开始翻译丛书文章Best American Science Writing和
Best American Science and Nature Writing，希望坚持下去。
关于这两部丛书的介绍引用bambooman's blog上的介绍：
这些文章都是从上百篇纽约客、纽约时报、华尔街日报、科学、Wired等等报刊中选出来的精品，面向喜好科学前沿进
展的读者，写手如果不是活跃在第一线的科学家本人（前几年有诺奖得主的短文），就是这些大报专事科学报道的记者，这些记者也是老手，自己一般都已经有书面
世。这些文章涉及的领域很广泛，有基础的数学、物理、生物学、心理学、天文、医学，也有IT的。但更多的是这些领域之间的杂交产品，而且议题一般很具争议
性，对研究结果在文化和政治上的影响从不回避。
今年还加了一套Best
American Technology Writing，读下来的感觉要比这两套丛书相对要弱一点。文学类的有Best American
Essay和Best American Short Stories。这些文章，相对来说要自恋的多，不过也很可读。
第一篇刚刚完成，还没有检查和校对，先贴上来。
原文：
The Itch
: From The New Yorker
, by Atul Gawande
The Itch
（痒）
Its mysterious power
may be a clue to a new theory about brains and bodies.
（它神秘的力量可能是一个新的有关大脑和身体的理论的线索。）
by Atul
Gawande
June 30, 2008
Text Size:
Scientists once saw itching as a
form of pain. They now believe it to be a different order of sensation.
Photograph by Gerald Slota.(
科学家曾经看见痒成为一种疼痛，他们现在认为那是感觉的一种不同的顺序。
Gerald Slota
拍摄
)
Keywords
Itching
;
Oaklander,
Anne Louise (Dr.)
;
Brain
;
Obsessive-Compulsive
Disorders (O.C.D.)
;
It was still shocking to M. how
much a few wrong turns could change your life. She had graduated from Boston College
with a degree in psychology, married at twenty-five, and had two children, a
son and a daughter. She and her family settled in a town on Massachusetts’ southern shore. She worked
for thirteen years in health care, becoming the director of a residence program
for men who’d suffered severe head injuries. But she and her husband began
fighting. There were betrayals. By the time she was thirty-two, her marriage
had disintegrated. In the divorce, she lost possession of their home, and, amid
her financial and psychological struggles, she saw that she was losing her
children, too. Within a few years, she was drinking. She began dating someone,
and they drank together. After a while, he brought some drugs home, and she
tried them. The drugs got harder. Eventually, they were doing heroin, which
turned out to be readily available from a street dealer a block away from her
apartment.
(
对于一些错误的转折会改变人生的程度，
M
依然感到十分震惊。她从波士顿大学毕业，获得了心理学的学位，
25
岁结婚，有两个小孩，一个儿子和一个女儿。她和她的家庭安顿在马萨诸塞州南海岸的一个小镇上。她从事卫生保健的工作
13
年了，已经成为一个居民项目的领导者，这个居民项目是为了一些受到严重头痛困扰的人而建的。但是她和她的丈夫开始不合，他们的婚姻中存在背叛，她
32
岁时婚姻破裂了。在这次离婚过程中她面临着经济和心理的挣扎，先后失去了房子所有权和小孩抚养权。在接下来的几年，她开始喝酒，她开始和某人约会，然后他们一起喝酒。不久后，他带回家一些毒品，她尝试了，接着毒品开始越来越烈性，最后，他们吸起了海洛因，可以从离他们只有一个街区之遥的人那儿买到。
)
One day, she went to see a doctor
because she wasn’t feeling well, and learned that she had contracted H.I.V.
from a contaminated needle. She had to leave her job. She lost visiting rights
with her children. And she developed complications from the H.I.V., including
shingles, which caused painful, blistering sores across her scalp and forehead.
With treatment, though, her H.I.V. was brought under control. At thirty-six,
she entered rehab, dropped the boyfriend, and kicked the drugs. She had two
good, quiet years in which she began rebuilding her life. Then she got the
itch.
