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  1. About Paul Stepansky
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Scipione Riva-Rocci's mercury sphygmomanometer of , little different from mercury-column blood pressure meters of today. All its key components relied on technologies that only became available in the s. The machine initially confirmed clinical diagnoses of atrial fibrillation and heart block, but came into its own after James Herrick described EKG changes in myocardial infarction in The Becton-Dickinson all-metal "Empire," a general utility syringe, was available in sizes from.

It first appeared in the B-D catalog of , where it was offered with a variety of tips for all manner of irrigation nasal, ear, intra-trachael, intra-venous, urethral, and rectal. Medicine, Health, and History. James Lieberman January 10, at Pranab May 10, at Paul Stepansky May 10, at 8: Pranab Chatterjee September 8, at 1: Leave a Reply Cancel reply Enter your comment here Fill in your details below or click an icon to log in: He was so wobbly he almost had to lean up against the wall.

As it happened I had a new violin and bow, which had been bound for our embryo orchestra, here in my office. The man had it in shape in no time and then he began to play and how he could play! We let him take the violin down to his tent, and later sent him some of my music. He was a shell shock, and all the evening and the next few days until he was sent to England he played to rapt audiences of fellow patients.

With the shell shocked, the therapeutic gift of the WWI nurses resided less in their ability to empathize than in their acceptance that their patients had experienced horrors that could not be empathized with. Their duty, their calling, was simply to stay with these soldiers in an accepting manner that coaxed them toward commonality among the wounded, the sense that their symptoms and the underlying terror were not only understandable but unexceptional and well within the realm of nursing care.

In this sense — in the sense of a daily willingness to be with these soldiers in all their bodily dysfunction, mental confusion, and florid symptomatic displays — the nurses strove to normalize shell shock for the shell shocked. Just imagine, to wet the bed at my age! Poor fellows, they were so embarrassed — especially the better-class men. But such embarrassment was a relic of civilian life. It had no place among battle-hardened nurses who coped daily with the sensory overload of trench warfare: Alongside such things, how off-putting could incontinence be?

The fact is that shell shocked soldiers, no less than the nurses themselves, were warriors. Warriors are wounded and scarred in many ways; nurses themselves fell victim to shell shock, even if they were not officially diagnosed as such. Now he was to face death in another form. Norton, , Penguin, , Manchester University Press, , I was away now, and I seemed to be breaking to pieces. La Motte, The Backwash of War: Now, sadly, chemical weapons are back in the news.

Thus the birth of chemical warfare. Chlorine gas attacked the airways. Severe respiratory swelling and inflammation killed many instantly and the rest struggled to nearby casualty clearing stations with acute congestion of the lungs, pneumonia, and blindness. For the rest, partial suffocation persisted for days, and long-term survivors had permanent lung damage, chronic bronchitis, and occasionally heart failure. Mustard gas burned the skin and respiratory tract, stripping the mucous membrane off the bronchial tubes and causing violent inflammation of the eyes.

Victims were left in excruciating pain and utterly helpless. Nurses, no less than physicians, were initially confused about the nature of the gas and the severity of its effects. Of course, nurses did what little they could. Inflamed eyes were repeatedly irrigated with alkaline solution.

Respirators soaked in hyposulphate could be provided to patients able to use them. At American Base Hospital 32, soldiers who had breathed in mustard gas were given a mixture of guiacol, camphor, menthol, oil of thyme, and eucalyptus that caused them to expectorate inflammatory material. According to Essig, the mixture provided some temporary relief to soldiers with burning throats and mouths.

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But nurses otherwise echoed a shared sense of impotence when it came to making gassed patients comfortable. During the Second Battle of Ypres, when chlorine gas was first used by the Germans, Canadian nurse Agnes Warner recalled the initial wave of gassed troops: We did what we could, but the best treatment for such cases had yet to be discovered, and we felt almost powerless.

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They cannot breathe lying down or sitting up. They just struggle for breath, but nothing can be done. Some with their eyes and faces entirely eaten away by the gas, and bodies covered with first degree burns. We try to relieve them by pouring oil on them. They cannot be bandaged or even touched. Pneumonia could be rampant during winter months; gangrene and tetanus were prevalent year round. But bronchitis, trench fever, diphtheria, cholera, dysentery, meningitis, measles, mumps, erysipelas, [8] and, finally, influenza, were not. Infected shrapnel and gunshot wounds could be irrigated or bathed continuously in antiseptics, first developed in the s and packed in sterile dressings available in sealed paper packages since Trench foot, a combination of fungal infection, frostbite, and poor circulation, was endemic during the winter months, when soldiers lived in trenches flooded with icy water, often waist-high, for days on end.

