克里米亚战争背景下英国军队医疗改革的影响.doc

克里米亚战争背景下英国军队医疗改革的影响.doc 克里米亚战争背景下英国军队医疗改革的影响 【摘 要】本文概述了克里米亚战争后英国军队医疗改革的影响。1854年春，英法联军与俄国展开了克里米亚战争，英军在战争中伤亡惨重，暴露了严重的行政问题与医疗弊端，随后，英国军部制定了一系列改革措施，并最终建立了相对完善的军队医疗。这次医疗改革是英国军队医疗体制适应现代化进程的一种标志。 【关键词】克里米亚战争;英国;医疗改革;影响 克里米亚战争暴露了英国军队医疗的严重弊端，战争期间和战争以后，以前任陆军大臣西德尼?赫伯特(Sidney Herbert)和护理创始人弗洛伦斯?南丁格尔(Florence Nightgale)为首的改革派对英国军队进行了改革，通过改革，英国首次在军中建立了完善的护理制度，英国的军事力量大大增强，军人的社会形象得到改变，改革对十九世纪中后期英国社会乃至全世界还是产生了积极的意义。 首先，它促进了现代护理制度与医疗管理的完善。 改革前的护理制度如果说是社会慈善性质的，那么医疗改革之后的护理制度则是医学性的，护理制度在克里米亚战争中的应用让该制度不再局限于社会服务性，而更注重医学性，也可以说，护理得以从宗教中解脱出来。“新护理强调医学性而非社 会?lnKjnmoTpl67popjkuI7lr7nnrZY86K6o6K665aSn5a2m6Iux6K+t6K++5aC C5Y+j6K+t5rS75Yqo5a2Y5Zyo55qE6Zeu6aKY5LiO5a+5562WZAJLD2QWAmYPFQ 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 vJrlip/og73igJTigJTku6XlsbHopb/nnIHlubPpgaXljr/kuLrkvotkAgYPZBYCZg8VBAANeGlqYTIwMTQwMzIwOCfkuK3opb/mlrnppJDmoYznpLzku6rmlofljJblt67lvILnoJTnqbYn5Lit6KW/5pa56aSQ5qGM56S85Luq5paH5YyW5beu5byC56CU56m2ZAIHD2QWAmYPFQQADXhpamEyMDE0MDMyMDkq6L6T5YWl5YGH6K+05Lit55qE4oCc5YaF5YyW4oCd6Zeu6aKY56CU56m2Kui+k+WFpeWBh+ivtOS4reeahOKAnOWGheWMluKAnemXrumimOeglOeptmQCCA9kFgJmDxUEAA14aWphMjAxNDAzMjEwLeS4reWbveS8oOe7n+aWh+WMluS4jueOsOS7o+WMluS5i+WFs+ezu+i+qOaekC3kuK3lm73kvKDnu5/mlofljJbkuI?裥浴～?南丁格尔积极介入印度的军队 卫生医疗，推荐约翰?劳伦斯(John Lawerence)担任印度总督，印度成 为世界上第一个成立卫生署、颁布并执行公共卫生政策的国家，最终英国 卫生署也得以成立。通过成立专门的卫生机构，公众生命和社会卫生环境 得到重视，英国的这种做法为很多国家的卫生治理树立了榜样。 针对克里米亚战争中军队医疗状况的混乱，尤其是医生行医资格方面 并没有立法保护的现状，英国尝试在医师资格认证方面进行立法。 1858年8月2日，英国女王签署了《1858年医疗法》(The Medical Act 1858)。医疗法案共有54项条款，明确了医疗人员相关培养。根据法 案规定，只有通过医师资格认证的学习者，才能取得合法的行医资格。