Leprosy Through the Ages历史上的麻风病

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.

在历史上人类所遭遇的病痛中，麻风病或许在痛楚、毁形和致死方面仅次于瘟疫。患者被社会所抛弃、被迫住在麻风村并在脖子上挂铃铛以示患病的形象是对中世纪麻风病的老套描绘，但与整个实际情况相去甚远。

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.

麻风病如今被称为汉森病。它是一种慢性疾病，由细菌感染引起，会造成皮肤疼痛，如果不及时治疗，最终会导致面部和手足骨骼损坏，呼吸困难以及失明。与瘟疫患者不同，麻风病人可能带病生存几年甚至几十年。因此，在过去的社会中，这些患者一直以来数量可观，他们可能在公元四世纪或更早就在英国出现了。直到近期以前，针对麻风病都没有有效的治疗手段。过去的治疗方法，如药浴、包扎以及饮食调理等都旨在缓解而非根治。

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.

麻风病及其患者的历史复杂且有时很模糊。《圣经》有好几个章节都提及这种顽疾。中世纪的欧洲曾受到麻风病影响，那时建了好多麻风病医院。到了16世纪，病情在欧洲大部分地区得以缓解；但在非洲、亚洲以及南美洲依然不断暴发。

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世纪，殖民者在世界其他地方遇到麻风病人，这使欧洲社会反思中世纪西方的麻风病，并发现对受到污名化和排挤的麻风病群体的描述与现实有明显差异。最近几十年来，这类描述一直遭到质疑。历史学家现在强调这样一个事实，即麻风病人曾被视为一个特殊的宗教群体，受上帝甄选，到人间遭受苦难并获得解救，而且他们是基督教慈善事业的重点关注对象。不仅如此，尽管麻风病医院都建在城镇之外，其病人与主流社会保持着联系，得到身心上的照料。主流社会并非对他们避之唯恐不及。

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.

过去人们对麻风病的看法也令人费解，因为历史资料对麻风病的特征描述得很模糊。1873年，麻风分枝杆菌被格哈特·亨里克·阿莫尔·汉森发现，之前，麻风病一词并不单指一种疾病。确切地讲，在古希腊希波克拉底所著的文献中，麻风被用于形容一系列不同的皮肤病。同样，在《圣经》拉丁通行本中，麻风并非与某一种病症有明确联系。事实上，在古代，与汉森病症状最接近的疾病被称为象皮病。

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.

在中世纪和近代早期，并非所有确诊麻风病的人都患有汉森病。其他皮肤疾病，如牛皮癣，会被误诊为麻风病。然而，对麻风病医院墓地的考古发掘证实了这些机构曾收容汉森病患者。这种疾病所导致的变化，如骨损伤以及手指脚趾的丧失，都能通过骨骼残骸明显地观察到。最近通过对中世纪人骨上保留的DNA进行的科学分析，进一步证实了汉森病的存在，也进一步揭示了造成感染的历史菌株和现代菌株之间的关系。

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世纪，欧洲的麻风病发病率明显减少，这时，一种极为敏锐的诊断程序得以运用。显然，人们认为正确地识别这种疾病很重要。这确实事关重大：确诊阳性会对个人的职业和法律地位产生影响，且需要入住麻风病医院。为了做出诊断，内科和外科医生会检查病人的体征以及血液和尿液，并仔细查问病史。其他人们认为具备麻风病相关专业知识的人，包括麻风病医院的病人，也参与诊断检查。

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.

在历史上的任何时期，麻风病只影响了很小一部分人。其传染性并不高，这是中世纪和近代早期被许多人公认的事实。在一本16世纪的外科实践笔记中，一幅木刻画描绘了检查麻风病的画面：一位外科医生在无任何防护措施的情况下，触碰疑似患者，将手放在患者头上。然而，麻风病引发了与实际造成的威胁不符的恐慌和焦虑。这些反应有许多源于麻风病晚期患者的身体损伤和严重畸形。

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，人们将麻风病与对一般传染病的担忧联系在一起。随着14世纪中期的黑死病和15世纪90年代梅毒在欧洲的出现，人们对麻风病的恐慌急剧上涨。在许多中世纪晚期和近代早期的图像中，梅毒、瘟疫和麻风病患者们的形象相差无几。他们身上都布满了溃疡，说明他们都被认为是同一大类的“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.

尽管历史上不同时期、不同地区的人们对待麻风病的态度各不相同，但都带有同情和歧视的特征。今天，有效的抗生素治疗广泛应用，但在印度，许多病人仍等到症状很严重才会就医，因为他们会为得此病而感到耻辱和羞愧。从历史角度讲，麻风病作为一种特殊疾病而显得与众不同，被认为是神的恩惠，但更普遍的看法是，麻风病是一种典型的疾病。进一步研究麻风病的历史会帮助我们理解疾病在过去、现在以及未来的社会影响。

（译者单位：浙江农林大学）