【简译】Renkioi医院

2023-08-01 09:49 作者:神尾智代 0人读过 | 我要投稿

克里米亚战争中的医院是什么样的？

在克里米亚战争中，有两家医院值得一提。第一家医院位于斯库塔里，因缺乏卫生条件而声名狼藉，直到弗洛伦斯·南丁格尔（Florence Nightingale）才改善了情况。第二家医院是Renkioi医院，这是一家预制综合医院，由工程师布鲁内尔（Brunel）根据新式健康和卫生理念设计而成。

南丁格尔在克里米亚的哪家医院工作过？

克里米亚战争期间，弗洛伦斯·南丁格尔曾在斯库塔里医院工作，大大改善了该医院因卫生条件差而导致死亡的糟糕情况。

Renkioi医院有什么特别之处？

Renkioi 医院之所以具有创新性，是因为它是一座预制建筑，具有许多促进良好个人卫生和环境卫生的设计特点，从而减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医院是伊桑巴德·金德姆·布鲁内尔（Isambard Kingdom Brunel）为克里米亚战争（1853-1856年）设计的创新型预制建筑群。布鲁内尔对战争期间大量的人员伤亡和更高的疾病死亡率深有感触，他设计的这座拥有1000张床位的医院采用了弗洛伦斯·南丁格尔（Florence Nightingale）等护理先驱开创的通风和卫生方面的最新理念。

克里米亚战争和弗洛伦斯·南丁格尔

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.

克里米亚战争是俄国与奥斯曼帝国之间的战争，奥斯曼帝国的盟国包括英国。长期以来，俄国一直试图从摇摇欲坠的奥斯曼帝国手中夺取领土，并于1853年入侵多瑙河公国（奥斯曼帝国的附庸国摩尔达维亚和瓦拉几亚）。当俄国拒绝撤军时，英国和法国向其宣战。一支联盟远征军被派往进攻克里米亚黑海沿岸的塞瓦斯托波尔，那里是俄国在该地区的主要海军基地。1854年，对塞瓦斯托波尔的围攻开始，持续了一年。1854年10月，在巴拉克拉瓦战役中发生了灾难性的“轻骑兵的冲锋（Charge of the Light Brigade）”事件。联盟远征军虽然取得了重大胜利，但也付出了巨大的伤亡和生命代价。

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.

成千上万的英国士兵在战场上受伤、吃不饱、穿不暖、缺医少药、霍乱肆虐，这些可怕的命运促使著名工程师伊桑巴德·金德姆·布鲁内尔（Isambard Kingdom Brunel，1806-1859年）采取行动提供帮助。威廉·霍华德·拉塞尔（William Howard Russell，1820-1907）等记者使用新式电报机向国内发出有关战争各方严峻状况的令人震惊的报告。从 1854年到1855年，在短短六个月的时间里，派往克里米亚的56000名英国士兵中有 34000人死亡，其中约16300人死于疾病。英国护士弗洛伦斯·南丁格尔（Florence Nightingale，1820-1910年）也积极提供帮助，她成为英国军队医院的护理主管，并直言不讳地批评政府和军队的无能。军医院的病人死亡率曾高达42%，但南丁格尔通过严格的卫生管理、良好的通风和对病人的饮食照顾，降低了这一数字，大大减少了霍乱、痢疾和斑疹伤寒的死亡人数。尽管她的管理模式取得了成功，但南丁格尔仍游说政府为战争伤员提供新的、更好的医疗设施。

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.

布鲁内尔为战争做出了两方面的贡献：他设计和建造的巨型蒸汽船“大西方号 (SS Great Western)”号被用作运兵船，他还创造了一种全新的医院。布鲁内尔还设计了可在水中使用的浮动炮台，可以向沿海堡垒开火，但海军部这个相当笨重的机构并不以快速创新而闻名，它既不批准也不反对这些计划，因此第三个方面的帮助最终无果而终。

预制设计

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.

克里米亚战争期间，英国陆军的主要医院位于斯库塔里，但其声誉极差，不止一个消息来源将其描述为“国家耻辱”（Bryan，142）。斯库塔里是冲突期间导致政府于1855 年1月垮台的无能地区之一。由巴麦尊勋爵领导的新政府至少对公众的呼声做出了回应，并由卫生委员会对克里米亚的状况展开了调查。2月，布鲁内尔与陆军部常务次官本杰明·霍伊斯（Benjamin Hawes）取得联系，事情开始向好的方向发展，霍伊斯也是布鲁内尔的朋友兼姐夫。鉴于情况紧急，这位工程师被要求设计一座完整的野战医院，可以尽快运到克里米亚并在现场建造。布鲁内尔清楚地意识到正在进行的冲突所带来的苦难，他只用了几周时间就向陆军部提交了新医院的计划。

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.