In addition to giving morphine, there was a treatment protocol to follow, such as this one at a British Military Hospital in the winter of Their feet were absolutely white, swollen up and dead.

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Some of their toes dropped off with it, and their feet looked dreadful. Can you feel it? She had in mind. The man with two broken arms has also a wound in the knee — joint in a splint — and has had his left eye removed today. He is nearly crazy. Another man has compound fractures of both legs, one arm, and head, and is quite sensible. Another has both legs amputated, and a compound fracture of [the] arm. These people — as you may imagine — need very special nursing. If one adds to such clusters the serious general infections that often accompanied battlefield injuries, one has some sense of what nurses were up against, and just how special their nursing had to be.

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When influenza, the deadly Spanish flu, began to swamp clearing stations and hospitals in the spring of , nurses simply added it to the list of challenges to be met with the resources at hand. And they did so in the knowledge that as many as half of the infected would die. Omer to meet the rush of influenza patients:. During those early days of the flu the treatment was to strip the patients in one tent, their clothing going immediately to the fumigator. Then, the patient was bathed in disinfectant and taken to the different wards.

Some of the patients were very ill and died with pneumonia after a few days. By the same token, they realized the importance of compassion in the face of ameliorative impotence. Nurses, technically noncombatants, suffered alongside the troops. During rushes, their clearing stations, hospitals, and living quarters were under land and air assault and occasionally took direct hits.

Christine Shock, MD, primary care doctor, Southport Family & Sports Medicine

They contracted infectious diseases, especially flu, [19] during which they usually carried on with the aid of simple analgesics until they felt better or worse. She collapsed at the dance with a bad chill and had to be carried to her bed. When she went on duty the following day, she became delirious in the ward and was lugged off by an orderly and subsequently seen by a doctor. I have to lie flat on my back and be fed.

For three days I lay motionless all day long, not caring to move or to speak, I was so tired. Despite training in the use of gas masks in the event of direct shelling, mask-less nurses suffered the effects of poison gas from daily proximity to patients on whom the shells had landed. Their own vulnerability to gas attack and attenuated exposure to the poison lent special intensity to their care of burn victims. It was the nurses of WWI who took it on the chin.

They could not sustain themselves and their patients with the naturalistic view of the afterlife popular during the Civil War. In the summer of , the nurses at No. To quiet him, they rigged up a croup tent under which they took turns holding a small stove that heated a croup kettle from which the soldier could breathe the steam. It was bearing witness to unrelievable suffering that was the worst assault borne by the nurses.

This is the nearest to Hell I have yet been. The American nurses at No. And yet the nurses of WWI were not stymied by seeming impotence in the face of pain. They labored on to the breaking point in the service of soldiers who, all too often, were already broken. This makes them warriors of care and, in a devotion to patients that was literally and not metaphorically self-less, heroes of the first rank.

OUP, , , Barnes, , loc Quid Pro, , loc Without antibiotic treatment, It can spread through the blood stream and cause sepsis. These nineteenth-century antiseptics included salicylic, thymol, Eucalyptus oil, aluminum acetate, and boric acid. Ives Washburn, , loc Penguin, [] , Stepansky, I n the Hands of Doctors: Her loss is irreparable. Vintage, , chapter 1. Of course the surgeons of WWI could only save so many lives.

Many cases were deemed hopeless and simply handed back to the Sisters, to provide what meager palliative care they could while the soldiers awaited death in the tent set aside for them, the Moribund Ward. But the Sisters sometimes refused to let matters rest, recognizing that the surgeons, often operating at breakneck speed in a state of exhaustion, did not have the last word on life and death. Mary Norman Derr, an American nurse trained by the French Red Cross in and assigned to a French Army Hospital near the trenches of the Marne in , recalled an Arab soldier who arrived at the hospital barely conscious.

It is one of the few dressings I have had that really frightened me; for it was so long, and every day for a week or more, I extracted bits of cloth and fragments of metal, sometimes at a terrifying depth. Besides my patient was savage and sullen, all that is ominous in the Arab nature. Gradually, however, the suppuration ceased, the fever fell, and suddenly one day Croya smiled.

