조중환의 번안소설과 열병의 상상력 -장티푸스의 변주와 형상화를 중심으로

박성호 한국현대소설학회 2024 현대소설연구 Vol.0 No.93

장티푸스는 20세기 중반까지 맹위를 떨쳤던 감염병으로 한국에서도 여러 차례유행한 바 있다. 이미 19세기 말부터 위생과 방역을 중심으로 한 대응이 이루어졌으며, 대중들에게도 주요한 감염병 가운데 하나로 폭넓게 인식되고 있었다. 하지만 문학 작품에서는 장티푸스가 직접적으로 등장하는 사례를 찾아보기 어렵다. 신경쇠약이 결핵, 천연두 등과 달리 장티푸스는 1910년대 초반까지도 거의소설에서 거론되지 않았다. 조중환의 번안소설인 「쌍옥루」나 「비봉담」에 이르러서야 비로소 등장하게 되는데, 이 역시 장티푸스를 병명을 직접적으로 채택하지는 않았다. 조중환의 번안소설에서 장티푸스는 감염병의 측면보다는 불명열(不明熱)의 일환으로 등장한다. 감염병임을 추론할 수 있는 서술이 작중에서 등장하기는 해도 발병의 중심에는 작중인물의 죄책감과 같은 심리적 요인이 강하게 작동한다. 이는19세기 영미소설이 채택한 neural fever와도 연결된 것으로, 열이라는 요소를 중심으로 작중의 갈등을 설명하거나 이를 해소하는 계기를 제시하였다. 다른 한편으로는 열병을 중심으로 하여 근대의료를 소설 속에 본격적으로 도입하는 계기를 마련하기도 했다. 혈액검사와 혈청주사, 체온 측정을 중심으로 한 진단과 치료는 모두 의사와 의료기관을 중심으로 이루어지며, 작중인물의 병을 치료하는 것 역시 의사의 역할로 분리된다. 같은 시기 소설에서 나타나는 신경쇠약이의료와는 무관하게 작중인물 간의 갈등 해소를 통해 치유된다는 점을 감안하면, 장티푸스를 중심으로 한 열병의 상상력은 소설에서의 근대의료를 구체화하는 데 적잖은 역할을 수행하였다고 볼 수 있다. 나아가서는 열병을 중심으로 결핵이나 신경쇠약과 같은 여타의 질병과도 연결될 수 있는 지점을 마련한다는 점도 주목할 필요가 있다. 이는 20세기 초 문학에서질병을 인식하고 형상화하는 양상을 살펴보는 데 또 다른 시각을 제공할 수 있을것이다. Typhoid fever was a rampant infectious disease until the mid-20th century, experiencing several outbreaks in Korea. Since the late 19th century, responses centered around hygiene and quarantine were implemented, and it was widely recognized as one of the major infectious diseases among the public. However, it is difficult to find cases where typhoid fever directly appears in literary works. Unlike neurasthenia, tuberculosis, or smallpox, typhoid fever was almost never mentioned in novels until the early 1910s. It was not until Jo Jung-hwan's adapted novels, such as "Ssangokru" and "Bibongdam," that typhoid fever finally made an appearance, albeit not adopting the disease name directly. In Jo Jung-hwan's adapted novels, typhoid fever appears more as a part of an unknown fever than from the aspect of an infectious disease. Although there are descriptions that allow readers to infer it as an infectious disease, psychological factors like the characters' guilt play a strong role at the outbreak's center. This is connected to the neural fever adopted in 19th-century English and American novels, where fever is central to explaining conflicts within the story or providing an opportunity for resolution. On the other hand, these novels also provided an opportunity to formally introduce modern medicine into the story, centered around fever. Diagnosis and treatment focused on blood tests, serum injections, and temperature measurements are all conducted by doctors and medical institutions, separating the act of curing the characters' diseases as the doctors' role. Considering that neurasthenia, appearing in novels from the same period, is healed through the resolution of conflicts between characters independently of medical intervention, the imagination of fever centered around typhoid fever plays a significant role in concretizing modern medicine in literature. Furthermore, it is worth noting that fever, centered around typhoid, creates connections with other diseases such as tuberculosis and neurasthenia. This offers another perspective in examining how diseases were recognized and visualized in early 20th-century literature.