(
一天，她感到不太舒服于是去看医生，得知她已经从一个受染的针头那儿感染了
HIV
。她不得不停止工作。她失去了去看她孩子的权利。由
HIV
引起的情况越来越严重，包括带状疱疹，它会引起横跨头皮和前额的剧烈的疼痛。不过在治疗之下，她的
HIV
已经稳定。
36
岁时她进了戒毒所，甩了男朋友，戒了毒。在接下来的比较平静的两年中她开始重新生活。然后她开始痒。
)
It was right after a shingles
episode. The blisters and the pain responded, as they usually did, to
acyclovir, an antiviral medication. But this time the area of the scalp that
was involved became numb, and the pain was replaced by a constant, relentless
itch. She felt it mainly on the right side of her head. It crawled along her
scalp, and no matter how much she scratched it would not go away. “I felt like
my inner self, like my brain itself, was itching,” she says. And it took over
her life just as she was starting to get it back.
(
就在带状疱疹那段之后，像往常一样，阿昔洛韦（治疗疱疹的药物）的反应
--
水疱和疼痛随之而来，但是不同的是这次头皮涉及的区域开始变得麻木，疼痛被一阵持久的，不间断的痒替代了。她感觉到主要在她大脑的右边，跨过她的头皮，不管她怎么抓都不消失。“我感觉就像我身体的自己，我的大脑里面，在痒”，她说。就在她本开始重新生活的时候，它充斥了她的生活
)
Her internist didn’t know what to
make of the problem. Itching is an extraordinarily common symptom. All kinds of
dermatological conditions can cause it: allergic reactions, bacterial or fungal
infections, skin cancer, psoriasis, dandruff, scabies, lice, poison ivy, sun
damage, or just dry skin. Creams and makeup can cause itch, too. But M. used
ordinary shampoo and soap, no creams. And when the doctor examined M.’s scalp
she discovered nothing abnormal—no rash, no redness, no scaling, no thickening,
no fungus, no parasites. All she saw was scratch marks.
(
她的内科医生不知道问题的根源在哪里。痒是一种非常普遍的现象。所有皮肤学的问题都可能引起痒：过敏反应，细菌或真菌感染，皮肤癌，牛皮癣，头皮屑，疥疮，虱子，毒葛，太阳照射或者仅仅是皮肤干燥。奶油和化妆品也能引起痒。但是
M.
使用的是普通的洗发水和肥皂，没有奶油
)
。医生检查了
M.
的头皮，也没有发现任何异样
—
没有皮疹，没有红斑，没有真菌，没有寄生虫。所能看到的只有抓痕，
The internist prescribed a
medicated cream, but it didn’t help. The urge to scratch was unceasing and
irresistible. “I would try to control it during the day, when I was aware of
the itch, but it was really hard,” M. said. “At night, it was the worst. I
guess I would scratch when I was asleep, because in the morning there would be
blood on my pillowcase.” She began to lose her hair over the itchy area. She
returned to her internist again and again. “I just kept haunting her and
calling her,” M. said. But nothing the internist tried worked, and she began to
suspect that the itch had nothing to do with M.’s skin.
(
内科医生开了一些药，但是没有任何效果。抓的欲望不间断，不可抗拒。“白天的时候当我想到痒的时候我试着控制，但是真的很难。到了晚上就非常糟糕，我猜我睡着的时候一定在抓，因为早上我能看见我的枕套上有血。”她头上痒的区域开始掉发。她一次又一次的回去找医生。“我不停的打扰她，打电话给她”，
M.
说。但是医生所有的尝试都没有用，她开始怀疑痒和
M.
的皮肤无关。
)
Plenty of non-skin conditions can
cause itching. Dr. Jeffrey Bernhard, a dermatologist with the University of
Massachusetts Medical School, is among the few doctors to study itching
systematically (he published the definitive textbook on the subject), and he
told me of cases caused by hyperthyroidism, iron deficiency, liver disease, and
cancers like Hodgkin’s lymphoma. Sometimes the syndrome is very specific. Persistent
outer-arm itching that worsens in sunlight is known as brachioradial
pruritus
, and it’s caused by a crimped nerve in the neck. Aquagenic
pruritus
is recurrent, intense, diffuse itching upon getting out of a bath
or shower, and although no one knows the mechanism, it’s a symptom of
polycythemia vera, a rare condition in which the body produces too many red
blood cells.
