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改变20世纪人类历史的西班牙大流感

更新时间:2018/12/4 20:58:30 来源:纽约时报中文网 作者:佚名

The flu that transformed the 20th Century
改变20世纪人类历史的西班牙大流感

The picture we have of the 1918 flu pandemic is vastly more detailed today than it was 20 years ago, let alone 50 or 100 years ago. But it’s nowhere near complete. Pathologist Jeffery Taubenberger of the US National Institute of Allergy and Infectious Diseases – the man who in 2005, with his colleague Ann Reid, published the genetic sequence of the virus responsible for the pandemic – said at a recent conference there were still many unanswered outstanding questions.

1918年爆发的大流感横扫世界,今天我们对这场流感的认识远远比20年前详尽,更别提半世纪或一个世纪前。但是离全面掌握还远着呢。美国国家过敏症与传染病研究所的病理学家陶贝伯格(Jeffery Taubenberger)与其同事里德(Ann Reid)对9段当年流感病毒的RNA“碎片”进行分析,2005年其研究成果发表在美国《科学》杂志上。陶贝伯格在最近的一次会议上指出,仍有很多疑难之处尚未解决,找不到答案。

Researchers all over the world are working hard to answer them. But what they have already uncovered might surprise you.

世界各地的研究人员正在努力回答这些问题。但是他们已经揭示的谜团可能令人大为震惊。

The fittest were among the most vulnerable

身体越壮越易被感染

Austrian artist Egon Schiele died of influenza in October 1918, just a few days after his wife Edith, who was pregnant with their first child. In the interim, though desperately sick and grieving, he worked on a painting that depicted a family – his own – that would never exist.

1918年10月,奥地利绘画巨子席勒(Egon Schiele)因流感而病逝,就在三天前,他怀有六个月身孕的妻子爱迪斯也因这场流感已先于他过世。在这生命的最后几天,尽管席勒病情危重,悲伤不已,这位画家仍挣扎着创作了一幅作品,描绘了一个三口人的家庭,而这就是即将被流感卷走的席勒自己一家。

Schiele was 28 years old, firmly within an age group that proved acutely vulnerable to the 1918 flu. It is one reason why his unfinished painting, The Family, is often described as a poignant testimony to the disease's cruelty.

席勒当时28岁,正好处在非常易受1918年大流感侵袭的年龄段。所以席勒这幅未竟之作《家庭》(The Family)常被人称之为这场流感之残酷的凄美见证。

Because it was so deadly to 20-to-40-year-olds, the disease robbed families of their breadwinners and communities of their pillars, leaving large numbers of elderly people and orphans with no means of support. Men were at greater risk of dying than women, in general, unless the women were pregnant – in which case they died or suffered miscarriages in droves.

在这场大流感中20到40岁的青壮之士死亡率最高。大批挣钱养家的青壮年和社区的栋梁被大流感夺走了生命,留下无数的老人和孤儿无依无靠。总体而言,在这场流感中男性比女性更易染上流感而死亡,除非是妊娠女性。当时大批怀孕女性或一命呜呼或不幸流产。

Scientists don't know precisely why those in the prime of life were so vulnerable, but a possible clue lies in the fact that the elderly – always a high-risk group for flu – were actually less likely to die in the 1918 pandemic than they had been in flu seasons throughout the previous decade.

科学家不清楚为什么正值盛年的人在这场流感死亡率最高,因为通常是老年人为流感高危群体。一项可能的线索是,老人在遭遇1918年大流感之前的死亡率确实低于他们在过去十年所经历的多次季节性流感。

One theory that potentially explains both observations is "original antigenic sin" – the idea that a person's immune system mounts its most effective response to the first strain of flu it encounters. Flu is a highly labile virus, meaning that it changes its structure all the time – including that of the two main antigens on its surface, known by the shorthand H and N, that engage with the host's immune system.