장티푸스 이환시 Salmonella typhi Vi 항원에 대한 IgG , IgM IgA 항체가의 시간에 따른 변화

김준명(June Myeong Kim),안광진(Kwang Jin Ahn),김응(Eung Kim),홍천수(Chein Soo Hong) 대한내과학회 1989 대한내과학회지 Vol.37 No.3

N/A The varied antigenicity of salmonella species is determined by O, H and Vi antigens whose chemical components and roles are recognized partiallty and are still under study. The Vi antigen of Salmonella typhi is known to have a specific role in the pathogenesis of typhoid fever by exerting a protective action upon the serum complement system and thus resisting phagocytosis. Lately, Vi antigen was introduced for the diagnosis of typhoid fever, and sequential changes of polyvalent immunoglobulin antibody titers against Vi antigen in typhoid fever were reported. So we studied immunological responses against Vi antigen in twelve patients with typhoid fever, and sequentially measured immunoglobulin G, M and A titers by indirect fluorescent antibody test using Vi antigen (Vi-IFAT). The IgG antibody titers were already increased 1 week after fever onset, reached a peak level at 3 to 4 weeks, and then showed some period of plateau followed by a gradual decrease after 2 to 3 months. The IgM antibody titers showed no definite increase in the early phase of the disease in most of the patients, but a slight increase was noted 2 to 3 weeks after fever onset followed by a rapid decrease thereafter. The IgA antibody titers were already highly increased 1 week after fever onset, and then showed some period of plateau followed by a rapid decrease after 6 to 8 weeks. Compared with previous studies regarding O antibody production in Korea, the pattern of antibody responses against Vi antigen was very similar. Based on these results, we found that IgG antibody production was predominant and IgM antibody production was relatively suppressed even in the acute phase of typhoid fever. Considering that Korea is one of the endemic areas of typhoid fever, a previously acquired immunity against typhoid fever or exhaustion of IgM antibody-forming cells may lead to the relatively low IgM antibody titers.

중합효소 연쇄반응을 이용한 장티푸스의 새로운 진단법의 개발

송재훈(Jae Hoon Song) 대한내과학회 1994 대한내과학회지 Vol.46 No.2

N/A Background: Typhoid fever still poses a major health problem in many parts of the world. Rapid and sensitive tests for diagnosis of typhoid fever are essential for prompt and effective therapy. There is currently no test that fulfills the sensitivity, specificity, speed and practicalness. To develop a novel diagnostic method of typhoid fever, a polymerase chain reaction (PCR) was tested for the detection of Salmonella typhi (S. typhi) DNA in the blood of patients with suspected typhoid fever on the basis of clinical finings but with negative cultures for S. typhi. To search the optimal blood specimen, results of the PCR with whole blood, serum and mononuclear cells were also compared in term of sensitivity and speed of the test. Methods: Blood specimens (3 ml each far 3 kinds of specimens) were obtained before antibiotic therapy from 14 patients with suspected typhoid fever who were admitted to the Asan Medical Center consecutively during the period from march 1992 to October 1992. Extraction of DNA was followed in the conventional manner. From the sequence of the flagellin gene of S. typhi, two pairs of oligonucleotide primers, of which one is nested in the other, were synthesized by use of a DNA synthesizer. Each round of the PCR consisted of 40 cycles. The DNA fragment of flagellin gene of S. typhi amplified by the nested PCR were identified by 2% agarose gel electrophoresis and Southern blot hybridization using 32P-labeled internal probe. Results: With the nested PCR, amplification product of 343-bp were in 8 of 14 mononuclear cell specimens on the gel. Southern blot hybridization showed the same pattern and confirmed the agarose gel results. Thses 8 patients were treated with ciprofloxacin and were completely cured. Six patients with negative result in the PCR were proved to have another infectious diseases. The mononuclear cells were the most optimal specimen in terms of sensitivity and speed of the test. Conclusion: By using two pairs of primers evaluated in this study, amplification of flagellin gene of S. typhi identified the presence of the organism in the blood of patients with suspected clinical findings of typhoid fever. The whole prcedure to identify S. typhi DNA in the mononuclear cells by agarose gel electrophoresis took only 13 hours, demonstrating the PCR a simple, specific, sensitive and rapid method for early diagnosis of typhoid fever.

