If you haven't ordered yet, I generally find the rigatoni with the spicy tomato sauce goes best with diseases of the small intestine.
如果你還沒有吃飯的話,我個人覺得蕃茄辣醬通心粉 和小腸感染疾病還滿配的。
(Laughter)
(笑聲)
So, sorry -- it just feels like I should be doing stand-up up here because of the setting. No, what I want to do is take you back to 1854 in London for the next few minutes, and tell the story -- in brief -- of this outbreak, which in many ways, I think, helped create the world that we live in today, and particularly the kind of city that we live in today. This period in 1854, in the middle part of the 19th century, in London's history, is incredibly interesting for a number of reasons. But I think the most important one is that London was this city of 2.5 million people, and it was the largest city on the face of the planet at that point. But it was also the largest city that had ever been built.
很抱歉,這講台的配置會讓人以為我要講脫口秀, 並不是。接下來的幾分鐘,我要帶各位 回到1854年的倫敦,我要講一個故事, 很短,關於疾病爆發的故事, 我認為這個故事幫助了我們建立現代人居住的環境, 特別是我們所居住的城市。 在1854年,也就是十九世紀中葉, 那時的倫敦在許多方面都非常有趣。 我認為最重要的是 那時的倫敦有二百五十萬人居住在內, 那是當時世界上最大的城市, 也是歷史上曾經出現過最大的城市。
And so the Victorians were trying to live through and simultaneously invent a whole new scale of living: this scale of living that we, you know, now call "metropolitan living." And it was in many ways, at this point in the mid-1850s, a complete disaster. They were basically a city living with a modern kind of industrial metropolis with an Elizabethan public infrastructure. So people, for instance, just to gross you out for a second, had cesspools of human waste in their basement. Like, a foot to two feet deep. And they would just kind of throw the buckets down there and hope that it would somehow go away, and of course it never really would go away. And all of this stuff, basically, had accumulated to the point where the city was incredibly offensive to just walk around in.
維多利亞女王時代的人希望能建立一種 新的居住模式, 這種居住模式,我們現在稱之為都市生活。 這在許多方面來說,尤其是在1850年代前後,簡直就是個大災難。 他們所謂的都市生活,其實就是將現代工業都市的模型, 套用在伊莉莎白女王時代所留下來的公共建設上。 舉例來說,讓你們體會一下, 他們就把糞坑建在地下室裡,大約就是一、二呎深吧。 然後他們就把穢物丟進去, 希望穢物有一天會自己消失, 這當然是不可能的。 在堆積了這麼多穢物後, 就算你只是走進這個城市,也會有令人作嘔的感覺。
It was an amazingly smelly city. Not just because of the cesspools, but also the sheer number of livestock in the city would shock people. Not just the horses, but people had cows in their attics that they would use for milk, that they would hoist up there and keep them in the attic until literally their milk ran out and they died, and then they would drag them off to the bone boilers down the street. So, you would just walk around London at this point and just be overwhelmed with this stench. And what ended up happening is that an entire emerging public health system became convinced that it was the smell that was killing everybody, that was creating these diseases that would wipe through the city every three or four years. And cholera was really the great killer of this period.
倫敦變得很臭,不只是因為糞坑的問題, 還有令人咋舌的家畜數量,也讓問題雪上加霜。 不只有馬,還有人在頂樓飼養乳牛,以便擠奶。 他們把乳牛趕到頂樓,關在那兒, 然後一直到榨乾乳牛的奶,直到乳牛死去, 他們再把乳牛拖下來,送到街底的屠宰場去。 所以,在那個時代走在倫敦的街上, 你恐怕會被惡臭薰死。 到後來,公共衛生部門讓大家開始相信, 就是這股惡臭害死了大家, 這股惡臭製造了瘟疫, 而且每三到四年會大流行一次。 而霍亂,正是那個時代最兇惡的殺手。
It arrived in London in 1832, and every four or five years another epidemic would take 10,000, 20,000 people in London and throughout the U.K. And so the authorities became convinced that this smell was this problem. We had to get rid of the smell. And so, in fact, they concocted a couple of early, you know, founding public-health interventions in the system of the city, one of which was called the "Nuisances Act," which they got everybody as far as they could to empty out their cesspools and just pour all that waste into the river. Because if we get it out of the streets, it'll smell much better, and -- oh right, we drink from the river. So what ended up happening, actually, is they ended up increasing the outbreaks of cholera because, as we now know, cholera is actually in the water. It's a waterborne disease, not something that's in the air. It's not something you smell or inhale; it's something you ingest.