(
很多非皮肤的情况会引起痒。
Jeffrey Bernhard
博士，马萨诸塞州大学医学院的皮肤学专家，少数系统研究杨的医生之一
(
他出版了这个学科的教科书
)
，他告诉我一些由甲状腺机能亢进，肝脏疾病，和癌症例如霍奇金淋巴瘤引起的例子。有时候症状很特殊。持续的外部瘙痒且在阳光下更甚的症状被称为
brachioradial pruritus
，
它是由脖子上的褶皱神经引起的。水源性瘙痒在沐浴后会持续，强烈且弥漫，尽管没有人知道机理，它是红细胞增多的征兆，那是一种极少见的情况，身体会产生太多的红细胞。
)
But M.’s itch was confined to the
right side of her scalp. Her viral count showed that the H.I.V. was quiescent.
Additional blood tests and X-rays were normal. So the internist concluded that
M.’s problem was probably psychiatric. All sorts of psychiatric conditions can
cause itching. Patients with psychosis can have cutaneous delusions—a belief
that their skin is infested with, say, parasites, or crawling ants, or laced
with tiny bits of fibreglass. Severe stress and other emotional experiences can
also give rise to a physical
symptom like itching—whether from the body’s release of endorphins (natural
opioids, which, like morphine, can cause itching), increased skin temperature,
nervous scratching, or increased sweating. In M.’s case, the internist
suspected tricho-tillomania, an obsessive-compulsive disorder in which patients
have an irresistible urge to pull out their hair.
(
但是
M.
的痒已经确认局限在头皮的右边。她的病毒计数表明
HIV
是稳定的、另外的血液测试和
X
涉嫌也正常。所以医生总结
M.
的问题可能是精神上的。所有的精神状况都可导致痒。精神病患者可能会产生皮肤幻觉
-
认为他们的皮肤被侵入，比如说，寄生虫，爬行蚂蚁，或者被小玻璃丝缠绕。巨大的压力和其他情绪经历也能产生诸如痒之类的身体症状
-
可能是身体释放的内啡肽
(
自然的类阿片，像吗啡，导致痒
)
，升高的皮肤温度，紧张的抓挠，不断的出汗。对于
M.
的案例来说，医生猜想是
tricho-tillomania
，一种强迫观念与行为的混乱，迫使病人有冲动去拉扯头发。
)
M. was willing to consider such
possibilities. Her life had been a mess, after all. But the antidepressant
medications often prescribed for O.C.D. made no difference. And she didn’t
actually feel a compulsion to pull out her hair. She simply felt itchy
,
on the area of her scalp that was left numb from the shingles. Although she
could sometimes distract herself from it—by watching television or talking with
a friend—the itch did not fluctuate with her mood or level of stress. The only
thing that came close to offering relief was to scratch.
(M.
愿意考虑这些可能性。毕竟她的生活已经一团糟。但是用来治疗强迫性官能症
(O.C.D.)
的抗抑郁性药物没有任何作用。她并没有感觉到一种拉扯头发的强制力。她只是头皮上的那块已经被带状疱疹搞得麻木的区域觉得痒。尽管有时候她能转移她的注意力
-
看电视或者和朋友聊天
-
痒并没有随着她的情绪或者压力波动。唯一能够缓解的办法就是抓。
)
“Scratching is one of the
sweetest gratifications of nature, and as ready at hand as any,” Montaigne
wrote. “But repentance follows too annoyingly close at its heels.” For M.,
certainly, it did: the itching was so torturous, and the area so numb, that her
scratching began to go through the skin. At a later office visit, her doctor
found a silver-dollar-size patch of scalp where skin had been replaced by scab.
M. tried bandaging her head, wearing caps to bed. But her fingernails would
always find a way to her flesh, especially while she slept.
(“
抓是自然界最让人高兴的事情之一，并且就在手边
”,M.
写道。“但是，后悔也随之而来”，对于
M.
当然是，因为痒是在是太让人难以忍受，并且那块区域也已经麻木，以至于她已经开始抓挠整个皮肤。在随后一次拜访医生时，医生发现她头皮的一个银元大小的区域已经被疤代替了。
M.