장티푸스 진단에 있어서 Vi - 간접형광항체법의 유용성

김준명(June Myeong Kim),김응(Eung Kim),홍천수(Chein Soo Hong),정윤섭(Yun Sop Chong),박기일(Ki Il Park) 대한내과학회 1987 대한내과학회지 Vol.33 No.6

N/A Although the confirmative diagnosis of typhoid fever is by culture of the causative organism usually from body fluids, serological test can be helpful in providing a more rapid method of diagnosis. The indirect fluorescent antibody test using a Salmonella typhi Vi-antigen and a FITC-conjugated rabbit anti-human polyvalent immunoglobulins has been evaluated for the diagnosis of typhoid fever. The results obtained were as follows: 1) Only two of 61 sera from culture proved typhoid fever patients were falsely negative. Of 79 sera from patients with febrile diseases other than typhoid fever only one had falsely positive titer. Forty sera from normal subjects were all negative. The sensitivity and specificity were 96.7% and 99.2% respectively. 2) The positive rate of the test was 71.4% within the 1st week, 90.0% from the 1st week to 2nd week, and 100% since the 2nd week after fever onset. 3) The antibody titer to Vi-antigen was already increased within the 1st week after fever onset. And the titer showed its maximum response in the 2nd and 3rd week and was gradually decreased to near normal level throughout this study. In conclusion, the Vi-indirect fluorescent antibody test (Vi-IFAT) could serve as an useful serologic test for the diagnosis of typhoid fever.

