A Twist on Charles Dickens: He Was a Public Health Pioneer Too 狄更斯的另一面：公共卫生先锋

乔安妮·西尔伯纳

In London， theres a museum dedicated to Charles Dickens， housed in his old， lovingly preserved home near the Kings Cross rail station. There are over 200 museums in London. This one wasnt anywhere near the top of my list.

But in May it opened an exhibit called “Dickens， Man of Science.” The idea that Dickens was interested in science was surprising enough that I figured Id give the exhibit a chance. And I learned from the exhibit and from Dickens scholars that this bane1 of high school students was not just a Man of Science， but a committed and effective public health activist with a strong eye for general medicine as well.

On display at the museum is an original copy of a weekly journal established and edited by Dickens in 1850 called Household Words， a two-penny weekly of the time. Dickens scholar Tony Williams has gone through hundreds of issues and his list of medical and health topics it covered is， well， Dickensian in length2：

“Public health issues， sanitation， housing， slums.” And more： “Hospital development， medical schools， proposals for health insurance， the problems facing new entrants to the medical profession， education for the disabled child.”

Not done yet！ “Compulsory vaccination， water pollution and food adulteration， the need for restrictions on the sale of poisons， the care of fighting men brought back from overseas conflicts， the spread of disease and how to prevent it; what we would now call repetitive stress syndrome for workers using the newly-invented sewing machine; homeopathy， epilepsy， lead poisoning.”

And Dickens practiced epidemiology in the journals， and elsewhere. An article Dickens commissioned and edited compared mortality rates in a London slum to those in a specially designed housing project for the poor. In May of 1863 he gave a speech alerting the public to what had only been appreciated by a handful of epidemiologists at the time—that premature death was far more common in the poor than in the rich.

Williams counted 125 articles on public health， sanitation and water， another 289 on medical care， nursing， hospitals， surgery and doctors， plus several hundred more on social conditions， poverty， psychiatry and mental health.

The exhibit credits Dickens as being a thorough student of medicine. He visited waxworks and anatomy museums， and walked the streets of London looking for people with injuries and diseases. He used the knowledge he acquired to describe “conditions not yet named by doctors，” such as sleep apnea.

Dickens even left his mark on medical history. An exhibit in the museum tells the tale of “fat boy Joe，” a character in The Pickwick Papers. Joe constantly fell asleep， sometimes when walking.

“That description entered into medical textbooks，” says Adelene Buckland， one of the curators of the exhibit and a lecturer at Kings College London. William Osler， widely recognized as the founder of modern medicine， cited Joe as an example of a syndrome that occurs in some obese people： an uncontrollable tendency to sleep. The condition was initially called Pickwickian syndrome. Today its obesity hypoventilation syndrome.

Dickens had his neuroscience moments as well. A character3 in Dombey and Son is paralyzed on her right side， and just before she dies she loses her ability to speak， demonstrating what neuroscientists now know—that both a persons ability to speak， and their control of the right side of the body rely on an area in the brains left hemisphere.

Not that Dickens was always on the right track—some of his medical ideas fall more into the science fiction genre： In Bleak House， a character spontan-eously combusts. Dickens believed that electromagnetic fields could cure illnesses， and he thought cholera and typhus could spread through the air.

One panel at the exhibit begrudgingly admits to the authors fascination with mesmerism， or hypnotism. “Its one of the reasons people hadnt thought about Dickens as being interested in science，” Buckland says. “People looked at him and said he couldnt see between good and bad science.”

But that， she says， is an anachronism. At the time， mesmerism as a treatment for illness was a valid line of inquiry. “They just didnt know the answers we have now，” she says. And he shared this interest with friend and noted chemist Michael Faraday. They were experimenting—doing science.

Dickens successfully hypnotized his wife. And he tested out chloroform as an anesthetic， first on himself， and then on his wife during childbirth. He encouraged other people to use it as well， and after many of them died he still insisted the benefits outweighed the risks.

But its his influence on public health where Dickens legacy is perhaps most impressive. Dickens thought it imperative that people did things with medical knowledge， says Williams. “The message of A Christmas Carol， that Tiny Tim will die if nothing is done for him， thats very strongly Dickens argument，” he says. “Its no good just to feel sympathetic. You have to take action.”

