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【簡(jiǎn)譯】Renkioi醫(yī)院

2023-08-01 09:49 作者:神尾智代 0人讀過 | 我要投稿

克里米亞戰(zhàn)爭(zhēng)中的醫(yī)院是什么樣的？

? ? ? ? ? 在克里米亞戰(zhàn)爭(zhēng)中，有兩家醫(yī)院值得一提。第一家醫(yī)院位于斯庫塔里，因缺乏衛(wèi)生條件而聲名狼藉，直到弗洛倫斯·南丁格爾（Florence Nightingale）才改善了情況。第二家醫(yī)院是Renkioi醫(yī)院，這是一家預(yù)制綜合醫(yī)院，由工程師布魯內(nèi)爾（Brunel）根據(jù)新式健康和衛(wèi)生理念設(shè)計(jì)而成。

南丁格爾在克里米亞的哪家醫(yī)院工作過？

? ? ? ? ? 克里米亞戰(zhàn)爭(zhēng)期間，弗洛倫斯·南丁格爾曾在斯庫塔里醫(yī)院工作，大大改善了該醫(yī)院因衛(wèi)生條件差而導(dǎo)致死亡的糟糕情況。

Renkioi醫(yī)院有什么特別之處？

? ? ? ? ? Renkioi?醫(yī)院之所以具有創(chuàng)新性，是因?yàn)樗且蛔A(yù)制建筑，具有許多促進(jìn)良好個(gè)人衛(wèi)生和環(huán)境衛(wèi)生的設(shè)計(jì)特點(diǎn)，從而減少了不必要的疾病致死。

The Renkioi Hospital, was a complex of innovative prefabricated buildings designed by Isambard Kingdom Brunel for use during the Crimean War (1853-56). Brunel had been moved by the heavy casualties and even higher deaths via disease during the war, and his 1,000-bed hospital included the latest ideas in ventilation and sanitation as advocated by such nursing pioneers as Florence Nightingale.

? ? ? ? ? Renkioi醫(yī)院是伊桑巴德·金德姆·布魯內(nèi)爾（Isambard Kingdom Brunel）為克里米亞戰(zhàn)爭(zhēng)（1853-1856年）設(shè)計(jì)的創(chuàng)新型預(yù)制建筑群。布魯內(nèi)爾對(duì)戰(zhàn)爭(zhēng)期間大量的人員傷亡和更高的疾病死亡率深有感觸，他設(shè)計(jì)的這座擁有1000張床位的醫(yī)院采用了弗洛倫斯·南丁格爾（Florence Nightingale）等護(hù)理先驅(qū)開創(chuàng)的通風(fēng)和衛(wèi)生方面的最新理念。

克里米亞戰(zhàn)爭(zhēng)和弗洛倫斯·南丁格爾

The Crimean War was fought between Russia and the Ottoman Empire whose allies included Great Britain. Russia had long been seeking to grab territory from the crumbling Ottoman Empire, and it invaded the Danubian principalities (the Ottoman tributaries of Moldavia and Wallachia) in 1853. Both Britain and France declared war on Russia when it refused to withdraw. An allied expeditionary force was sent to attack Sevastopol on the Black Sea Coast of the Crimea, which was Russia's main naval base in the region. In 1854, a siege of Sevastopol began which lasted a year. The war became a tale of military mismanagement and incompetence, most infamously exampled by the disastrous Charge of the Light Brigade during the Battle of Balaclava in October 1854. The allies won important victories but at a tremendous cost in casualties and lives.