试图用绷带绑着头，睡觉戴帽子。但是她的指头总是能够找到地方，尤其是她睡着的时候。
)
One morning, after she was
awakened by her bedside alarm, she sat up and, she recalled, “this fluid came
down my face, this greenish liquid.” She pressed a square of gauze to her head
and went to see her doctor again. M. showed the doctor the fluid on the
dressing. The doctor looked closely at the wound. She shined a light on it and
in M.’s eyes. Then she walked out of the room and called an ambulance. Only in
the Emergency Department at Massachusetts
General Hospital,
after the doctors started swarming, and one told her she needed surgery now
,
did M. learn what had happened. She had scratched through her skull during the
night—and all the way into her brain.
(
一天早上被闹钟闹醒之后，她坐起来，回忆道，有一种液体从脸上留下来，是绿色的液体，她在头上包了纱布后再次去看医生。
M.
给医生看她裙子上的液体，医生仔细的看了伤口，她在伤口上和
M.
的眼睛上打灯，然后走出房间叫了救护车。直到在麻省总医院的急救室里，当医生开始会诊后，一个医生告诉她她需要马上手术时，她才知道发生了什么。她在晚上睡觉的时候一直抓头皮，一直抓到大脑里。
)
Itching is a most peculiar and
diabolical sensation. The definition offered by the German physician Samuel
Hafenreffer in 1660 has yet to be improved upon: An unpleasant sensation that
provokes the desire to scratch. Itch has been ranked, by scientific and artistic
observers alike, among the most distressing physical sensations one can
experience. In Dante’s Inferno, falsifiers were punished by “the burning rage /
of fierce itching that nothing could relieve”:
(
痒是一种奇怪的，如恶魔般的感觉。德国医生
Samuel Hafenreffer
在
1660
年时曾给痒的定义仍然可以改进：一种让人产生抓挠欲望的不愉快的感觉。按照科学的和艺术观察者的观点，痒被归于最让人痛苦的物理感觉之一。在人间地狱，说谎者被惩罚以“没有什么能减轻的痒
(???)
”
)
Though scratching can provide
momentary relief, it often makes the itching worse. Dermatologists call this
the itch-scratch cycle. Scientists believe that itch, and the accompanying
scratch reflex, evolved in order to protect us from insects and clinging plant
toxins—from such dangers as malaria, yellow fever, and dengue, transmitted by
mosquitoes; from tularemia, river blindness, and sleeping sickness, transmitted
by flies; from typhus-bearing lice, plague-bearing fleas, and poisonous
spiders. The theory goes a long way toward explaining why itch is so
exquisitely tuned. You can spend all day without noticing the feel of your
shirt collar on your neck, and yet a single stray thread poking out, or a
louse’s fine legs brushing by, can set you scratching furiously.
(
尽管抓挠能缓解一时的痛苦，但是会使痒更加糟糕。皮肤学专家称这个为痒
-
挠循环。科学家认为痒和伴随而来的搔反射是在进化中保护我们免受被昆虫，有粘性的植物毒素，诸如疟疾，黄热病，登革热等由蚊子引起的为危险，诸如兔热病，河盲症，昏睡症等由蚊子引起的，诸如鼠疫，和有毒蜘蛛等。这个理论有助于解释为什么痒被如此精致的调音
(???)
。你可以在没有注意到你的衬衫领子在脖子里的情况下度过一整天，但是一个流浪线突出（？？？），或者一个虱子爬过就能让你抓狂的挠上半天。
)
But how, exactly, itch works has
been a puzzle. For most of medical history, scientists thought that itching was
merely a weak form of pain. Then, in 1987, the German researcher H. O.
Handwerker and his colleagues used mild electric pulses to drive histamine, an
itch-producing substance that the body releases during allergic reactions, into
the skin of volunteers. As the researchers increased the dose of histamine,
they found that they were able to increase the intensity of itch the volunteers
reported, from the barely appreciable to the “maximum imaginable.” Yet the
volunteers never felt an increase in pain. The scientists concluded that itch and
pain are entirely separate sensations, transmitted along different pathways.