有一种叫做人体“抗原原罪”(original antigenic sin,OAS)的理论或许可以解释上述两种观察现象。这个理论称,人体免疫系统遭遇首次流感病毒后产生的免疫反应对防御这种初遇病毒最为有效。但流感病毒又极不稳定,无时无刻不在发生变异(包括甲型流行病毒表面的两大类核蛋白抗原,简记为H和N)以对付寄主的免疫系统。

There's some evidence to suggest the first flu subtype that young adults in 1918 had been exposed to was H3N8, meaning they were primed to fight a very different germ from the one that caused the 1918 flu – which belonged to the H1N1 subtype. Following the same logic, the elderly may have been relatively protected in 1918 by dint of having been exposed to an H1 or N1 antigen that was circulating in the human population circa 1830.

部分实证依据显示,1918死亡的年轻人感染的第一波流感病毒亚型是H3N8,但1918年大流感是由流感病毒亚型H1N1造成,这说明当时年轻人面临的是另一种差异很大的病毒而难以抵抗。按此推理, 1830年全世界也爆发过一次大流感,那次的流感病毒是H1或N1亚型抗原,1918年时的老年人曾经历过那次流感,因此在1918年大流感中对H1N1病毒有一定抵抗力。

Death rates varied greatly across the globe

致死率在世界各地差别很大

Flu has sometimes been called a democratic disease, but in 1918 it was anything but. If you lived in certain parts of Asia, for example, you were 30 times more likely to die than if you lived in certain parts of Europe.

全球性大爆发的流感有时候被称为民主瘟疫(所谓不分贵贱,人人皆会受传染),但是1918年大流感远非如此。例如,如果是生活在亚洲某些地区,致死率是欧洲一些地区的30倍。

Asia and Africa suffered the highest death rates, in general, and Europe, North America and Australia the lowest, but there was great variation within continents too. Denmark lost around 0.4 per cent of its population, while Hungary lost around three times that. Cities tended to suffer worse than rural areas, but there was variation within cities too.

总体上看,亚洲和非洲的流感死亡率最高,欧洲、北美和澳大利亚的最低,但各个洲以内的情况也有很大差异。在丹麦,流感造成的死亡人数占总人口的0.4%,而在匈牙利,死亡率大约是丹麦的三倍。城市往往比农村的损失更惨重,但城市与城市之间也有差异。

People had a vague sense of these inequalities at the time, but it took decades for statisticians to put hard numbers on them. Once they had, they realised that the explanation must lie in differences between human populations – notably, socioeconomic differences.

人们当时已隐约感到这不均等的现象,但统计学家花了几十年才提供了确凿的数据。完成之后,他们意识到死亡率之悬殊应该是来自于群体人口的差异,特别是社会经济因素的差异。

In the US state of Connecticut, for example, the newest immigrant group – the Italians – suffered the worst losses, while in Rio de Janeiro, then the capital of Brazil, it was those inhabiting the sprawling shanty towns at the city's edge who were hit hardest.

例如,在美国的康涅狄格州,最晚的一批移民是意大利人,死亡人数最多,而在曾是巴西首都的里约热内卢,市郊不断建起的棚户区是重灾区。

Paris presented a conundrum – the highest mortality being recorded in some of the wealthiest neighbourhoods – until the statisticians realised who was dying there. It wasn't the owners of the grand apartments, but their overworked maids who slept in chilly chambres de bonne high up under the eaves.

巴黎出了个难解的现象,部分高级富人区所记录的死亡率最高。最后统计学家弄明白原来死于流感的不是豪宅的业主,而是他们过度劳累的女仆,她们夜晚是睡在屋顶下冰冷的阁楼单间里。

All over the world, the poor, immigrants and ethnic minorities were more susceptible – not, as eugenicists liked to claim, because they were constitutionally inferior, but because they were more likely to eat badly, to live in crowded conditions, to be suffering from other, underlying diseases, and to have poor access to healthcare.