? ? ? ? ? 克里米亞戰(zhàn)爭(zhēng)是俄國與奧斯曼帝國之間的戰(zhàn)爭(zhēng)，奧斯曼帝國的盟國包括英國。長(zhǎng)期以來，俄國一直試圖從搖搖欲墜的奧斯曼帝國手中奪取領(lǐng)土，并于1853年入侵多瑙河公國（奧斯曼帝國的附庸國摩爾達(dá)維亞和瓦拉幾亞）。當(dāng)俄國拒絕撤軍時(shí)，英國和法國向其宣戰(zhàn)。一支聯(lián)盟遠(yuǎn)征軍被派往進(jìn)攻克里米亞黑海沿岸的塞瓦斯托波爾，那里是俄國在該地區(qū)的主要海軍基地。1854年，對(duì)塞瓦斯托波爾的圍攻開始，持續(xù)了一年。1854年10月，在巴拉克拉瓦戰(zhàn)役中發(fā)生了災(zāi)難性的“輕騎兵的沖鋒（Charge of the Light Brigade）”事件。聯(lián)盟遠(yuǎn)征軍雖然取得了重大勝利，但也付出了巨大的傷亡和生命代價(jià)。

It was horror stories of the dreadful fate of thousands of British soldiers – wounded in battle, underfed, underclothed, lacking in medicine, and battling outbreaks of cholera – that motivated the famed engineer Isambard Kingdom Brunel (1806-1859) to do something to help. Journalists like William Howard Russell (1820-1907) used the new electrical telegraph to send home shocking reports of the terrible conditions for all sides in the war. In a mere six months from 1854 to 1855, of the 56,000 British soldiers sent to the Crimea, 34,000 died, and for some 16,300 of these, the cause was disease. The English nurse Florence Nightingale (1820-1910) was also motivated to help, and she became the supervisor of nursing in British army hospitals and an outspoken critic of government and military ineptitude. The death rate of patients in military hospitals had been 42%, but Nightingale reduced this figure with her strict regime of hygiene, good ventilation, and dietary care for patients, greatly reducing deadly cases of cholera, dysentery, and typhus. Despite her successful new regime, Nightingale lobbied the government for new and better medical facilities for the war wounded.

? ? ? ? ? 成千上萬的英國士兵在戰(zhàn)場(chǎng)上受傷、吃不飽、穿不暖、缺醫(yī)少藥、霍亂肆虐，這些可怕的命運(yùn)促使著名工程師伊桑巴德·金德姆·布魯內(nèi)爾（Isambard Kingdom Brunel，1806-1859年）采取行動(dòng)提供幫助。威廉·霍華德·拉塞爾（William Howard Russell，1820-1907）等記者使用新式電報(bào)機(jī)向國內(nèi)發(fā)出有關(guān)戰(zhàn)爭(zhēng)各方嚴(yán)峻狀況的令人震驚的報(bào)告。從 1854年到1855年，在短短六個(gè)月的時(shí)間里，派往克里米亞的56000名英國士兵中有 34000人死亡，其中約16300人死于疾病。英國護(hù)士弗洛倫斯·南丁格爾（Florence Nightingale，1820-1910年）也積極提供幫助，她成為英國軍隊(duì)醫(yī)院的護(hù)理主管，并直言不諱地批評(píng)政府和軍隊(duì)的無能。軍醫(yī)院的病人死亡率曾高達(dá)42%，但南丁格爾通過嚴(yán)格的衛(wèi)生管理、良好的通風(fēng)和對(duì)病人的飲食照顧，降低了這一數(shù)字，大大減少了霍亂、痢疾和斑疹傷寒的死亡人數(shù)。盡管她的管理模式取得了成功，但南丁格爾仍游說政府為戰(zhàn)爭(zhēng)傷員提供新的、更好的醫(yī)療設(shè)施。

Brunel's contribution to the war effort was two-fold: the giant steamship he designed and built, SS Great Western, was used as a troopship, and he invented an entirely new kind of hospital. Brunel also drew up plans for floating batteries of cannons that could be used on water to fire at coastal fortresses, but the Admiralty, a rather ponderous institution not known for its rapid innovation, neither approved nor disapproved of the plans, and so this third area of assistance came to nothing.