霍亂在1832年開始侵襲倫敦,而後每四到五年會再流行一次, 每次都會奪走倫敦一萬至二萬條人命, 並且擴及全英國。 政府當局開始相信,這股惡臭就是原兇, 必須清除這股惡臭。 所以他們開始在倫敦 建立幾個類似公衛介入的系統, 其中一個叫做「干涉法案」, 公共衛生部門會將人們趕出住宅, 好將他們的糞坑清空,再把穢物倒入河裡。 因為他們覺得只要把街道清理乾淨,臭味就會消失 -- 噢,對了,我們的飲用水是來自河水耶... 這些行動最後反而 造成霍亂的大流行, 因為--我們現在已經知道--霍亂是經由飲用水傳染的。 霍亂的傳染的媒介是水,而不是空氣; 不是你所聞到或是吸入的空氣讓你生病,而是你喝下去的水。
And so one of the founding moments of public health in the 19th century effectively poisoned the water supply of London much more effectively than any modern day bioterrorist could have ever dreamed of doing. So this was the state of London in 1854, and in the middle of all this carnage and offensive conditions, and in the midst of all this scientific confusion about what was actually killing people, it was a very talented classic 19th century multi-disciplinarian named John Snow, who was a local doctor in Soho in London, who had been arguing for about four or five years that cholera was, in fact, a waterborne disease, and had basically convinced nobody of this. The public health authorities had largely ignored what he had to say. And he'd made the case in a number of papers and done a number of studies, but nothing had really stuck. And part of -- what's so interesting about this story to me is that in some ways, it's a great case study in how cultural change happens, how a good idea eventually comes to win out over much worse ideas. And Snow labored for a long time with this great insight that everybody ignored.
當公共衛生部門在十九世紀開始運作的時候, 反而在倫敦居民喝的水裡下了毒, 那個規模簡直是現代恐怖份子夢寐以求的生化戰。 這就是1854年倫敦的狀況, 有令人作嘔的惡臭,也有不為人知的大屠殺; 政府對科學一知半解, 根本不知道人們死去的真正原因。 十九世界有一位非常有才華的專業人士John Snow, 他是住在倫敦蘇活區的一位醫生, 他高唱霍亂是經由飲用水所傳染 已經有四、五年了, 但沒有人相信他。 公共衛生部門也沒有把他的話聽進去。 他還針對這件事發表了數篇論文,也做了好幾項研究, 但沒有一項被採納。 我覺得這個故事最有趣的地方在於, 這個事件在許多方面都是文化變革最好的教材。 一個好的建議要怎樣才能擊敗其他的爛建議? Snow花了許多時間與精力在這上面,但是沒有人注意到他偉大的發現。
And then on one day, August 28th of 1854, a young child, a five-month-old girl whose first name we don't know, we know her only as Baby Lewis, somehow contracted cholera, came down with cholera at 40 Broad Street. You can't really see it in this map, but this is the map that becomes the central focus in the second half of my book. It's in the middle of Soho, in this working class neighborhood, this little girl becomes sick and it turns out that the cesspool, that they still continue to have, despite the Nuisances Act, bordered on an extremely popular water pump, local watering hole that was well known for the best water in all of Soho, that all the residents from Soho and the surrounding neighborhoods would go to.
