A Twist on Charles Dickens: He Was a Public Health Pioneer Too 狄更斯的另一面：公共衛(wèi)生先鋒

喬安妮·西爾伯納

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，離國王十字火車站不遠處坐落著一棟精心保存的老房子，那便是查爾斯·狄更斯故居博物館。倫敦有200多家博物館，這個還算不上我最想去的。

但2018年5月，這里舉辦了一場名為“狄更斯——一位科學家”的專題展。聽聞狄更斯對科學感興趣，我倍感吃驚，于是決定還是去參觀一下。我從這個展覽和狄更斯研究學者那里了解到，這位令高中生頭疼的大作家不僅是位科學家，還是位堅定且有影響力的公共衛(wèi)生活動家，在醫(yī)學領域展現(xiàn)了自己敏銳的洞察力。

博物館里展出了狄更斯于1850年創(chuàng)辦并主編的周刊《家常話》原本，當時一份兩便士。狄更斯研究學者托尼·威廉姆斯通讀數百期《家常話》，找出刊物討論過的醫(yī)學與健康主題，列了一張單子，堪比狄更斯的著作那么長：

“公共衛(wèi)生問題、衛(wèi)生設施、住房、貧民窟。”還有：“醫(yī)院發(fā)展、醫(yī)學院、健康保險提案、醫(yī)療行業(yè)新入行者所面臨的問題、殘疾兒童的教育問題?！?/p>

這還沒完呢！“強制性疫苗接種、水污染及食品摻假、對銷售毒藥的必要限制、海外戰(zhàn)爭歸國軍人的護理、疾病的傳播及預防;縫紉機剛剛發(fā)明后，操作工人們罹患的重復性壓力綜合征（現(xiàn)在的叫法）;順勢療法、癲癇、鉛中毒?！?/p>

狄更斯還在《家常話》和其他場合展開了流行病學研究。比如，狄更斯曾約稿并編輯過一篇文章，該文對比了倫敦貧民窟和專為窮人打造的住宅區(qū)中的死亡率。1863年5月，狄更斯發(fā)表了一場演講，提醒公眾注意當時只有少數流行病學家才意識到的問題——窮人過早死亡的情況要比富人普遍得多。

根據威廉姆斯的統(tǒng)計，《家常話》中共有125篇關于公共衛(wèi)生、衛(wèi)生設施和用水的文章，289篇關于醫(yī)療、護理、醫(yī)院、手術和醫(yī)生的文章，還有幾百篇關于社會狀況、貧困、精神病學和心理健康的文章。

這個展覽將狄更斯視作完完全全的學醫(yī)之人。狄更斯參觀蠟像館和解剖博物館，在倫敦的大街上尋找傷病患者。他用所學的知識來描述“醫(yī)生尚未命名的病癥”，比如睡眠呼吸暫停。

狄更斯甚至在醫(yī)學史上留下了濃重的一筆。博物館中的一個展覽講述了“胖男孩喬”的故事，喬出自狄更斯的小說《匹克威克外傳》，他經常睡著，有時走著路都會睡著。

這次展覽的策劃者之一、倫敦國王學院的講師阿德琳·巴克蘭介紹道：“狄更斯對喬的描述已被收進了醫(yī)學教科書?！惫J的現(xiàn)代醫(yī)學創(chuàng)始人威廉·奧斯勒則將喬引為病例——某些肥胖者會罹患的一種綜合征：無法控制的嗜睡。這種病最初被稱作匹克威克綜合征，現(xiàn)在名為肥胖低通氣綜合征。

狄更斯在神經科學方面也有所建樹。在其小說《董貝父子》中，有一個女性人物右側身體癱瘓，臨死前失去了說話能力。這印證了神經科學家現(xiàn)在所掌握的知識——一個人的說話能力及其對右側身體的控制都依賴于大腦左半球的一個區(qū)域。

這并不是說狄更斯總是正確的——他的某些醫(yī)學思想聽著更像科幻小說中才有的：比如在《荒涼山莊》中，有一個人物自燃了。狄更斯相信電磁場可以治愈疾病，他還認為霍亂和斑疹傷寒可以通過空氣傳播。