“委 员会是第一个对医疗行业进行管理的法案――对整个职业有准司法权，它 的法律目标是在某些方面维护公共的利益，委员会成功地建立了医疗行业 的道德，为其他行业树立了楷模，也为德国和法国做出了榜样。” ii 南丁格尔与统计学家威廉?费尔在改革期间整理了许多卫生统计数 据，统计学成了提高军事和民用医院医疗保健效率的工具。“1858年，英 国成立了统计学会，1860年，统计学会专门召开了‘关于南丁格尔的医院统计学’的大会，从此以后，标准统计表为大家广泛接受，英国主要医院代表们一致通过决议，采用统一标准统计表办理病人入院登记制度，并每年公布统计数据。” iii统计学和医学相辅相成，对完善医院管理有重要意义。 “1865年，经过与国防部部长哈丁顿(Hartington)爵士的辩论后，英国议会最终通过南丁格尔的建议，承认护理这一职业的独立性，由内政部统一管理。随后，议会又通过决议，确定护理人员的职业分类由“市政类”改为“医学”专业类，规定护理人员的产生必须经过严谨的科学训练。”iv从此以后，上至卫生署，下至各医院，开始设立新的医院管理办法，与此同时，护理人员在工作职权的确定、待遇标准、升迁晋级办法、上班时间也被一一确定保障下来，现代护理制度真正确立起来。 其次，医疗改革有利于英国军队建设的发展。 “克里米亚战争对英国军队的发展具有分水岭的意义，克里米亚战争之后，英国开始从军队的组织管理、后勤装备、行政效率上反思存在的问题，即使在士兵的服装上，英军都有了很大的变化。”v作为后勤之一的医疗问题，也恰恰体现了这种变化，军队中采用了更加具有人性化的管理方式，采用了更为合理的医疗措施，对改变陆军不良的社会形象有很大的作用，19世纪后期，英国军人成为了一个备受崇拜与尊敬的群体。通过改革，英国军队医疗效率明显增强，军事实力得以彰显，为英国成为日不落帝国提供了军事依托，与此同时，英国先进的军队医疗体制也成为其他国家效仿的典范，有利于军队医疗向近现代的转型。 医疗改革直面了军队后勤中难以为继的问题，但是由于反对派力量过于强大，改革曾一度被搁置，1872年，爱德华?卡德维尔(Edward Cardwell)上任期间，再次就陆军部问题进行改革，军队实行了短期服兵役法，体现出了对军人人权的重视。“到1899年布尔战争时，英国护理队被正式委任，成为皇家陆军医疗队(Royal Army Medical Corps)。” vi 第三，英军医疗改革对普世医疗体系的建立有很大作用。 这次医疗改革发轫于军队，同时也随着军队向社会的各个方面延伸，尤其是护理制度确立后，护理成为一门具有专业技术的职业，也成为各个医学门类的基础学科。南丁格尔在1860年3月30日开办护士学校，培养的护士遍布世界各地。1867年，南丁格尔在国王学院附属医院(King’s College Hospital)设立了一所助产护士学校。第六届学生露西?奥斯本(Lucy Osburn)为第一位护理宣教士，她学习了护理学与毛利语，毕业后去了澳洲医院，担任护士长，被公认为澳洲护理的创始人。瑞切尔?威廉斯(Rachel Williams)不仅建立了“卫生护士”，还成立了第一家“家庭看护”。伊丽莎白?文森特(Elizabeth Vincent)则担任了英国收容所与监狱医院的护理主任，改变了监狱卫生状况。1864年，伊丽莎白?麦基金妮(Elizabeth Mckechnie)来到中国上海，成立了中国第一所护士学校。1885年，琳达?理查兹(Linda Richards)到日本东京，建立护士学校。宣教士玛格丽特?J?爱德蒙(Margaret J.Edmunds)在汉城开办护理学校。李文斯通(Livingstone)前往非洲布道，把护理学福音带给非洲，被称为“非洲护理学之父”。英国军队医疗体系的建立从军队推向医学的各个方面，医学分科更加完善，诸如营养学、急诊学、儿科、外科、眼科、 消毒科、预防医学等开始从医学大类中渐渐分支出来。