在世界范围内,贫困人口、移民和少数民族更易受感染,不是因为如优生学家所谓他们体质差人一等,而更可能是因为他们饮食不好,居住拥挤,本身已患有其它疾病,以及很难获得医疗等。

Things haven't changed all that much. A study of the 2009 flu pandemic in England showed that the death rate in the poorest fifth of the population was triple that in the richest.

上述情况至今没有大幅好转。一项对英国2009年流感大流行的研究表明,在最贫困的五分之一人口中,死亡率是富人中的三倍。

It wasn't just a respiratory disease

不只是呼吸道疾病

The vast majority of those who fell sick recovered, but among the unlucky minority who did not – and they were at least 25 times more numerous, proportionately, than in other flu pandemics – the disease took a grisly course.

感染西班牙大流感的患者大部分得以康复,但是在倒地不起的贫困人口中,流感来势迅猛,发作速度很快——感染人数至少是其它流感疫情中的25倍。

They began to have trouble breathing, and their faces turned a mahogany colour. The mahogany darkened to blue – an effect doctors dubbed "heliotrope cyanosis" – and by the time they died they were black all over. The cause of death in almost all cases was not the flu itself, but opportunistic bacteria that colonised the lung lesions created by the virus, producing the symptoms of the "old man's friend", pneumonia.

患者感染后开始呼吸困难,面色发绀,变成红紫——医学上称之为“淡紫色发绀”——死时全身发青。在几乎所有病例中,死因不是流感病毒,而是并发的肺炎链球菌,这种病菌侵入被流感病毒感染的肺部,引发的症状属于肺炎,这一老年人的“特殊朋友”。

That much is relatively well known. Less well-known is that the flu affected the entire constitution. Teeth and hair fell out. People reported dizziness, insomnia, loss of hearing or smell and blurred vision. There were psychiatric after-effects, notably "melancholia" or what we might now call post-viral depression.

有关西班牙流感上述情况世人所知较多。但流感会殃及整个人体,这一点少为人知。脱发齿松,引起头晕失眠,听力下降,嗅觉减退,视力下降。甚至出现精神病后遗症,特别是“忧郁症”,或按现在的说法,叫做病毒感染后抑郁症。

It continues to be true that the waves of death associated with both flu pandemics and annual flu seasons are followed by waves of death due to other causes, notably heart attacks and strokes – indirect consequences of the inflammatory response to flu. Flu wasn't in 1918, and still isn't, exclusively a respiratory disease.

不断有实证表明,流感大流行和寻常的季节性流感会导致死亡高发,随即出现大批患者死于其它病因,特别是心脏病和中风,这些是流感引起的并发炎症。流感不仅仅是呼吸道疾病,1918年如此,现在也一样。

The pandemic transformed public health…

西班牙大流感改变了人类的公共卫生观念

Eugenics was a mainstream current of thought both before and after the 1918 flu, but the pandemic undermined it in at least one domain: infectious diseases.

优生学是1918年大流感出现前后的社会主流观点,但是大流感至少在一个领域对其有所撼动:传染病。

Previously, social Darwinist – and misguided – thinking about some human "races" or castes being superior to others had mixed insidiously with the insight of Louis Pasteur and others that infectious diseases were preventable. They produced a toxic cocktail of an idea: people who caught infectious diseases only had themselves to blame.

以前,社会达尔文主义者错误地认为,有些"人种"或等级比另外一些种族或等级优秀,他们将此观点与巴斯德(Louis Pasteur,19世纪法国微生物学家,微生物学奠基人之一)和其他科学家等人称传染病可以预防的科学见解,混为一谈,提出了一种有毒的看法:得了传染病的人只能怪责自己。

The pandemic revealed the truth: that although the poor and immigrants died in higher numbers, nobody was immune. When it came to contagion, in other words, there was no point in treating individuals in isolation or lecturing them on personal responsibility. Infectious diseases were a problem that had to be tackled at the population level.

