disorder that most closely manifested the symptoms of Hansen’s disease was called elephantiasis.

過(guò)去人們對(duì)麻風(fēng)病的看法也令人費(fèi)解，因?yàn)闅v史資料對(duì)麻風(fēng)病的特征描述得很模糊。1873年，麻風(fēng)分枝桿菌被格哈特·亨里克·阿莫爾·漢森發(fā)現(xiàn)，之前，麻風(fēng)病一詞并不單指一種疾病。確切地講，在古希臘希波克拉底所著的文獻(xiàn)中，麻風(fēng)被用于形容一系列不同的皮膚病。同樣，在《圣經(jīng)》拉丁通行本中，麻風(fēng)并非與某一種病癥有明確聯(lián)系。事實(shí)上，在古代，與漢森病癥狀最接近的疾病被稱為象皮病。

In the medieval and early modern periods， not all people who were diagnosed with leprosy suffered from Hansen’s disease—other skin complaints， such as psoriasis， could be mistaken for the disease. Nonetheless， archaeological excavations of cemeteries associated with leprosy hospitals have confirmed that these institutions accommodated Hansen’s disease sufferers： changes caused by the disease， ranging from bone lesions to the loss of fingers and toes， are clearly visible in skeletal remains. Recent scientific analysis of the DNA preserved in medieval bones has shed further light on the presence of Hansen’s disease， and on the relationship between historical and modern strains of the infection.

在中世紀(jì)和近代早期，并非所有確診麻風(fēng)病的人都患有漢森病。其他皮膚疾病，如牛皮癬，會(huì)被誤診為麻風(fēng)病。然而，對(duì)麻風(fēng)病醫(yī)院墓地的考古發(fā)掘證實(shí)了這些機(jī)構(gòu)曾收容漢森病患者。這種疾病所導(dǎo)致的變化，如骨損傷以及手指腳趾的喪失，都能通過(guò)骨骼殘骸明顯地觀察到。最近通過(guò)對(duì)中世紀(jì)人骨上保留的DNA進(jìn)行的科學(xué)分析，進(jìn)一步證實(shí)了漢森病的存在，也進(jìn)一步揭示了造成感染的歷史菌株和現(xiàn)代菌株之間的關(guān)系。

By the 16th century， when markedly fewer incidences of leprosy were occurring in Europe， a finely tuned diagnostic procedure was in place; evidently， correct identification of the disease was considered important. Indeed， much was at stake： a positive diagnosis would affect an individual’s professional and legal status， and would necessitate entry to a leprosy hospital. To make the diagnosis， physicians and surgeons examined the exterior of the patient’s body and his or her blood and urine， and took a detailed case history. Other people who were considered to have expertise relating to leprosy， including the sick residents of leprosy hospitals， were also involved in diagnostic examinations.

到了16世紀(jì)，歐洲的麻風(fēng)病發(fā)病率明顯減少，這時(shí)，一種極為敏銳的診斷程序得以運(yùn)用。顯然，人們認(rèn)為正確地識(shí)別這種疾病很重要。這確實(shí)事關(guān)重大：確診陽(yáng)性會(huì)對(duì)個(gè)人的職業(yè)和法律地位產(chǎn)生影響，且需要入住麻風(fēng)病醫(yī)院。為了做出診斷，內(nèi)科和外科醫(yī)生會(huì)檢查病人的體征以及血液和尿液，并仔細(xì)查問(wèn)病史。其他人們認(rèn)為具備麻風(fēng)病相關(guān)專業(yè)知識(shí)的人，包括麻風(fēng)病醫(yī)院的病人，也參與診斷檢查。

At any point in time leprosy affected only a very small proportion of the population. It is not highly contagious， a fact recognized by many medieval and early modern people. A woodcut of a leprosy examination in a 16th-century surgical fieldbook shows a surgeon freely touching a suspected sufferer， placing his hands on the examinee’s head. Yet the disease provoked fear and anxiety disproportionate to the threat that it actually posed. Many of these responses stemmed from the physical impairment and shocking disfigurement seen in advanced cases of leprosy.

在歷史上的任何時(shí)期，麻風(fēng)病只影響了很小一部分人。其傳染性并不高，這是中世紀(jì)和近代早期被許多人公認(rèn)的事實(shí)。在一本16世紀(jì)的外科實(shí)踐筆記中，一幅木刻畫描繪了檢查麻風(fēng)病的畫面：一位外科醫(yī)生在無(wú)任何防護(hù)措施的情況下，觸碰疑似患者，將手放在患者頭上。然而，麻風(fēng)病引發(fā)了與實(shí)際造成的威脅不符的恐慌和焦慮。這些反應(yīng)有許多源于麻風(fēng)病晚期患者的身體損傷和嚴(yán)重畸形。

In addition， leprosy became bound up with concerns about contagious illness in general—fears that increased dramatically following the Black Death of the mid-14th century and the arrival in Europe in the 1490s of the pox （syphilis）. In many late medieval and early modern images， pox， plague and leprosy sufferers are depicted in much the same way， with their bodies covered in ulcers， suggesting that they were considered together as one large category of ‘the sick’.

此外，人們將麻風(fēng)病與對(duì)一般傳染病的擔(dān)憂聯(lián)系在一起。隨著14世紀(jì)中期的黑死病和15世紀(jì)90年代梅毒在歐洲的出現(xiàn)，人們對(duì)麻風(fēng)病的恐慌急劇上漲。在許多中世紀(jì)晚期和近代早期的圖像中，梅毒、瘟疫和麻風(fēng)病患者們的形象相差無(wú)幾。他們身上都布滿了潰瘍，說(shuō)明他們都被認(rèn)為是同一大類的“病人”。

Though attitudes to leprosy have varied through history and across locations， responses to leprosy have been characterized by both compassion and stigma. Today， effective treatment with antibiotics is widely available， but in India many sufferers still do not seek treatment until their symptoms are advanced， because of the associated stigma and shame. Historically， leprosy has stood out as a special illness， associated with divine grace， but has also become representative of sickness more broadly. Further historical study of the disease will help us understand the social impact of diseases in the past， present and future.

盡管歷史上不同時(shí)期、不同地區(qū)的人們對(duì)待麻風(fēng)病的態(tài)度各不相同，但都帶有同情和歧視的特征。今天，有效的抗生素治療廣泛應(yīng)用，但在印度，許多病人仍等到癥狀很嚴(yán)重才會(huì)就醫(yī)，因?yàn)樗麄儠?huì)為得此病而感到恥辱和羞愧。從歷史角度講，麻風(fēng)病作為一種特殊疾病而顯得與眾不同，被認(rèn)為是神的恩惠，但更普遍的看法是，麻風(fēng)病是一種典型的疾病。進(jìn)一步研究麻風(fēng)病的歷史會(huì)幫助我們理解疾病在過(guò)去、現(xiàn)在以及未來(lái)的社會(huì)影響。

（譯者單位：浙江農(nóng)林大學(xué)）