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热疗:糟糕的诺贝尔奖 – 译学馆
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Pyrotherapy: An Awful Nobel Prize for Infecting People with Malaria

Imagine, for a second, that’s the early 1900s,
and you got an untreatable disease
that leads to terrible mental and physical degeneration.
此时 你会让一个赤脚医生用更好的治疗手段
Would you let a sketchy doctor treat it for a slightly less awful disease
with a slightly better chance of a cure?
这就是烧蚀疗法的理论原理 它是一种带有风险的技术手段
That was the logic behind pyrotherapy, a risky technique
在20世纪初 通常被用来治疗神经梅毒
that was used to treat neurosyphilis in the early 20th century.
Neurosyphilis can happen when you don’t treat syphilis,
an infection caused by the spiral-shaped bacterium Treponema pallidum.
如今这种病比较少见 因为我们可以用抗生素来治疗
It’s rare today, because we can treat syphilis with antibiotics.
但第一种抗生素盘尼西林 直到二战才广泛投入使用
But penicillin, the first antibiotic, didn’t come into widespread use until World War II.
在那之前 没有能够杀死导致梅毒的细菌的办法
Before then, there was no known way to kill the bacteria that causes syphilis.
这是一种非常可怕 而且臭名昭著的疾病 主要是通过性接触传播
It was a terrible and stigmatized disease, typically spread by sexual contact because
of sores that form around the genitals or mouth.
发展到二期 会引发感冒和皮疹症状
The second stage of a syphilis infection involves a fever and a rash.
That didn’t advance to the dreaded neurosyphilis stage in everyone,
but it was a significant risk.
初次感染之后 神经梅毒可能会潜伏数十年
Neurosyphilis can occur decades after the initial infection, when the bacterium burrows
直到细菌病毒侵入到患者的中枢神经系统 从而引发各种可怕症状
into the patient’s central nervous system and causes a variety of awful symptoms,
including dementia-like decline and muscle paralysis.
尽管梅毒还不能彻底治愈 尤其是感染晚期
Even though there was no cure for syphilis, especially the late stage infection,
a Viennese psychiatrist named Julius Wagner-Jauregg noticed
that a neurosyphilis patient under his care
showed a remarkable improvement after coming down with a nasty fever.
He thought the fever might have helped with the disease,
但是他还没有找到可行的办法来诱发高温 来测试他这种想法
but he didn’t have a reliable way to cause a fever and test that idea.
所以他进行了一些小型 危险 有争议的实验 主要是利用肺结核
So he conducted small, dangerous, non-consensual experiments with a protein involved in tuberculosis,
伤寒菌苗中的蛋白质 及链球菌的细菌进行实验 不过并没有取得什么成就
typhoid vaccines, and a strain of Streptococcus bacteria without much success.
1917年 一名患疟疾的士兵被误送到他的精神病诊所
Then, in 1917, a soldier with malaria was sent to his psychiatric clinic by mistake.
And Wagner-Jauregg seized his chance to carry out another pretty shady experiment.
当然 这位士兵的疟疾 本身就已经很严重了
Malaria is awful, too.
It’s caused by protozoan parasites from the genus Plasmodium and
is transmitted by certain mosquitoes.
患病者高烧反复发作 而且这种疾病通常是致命的
It causes repeated bouts of high fever, among other symptoms, and is often fatal.
但跟梅毒不同 在那个时候 使用奎宁能治疗疟疾
But unlike syphilis, at the time there was a treatment for malaria in the form of quinine,
an alkaloid derived from tree bark that’s toxic to the malaria protozoa.
从17世纪 欧洲人就开始广泛的使用奎宁
Quinine had been in use by Europeans since the 17th century, and they got it from indigenous
peoples of South America who had known about it long before then.
So Wagner-Jauregg took blood from the malaria-infected soldier
and injected it into some of his neurosyphilis patients.
当然 这一做法都没有经过他们同意
Without their consent, of course.
如今看来 那是危险且违背药物实践理论的
Which we don’t consider safe or ethical medical practice today.
直到奎宁的应用才阻止疾病的恶化 否则患者就无法摆脱与疟疾和反复发烧作斗争
They came down with malaria and endured the cycles of high fever until he gave them quinine to stop it.
2/3的病患通过他的治疗 都从神经梅毒中恢复过来
Six of the nine patients he treated in this way recovered at least partially from their neurosyphilis.
