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醫學 1798

牛痘成因與影響之探究

愛德華·詹納

一份輕微的牛痘,教會身體戰勝致命的天花——第一支疫苗。

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In depth · the introduction

一位鄉村醫生注意到:擠奶女工似乎從不得天花——他把這條線索,變成了世界上第一支疫苗。

核心想法

天花是歷史上數一數二的殺手:它奪走約三分之一被感染者的性命,又在其餘人身上留下疤痕、甚至致盲。愛德華·詹納找到的對付它的辦法,聽起來簡單得幾乎不真實。給一個人一份微小而安全的「親戚病」——牛痘,從牛身上染來、症狀輕微——他的身體就學會了抵禦天花,而無須真的去面對它。他給這辦法取名「疫苗接種(vaccination)」,源自拉丁文「vacca」,即「牛」。

它之所以管用,是因為免疫系統會記住自己打過的仗。牛痘長得與天花足夠像,於是一個戰勝過這位「溫和表親」的身體,一見到那個致命的傢伙,就認得出來,並在它站穩腳跟之前將其摧毀。

它是如何誕生的

在詹納的時代,唯一的防護是「人痘接種」——刻意讓人染上真正的天花,指望它來得輕些。它常常奏效,但有時也會致命,而且病人還可能把病傳給別人。詹納屢屢聽到奶牛之鄉的一則傳聞:染過牛痘的擠奶女工,不得天花。

1796 年,他動手驗證。他從擠奶女工莎拉·內爾梅斯手上一處牛痘膿瘡裡取出痘漿,劃進一個八歲男孩詹姆斯·菲普斯的手臂。男孩病懨懨了一天,便好了。幾週後,詹納讓他接觸真正的天花——什麼也沒發生。他把結果寫進 1798 年那本薄薄的小冊子。他並非頭一個嘗試牛痘的人——一位名叫班傑明·傑斯蒂的農夫,二十年前就給自家人這麼做過——但詹納仔細地考究它、並為它辯護,直到世界肯聽。

它為何重要

疫苗接種比人痘接種安全得多,而且能從一個人的手臂傳到下一個人,於是能從一個源頭抵達整個人群。它生長為免疫學這門科學、以及現代疫苗的實踐,並引發了人類史上唯一一場根除某種疾病的戰役:天花於 1980 年被宣告從世界上消失。此後的每一支疫苗——脊髓灰質炎的、麻疹的、新冠的——走的都是詹納開闢的那條路。

一個可以想像的畫面

把它想成給你的免疫系統看一張通緝令。牛痘是罪犯的一張草圖——不是真兇,卻像得足夠:等天花終於走進門來,身體的衛兵一眼認出這張臉,當場把它按在門口拿下。一支現代疫苗,不過是同一張通緝令、畫得更清晰也更安全的版本。

可互動的傳染病:96 人的網格。拖動接種覆蓋率滑桿為更多人免疫;中心被植入一個病例,疫情隨之展開。低於群體免疫閾值時疾病橫掃未接種者,高於閾值時傳播鏈斷裂,連未接種者也得以倖免。

它的位置

在詹納之前,有的是民間偏方和「人痘接種」這門冒險的手藝;在他之後,來了一門科學。一個世紀後,路易·巴斯德把這一構想推廣到狂犬病與炭疽,並為致敬詹納,把「vaccine(疫苗)」一詞留給了所有這些。它與本館中醫學的其他轉折點同列——哈維追蹤血液的循環、弗萊明偶然撞見青黴素——每一刻,都是細緻的觀察改寫了「一個身體能被保護免於什麼」。

The original document
Original source text
Edward Jenner · An Inquiry into the Causes and Effects of the Variolæ Vaccinæ · London, 1798
The deviation of Man from the state in which he was originally placed by Nature seems to have proved to him a prolific source of Diseases. From the love of splendour, from the indulgences of luxury, and from his fondness for amusement he has familiarised himself with a great number of animals, which may not originally have been intended for his associates.
[ … ]
There is a disease to which the Horse, from his state of domestication, is frequently subject. The Farriers have termed it the Grease. … Thus the disease makes its progress from the horse to the nipple of the cow, and from the cow to the human subject.
[ … ]
Case XVII.
The more accurately to observe the progress of the infection I selected a healthy boy, about eight years old, for the purpose of inoculation for the cow-pox. The matter was taken from a sore on the hand of a dairymaid, who was infected by her master's cows, and it was inserted, on the 14th of May, 1796, into the arm of the boy by means of two superficial incisions, barely penetrating the cutis, each about half an inch long.
On the seventh day he complained of uneasiness in the axilla, and on the ninth he became a little chilly, lost his appetite, and had a slight headache. During the whole of this day he was perceptibly indisposed, and spent the night with some degree of restlessness, but on the day following he was perfectly well.
In order to ascertain whether the boy, after feeling so slight an affection of the system from the cow-pox virus, was secure from the contagion of the small-pox, he was inoculated the 1st of July following with variolous matter, immediately taken from a pustule. Several slight punctures and incisions were made on both his arms, and the matter was carefully inserted, but no disease followed.
Several months afterwards he was again inoculated with variolous matter, but no sensible effect was produced on the constitution.
[ … ]
I presume it may be unnecessary to produce further testimony in support of my assertion that the cow-pox protects the human constitution from the infection of the small-pox.
Thus far have I proceeded in an inquiry founded, as it must appear, on the basis of experiment; in which, however, conjecture has been occasionally admitted in order to present to persons well situated for such discussions objects for a more minute investigation. In the mean time I shall myself continue to prosecute this inquiry, encouraged by the hope of its becoming essentially beneficial to mankind.
Edward Jenner · Berkeley, Gloucestershire · 1798