然後有一天,在1854年的八月二十八日, 一個嬰孩,五個月大的小女嬰,我們不知道她的姓, 只知道她叫露意絲,感染了霍亂, 她住在博德街四十號。 這張地圖上沒有特別標示出來, 但這張地圖是我書中後半部的重點。 這個地點在蘇活區的中央,附近是工人群聚的住宅。 這個小女嬰病了,儘管政府發佈了「干涉法案」, 但她的家人還在繼續使用他們的糞坑, 而這個糞坑緊鄰著這個住宅區最多人使用的汲水幫浦, 那還是蘇活區住民公認最好的水質, 所以蘇活區和其他附近的人都會來這裡取水。
And so this little girl inadvertently ended up contaminating the water in this popular pump, and one of the most terrifying outbreaks in the history of England erupted about two or three days later. Literally, 10 percent of the neighborhood died in seven days, and much more would have died if people hadn't fled after the initial outbreak kicked in. So it was this incredibly terrifying event. You had these scenes of entire families dying over the course of 48 hours of cholera, alone in their one-room apartments, in their little flats. Just an extraordinary, terrifying scene. Snow lived near there, heard about the outbreak, and in this amazing act of courage went directly into the belly of the beast because he thought an outbreak that concentrated could actually potentially end up convincing people that, in fact, the real menace of cholera was in the water supply and not in the air. He suspected an outbreak that concentrated would probably involve a single point source. One single thing that everybody was going to because it didn't have the traditional slower path of infections that you might expect.
結果這個小女嬰 不慎污染了公眾水源, 二到三天之後,爆發了英國有史以來 最恐怖的瘟疫。 七天之內,蘇活區有百分之十的人死於霍亂, 如果不是有人在霍亂爆發初期就逃跑了的話, 死傷的人會更多。 那時真的很可怕, 你會看到某個家族在霍亂開始傳染 的48小時內全部死亡, 死在他們那間只有一個房間的公寓裡。 那是你無法想像的恐怖。 Snow住在那附近,他知道霍亂開始流行了, 他鼓起驚人的勇氣直搗黃龍, 因為他認為這次霍亂的流行很集中, 或許可以說服人們 霍亂的真實傳播媒介是飲用水,而不是空氣。 他懷疑這麼集中的霍亂傳染, 應該可以找到某個特定傳播霍亂的水源, 這個水源是那區居民都會使用到的, 因為這次的傳染並不像人們所預期的 緩慢地流行。
And so he went right in there and started interviewing people. He eventually enlisted the help of this amazing other figure, who's kind of the other protagonist of the book -- this guy, Henry Whitehead, who was a local minister, who was not at all a man of science, but was incredibly socially connected; he knew everybody in the neighborhood. And he managed to track down, Whitehead did, many of the cases of people who had drunk water from the pump, or who hadn't drunk water from the pump. And eventually Snow made a map of the outbreak. He found increasingly that people who drank from the pump were getting sick. People who hadn't drunk from the pump were not getting sick. And he thought about representing that as a kind of a table of statistics of people living in different neighborhoods, people who hadn't, you know, percentages of people who hadn't, but eventually he hit upon the idea that what he needed was something that you could see. Something that would take in a sense a higher-level view of all this activity that had been happening in the neighborhood.
所以他跑到了傳染集中地,開始訪問附近的人。 最後他得到了一位傳奇人物的協助, 這個人算是這本書中的另一個主角。 Henry Whitehead是當地的區長, 他不是什麼科學家,但是卻很瞭解基層人民的生活方式。 他認識他區裡的所有住民, 他開始追蹤看有什麼人 喝了那個汲水幫浦裡的水, 又有誰沒有喝。 最後Snow為這次大流行畫了一幅地圖。 他發現許多喝了那個汲水幫浦裡的水的人,最後都生病了; 但沒有喝那裡的水的人,卻沒有生病。 他本來想為住在不同區域的人 繪製一張統計圖表, 看看哪些人沒有得到霍亂; 但最後他想到了一個點子, 他要做的是讓人可以一看就明白的東西。 他要讓人一看就知道, 這個區域究竟發生了什麼事。
And so he created this map, which basically ended up representing all the deaths in the neighborhoods as black bars at each address. And you can see in this map, the pump right at the center of it and you can see that one of the residences down the way had about 15 people dead. And the map is actually a little bit bigger. As you get further and further away from the pump, the deaths begin to grow less and less frequent. And so you can see this something poisonous emanating out of this pump that you could see in a glance. And so, with the help of this map, and with the help of more evangelizing that he did over the next few years and that Whitehead did, eventually, actually, the authorities slowly started to come around. It took much longer than sometimes we like to think in this story, but by 1866, when the next big cholera outbreak came to London, the authorities had been convinced -- in part because of this story, in part because of this map -- that in fact the water was the problem.