布鲁内尔的医院由预制部件组成，这些预制部件可以很容易地运到目的地，然后无需熟练的木匠、细木工和水管工就可以组装起来。预制部件的想法很可能是受到1851年伦敦大博览会主办方巨型水晶宫的成功启发。水晶宫由约瑟夫·帕克斯顿爵士（1801-1865年）设计，以他在德文郡公爵宅邸查茨沃斯庄园设计的小型玻璃和铁结构为基础。它也必须满足快速建造临时建筑的要求。水晶宫的玻璃墙和屋顶都是由混凝土地基上的铁架支撑的，仅用了四个月的时间就建成了。

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.

布鲁内尔曾在他的大西部铁路伦敦终点站帕丁顿车站建造中使用了部分预制构件。预制构件非常符合现代理念，即建筑物应优先考虑形式和功能，而不是纯粹的装饰。此外，预制构件的理念也吸引了像布鲁内尔这样的工程师，他们认为工业革命期间机器大规模生产的新能力可以更高效、更经济地替代熟练劳动力。

规划设施

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.

布鲁内尔提出了按照相同规格建造多个病房模块的想法。这些建筑的各个部分都由木头制成，并经过专门设计，使每个部分都不会太重，一两个人就能搬运并在现场摆放到正确的位置。每栋建筑可容纳 48 张病床，平均分成两个病房，不过布鲁内尔也考虑到了在需要时每栋建筑都可以轻松扩建的可能性。医院的总容量约为1000张病床，设计包括盥洗设施和良好的卫生条件，有大量的水龙头、浴室（包括经过特别改造的供残疾人使用的浴缸）、用于烧水和为病房供暖的炉子、盥洗室（厕所）、下水道以及由风扇提供的良好通风设施。另外，还有专门用于烹饪和洗衣的铁架结构建筑。布鲁内尔没有忘记任何一个细节，甚至在他的总体规划中还包括了卫生纸，即在所有设备组装完毕后，所有东西的摆放位置。

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.

所有这些要素在今天看来都很简单明了，但在当时却是革命性的。战场上的医疗服务充其量还很简陋，通常是搭建帆布帐篷或征用私人乡村别墅作为临时医院。设备的可用性完全取决于医生个人的远见卓识。这一时期，疾病而非子弹仍是战争中的最大杀手，红十字会等组织也尚未成立（1863年）。Renkioi医院计划无疑开辟了新天地。

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.

医院的设计得到了陆军部的批准，布鲁内尔开始建造医院的各个组成部分，然后规划庞大的后勤工作，不仅要将预制构件（共约11500吨材料）运往克里米亚，还要确保随车携带正确的工具和组装说明。布鲁内尔的设计意味着在最终目的地建造医院的人员无需经过专门培训。将医院建筑组装在一起所需的只是一些运输船只、现场的人力以及一个地势相对平坦的地点。

地图显示由伊桑巴德·金德姆·布鲁内尔（1806-1859 年）设计、供克里米亚战争（1853-6 年）期间使用的创新预制Renkioi 医院的布局

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.

布鲁内尔的助手约翰·布伦顿（John Brunton）受命在新地点 Renkioi（有时拼写为 Renkoi）监督医院的建设，而不是在100英里外的斯库塔里 (Scutari)。布伦顿被任命为专员，并于3月率领一支由30名陆军工程兵组成的队伍前往克里米亚。与此同时，布鲁内尔安排了预制建筑的运输，使其于5月7日抵达现场。

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张病床准备就绪，但战争的进行仍像以前一样效率低下，直到10月2日才收治病人。问题在于，地势平坦的Renkioi医院距离前线太远，病人必须乘船运来。医院本身直到12月才完全竣工，1000张病床全部开放。负责Renkioi医院的医务官埃德蒙·亚历山大·帕克斯（Edmond Parkes）医生对医院的设施作了如下描述：

医院的构造非常适合病后康复人员。由于所有病房都在地面上，因此只要能行走，就可以在凉爽而隐蔽的走廊或医院周围的空间里呼吸新鲜空气。

一年多的经验证实了我们对该地健康状况和医院适应性的预期。冬天气候温和，似乎特别适合肺部疾病的治疗，而我们有很多肺部疾病患者。诚然，气温的变化非常突然和剧烈，但由于病人住在温暖的病房里，这些变化并不明显，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挡的走廊里呆上一小会儿。(雪莱等人，第122页）

后续

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，战斗已经停止。《巴黎条约》结束了克里米亚战争，俄国同意尊重多瑙河各公国的独立。尽管布鲁内尔的医院投入使用的时间相对较短，但却取得了巨大的成就。总共有1351名病人在医院接受了治疗，除50人外，其余患者均已康复。与之前的情况相比，这是一个惊人的成功率。南丁格尔和布鲁内尔实际上从未合作过，这可能是因为这位护士曾公开批评战争管理和伤员治疗，在高层树敌，但这对从未合作过的搭档，护士和工程师，却成功地改变了人们对战区医疗护理的态度。就在几年后的美国内战（1861-65年）期间，布鲁内尔的医院设计被联邦军队采用，证明了这种方法的有效性。