At a time when society was indelibly divided into the rich and the terribly downtrodden—he drew attention to working people laboring in dangerous factories and living in unsanitary ghettos with few public protections in place. He created charismatic， impoverished characters like Tiny Tim to generate sympathy among Londons middle and upper class， getting readers to see poor people as human. He pushed the same idea in speeches.

In Dickens day， there were no separate wards for children in hospitals in England， and no separate specialty of pediatrics. In essays in Household Words， he argued for the establishment of a hospital dedicated to children. That hospital， now called Great Ormond Street Hospital， was subsequently opened， thanks to his efforts. He spared no words in lobbying the public for funding， describing an imaginary London where the bodies of dead children lined the streets. In an essay called “Drooping Buds，” he noted that it was not natural “to men and women that they should see the glaze of death upon so many of the bright eyes that come to laugh and love among them...”

Doctors of the day loved him， even though some of his physician characters were not particularly admirable. From the Lancet in 1865： “We are especially glad to find at our side Charles Dickens， the earnest and warmhearted opponent of social tyranny， one of the truest and most powerful friends of the oppressed， whether in middle or lower ranks of life.”

But Dickens own medical instincts failed him at the end of his life. According to his obituary in the Manchester Guardian， his sister-in-law told him he looked unwell， and pleaded with him to let her call for a doctor. “No，” he answered， “I have a toothache. I shall be better presently.” He soon fell unconscious， and died of a stroke.

Dickens lasting legacy is not just literary—he left his mark on public health and medicine， and deserves the attention of anyone interested in the history of those fields.

在倫敦，离国王十字火车站不远处坐落着一栋精心保存的老房子，那便是查尔斯·狄更斯故居博物馆。伦敦有200多家博物馆，这个还算不上我最想去的。

但2018年5月，这里举办了一场名为“狄更斯——一位科学家”的专题展。听闻狄更斯对科学感兴趣，我倍感吃惊，于是决定还是去参观一下。我从这个展览和狄更斯研究学者那里了解到，这位令高中生头疼的大作家不仅是位科学家，还是位坚定且有影响力的公共卫生活动家，在医学领域展现了自己敏锐的洞察力。

博物馆里展出了狄更斯于1850年创办并主编的周刊《家常话》原本，当时一份两便士。狄更斯研究学者托尼·威廉姆斯通读数百期《家常话》，找出刊物讨论过的医学与健康主题，列了一张单子，堪比狄更斯的著作那么长：

“公共卫生问题、卫生设施、住房、贫民窟。”还有：“医院发展、医学院、健康保险提案、医疗行业新入行者所面临的问题、残疾儿童的教育问题。”

这还没完呢！“强制性疫苗接种、水污染及食品掺假、对销售毒药的必要限制、海外战争归国军人的护理、疾病的传播及预防;缝纫机刚刚发明后，操作工人们罹患的重复性压力综合征（现在的叫法）;顺势疗法、癫痫、铅中毒。”

狄更斯还在《家常话》和其他场合展开了流行病学研究。比如，狄更斯曾约稿并编辑过一篇文章，该文对比了伦敦贫民窟和专为穷人打造的住宅区中的死亡率。1863年5月，狄更斯发表了一场演讲，提醒公众注意当时只有少数流行病学家才意识到的问题——穷人过早死亡的情况要比富人普遍得多。

根据威廉姆斯的统计，《家常话》中共有125篇关于公共卫生、卫生设施和用水的文章，289篇关于医疗、护理、医院、手术和医生的文章，还有几百篇关于社会状况、贫困、精神病学和心理健康的文章。

这个展览将狄更斯视作完完全全的学医之人。狄更斯参观蜡像馆和解剖博物馆，在伦敦的大街上寻找伤病患者。他用所学的知识来描述“医生尚未命名的病症”，比如睡眠呼吸暂停。

狄更斯甚至在医学史上留下了浓重的一笔。博物馆中的一个展览讲述了“胖男孩乔”的故事，乔出自狄更斯的小说《匹克威克外传》，他经常睡着，有时走着路都会睡着。

这次展览的策划者之一、伦敦国王学院的讲师阿德琳·巴克兰介绍道：“狄更斯对乔的描述已被收进了医学教科书。”公认的现代医学创始人威廉·奥斯勒则将乔引为病例——某些肥胖者会罹患的一种综合征：无法控制的嗜睡。这种病最初被称作匹克威克综合征，现在名为肥胖低通气综合征。

