Why is it so dangerous to step on a rusty nail? - Louise Thwaites

譯者: Lilian Chiu 審譯者: 麗玲 辛

In the 5th century, Greek physician Hippocrates,

在第五世紀，

立下希波克拉底誓詞的 希臘醫生希波克拉底，

creator of the Hippocratic Oath, was sailing with a very ill shipmaster.

和一位病得很重的船長一同航行。

The captain was suffering a nasty infection

船長受到嚴重的感染，

that caused his jaws to press together, his teeth to lock up,

導致他的上下顎緊壓在一起，

牙齒緊咬，

and the muscles in his neck and spine to spasm.

頸部和脊椎的肌肉都在痙攣。

Hippocrates dutifully recorded these symptoms,

希波克拉底盡職地 記錄下了這些症狀，

but he was unable to treat the mysterious disease.

但他無法治療這種神秘的疾病。

And six days later, the shipmaster succumbed to his illness.

六天後，船長病逝。

Today, we know this account to be one of the first recorded cases of tetanus,

現今，我們知道這段記載 是最早被記錄的破傷風案例之一，

and thankfully, modern physicians are much more prepared

且，謝天謝地，現代醫生 更有辦法處理這種特殊的感染。

to handle this peculiar infection.

Unlike other common bacterial infections like tuberculosis and strep throat,

與其他常見的細菌感染 （如結核病和鏈球菌性喉炎）不同，

tetanus doesn’t pass from person to person.

破傷風不會人傳人。

Instead, the offending bacterium, known as Clostridium tetani,

反之，身為罪魁禍首的破傷風桿菌

infects the body through cuts and abrasions.

會透過割傷和擦傷感染身體。

These infection sites are why tetanus is so strongly associated

這些感染部位正是破傷風和 生鏽釘子及廢金屬息息相關的原因，

with rusty nails and scrap metal, which can cause such wounds,

它們都有可能造成這類傷口，

but the condition's connection to rust is actually much less direct.

但這種疾病與生鏽的關聯 其實不那麼直接。

Clostridium tetani bacteria are often found in soil, manure, and dead leaves,

破傷風桿菌通常存在於 土壤、肥料，和枯葉中，

where they can survive for years in the form of spores,

在這些地方，它們可以 以孢子的形式存活數年，

even amidst extreme heat and dryness.

連極端的高溫和乾燥都不怕。

These piles of organic material can sit undisturbed for long periods,

這些堆積起來的有機材料 有可能長時間都不會被動到，

potentially concealing old metal, which rusts over time.

因此有可能會有金屬 藏在裡面，隨著時間生鏽。

So, if someone does blunder into this environment and cuts themselves,

如果有人不慎進入這個環境且被割傷，

it would likely increase their odds of infection.

就可能會增加他們被感染的機率。

Especially since rusty metal can create jagged wounds

尤其因為生鏽的金屬 可能會造成參差不齊的傷口，

with lots of deoxygenated dead tissue for them to latch on to.

有大量的缺氧死組織， 讓孢子可以附著。

Once in the body, the spores begin to germinate.

進入體內後，孢子就會開始發芽。

This process releases several toxins, including deadly tetanus toxin.

這個過程會釋放數種毒素，

包括致命的破傷風毒素。

Nerve endings soak up this toxin,

神經末稍會吸收這種毒素，

drawing it into the brain and spinal cord where it wreaks havoc on interneurons.

將毒素導入大腦和脊髓，在那裡 毒素會大肆破壞中樞神經元。

Typically, these work alongside motor neurons to regulate our muscle actions,

通常，這些神經元會搭配運動神經 來調節我們的肌肉動作，

from endeavors as complex as kicking a ball to those as simple as breathing.

包括各種動作，複雜如踢球， 簡單的像呼吸。

But by blocking neurotransmitters released by interneurons,

但因為會阻斷中樞神經元 釋放的神經傳遞質，

tetanus toxin causes uncontrollable muscle contractions and spasms.