(
但是痒到底是如何工作的还是一个谜。大多数的医学历史中，科学家认为痒只是一种轻度的疼痛。在
1987
年，德国研究者
H. O. Handwerker
和他的团队使用轻微的电脉冲来把组胺打入志愿者的皮肤里，组胺是当有过敏反应时身体会释放的一种会产生痒的感觉的物质。当研究者加大组胺的剂量时，他们发现他们能够增加志愿者报告的痒的强度，从几乎感觉不到到能想象的极限。然后志愿者并没有感觉到疼痛的增加。科学家推断痒和疼是完全不同的两种感觉，通过不同的路径传递。
)
Despite centuries spent mapping
the body’s nervous circuitry, scientists had never noticed a nerve specific for
itch. But now the hunt was on, and a group of Swedish and German researchers
embarked upon a series of tricky experiments. They inserted ultra-thin metal
electrodes into the skin of paid volunteers, and wiggled them around until they
picked up electrical signals from a single nerve fibre. Computers subtracted
the noise from other nerve fibres crossing through the region. The researchers
would then spend hours—as long as the volunteer could tolerate it—testing
different stimuli on the skin in the area (a heated probe, for example, or a
fine paintbrush) to see what would get the nerve to fire, and what the person
experienced when it did.
(
尽管科学家们花了几个世纪来映射人体的神经网络，但是从来没有注意过对应痒的那根神经。不过现在探索已经开始了，一组挪威和德国的研究人员已经着手一系列的实验了。他们将一些超级薄的金属电极插入付费志愿者的皮肤，并不断的转动他们知道他们接收到来自神经纤维的电信号。计算机取出来自该区域的其他神经纤维的噪声。然后研究人员会花上数小时
-
只要志愿者能够忍受
-
在该区域的皮肤上测试不同的激励，来看什么会导致神经反应，以及人会有什么样的体验。
)
They worked their way through
fifty-three volunteers. Mostly, they encountered well-known types of nerve
fibres that respond to temperature or light touch or mechanical pressure. “That
feels warm,” a volunteer might say, or “That feels soft,” or “Ouch! Hey!” Several
times, the scientists came across a nerve fibre that didn’t respond to any of
these stimuli. When they introduced a tiny dose of histamine into the skin,
however, they observed a sharp electrical response in some of these nerve
fibres, and the volunteer would experience an itch. They announced their
discovery in a 1997 paper: they’d found a type of nerve that was specific for
itch.
(
他们在
53
位志愿者身上做了这样的实验。大多数情况下他们会碰到那些众所周知的对温度或者轻触或者金属压力有反应的神经。“感觉很温暖”一个志愿者这么说，或者“感觉很柔软”或者“喔！疼！”几次之后，科学家们找到了对于这些激励都没有反应的一个神经纤维。然而，当他们将一小剂量的组胺打入志愿者的皮肤时，他们观察到这些神经纤维中的一些会产生很强的电反应，志愿者会感觉到痒。他们在
1997
的论文中发表：他们已经找到了对应痒的神经。
)
Unlike, say, the nerve fibres for
pain, each of which covers a millimetre-size territory, a single itch fibre can
pick up an itchy sensation more than three inches away. The fibres also turned
out to have extraordinarily low conduction speeds, which explained why
itchiness is so slow to build and so slow to subside.
(
与对应疼痛的那些神经纤维不同，他们中的每一个都能覆盖微米级的范围，而对应痒的神经纤维能够捕获超过三英寸距离的痒的感觉。这些纤维的传播速度也很慢，这也就解释了为什么痒的感觉建立的这么慢，平息的也这么慢。
)
Other researchers traced these
fibres to the spinal cord and all the way to the brain. Examining functional
PET-scan studies in healthy human subjects who had been given
mosquito-bite-like histamine injections, they found a distinct signature of
itch activity. Several specific areas of the brain light up: the part of the
cortex that tells you where on your body the sensation occurs; the region that
governs your emotional responses, reflecting the disagreeable nature of itch;
and the limbic and motor areas that process irresistible urges (such as the
urge to use drugs, among the addicted, or to overeat, among the obese),
reflecting the ferocious impulse to scratch.