1928년 경성의 장티푸스 유행과 상수도 수질 논쟁

백선례 서울역사편찬원 2019 서울과 역사 Vol.- No.101

During the colonial period, Typhoid fever was one of the most common infectious disease in Joseon. Typhoid, a water-borne disease, occurred at a certain time each year, although its fatality rate was lower that of the same water-borne disease, cholera. Typhoid was not a priority of the sanitary authorities, but it was more difficult to prevent because it was a common disease. Milk, vegetables and fruits were also the causes of typhoid, but the main cause was water. In the colonial Joseon, people were supplied with drinking water primarily through wells and water supply facilities, and wells were generally blamed for the cause of typhoid. However, the typhoid epidemic of Seoul(Gyeongseong) in 1928 was different. In 1928, typhoid epidemic broke out in Seoul from midwinter to early spring and the patients of typhoid were mostly Japanese. Therefore, the water supplies were pointed out as the cause of typhoid. The deficiencies and water quality of the water supply facilities were embroiled in controversy. There was a disagreement between the Gyeongseong city government and the medical community that water supply was the cause of typhoid outbreak. Japanese of all levels of society, including medical circles, Gyeongseong city government officials, citizens, and journalists, argued over water quality and water supply facilities, but as typhoid faded away, the debate on water quality ended without a conclusion. In the debate about water quality, the problems of the Gyeongseong Water Supply System, which used to be the largest facilities of the time, were clearly revealed. The medical community also failed to win a complete victory. In 1928, the typhoid epidemic and the debate about water quality did not serve as a momentum for the management or establishment of the water supply of Seoul. The water supply expansion plan went ahead as scheduled, but the improvements to the water supply facilities was carried out more later. In the end, in 1928, in the debate about water quality, the Keijo Imperial University Medical School and the Gyeongseong city government were busy trying to shift the responsibility to others. In 1928, the typhoid epidemic ended up in exposing the weaknesses of medical knowledge and modern facilities until then. 식민지시기 내내 조선에서 장티푸스는 가장 흔한 전염병 중의 하나였다. 물을 매개로 전파되는 전염병인 장티푸스는 같은 수인성 전염병인 콜레라처럼 치사율이 높지 않았고 매년 일정한 시기에 발생하는 전염병이었기 때문에 방역당국의 우선순위는 아니었다. 그러나 한편으로 일상적으로 발생하는 병이었기 때문에 방역에 더 어려운 점도 있었다. 장티푸스를 매개하는 것으로는 물, 우유, 야채, 과일 등이 있었으나 장티푸스가 발생할 경우 가장 큰 의심을 받는 것은 주로 물이었다. 식민지 조선에서 사람들이 식수를 공급받는 방법은 크게 우물과 수도였고 대개는 우물이 더 강력한 병원으로 지목되었다. 그러나 1928년 경성의 장티푸스 유행은 상황이 달랐다. 1928년 경성의 장티푸스 유행은 한겨울부터 초봄까지 발생하였으며 일본인들에게 주로 발생하였다. 이러한 특이점에 따라 장티푸스의 병원으로 우물이 아닌 수도가 더욱 부각되었다. 상수도 시설의 불완전함과 수질이 논란의 중심이 되었고 수도가 병원이 아니라는 경성부측과 수도가 장티푸스 발생의 원인이라는 의학계측의 의견이 대립하였다. 의학계, 경성부 관계자, 시민, 언론인 등 각계각층의 일본인들이 수질과 상수도 시설을 둘러싼 논쟁을 펼쳤으나, 장티푸스가 점점 사그라지면서 1928년 상수도 수질 논쟁은 결론도 없이 흐지부지 마무리되었다. 이러한 결과와는 별개로 상수도 수질 논쟁 과정에서 당대 최고이자 최대의 시설을 내세웠던 경성 상수도 시설의 문제점이 여실히 드러났으며, 의학계로서도 완전한 승리를 거두지는 못했다. 1928년의 장티푸스 유행과 수질 논쟁은 이후 경성의 상수도 관리나 시설 개선의 특별한 계기가 되었다고 보기는 어렵다. 경성의 상수도 확장 계획은 예정대로 진행되었으나 문제가 되었던 상수도 시설의 개선은 좀 더 이후에 진행되었다. 결국 1928년 경성의 수질 논쟁은 조선 의학계에서 최고의 권위를 지닌 경성제대 의학부와 조선 내 최고의 상수도 시설을 내세운 경성부의 책임회피와 함께 당시까지의 의학 지식과 근대적 시설이 가지는 취약점을 노출한 채 마무리되었다.

장티푸스의 혈청학적 진단을 위한 Vi-수동혈구응집법, SD$^{(R)}$ Kit 및 Widal 시험에 대한 효용성 평가

김성훈,김석호,이덕용,이에스더,박미선,이복권,Kim, Sung-Hun,Kim, Shuk-Ho,Lee, Deog-Yong,Lee, Esther,Park, Mi-Sun,Lee, Bok-Kwon 한국미생물학회 2010 미생물학회지 Vol.46 No.2

