A Cultural History of the Fever 發(fā)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(xiàn)象。發(fā)燒雖兇險但卻常見，雖反常但卻真實存在。

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

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

過去發(fā)燒之所以玄秘難解，很大程度上是因為那時人們不知道發(fā)燒本身是癥狀而非疾病——而另一部分原因是發(fā)燒有一些看似自相矛盾的特征：發(fā)燒之人體表摸著很熱，但卻一陣陣打寒戰(zhàn);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(xué)醫(yī)學(xué)史中心主任、兒科學(xué)和傳染病學(xué)教授霍華德·馬克爾說：“回想希波克拉底的時代，那時人們——醫(yī)生及其病人——認(rèn)為發(fā)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(fā)燒被視為一種疾病。”

一代代醫(yī)生試圖治療發(fā)燒，但都是治標(biāo)不治本，結(jié)果往往很糟。美國國家過敏和傳染病研究所高級科學(xué)顧問戴維·莫倫斯說：“特別針對發(fā)熱性疾病，有一種觀點(diǎn)認(rèn)為病因是體液失調(diào)：不良體液引發(fā)疾病或至少導(dǎo)致發(fā)燒，因此必須祛除毒素。”18世紀(jì)，為祛除體液中的毒素，醫(yī)生會給熱病患者放血，此舉有時導(dǎo)致病人死亡。

即使到了20世紀(jì)，人們開始認(rèn)識到發(fā)燒是癥狀而不是疾病，但描述疾病時還是明確與發(fā)燒相關(guān)聯(lián)，例如黃熱病、傷寒熱、猩紅熱。

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

那么，從進(jìn)化角度看，發(fā)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(jì)的災(zāi)難性麻疹疫情，想想當(dāng)時發(fā)生的一切吧。“當(dāng)?shù)厝藦奈匆娺^流行性發(fā)燒——從來沒有?！蹦獋愃拐f，“這個族群在群島上生活了1000多年。當(dāng)?shù)卮饲皬奈窗l(fā)生過流行性熱病。”但他們立時就知道了如何保護(hù)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(fā)燒，卻即刻認(rèn)識到發(fā)燒會傳染。人們成群結(jié)隊跑到高地躲藏起來，直到疫情消退。在某些情況下，發(fā)現(xiàn)有人生病時，他們會將病人關(guān)押在村子里，將其燒死?！?/p>

現(xiàn)在，醫(yī)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(rèn)為發(fā)燒是被神靈擊倒的征象，諸如此類的神學(xué)詮釋已被大多數(shù)文化所擯棄。然而，對發(fā)燒根深蒂固的恐懼依舊存在，這是對自己的身體和弱點(diǎn)有著不同理解的先人一代代流傳下來的。

莫倫斯說：“發(fā)燒非同小可，這一觀點(diǎn)已流傳幾千年。對人們來說，發(fā)燒曾是一種實實在在的疾病，而我們現(xiàn)在要把這種認(rèn)識向前推進(jìn)?！?/p>

（譯者為“《英語世界》杯”翻譯大賽獲獎?wù)撸?/p>

1 sinister險惡的，不祥的。? ?2 amulet護(hù)身符，驅(qū)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(qū)邪儀式或法術(shù)。

8 paradoxical自相矛盾的。? 9 bout發(fā)作。? 10 pediatrics兒科，兒科學(xué)。? 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(xué)的。