Leprosy Through the Ages歷史上的麻風病

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，麻風病或許在痛楚、毀形和致死方面僅次于瘟疫。患者被社會所拋棄、被迫住在麻風村并在脖子上掛鈴鐺以示患病的形象是對中世紀麻風病的老套描繪，但與整個實際情況相去甚遠。

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.

麻風病如今被稱為漢森病。它是一種慢性疾病，由細菌感染引起，會造成皮膚疼痛，如果不及時治療，最終會導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，麻風病人可能帶病生存幾年甚至幾十年。因此，在過去的社會中，這些患者一直以來數(shù)量可觀，他們可能在公元四世紀或更早就在英國出現(xiàn)了。直到近期以前，針對麻風病都沒有有效的治療手段。過去的治療方法，如藥浴、包扎以及飲食調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.

麻風病及其患者的歷史復雜且有時很模糊。《圣經》有好幾個章節(jié)都提及這種頑疾。中世紀的歐洲曾受到麻風病影響，那時建了好多麻風病醫(yī)院。到了16世紀，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，殖民者在世界其他地方遇到麻風病人，這使歐洲社會反思中世紀西方的麻風病，并發(fā)現(xiàn)對受到污名化和排擠的麻風病群體的描述與現(xiàn)實有明顯差異。最近幾十年來，這類描述一直遭到質疑。歷史學家現(xiàn)在強調這樣一個事實，即麻風病人曾被視為一個特殊的宗教群體，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)的重點關注對象。不僅如此，盡管麻風病醫(yī)院都建在城鎮(zhèn)之外，其病人與主流社會保持著聯(lián)系，得到身心上的照料。主流社會并非對他們避之唯恐不及。

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.

過去人們對麻風病的看法也令人費解，因為歷史資料對麻風病的特征描述得很模糊。1873年，麻風分枝桿菌被格哈特·亨里克·阿莫爾·漢森發(fā)現(xiàn)，之前，麻風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中，麻風被用于形容一系列不同的皮膚病。同樣，在《圣經》拉丁通行本中，麻風并非與某一種病癥有明確聯(lián)系。事實上，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.

在中世紀和近代早期，并非所有確診麻風病的人都患有漢森病。其他皮膚疾病，如牛皮癬，會被誤診為麻風病。然而，對麻風病醫(yī)院墓地的考古發(fā)掘證實了這些機構曾收容漢森病患者。這種疾病所導致的變化，如骨損傷以及手指腳趾的喪失，都能通過骨骼殘骸明顯地觀察到。最近通過對中世紀人骨上保留的DNA進行的科學分析，進一步證實了漢森病的存在，也進一步揭示了造成感染的歷史菌株和現(xiàn)代菌株之間的關系。

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，歐洲的麻風病發(fā)病率明顯減少，這時，一種極為敏銳的診斷程序得以運用。顯然，人們認為正確地識別這種疾病很重要。這確實事關重大：確診陽性會對個人的職業(yè)和法律地位產生影響，且需要入住麻風病醫(yī)院。為了做出診斷，內科和外科醫(yī)生會檢查病人的體征以及血液和尿液，并仔細查問病史。其他人們認為具備麻風病相關專業(yè)知識的人，包括麻風病醫(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.

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

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，人們將麻風病與對一般傳染病的擔憂聯(lián)系在一起。隨著14世紀中期的黑死病和15世紀90年代梅毒在歐洲的出現(xiàn)，人們對麻風病的恐慌急劇上漲。在許多中世紀晚期和近代早期的圖像中，梅毒、瘟疫和麻風病患者們的形象相差無幾。他們身上都布滿了潰瘍，說明他們都被認為是同一大類的“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.

盡管歷史上不同時期、不同地區(qū)的人們對待麻風病的態(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用，但在印度，許多病人仍等到癥狀很嚴重才會就醫(yī)，因為他們會為得此病而感到恥辱和羞愧。從歷史角度講，麻風病作為一種特殊疾病而顯得與眾不同，被認為是神的恩惠，但更普遍的看法是，麻風病是一種典型的疾病。進一步研究麻風病的歷史會幫助我們理解疾病在過去、現(xiàn)在以及未來的社會影響。

（譯者單位：浙江農林大學）