본 연구는 장티푸스 환자에 대한 혈청학적 시험법인 Vi-PHA, $SD^{(R)}$ kit, Widal 시험(O & H)에 대하여 평가를 위해 수행하였다. 2005년부터 2006년까지 수집된 36건의 혈청검체를 대상으로 하였으며, 9건은 배양검사를 통하여 장티푸스균이 검출된 확진환자의(Typhoid fever) 검체이며, 27건은 비장티푸스성 열성환자의(Non-typhoid fever) 검체이다. 시험결과 Vi-PHA는 환자 혈청 9건 중 양성 8건으로 민감도 88.9% (P<0.001; Fisher's exact test), 비장티푸스성 열성환자 27건 중 1건이 양성을 보여 특이도 96.3%로 나타났다. $SD^{(R)}$ kit는 민감도 100% (P<0.001), 특이도 92.6%로 나타났다. Widal (O & H) 시험의 민감도는 각각 88.9% (P=0.001), 100% (P<0.001), 특이도는 77.8%, 70.4%로 나타났다. 민감도는 $SD^{(R)}$ kit와 Widal H 검사법이 가장 높은 것으로 확인되었으며, 특이도는 Vi-PHA가 가장 높게 나타났다. 장티푸스의 효과적인 혈청학적 진단을 위하여 급성 또는 유행지역에서는 특이도가 높은 Vi-PHA로 검사를 수행하고, 장티푸스 비 유행지역과 고위험군에 대하여는 민감도가 높은 Widal H와 $SD^{(R)}$ kit를 적용하는 것이 진단의 유의수준을 높일 수 있을 것으로 판단된다. In this study, we evaluated Vi-passive hemagglutination (Vi-PHA), SD Salmonella Typhi IgG/IgM ($SD^{(R)}$ kit) and Widal test for the rapid laboratory diagnosis of typhoid fever patients. A total of 36 serum samples from febrile patients in Korea from 2005 to 2006 were used. Among 36 patients, 27 were fever patients without typhoid, 9 were typhoid fever. Vi-PHA showed 8 positive results out of 9 typhoid fever patients (sensitivity 88.9%) and 1 positive and 26 negative results out of 27 febrile patients without typhoid (specificity 96.3%). The sensitivity and the specificity of $SD^{(R)}$ kit were 100% and 92.6%, respectively. However, the sensitivity and the specificity of Widal O & H tests were 88.9%, 100%, and 77.8%, 70.4%, respectively. Consequently, Widal H and $SD^{(R)}$ kit showed higher sensitivity and Vi-PHA showed higher specificity. To efficient diagnosis, Vi-PHA may be sufficient diagnosis method in acute cases and $SD^{(R)}$ kit and Widal test may be sufficient in sporadic area and high risk group.

Management of Typhoid Fever – Clinical and Historical Perspectives in Korea

장미수,우준희,김성민 대한감염학회 2019 Infection and Chemotherapy Vol.51 No.3

Typhoid fever, showed a dramatic decrease in its incidence from 56 per 100,000 population just after Korea's independence to <1 per 100,000 population in 2000s. The clinical features of patients with typhoid fever in Korea were not too different from those reported in textbooks. Beyond cultures and Widal test, other diagnostic techniques such as string capsule culture and polymerase chain reaction have been tried in Korea. As chloramphenicol is not used anymore in Korea, ampicillin, cotrimoxazole, fluoroquinolones, and third-generation cephalosporins have been administered for therapy of typhoid fever. Especially, ciprofloxacin and ceftriaxone were successfully tried with shorter duration of treatment (1 week). However, cases of treatment failure and resistance in ciprofloxacin were reported in Korea, which requires a great caution. As preventive vaccines, parenteral Vi polysaccharide vaccine and oral live attenuated vaccine are mainly used in Korea. The decline in the number of chronic carriers of typhoid fever in Korea by the roles of doctors and patient management from the health care authorities such as Korea Centers for Diseases Control and Prevention, prescription of effective antimicrobial agents, and increased piped water supply ratio are considered to be the major contributing factors to the reduction in the outbreak of typhoid fever in Korea.

Novel Heptaplex PCR-Based Diagnostics for Enteric Fever Caused by Typhoidal Salmonella Serovars and Its Applicability in Clinical Blood Culture

Kim Hyun-Joong,Jung Younsik,Kim Mi-Ju,Kim Hae-Yeong 한국미생물·생명공학회 2023 Journal of microbiology and biotechnology Vol.33 No.11

