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医学 1798

牛痘成因与影响之探究

爱德华·詹纳

一份轻微的牛痘,教会身体战胜致命的天花——第一支疫苗。

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In depth · the introduction

一位乡村医生注意到:挤奶女工似乎从不得天花——他把这条线索,变成了世界上第一支疫苗。

核心想法

天花是历史上数一数二的杀手:它夺走约三分之一被感染者的性命,又在其余人身上留下疤痕、甚至致盲。爱德华·詹纳找到的对付它的办法,听起来简单得几乎不真实。给一个人一份微小而安全的「亲戚病」——牛痘,从牛身上染来、症状轻微——他的身体就学会了抵御天花,而无须真的去面对它。他给这办法取名「疫苗接种(vaccination)」,源自拉丁文「vacca」,即「牛」。

它之所以管用,是因为免疫系统会记住自己打过的仗。牛痘长得与天花足够像,于是一个战胜过这位「温和表亲」的身体,一见到那个致命的家伙,就认得出来,并在它站稳脚跟之前将其摧毁。

它是如何诞生的

在詹纳的时代,唯一的防护是「人痘接种」——刻意让人染上真正的天花,指望它来得轻些。它常常奏效,但有时也会致命,而且病人还可能把病传给别人。詹纳屡屡听到奶牛之乡的一则传闻:染过牛痘的挤奶女工,不得天花。

1796 年,他动手验证。他从挤奶女工莎拉·内尔梅斯手上一处牛痘脓疮里取出痘浆,划进一个八岁男孩詹姆斯·菲普斯的手臂。男孩病恹恹了一天,便好了。几周后,詹纳让他接触真正的天花——什么也没发生。他把结果写进 1798 年那本薄薄的小册子。他并非头一个尝试牛痘的人——一位名叫本杰明·杰斯蒂的农夫,二十年前就给自家人这么做过——但詹纳仔细地考究它、并为它辩护,直到世界肯听。

它为何重要

疫苗接种比人痘接种安全得多,而且能从一个人的手臂传到下一个人,于是能从一个源头抵达整个人群。它生长为免疫学这门科学、以及现代疫苗的实践,并引发了人类史上唯一一场根除某种疾病的战役:天花于 1980 年被宣告从世界上消失。此后的每一支疫苗——脊髓灰质炎的、麻疹的、新冠的——走的都是詹纳开辟的那条路。

一个可以想象的画面

把它想成给你的免疫系统看一张通缉令。牛痘是罪犯的一张草图——不是真凶,却像得足够:等天花终于走进门来,身体的卫兵一眼认出这张脸,当场把它按在门口拿下。一支现代疫苗,不过是同一张通缉令、画得更清晰也更安全的版本。

可交互的传染病:96 人的网格。拖动接种覆盖率滑块为更多人免疫;中心被植入一个病例,疫情随之展开。低于群体免疫阈值时疾病横扫未接种者,高于阈值时传播链断裂,连未接种者也得以幸免。

它的位置

在詹纳之前,有的是民间偏方和「人痘接种」这门冒险的手艺;在他之后,来了一门科学。一个世纪后,路易·巴斯德把这一构想推广到狂犬病与炭疽,并为致敬詹纳,把「vaccine(疫苗)」一词留给了所有这些。它与本馆中医学的其他转折点同列——哈维追踪血液的循环、弗莱明偶然撞见青霉素——每一刻,都是细致的观察改写了「一个身体能被保护免于什么」。

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