? ? ? ? ? 布魯內(nèi)爾為戰(zhàn)爭(zhēng)做出了兩方面的貢獻(xiàn)：他設(shè)計(jì)和建造的巨型蒸汽船“大西方號(hào) (SS Great Western)”號(hào)被用作運(yùn)兵船，他還創(chuàng)造了一種全新的醫(yī)院。布魯內(nèi)爾還設(shè)計(jì)了可在水中使用的浮動(dòng)炮臺(tái)，可以向沿海堡壘開火，但海軍部這個(gè)相當(dāng)笨重的機(jī)構(gòu)并不以快速創(chuàng)新而聞名，它既不批準(zhǔn)也不反對(duì)這些計(jì)劃，因此第三個(gè)方面的幫助最終無果而終。

預(yù)制設(shè)計(jì)

The main hospital for the British Army during the Crimean War was at Scutari, but its reputation was so bad that more than one source described it as "a national disgrace" (Bryan, 142). Scutari was one of many others areas of incompetence during the conflict that led to the fall of the government in January 1855. A new government led by Lord Palmerston at least responded to the public outcry and launched an investigation into conditions in the Crimea, conducted by a Sanitary Commission. In February, things began to move in a better direction when Brunel was contacted by Benjamin Hawes, the Permanent Undersecretary at the War Office who was also a friend and brother-in-law of Brunel. Given the urgent need, the engineer was asked to design an entire field hospital which could be shipped to the Crimea and made on-site as quickly as possible. Acutely aware of the hardships being endured in the ongoing conflict, Brunel took just a couple of weeks to submit his plans for the hospital to the War Office.

? ? ? ? ? 克里米亞戰(zhàn)爭(zhēng)期間，英國陸軍的主要醫(yī)院位于斯庫塔里，但其聲譽(yù)極差，不止一個(gè)消息來源將其描述為“國家恥辱”（Bryan，142）。斯庫塔里是沖突期間導(dǎo)致政府于1855 年1月垮臺(tái)的無能地區(qū)之一。由巴麥尊勛爵領(lǐng)導(dǎo)的新政府至少對(duì)公眾的呼聲做出了回應(yīng)，并由衛(wèi)生委員會(huì)對(duì)克里米亞的狀況展開了調(diào)查。2月，布魯內(nèi)爾與陸軍部常務(wù)次官本杰明·霍伊斯（Benjamin Hawes）取得聯(lián)系，事情開始向好的方向發(fā)展，霍伊斯也是布魯內(nèi)爾的朋友兼姐夫。鑒于情況緊急，這位工程師被要求設(shè)計(jì)一座完整的野戰(zhàn)醫(yī)院，可以盡快運(yùn)到克里米亞并在現(xiàn)場(chǎng)建造。布魯內(nèi)爾清楚地意識(shí)到正在進(jìn)行的沖突所帶來的苦難，他只用了幾周時(shí)間就向陸軍部提交了新醫(yī)院的計(jì)劃。

Brunel's hospital was to be made of prefabricated sections which could be easily shipped to their destination and then assembled without the need for skilled carpenters, joiners, and plumbers. The idea of prefabricating pieces was likely inspired by the success of the giant Crystal Palace, the host of the 1851 Great Exhibition in London. The Crystal Palace was designed by Sir Joseph Paxton (1801-1865), based on his own smaller structure of glass and iron at the home of the Duke of Devonshire, Chatsworth House. It, too, had had to meet the requirement of being a temporary building that was quick to build. The Crystal Palace had both glass walls and roofing supported by iron framing set on concrete foundations; it took just four months to build.