Enteric fever is caused by typhoidal Salmonella serovars (Typhi, Paratyphi A, Paratyphi B, and Paratyphi C). Owing to the importance of Salmonella serovars in clinics and public hygiene, reliable diagnostics for typhoidal serovars are crucial. This study aimed to develop a novel diagnostic tool for typhoidal Salmonella serovars and evaluate the use of human blood for clinically diagnosing enteric fever. Five genes were selected to produce specific PCR results against typhoidal Salmonella serovars based on the genes of Salmonella Typhi. Heptaplex PCR, including genetic markers of generic Salmonella, Salmonella enterica subsp. enterica, and typhoidal Salmonella serovars, was developed. Typhoidal Salmonella heptaplex PCR using genomic DNAs from 200 Salmonella strains (112 serovars) provided specifically amplified PCR products for each typhoidal Salmonella serovar. These results suggest that heptaplex PCR can sufficiently discriminate between typhoidal and nontyphoidal Salmonella serovars. Heptaplex PCR was applied to Salmonella-spiked blood cultures directly and provided diagnostic results after 12- or 13.5-h blood culture. Additionally, it demonstrated diagnostic performance with colonies recovered from a 6-h blood culture. This study provides a reliable DNA-based tool for diagnosing typhoidal Salmonella serovars that may be useful in clinical microbiology and epidemiology.

장티푸스 환아에서 병발한 급성 신부전을 동반한 급성 간질성 신염 1례

오정민,이나라,임형은,유기환,정운용,홍영숙,이주원,Oh, Jung-Min,Lee, Na-Ra,Yim, Hyung-Eun,Yoo, Kee-Hwan,Jeong, Woon-Yong,Hong, Young-Sook,Lee, Joo-Won 대한소아신장학회 2010 Childhood kidney diseases Vol.14 No.2

장티푸스에 의한 신장 합병증은 전체 환자의 2-3% 정도로, 소아에서는 드물게 발견되며 최근 위생상태의 호전으로 장티푸스 발생율은 점점 감소하고 있다. 저자들은 장기간의 발열, 구토, 설사를 보였던 환아에서 단백뇨, 신기능 저하 소견이 나타나 경피적 신생검을 시행하여 급성 간질성 신염 소견이 증명된 환자를 경험하였기에 이를 보고하는 바이다. Typhoid fever is a systemic infectious disease which affects many organs. In children, few cases have been reported of acute nephritic syndrome in typhoid fever. We report an immunocompetent 9-year old girl with typhoid fever complicated by acute tubulointerstitial nephritis who presented with prolonged fever and acute renal failure.

봄철 농촌에서 집단발생한 장티푸스의 임상상

김창호,조무식,정재삼,백정선,구영무,송옥평 순천향대학교 1989 논문집 Vol.12 No.3

Chinical observation was made of 202 cases of typhoid fever, whose charts were reviewed at the department of general surgery of Soonchunhyang University, Chunan Hospital from Mar., 1988 to May, 1988. 1) Typhoid fever was occured most frenquetly in those between the age of 0-9 years old. 2) The male-female ratio on admission was 112:90. 3) Symptoms and signs on admission were fever: 87%, abdominal pain: 68%, diarrhea: 52%, headache: 50%, chill: 43%, nausea and vomiting: 38%. 4) In hematologic fidings on admission, the leucocyte count was below 5000/㎣: 33%, between 5000-10000/㎣: 51%, and above 100000/㎣: 16%. 5) The result of Widal test was positive: 69%(above 1:160). 6) Complications of typhoid fever were intestinal bleeding: 29%, hepatitis or decreased liver function and no jaundice: 19%, intestinal perforation: 10%. 7) Intestinal perforation was occured most frequently in those 20-39 years old and the male-female ratio was 7:3. 8) Intestinal hemorrhage(31%) and intestinal perforation(51%) were developed most frequently at 2 to 3 weeks after onset of symptom. 9) Subdiaphragmatic free air in simple X-ray was found in 70% of intestinal perforated cases. 10) The site of intestinal perforation was within 60cm. proximal from ileocecal valve in 65% of the intestinal perforated cases. 11) Intestinal perforation showed multiple perforation(2-5 sites), 55% and single perforation, 45%. 12) In surgical management, primary closure of the perforation site was in 30% of the cases of anastomosis after resection in 70%.