他最後畫出了這幅地圖, 他用黑線來代表死去的人, 並在街道圖上的每一個門牌標識出死亡人數。 在這張地圖上你會看到,汲水幫浦在地圖的中央, 在它旁邊的住家 就死了十五個人。 這幅地圖本來比現在看到的大一點, 離汲水幫浦愈遠的住家, 死亡人數就呈現遞減狀況。 你可以從這張圖清楚地看到毒物擴散的狀況, 也就是以汲水幫浦為中心的發散狀況。 然後,靠著這張地圖, 他以宣講福音的熱情, 又宣導了好幾年, Whitehead也幫忙宣導, 政府當局終於慢慢瞭解這是怎麼一回事了。 他們所花的時間比我們想像的還要久, 但是在1866年第二次霍亂大流行在倫敦爆發的時候, 政府當局終於相信--部分是因為上一次的教訓, 部分是因為這幅地圖--問題出在飲用水上。
And they had already started building the sewers in London, and they immediately went to this outbreak and they told everybody to start boiling their water. And that was the last time that London has seen a cholera outbreak since. So, part of this story, I think -- well, it's a terrifying story, it's a very dark story and it's a story that continues on in many of the developing cities of the world. It's also a story really that is fundamentally optimistic, which is to say that it's possible to solve these problems if we listen to reason, if we listen to the kind of wisdom of these kinds of maps, if we listen to people like Snow and Whitehead, if we listen to the locals who understand what's going on in these kinds of situations. And what it ended up doing is making the idea of large-scale metropolitan living a sustainable one.
那時倫敦正在興建污水下水道, 所以政府當局立刻來到霍亂爆發點, 要求每一個人要飲用煮沸過的水。 自從那次之後,倫敦就不曾再發生過霍亂大流行了。 所以,這個故事,嗯,是有點嚇人, 而且有點恐怖, 但是這個故事卻成了世界上許多城市發展的教材。 這個故事基本上還是有樂觀的一面, 它告訴我們問題是可以解決的, 只要我們找到原因、只要我們看看這幅地圖背後所隱藏的智慧、 只要我們聽取像Snow或是Whitehead這類人的意見、 只要我們尊重瞭解狀況的 當地人的聲音, 最後我們一定能讓 這麼大規模的城市穩健地發展起來。
When people were looking at 10 percent of their neighborhoods dying in the space of seven days, there was a widespread consensus that this couldn't go on, that people weren't meant to live in cities of 2.5 million people. But because of what Snow did, because of this map, because of the whole series of reforms that happened in the wake of this map, we now take for granted that cities have 10 million people, cities like this one are in fact sustainable things. We don't worry that New York City is going to collapse in on itself quite the way that, you know, Rome did, and be 10 percent of its size in 100 years or 200 years. And so that in a way is the ultimate legacy of this map. It's a map of deaths that ended up creating a whole new way of life, the life that we're enjoying here today. Thank you very much.
當人們在七天內目睹了百分之十 的鄰居死亡, 大家都知道不能再這樣下去了, 也就是城市不應該擠進二百五十萬人口。 但由於Snow製作出了這張地圖, 也因為這張地圖喚醒政府當局 進行了一連串的改革, 我們現在對於擁有千萬以上居民的城市,早已司空見慣。 這種規模的城市可以持續存在, 我們不會擔心紐約有一天 會像羅馬帝國那樣瓦解, 在100或200年之後縮小到只有原來百分之十的規模。 這或許是這幅地圖所留給我們最好的遺產, 雖然這是一張死屍地圖,但卻為我們創造了全新的生活方式, 讓我們在今日得以享受人生。謝謝各位。