? ? ? ? ? 布魯內(nèi)爾的醫(yī)院由預(yù)制部件組成，這些預(yù)制部件可以很容易地運(yùn)到目的地，然后無需熟練的木匠、細(xì)木工和水管工就可以組裝起來。預(yù)制部件的想法很可能是受到1851年倫敦大博覽會(huì)主辦方巨型水晶宮的成功啟發(fā)。水晶宮由約瑟夫·帕克斯頓爵士（1801-1865年）設(shè)計(jì)，以他在德文郡公爵宅邸查茨沃斯莊園設(shè)計(jì)的小型玻璃和鐵結(jié)構(gòu)為基礎(chǔ)。它也必須滿足快速建造臨時(shí)建筑的要求。水晶宮的玻璃墻和屋頂都是由混凝土地基上的鐵架支撐的，僅用了四個(gè)月的時(shí)間就建成了。

Brunel had himself used partially prefabricated elements to build Paddington Station at the London end of his Great Western Railway. Prefabrication went well with the modern idea that buildings should prioritise form and function over the purely decorative. In addition, the idea of prefabrication appealed to engineers like Brunel who saw the new capabilities of mass-producing machines during the Industrial Revolution as a more efficient and cost-effective substitute for skilled labour.

? ? ? ? ? 布魯內(nèi)爾曾在他的大西部鐵路倫敦終點(diǎn)站帕丁頓車站建造中使用了部分預(yù)制構(gòu)件。預(yù)制構(gòu)件非常符合現(xiàn)代理念，即建筑物應(yīng)優(yōu)先考慮形式和功能，而不是純粹的裝飾。此外，預(yù)制構(gòu)件的理念也吸引了像布魯內(nèi)爾這樣的工程師，他們認(rèn)為工業(yè)革命期間機(jī)器大規(guī)模生產(chǎn)的新能力可以更高效、更經(jīng)濟(jì)地替代熟練勞動(dòng)力。

規(guī)劃設(shè)施

Brunel came up with the idea of several ward buildings all built to the same specifications. The individual pieces of the buildings were made of wood and specifically designed so that each piece was not too heavy for one or two men to carry and put in the correct position on site. Each building would hold 48 beds divided equally into two wards, although Brunel allowed for the possibility that each building could be easily extended if required. The total capacity for the hospital would be around 1,000 beds. The design included facilities for washing and good sanitation with plenty of water taps, bathrooms (including specially adapted baths that could be used by invalids), stoves for heating water and the wards, lavatories, drains, and good ventilation provided by fans. There were, too, additional iron buildings devoted to cooking and laundry. Brunel forgot no detail, even including toilet paper in his master plan of what went where once everything was assembled.

? ? ? ? ? 布魯內(nèi)爾提出了按照相同規(guī)格建造多個(gè)病房模塊的想法。這些建筑的各個(gè)部分都由木頭制成，并經(jīng)過專門設(shè)計(jì)，使每個(gè)部分都不會(huì)太重，一兩個(gè)人就能搬運(yùn)并在現(xiàn)場(chǎng)擺放到正確的位置。每棟建筑可容納 48 張病床，平均分成兩個(gè)病房，不過布魯內(nèi)爾也考慮到了在需要時(shí)每棟建筑都可以輕松擴(kuò)建的可能性。醫(yī)院的總?cè)萘考s為1000張病床，設(shè)計(jì)包括盥洗設(shè)施和良好的衛(wèi)生條件，有大量的水龍頭、浴室（包括經(jīng)過特別改造的供殘疾人使用的浴缸）、用于燒水和為病房供暖的爐子、盥洗室（廁所）、下水道以及由風(fēng)扇提供的良好通風(fēng)設(shè)施。另外，還有專門用于烹飪和洗衣的鐵架結(jié)構(gòu)建筑。布魯內(nèi)爾沒有忘記任何一個(gè)細(xì)節(jié)，甚至在他的總體規(guī)劃中還包括了衛(wèi)生紙，即在所有設(shè)備組裝完畢后，所有東西的擺放位置。

All of these elements seem rather simple and obvious nowadays, but at the time, they were revolutionary. Medical treatment in the field of battle was still rudimentary at best, often involving canvas tents or a private villa requisitioned for the purpose of serving as a temporary hospital. The availability of equipment was entirely dependent on the foresight of individual doctors. This was also a period when disease was still the biggest killer in warfare, not bullets, and such organisations as the Red Cross had yet to be founded (1863). The Renkioi plan was certainly breaking new ground.