其他梅毒患者得知这种治愈办法后 他们要求感染
When other syphilis patients learned there could be a cure, they asked to be infected
疟疾 因此医生开始了常规使用治疗
with malaria, and doctors began regularly using the treatment.
这就是热疗 其目的是提升身体温度 而“pyro”
It called pyrotherapy because the goal was to raise the body’s temperature, and “pyro”
是来源于希腊单词 意思是“火”
comes from the Greek word for “fire”.
总体来说 热疗已经治愈了半数的人
Overall, pyrotherapy cured about half of all the people who underwent it,
although an estimated 15% or so died from the malaria instead.
1927年 虽然他的实验违背道德
And in 1927, despite his unethical experimentation,
不过瓦格纳还是因他医学上的发现 被授予了诺贝尔奖
Wagner-Jauregg won a Nobel prize in medicine for his discovery.
第二次世界大战爆发时 需要大量的抗生素
When World War II rolled around, the need for antibiotics was massive, leading to the
这就使盘尼西林得到了发展 并广泛应用
development and widespread distribution of penicillin.
用抗生素治疗梅毒 不会让患者额外感染恶性疾病
Antibiotics cured syphilis without having to infect people with a dangerous disease
防止由副作用引发的死亡 所以从那点来说 这也是热疗为什么开始被弃用
that might kill them anyway, so at that point pyrotherapy fell out of use.
此外 二战中还发生了另外一件事
And then another thing happened around World War II,
which is that Wagner-Jauregg applied to join the Nazi party.
他主张改良人种 倡导种族纯洁性
He was a eugenicist and an advocate for racial purity.
事实是纳粹拒绝了他 认为他不够格 甚至认为他是花花公子
The fact that the Nazis rejected him is not enough to make him even remotely an okay dude,
因此这也是历史上 人们最后悔颁发给诺贝尔奖的人
and the Nobel he was awarded has gone down in history as a regrettable one.
但热疗投入使用后 确实帮助了一些人
But pyrotherapy did help some people while it was in use.
And another unexpected benefit was that having malaria on hand to treat people
led to a better understanding of how it grows and spreads.
即使在今天 疟疾仍然是一种全球性的灾祸
Even though it’s malaria that’s a global scourge today,
但是如果没有热疗 我们的情况可能更加恶化
without pyrotherapy we could have been a little worse off in our knowledge.
尽管如此 我们如今也不能完全获知热疗是为什么会奏效
Although, here’s the thing: we’re not even entirely sure why pyrotherapy worked.
当治疗中断的时候 任何研究的效用也就随之中断
When the treatment was discontinued, so was any study of its effects.
我们能做的猜想就是 他会燃烧你体内的梅毒
Our best guess is that it burns the syphilis bacteria right out of you,
因为发烧是我们体内免疫系统的一部分 他会提升我们的体温
because fever is a part of our innate immune systems — it heats us up to temperatures that are more
difficult for infectious agents to tolerate.
可是据我们所知 梅毒细菌事实上也会抵抗高温
But as far as we can tell, the syphilis bacterium is actually fairly heat-tolerant,
which doesn’t support this hypothesis.
由疟疾引发的反复高温 要使疾病情况更加严重
It could be that the repeated bouts of fever from malaria are simply too much for it, though.
我们不知道 而且也没有科学团体对这感兴趣
We just don’t know, and there’s not much appetite in the scientific community to find out.
Can’t really blame them.
还有一件奇怪的事在于 如果热疗奏效是因为热量假说
The other strange thing is that if pyrotherapy works because of the heat hypothesis,
那么 除了感染的情况外 他就不能奏效而且神经梅毒也是一种心理疾病
it shouldn’t work on anything besides infections — and neurosyphilis involves mental illness.
奇怪的是 回想希腊医学家希波克拉底的轶事
But, strangely, there are anecdotes going back to the Greek physician Hippocrates that
发烧可以治愈各种与脑类相关的疾病 比如癫痫
fever could treat a variety of brain-related illnesses, like epilepsy.
从2007年开始 之前有一件事在医疗著作中提到过
And at least one recent case in the medical literature, from 2007,
shows fever improving symptoms of psychosis.
But these cases don’t amount to any clear scientific understanding.
And if we want to find out whether heat can help ease any mental or physical illness,
我们需要科学的 严密的 清楚确切的患者同意
we’ll need scientific rigor /and/ clear, informed consent of patients — things that
weren’t on Wagner-Jauregg’s radar.
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