狄更斯在神经科学方面也有所建树。在其小说《董贝父子》中，有一个女性人物右侧身体瘫痪，临死前失去了说话能力。这印证了神经科学家现在所掌握的知识——一个人的说话能力及其对右侧身体的控制都依赖于大脑左半球的一个区域。

这并不是说狄更斯总是正确的——他的某些医学思想听着更像科幻小说中才有的：比如在《荒凉山庄》中，有一个人物自燃了。狄更斯相信电磁场可以治愈疾病，他还认为霍乱和斑疹伤寒可以通过空气传播。

展览中有个版块勉强承认了狄更斯对催眠疗法或催眠术的痴迷。巴克兰说：“这是人们否认狄更斯对科学感兴趣的原因之一。人们审视他，认为他分不清正统科学与伪科学。”

然而，她说，那是时代的问题。在那个时候，催眠术是一种有效的治疗疾病的方法。她说：“他们那时只是不知道我们现在所掌握的知识而已。”他和朋友、著名化学家迈克尔·法拉第对这个问题有相同的兴趣，两人一起做实验——搞科研。

狄更斯成功催眠了妻子。他将三氯甲烷作为麻醉剂，首先在自己身上做了测试，随后又在妻子分娩时在妻子身上做了测试。他鼓励其他人也使用这种麻醉剂，尽管许多人尝试之后丢了命，他仍然坚持这利大于弊。

但是，狄更斯对公共卫生领域的影响或许给世人留下了最为深刻的印象。威廉姆斯说，狄更斯认为人们必须掌握医学知识才能做事。他说：“《圣诞颂歌》传递的信息是，如果不为小蒂姆做点什么，他就会死——这正是狄更斯强有力的论点。仅仅感到同情没有用，必须采取行动。”

在社会被明明白白划分为富人和被悲惨压迫的阶层的那个时代，狄更斯唤起了人们对工人阶层的注意——注意到他们在充斥着危险的工厂里劳作，在肮脏的贫民区生活。几乎毫无适当的公共防护措施。他塑造了像小蒂姆那样魅力超凡却穷困潦倒的人物，以引起伦敦中上层阶级的同情，让读者把穷人看作人。他多次在演讲中提到同样的观点。

在狄更斯的时代，英国的医院没有独立的儿童病房，也没有独立的儿科。在《家常话》刊载的文章中，他主张建立一所专门的儿童医院。得益于他的努力，那家儿童医院（现名大奥蒙德街医院）随后建成了。他不遗余力地游说公众集资，为此描述了一个想象中的伦敦——街道两旁排列着死去儿童的尸体。在一篇名为“凋萎的蓓蕾”的文章中，他写道，“看到那么多本该充满爱意与欢笑的明亮眼睛闪烁着死亡之光，对世人来说”，这有违天道。

当时的医生都很喜欢狄更斯，尽管他在作品中塑造的一些医生角色并不那么可钦可佩。1865年，医学期刊《柳叶刀》中写道：“我们特别高兴地看到查尔斯·狄更斯与我们并肩战斗，他真切而热情地反抗社会暴政，是社会中下层受压迫民众最真诚、最强大的一位朋友。”

但是，狄更斯的医学天赋却在他生命的最后时刻辜负了他。根据《曼彻斯特卫报》上的讣告，狄更斯的弟媳曾告诉他，他的情况看上去不太妙，恳求他让她去请医生。但狄更斯却拒绝道：“不必，我只是牙痛，很快就会好。”不久他便失去了知覺，最终中风而死。

狄更斯的不朽影响不只在文学领域——他在公共卫生和医学领域也留下了功绩，值得对这些领域的历史感兴趣的人去关注。                                   □

（译者单位：北京语言大学）

1 bane祸害，克星。狄更斯的作品常常出现在高中生必读书目中，由于篇幅长，往往让高中生头疼。

2 Dickensian in length狄更斯式长度，意指很长。狄更斯一生共创作了14部长篇小说，如《艰难时世》《双城记》等，作者用这一表达来说明文中所提及的列表之长。

3即《董贝父子》中的斯克顿太太（Mrs. Skewton）。