? ? ? ? ? 所有這些要素在今天看來都很簡(jiǎn)單明了，但在當(dāng)時(shí)卻是革命性的。戰(zhàn)場(chǎng)上的醫(yī)療服務(wù)充其量還很簡(jiǎn)陋，通常是搭建帆布帳篷或征用私人鄉(xiāng)村別墅作為臨時(shí)醫(yī)院。設(shè)備的可用性完全取決于醫(yī)生個(gè)人的遠(yuǎn)見卓識(shí)。這一時(shí)期，疾病而非子彈仍是戰(zhàn)爭(zhēng)中的最大殺手，紅十字會(huì)等組織也尚未成立（1863年）。Renkioi醫(yī)院計(jì)劃無疑開辟了新天地。

The hospital design was approved by the War Office, and Brunel set about building the component parts and then planning the tremendous logistics involved of not only shipping the prefabricated elements to the Crimea – around 11,500 tons of material in all – but also ensuring the right tools and assembly instructions went with them. Brunel's design meant that men did not need to be specially trained to build the hospital at its final destination. All that was needed to put the hospital buildings together was a number of ships for transportation, muscle power on site, and a spot with relatively flat ground.

? ? ? ? ? 醫(yī)院的設(shè)計(jì)得到了陸軍部的批準(zhǔn)，布魯內(nèi)爾開始建造醫(yī)院的各個(gè)組成部分，然后規(guī)劃龐大的后勤工作，不僅要將預(yù)制構(gòu)件（共約11500噸材料）運(yùn)往克里米亞，還要確保隨車攜帶正確的工具和組裝說明。布魯內(nèi)爾的設(shè)計(jì)意味著在最終目的地建造醫(yī)院的人員無需經(jīng)過專門培訓(xùn)。將醫(yī)院建筑組裝在一起所需的只是一些運(yùn)輸船只、現(xiàn)場(chǎng)的人力以及一個(gè)地勢(shì)相對(duì)平坦的地點(diǎn)。

地圖顯示由伊桑巴德·金德姆·布魯內(nèi)爾（1806-1859 年）設(shè)計(jì)、供克里米亞戰(zhàn)爭(zhēng)（1853-6 年）期間使用的創(chuàng)新預(yù)制Renkioi 醫(yī)院的布局

拯救生命

Brunel's assistant John Brunton was given the responsibility of supervising the construction of the hospital at a new location, Renkioi (sometimes spelt Renkoi) rather than at Scutari 100 miles (160 km) distant. Brunton was given the rank of major, and he headed to the Crimea in March with a team of 30 members of the Army Works Corps. Meanwhile, Brunel organised the shipment of the prefabricated buildings so that they arrived on site on 7 May.

? ? ? ? ? 布魯內(nèi)爾的助手約翰·布倫頓（John Brunton）受命在新地點(diǎn) Renkioi（有時(shí)拼寫為 Renkoi）監(jiān)督醫(yī)院的建設(shè)，而不是在100英里外的斯庫塔里 (Scutari)。布倫頓被任命為專員，并于3月率領(lǐng)一支由30名陸軍工程兵組成的隊(duì)伍前往克里米亞。與此同時(shí)，布魯內(nèi)爾安排了預(yù)制建筑的運(yùn)輸，使其于5月7日抵達(dá)現(xiàn)場(chǎng)。

The first buildings and first 300 beds were ready by mid-July of 1855, but the conduct of the war continued to be as inefficient as previously, and no patients were admitted to the hospital until 2 October. The problem was that Renkioi, selected for its flat ground, was too far from the fighting front, and patients had to come in by ship. The hospital itself was not entirely finished until December when all 1,000 beds were made available. The medical officer in charge of Renkioi, Dr Edmond Parkes, gave the following description of the facilities:

? ? ?The construction of the hospital was admirably adapted for the men recovering from illness. As all the wards were on the ground, as soon as a man could crawl he could get into the air, either in the cool and sheltered corridor or in the spaces round the hospital.