大流感的真实情况是,虽然贫困人口和移民中的死亡率更高,但没有任何人对流感可以免疫。换句话说,当瘟疫来临,对个别患者进行隔离或者对他们讲个人的责任都毫无意义。流行传染病是要全民总动员来解决的问题。

Starting in the 1920s, this cognitive shift began to be reflected in changes to public health strategy. Many countries created or re-organised their health ministries, set up better systems of disease surveillance, and embraced the concept of socialised medicine – healthcare for all, free at the point of delivery.

自上世纪20年代起,对流感的认知转变体现在公共卫生政策的变革中。很多国家成立或重组卫生部,建立更先进的疾病监视系统,接受社会化医护的理念,即全民卫生保健,免费医疗。

There had been moves in this direction earlier – you don't put a universal healthcare system in place at the drop of a hat – but the pandemic seems to have galvanised governments. In Britain these efforts came to fruition in 1948, with the birth of the National Health Service, but Russia already had a centralised, fully public healthcare system up-and-running by 1920. To begin with only urban folk benefited (rural populations were finally covered in 1969), but it was still a major achievement, and the driving force behind it was Vladimir Lenin.

此前一直有这方面的措施,不过全民医疗卫生系统不是一蹴而就,但大流感似乎起到敦促政府的作用。英国这个方向的努力于1948年获得成果,建立起英国国民保健服务体系(National Health Service,NHS)。而俄罗斯在1920年已建立中央统筹、完全的公共卫生医疗服务体系并投入运行。起初只惠及城镇人口(1969年完成农村人口全覆盖),但仍然是很大的进步,背后的推动人物是列宁。

…and transformed society in other ways too

大流感也改变了社会的其它方面

The expression "the lost generation" has been applied to various groups of people who were alive in the early 20th Century, including the talented American artists who came of age during the First World War, and the British army officers whose lives were cut short by that war.

“失去的一代”是指20世纪初在世的一代人,包括一战期间成年的著名美国艺术家,以及战死沙场的英国军官。

But it could reasonably be argued, as I do in my book Pale Rider, that the title should really go to the millions of people in the prime of life who died of the 1918 flu, or to the children who were orphaned by it, or to those, not yet born, who suffered its slings and arrows in their mothers' wombs.

如我在《死亡骑士》中所述,也有理由认为,“失去的一代”应该是指在风华正茂时候死于1918年大流感的数百万青年,或大流感遗下的孤儿,或那些没来到世上便在娘胎里吃尽苦头的生命。他们才是实至名归的“失去的一代”。

The nature of the 1918 pandemic, and of scientific knowledge at the time, means that we don't know exactly how many there were in those three groups, but we can be certain that each one outnumbered both the Jazz-Age artists and the 35,000-odd British officers who died in combat (South Africa had an estimated 500,000 "flu orphans" alone).

1918年大流感的特点和当时的科学水平意味着我们无从确定这三类失落一代者的数子,但我们可以肯定,每一类在人数上都比爵士时代的艺术家多,也比死于一战的35000余名英国军官多(仅南非据估计就有50万名“流感造成的孤儿”)。

Those who survived the flu in utero to be born, lived with the scars until they died. Research suggests that they were less likely to graduate or earn a reasonable wage, and more likely to go to prison, than contemporaries who hadn’t been infected.

那些在大流感中母亲怀孕受到感染但能侥幸出生的人,流感创伤会伴随一生。研究表明,他们上大学的可能性较低,获得的薪资也较少,比起同代人中未受感染者,他们进监狱的几率则较高。

There is even evidence that the 1918 flu contributed to the baby boom of the 1920s, by leaving behind a smaller but healthier population that was able to reproduce at higher rates.

甚至有依据认为,1918年大流感促成了20年代的婴儿潮,因为人口虽然减少,但幸免于难活下来的人体质更好,其生儿育女的能力也很强。

That the 1918 flu cast a long shadow over the 20th Century is not in doubt. We should bear that in mind as we prepare for the next one.

毋庸置疑,1918年大流感为20世纪投下了一道长长的阴影。我们在防范另一个流感来袭时,应该将此铭记于心。

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