(
一些其他的研究人员从脊髓神经寻找这些神经纤维的根源，一直到大脑。通过在健康人体摄入类似蚊子咬的组胺，然后进行功能性的
PET
扫描研究发现，痒的一种不同的信号。大脑的一些区域突显出来：告诉你感觉来自身体的哪个部分的脑皮层区域，支配你情绪反应的区域，反应出令人不愉快的痒的感觉；处理那些不可抗拒的冲动的边缘的运动中枢，
(
比如说当有毒瘾时想吸毒的冲动，或者肥胖症想吃东西的冲动
)
，反应令人抓狂的想挠的冲动。
)
Now various phenomena became
clear. Itch, it turns out, is indeed inseparable from the desire to scratch. It
can be triggered chemically (by the saliva injected when a mosquito bites, say)
or mechanically (from the mosquito’s legs, even before it bites). The
itch-scratch reflex activates higher levels of your brain than the
spinal-cord-level reflex that makes you pull your hand away from a flame. Brain
scans also show that scratching diminishes activity in brain areas associated
with unpleasant sensations.
(
现在很多现象都变得很清晰了。事实证明，痒，确实与想抓的欲望不可分割。它肯能
)
But some basic features of itch
remained unexplained—features that make itch a uniquely revealing case study.
On the one hand, our bodies are studded with receptors for itch, as they are
with receptors for touch, pain, and other sensations; this provides an alarm
system for harm and allows us to safely navigate the world. But why does a
feather brushed across the skin sometimes itch and at other times tickle?
(Tickling has a social component: you can make yourself itch, but only another
person can tickle you.) And, even more puzzling, how is it that you can make
yourself itchy just by thinking about it?
(
但是痒的一些基本的特征还是没人能解释
-
这些特征使得痒成为一门特殊的学问。另一方面，我们的身体是痒的承载体，就像它们是触觉，疼痛和其他感觉的承载体一样；这为我们提供了一个危害的报警系统，使我们能够安全的生活。但是为什么有时候羽毛拂过皮肤的时候会痒，而有时候却像被人胳肢一样呢？（胳肢有互动的成分：你能使让你自己痒，但是只有他人能胳肢你。）更令人费解的是，你如何能够只是想想，便能让自己感觉痒呢？
)
Contemplating what it’s like to
hold your finger in a flame won’t make your finger hurt. But simply writing
about a tick crawling up the nape of one’s neck is enough to start my neck
itching. Then my scalp. And then this one little spot along my flank where I’m
beginning to wonder whether I should check to see if there might be something
there. In one study, a German professor of psychosomatics gave a lecture that
included, in the first half, a series of what might be called itchy slides,
showing fleas, lice, people scratching, and the like, and, in the second half,
more benign slides, with pictures of soft down, baby skin, bathers. Video
cameras recorded the audience. Sure enough, the frequency of scratching among
people in the audience increased markedly during the first half and decreased
during the second. Thoughts made them itch.
(
仅仅想象将手指放在火上的感觉不会让你的手指感到疼，但是仅仅是写虱子爬上某人的颈背时，就开始让我觉得脖子痒。然后是头皮。然后这个小点蔓延在我的腰窝，我开始想是不是要看看那儿有没有什么东西。一个德国的身心医学教授曾经做过一次演讲，在前一半，一系列的关于什么是痒的幻灯片，放映的是虱子，跳蚤，人们抓挠，等等，后一半是一些好的幻灯片，一些柔软的，宝宝的皮肤，沐浴等，
视频记录下了听众们在前半部分频繁的抓挠，而后一部分抓挠的情况显著减少。想想都让他们痒。
)
We now have the nerve map for itching,
as we do for other sensations. But a deeper puzzle remains: how much of our
sensations and experiences do nerves really explain?
(
就像其他的一些感觉一样，我们现在有了关于痒的神经地图。但是一个更深的困惑仍然存在：我们的感觉和经验到底有多少是神经能够解释的呢？
)
In the operating room, a
neurosurgeon washed out and debrided M.’s wound, which had become infected.
Later, a plastic surgeon covered it with a graft of skin from her thigh. Though
her head was wrapped in layers of gauze and she did all she could to resist the
still furious itchiness, she awoke one morning to find that she had rubbed the
graft away. The doctors returned her to the operating room for a second skin
graft, and this time they wrapped her hands as well. She rubbed it away again
anyway.
(
在手术室，神经外科医生清洗并清除了
M.