展覽中有個版塊勉強承認了狄更斯對催眠療法或催眠術的癡迷。巴克蘭說：“這是人們否認狄更斯對科學感興趣的原因之一。人們審視他，認為他分不清正統(tǒng)科學與偽科學?！?/p>

然而，她說，那是時代的問題。在那個時候，催眠術是一種有效的治療疾病的方法。她說：“他們那時只是不知道我們現(xiàn)在所掌握的知識而已。”他和朋友、著名化學家邁克爾·法拉第對這個問題有相同的興趣，兩人一起做實驗——搞科研。

狄更斯成功催眠了妻子。他將三氯甲烷作為麻醉劑，首先在自己身上做了測試，隨后又在妻子分娩時在妻子身上做了測試。他鼓勵其他人也使用這種麻醉劑，盡管許多人嘗試之后丟了命，他仍然堅持這利大于弊。

但是，狄更斯對公共衛(wèi)生領域的影響或許給世人留下了最為深刻的印象。威廉姆斯說，狄更斯認為人們必須掌握醫(yī)學知識才能做事。他說：“《圣誕頌歌》傳遞的信息是，如果不為小蒂姆做點什么，他就會死——這正是狄更斯強有力的論點。僅僅感到同情沒有用，必須采取行動?！?/p>

在社會被明明白白劃分為富人和被悲慘壓迫的階層的那個時代，狄更斯喚起了人們對工人階層的注意——注意到他們在充斥著危險的工廠里勞作，在骯臟的貧民區(qū)生活。幾乎毫無適當的公共防護措施。他塑造了像小蒂姆那樣魅力超凡卻窮困潦倒的人物，以引起倫敦中上層階級的同情，讓讀者把窮人看作人。他多次在演講中提到同樣的觀點。

在狄更斯的時代，英國的醫(yī)院沒有獨立的兒童病房，也沒有獨立的兒科。在《家常話》刊載的文章中，他主張建立一所專門的兒童醫(yī)院。得益于他的努力，那家兒童醫(yī)院（現(xiàn)名大奧蒙德街醫(yī)院）隨后建成了。他不遺余力地游說公眾集資，為此描述了一個想象中的倫敦——街道兩旁排列著死去兒童的尸體。在一篇名為“凋萎的蓓蕾”的文章中，他寫道，“看到那么多本該充滿愛意與歡笑的明亮眼睛閃爍著死亡之光，對世人來說”，這有違天道。

當時的醫(yī)生都很喜歡狄更斯，盡管他在作品中塑造的一些醫(yī)生角色并不那么可欽可佩。1865年，醫(yī)學期刊《柳葉刀》中寫道：“我們特別高興地看到查爾斯·狄更斯與我們并肩戰(zhàn)斗，他真切而熱情地反抗社會暴政，是社會中下層受壓迫民眾最真誠、最強大的一位朋友?！?/p>

但是，狄更斯的醫(yī)學天賦卻在他生命的最后時刻辜負了他。根據《曼徹斯特衛(wèi)報》上的訃告，狄更斯的弟媳曾告訴他，他的情況看上去不太妙，懇求他讓她去請醫(yī)生。但狄更斯卻拒絕道：“不必，我只是牙痛，很快就會好?！辈痪盟闶チ酥X，最終中風而死。

狄更斯的不朽影響不只在文學領域——他在公共衛(wèi)生和醫(yī)學領域也留下了功績，值得對這些領域的歷史感興趣的人去關注。? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?□

（譯者單位：北京語言大學）

1 bane禍害，克星。狄更斯的作品常常出現(xiàn)在高中生必讀書目中，由于篇幅長，往往讓高中生頭疼。

2 Dickensian in length狄更斯式長度，意指很長。狄更斯一生共創(chuàng)作了14部長篇小說，如《艱難時世》《雙城記》等，作者用這一表達來說明文中所提及的列表之長。

3即《董貝父子》中的斯克頓太太（Mrs. Skewton）。