破傷風毒素會造成 無法控制的肌肉收縮和痙攣。

Typically within 7 to 10 days of infection,

通常在感染後的七到十天內，

patients begin experiencing general aches, trouble swallowing, and lockjaw.

病人會開始出現全身疼痛、 吞嚥困難、牙關緊咬。

The head and neck tend to show symptoms first.

頭部和頸部通常會先出現症狀。

But as the toxin spreads, stronger muscle groups become more rigid,

但隨著毒素擴散， 更強壯肌群會變得更僵硬，

leading to a frightening arching of the back.

導致背部出現可怕的弧形。

Left untreated, these spasms become more extreme,

若不治療，痙攣會變得更嚴重，

eventually seizing the muscles in the windpipe and chest,

最終會使氣管和胸部的肌肉痙攣，

leading patients to suffocate within 72 hours of symptoms appearing.

導致患者在症狀出現後 七十二小時內因窒息死亡。

Without treatment, tetanus has an extremely low rate of survival.

若沒有治療，破傷風的生存率極低。

But fortunately, medical professionals have developed a robust plan

但幸運的是，

醫療專業人員已經開發出 完善的計畫來處理破傷風診斷。

to handle a tetanus diagnosis.

First, doctors clean the infected wound and administer antibiotics,

首先，醫生會清潔受感染的傷口，

並讓病人服用抗生素，

killing the bacteria and preventing further toxin production.

殺死細菌，並防止進一步的毒素產生。

Then, they inject antitoxin to neutralize any tetanus toxin

然後，他們注射抗毒素，

以中和留存在身體中、但尚未 進入中央神經系統的破傷風毒素。

still in the body that has yet to enter the central nervous system.

Finally, patients begin a several week period of supportive care,

最後，病人開始接受 數週的支持性治療，

which can include muscle relaxants to stop spasms

可能包括肌肉鬆弛劑以阻止痙攣，

and ventilators to prevent suffocation.

及呼吸器以防止窒息。

In the days of Hippocrates, the only course of treatment was to wait and hope.

在希波克拉底的時代，唯一的 治療方案就是等待和希望。

But now we know the best time to tackle Clostridium tetani

但現在，我們知道處理 破傷風桿菌的最佳時機

is before an infection even takes place.

是在感染發生之前。

Tetanus vaccines— originally developed in the early 1920s—

破傷風疫苗最初 是在 1920 年代被開發出來，

are crucial to preventing tetanus and stopping its spread.

對於預防和阻止破傷風至關重要。

Experts recommend a series of shots and boosters beginning at two months old

專家建議接種一系列疫苗和加強劑，

從兩個月大開始， 一直到約十二歲結束。

and ending around age 12.

Yet over 20,000 infants still die of tetanus every year,

但，每年仍有超過 兩萬名嬰兒死於破傷風，

mostly in low and middle income countries where vaccine access is limited,

大部分發生在中低收入國家，

在那裡不容易取得疫苗，

including South Asia and sub-Saharan Africa.

包括南亞和撒哈拉以南非洲。

And newborn babies are especially at risk if their mothers are unvaccinated,

如果母親未接種疫苗， 其新生兒的風險特別高，

as Clostridium tetani can infect a newborn's umbilical stump.

因為破傷風桿菌可能會 感染新生兒的臍帶殘端。

Though vaccinating mothers during pregnancy can help with this problem.

不過，讓母親在懷孕期間 接種疫苗有助解決這個問題。

The fact is tetanus remains a significant threat to human health.

事實是，破傷風仍然 是對人類健康的重大威脅。

So people should get vaccinated

因此，人們應該接種疫苗， 並在被割傷後，採取措施防止感染，

and take measures to prevent infection after cutting themselves—

whether it’s on a rusty nail or a 2,400-year-old ship anchor.

不論「兇器」是生鏽釘子， 還是有兩千四百年歷史的船錨。