受感染的伤口，然后，整形外科医生从她大腿的皮肤移植了皮肤到伤口处。尽管她的头被数层纱布包着，她也尽力去抵抗依然激烈的痒，她还是在一天早上醒来发现她把纱布挠开了。医生在手术室重新给她植皮，这次他们将她的手也绑上了。她又一次将纱布挠开了。
)
“They kept telling me I had
O.C.D.,” M. said. A psychiatric team was sent in to see her each day, and the
resident would ask her, “As a child, when you walked down the street did you
count the lines? Did you do anything repetitive? Did you have to count
everything you saw?” She kept telling him no, but he seemed skeptical. He
tracked down her family and asked them, but they said no, too. Psychology tests
likewise ruled out obsessive-compulsive disorder. They showed depression,
though, and, of course, there was the history of addiction. So the doctors
still thought her scratching was from a psychiatric disorder. They gave her
drugs that made her feel logy and sleep a lot. But the itching was as bad as
ever, and she still woke up scratching at that terrible wound.
(
“他们不停的告诉我我有
O.C.D.
”，
M
说。一个神经科医生被派去每天看着她，他问她：“你小时候走在街上会不会数路上的线？你会不会重复做一样事情？你是否会数你看到的每样东西？”她不停的告诉她没有，
)
One morning, she found, as she
put it, “this very bright and happy-looking woman standing by my bed. She said,
‘I’m Dr. Oaklander,’ ” M. recalled. “I thought, Oh great. Here we go again. But
she explained that she was a neurologist, and she said, ‘The first thing I want
to say to you is that I don’t think you’re crazy. I don’t think you have
O.C.D.’ At that moment, I really saw her grow wings and a halo,” M. told me. “I
said, ‘Are you sure?’ And she said, ‘Yes. I have heard of this before.’ ”
(
一天早上，她发现一个明亮的，看上去很开心的女人站在她的床边，她说“我是
Oaklander
医生”，
M.
回忆到，“我想，好吧，又来了。但是她解释她是一个神经病医生，她说首先她不认为我疯了，不认为我有
O.C.D.
，那一刻，我真的看见她长了翅膀，头顶有光环。”
M.
告诉我
,
“我说，你确定吗？她说，是的，我以前也听说过这个。”
)
Anne Louise Oaklander was about
the same age as M. Her mother is a prominent neurologist at Albert Einstein
College of Medicine, in New York,
and she’d followed her into the field. Oaklander had specialized in disorders
of peripheral nerve sensation—disorders like shingles. Although pain is the
most common symptom of shingles, Oaklander had noticed during her training that
some patients also had itching, occasionally severe, and seeing M. reminded her
of one of her shingles patients. “I remember standing in a hallway talking to
her, and what she complained about—her major concern—was that she was tormented
by this terrible itch over the eye where she had had shingles,” she told me.
When Oaklander looked at her, she thought that something wasn’t right. It took
a moment to realize why. “The itch was so severe, she had scratched off her
eyebrow.”
(Anne Louise Oaklander
和
M.
年龄相仿。她妈妈是纽约的爱因斯坦医学院的著名神经学专家，她跟随妈妈进了这个领域。
Oaklander
主修末梢神经混乱，像带状疱疹。尽管疼痛是带状疱疹的主要症状，但是
Oaklander
注意到在她的病人中有一些也养，偶尔十分严重，看到
M.
使他想起其中一个疱疹病人，“我记得当时站在走廊上和她说话，她在抱怨她被长疱疹的眼睛上的痒折磨得很难受”，她告诉我，当
Oaklander
看见她的时候，她觉得有点不对劲。过了一会儿她就意识到为什么了，“痒得非常严重，她把她的眼球给抓下来了。”
)
Oaklander tested the skin near
M.’s wound. It was numb to temperature, touch, and pinprick. Nonetheless, it
was itchy, and when it was scratched or rubbed M. felt the itchiness
temporarily subside. Oaklander injected a few drops of local anesthetic into
the skin. To M.’s surprise, the itching stopped—instantly and almost entirely.
This was the first real relief she’d had in more than a year.
(Oaklander
测试
M.
的伤口周围的皮肤。它对温度，触摸和针刺都麻木了。但是却十分痒，当抓挠它的时候
M.