? ? ?The anticipations we had formed of the health of the spot and of its adaptability for a hospital were quite confirmed by the experience of more than a year. The winter was mild and the climate seemed especially adapted for pulmonary complaints, of which we had a large number. The changes of temperature, it is true, were very sudden and great, but as the men had warm wards, these changes were not felt and there were few days in all but the most delicate and consumptive patient could not get out into the sheltered corridor for a short time during the day. (Shelley et al, 122)

? ? ? ? ? 1855年7月中旬，第一批建筑和300張病床準(zhǔn)備就緒，但戰(zhàn)爭(zhēng)的進(jìn)行仍像以前一樣效率低下，直到10月2日才收治病人。問題在于，地勢(shì)平坦的Renkioi醫(yī)院距離前線太遠(yuǎn)，病人必須乘船運(yùn)來。醫(yī)院本身直到12月才完全竣工，1000張病床全部開放。負(fù)責(zé)Renkioi醫(yī)院的醫(yī)務(wù)官埃德蒙·亞歷山大·帕克斯（Edmond Parkes）醫(yī)生對(duì)醫(yī)院的設(shè)施作了如下描述：

? ? ? ? ? 醫(yī)院的構(gòu)造非常適合病后康復(fù)人員。由于所有病房都在地面上，因此只要能行走，就可以在涼爽而隱蔽的走廊或醫(yī)院周圍的空間里呼吸新鮮空氣。

? ? ? ? ? 一年多的經(jīng)驗(yàn)證實(shí)了我們對(duì)該地健康狀況和醫(yī)院適應(yīng)性的預(yù)期。冬天氣候溫和，似乎特別適合肺部疾病的治療，而我們有很多肺部疾病患者。誠然，氣溫的變化非常突然和劇烈，但由于病人住在溫暖的病房里，這些變化并不明顯，而且除了最脆弱和最易患肺病的病人外，很少有其他病人不能在白天到有遮擋的走廊里呆上一小會(huì)兒。(雪萊等人，第122頁）

后? ? ?續(xù)

By February 1856, the fighting had ceased. The Treaty of Paris ended the Crimean War with Russia agreeing to respect the independence of the Danubian principalities. Even though Brunel's hospital had been open only for a relatively short time, it had done great work. In total, 1,351 patients had spent time in the hospital, and all but 50 made a recovery. This was an astonishing rate of success compared to the situation previously. Nightingale and Brunel had never actually worked together, probably because the nurse had made enemies in high places with her public criticism of the management of the war and the treatment of the wounded, but this unlikely pair, a nurse and an engineer, had managed to transform attitudes to medical care in war zones. Evidence of this change in approach was seen just a few years later during the American Civil War (1861-65) when Brunel's hospital design was adopted by the Union Army.

? ? ? ? ? 到1856年2月，戰(zhàn)斗已經(jīng)停止。《巴黎條約》結(jié)束了克里米亞戰(zhàn)爭(zhēng)，俄國同意尊重多瑙河各公國的獨(dú)立。盡管布魯內(nèi)爾的醫(yī)院投入使用的時(shí)間相對(duì)較短，但卻取得了巨大的成就?？偣灿?351名病人在醫(yī)院接受了治療，除50人外，其余患者均已康復(fù)。與之前的情況相比，這是一個(gè)驚人的成功率。南丁格爾和布魯內(nèi)爾實(shí)際上從未合作過，這可能是因?yàn)檫@位護(hù)士曾公開批評(píng)戰(zhàn)爭(zhēng)管理和傷員治療，在高層樹敵，但這對(duì)從未合作過的搭檔，護(hù)士和工程師，卻成功地改變了人們對(duì)戰(zhàn)區(qū)醫(yī)療護(hù)理的態(tài)度。就在幾年后的美國內(nèi)戰(zhàn)（1861-65年）期間，布魯內(nèi)爾的醫(yī)院設(shè)計(jì)被聯(lián)邦軍隊(duì)采用，證明了這種方法的有效性。