感觉痒暂时平息了。
Oaklander
给她注射了一些局部麻醉剂。令
M.
惊讶的是，痒停止了
-
马上，几乎是全部。这是她一年多来第一次感到放松。
)
It was an imperfect treatment,
though. The itch came back when the anesthetic wore off, and, although
Oaklander tried having M. wear an anesthetic patch over the wound, the effect
diminished over time. Oaklander did not have an explanation for any of this.
When she took a biopsy of the itchy skin, it showed that ninety-six per cent of
the nerve fibres were gone. So why was the itch so intense?
(
然而这不是一个完美的治疗。当麻醉劲过去后，痒又开始了，尽管
Oaklander
试着让
M.
在伤口上戴着麻醉剂包，可是时间一过效果就没了。
Oaklander
对此没有解释。当她对痒的皮肤做活组织检查后，结果显示
96%
神经纤维的都不见了。那么为什么痒还如此强烈呢？
)
Oaklander came up with two
theories. The first was that those few remaining nerve fibres were itch fibres
and, with no other fibres around to offer competing signals, they had become
constantly active. The second theory was the opposite. The nerves were dead,
but perhaps the itch system in M.’s brain had gone haywire, running on a loop
all its own.
(Oaklander
提出两个理论。第一个是剩余的那些神经纤维都是痒的纤维，在周围没有其他纤维提供完整信号的时候，它们变得非常活跃。第二个理论完全相反。神经都死了，但是可能
M.
大脑中的痒的系统已经混乱，它自己循环工作。
)
The second theory seemed less
likely. If the nerves to her scalp were dead, how would you explain the relief
she got from scratching, or from the local anesthetic? Indeed, how could you
explain the itch in the first place? An itch without nerve endings didn’t make
sense. The neurosurgeons stuck with the first theory; they offered to cut the
main sensory nerve to the front of M.’s scalp and abolish the itching
permanently. Oaklander, however, thought that the second theory was the right
one—that this was a brain problem, not a nerve problem—and that cutting the
nerve would do more harm than good. She argued with the neurosurgeons, and she
advised M. not to let them do any cutting.
(
第二个理论看起来不太可能。如果头皮的神经确实死了，那么如何解释她在抓挠或者局部麻醉剂后的症状的减轻？确实，如何解释开始的痒？没有神经末端的痒解释不通。神经外科医生坚持第一个理论。他们提出切除
M.
头皮的主要感觉神经，永久的消除痒。但是
Oaklander
认为第二个理论才是正确的，这是大脑的问题，不是神经的问题，切除神经弊大于利。她和神经外科医生理论，并建议
M.
不要让他们切除。
)
“But I was desperate,” M. told
me. She let them operate on her, slicing the supraorbital nerve above the right
eye. When she woke up, a whole section of her forehead was numb—and the itching
was gone. A few weeks later, however, it came back, in an even wider expanse
than before. The doctors tried pain medications, more psychiatric medications,
more local anesthetic. But the only thing that kept M. from tearing her skin
and skull open again, the doctors found, was to put a foam football helmet on
her head and bind her wrists to the bedrails at night.
(
“但是我很绝望”，
M.
告诉我。她让他们做了手术，切除了右眼上方的眼窝上神经。当她醒来时，她额头的整块区域都没有感觉了
-
痒也消失了。然而一个星期后，它又回来了，甚至比之前的区域更大。医生用疼痛治疗，更多的精神病治疗，更多的局部麻醉剂。但是医生发现唯一能让
M.
不把皮肤和头骨抓开的是，在她头上戴一个泡沫的橄榄球头盔，并在晚上把她的手腕绑到床沿。
)
She spent the next two years
committed to a locked medical ward in a rehabilitation hospital—because,
although she was not mentally ill, she was considered a danger to herself.
Eventually, the staff worked out a solution that did not require binding her to
the bedrails. Along with the football helmet, she had to wear white mitts that
were secured around her wrists by surgical tape. “Every bedtime, it looked like
they were dressing me up for Halloween—me and the guy next to me,” she told me.
(
接下来的两年她呆在复原医院的一个紧闭的内科病房，因为尽管她没有神经病，她对自己太危险。最后，工作人员发现了一个方法可