An American Red Cross nurse at work outside a French field hospital, MGH-trained Helen Dore Boylston, working in the post-surgical bone ward of her Base Hospital in the winter of , was no stranger to surgical aftercare. One day, when I was here before, he complained of a pain in his thigh and began to run quite a temp. As his leg was laid wide open anyhow, I took a look along the bone, Dad meantime cursing the roof off.

Then, before he knew what I was about, I had slit the thing open. At least two cupfuls of pus poured out, and his relief was tremendous at once. Of course his temp dropped, too. I put in a packing and watched it for a few days. It cleared up promptly. That was absolutely all. Nor did interventionist nursing end with bedside surgery.

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Nurses often believed rehabilitation was possible when doctors did not, and they proved their point with paralyzed soldiers who, so the surgeons declared, would never walk again. Unfazed by the pronouncement and unwilling to rest content giving the patient English lessons to help pass the time, she devised a program of rehabilitation that incorporated electrical stimulation, which only became available at the Hospital in late June.

Three weeks later, she had her paralyzed man out on the balcony, where he enjoyed fresh air for the first time in six months. She was assigned another patient paralyzed from the waist down a month later, and then in mid July she proudly reported on both patients:. My paralyzed man stood up alone last Sunday for the first time and now he walks, pushing a chair before him like a baby. He is the happiest thing you can imagine; for seven months he has had no hope of ever walking again.

My prize patient, Daillet walks down stairs by himself now. We are all proud of him. The doctor who sent him here from Besancon came in the other day to see how he was getting on and he could not believe it when he saw him. Worst of all were soldiers whose gaping wounds and limbless stumps were saturated with anaerobic bacteria of the genus Clostridium— soil-dwelling bacteria that thrive in the absence of oxygen — from the heavily fertilized fields of Flanders and Northern France.

The bacteria entered cavities through dirt and debris picked up by exploding shell fragments; bullet wounds and shrapnel typically drove into the body with pieces of bacteria-infested clothing. The result was the dreaded gas gangrene, easily detected by the darkened muscle, bubbling sound, and overpowering stench [4] emanating from the infected limb or body cavity. But left unattended in trenches and on battlefields for three, four, even five days, soldiers arrived at clearing stations with septicemia blood poisoning , which foretold an agonizing death, often within hours, almost always within a few days.

Among the multitude of stressors that made up ward nursing in CCSs and field hospitals, ministering to dying gangrenous soldiers was at the top of the list. What is remarkable is that even here nurses occasionally rejected the medical verdict and resolved to nurse on with those awaiting death in the Moribund Ward. This was true of Kate Luard, who, in the midst of the Battle of Arras in May, , battled on for her dying soldiers. The kidney man is being dressed with [the antiseptic] Flavine and has had a leg off and is nearly convalescent!

The Last Family Doctor: Remembering My Father's Medicine - Paul E. Stepansky - Google Книги

The vast majority of nursing saves went unrecorded, perhaps noticed at the time by a colleague, a supervisor, even the Head Matron. Without the wartime diaries and letters the nurses left behind, we would have little inkling of their quiet struggles to keep forsaken soldiers alive. Such struggles take us far from the world of high-tech nursing, even in its low-tech WWI incarnation.

What we behold, rather, is hard-core, soft-touch nursing, abetted by a Rube Goldberg inventiveness in making use of materials at hand, somehow garnering materials not easily obtainable, and then patiently titrating treatments including food intake in a manner responsive to states of severe, even deathlike, debilitation. A little Night Sister in the Medical last night pulled a man round who was at the point of death, in the most splendid way. He is still alive tonight, but not much more. You will like to hear of the living skeleton with wounds in back and hands and shoulder that they brought me filthy and nearly dead from another pavilion.

That was nine days ago. I diagnosed him as a case of neglect and slow starvation, and treated him accordingly — malted milk, eggs, soap, and alcohol to the fore. His dressing took one and a half hours every day, and all nourishment given a few drops at a time, and early all the time, for he was almost too weak to lift an eyelid, much less a finger. This morning he actually laughed with me and tried to clench his fist inside the dressings to show me how strong he was. I happened on a corpse-like child [a teenage soldier] the other day being brought into the Moribund Ward to die and we got to work on resuscitation, with some success.

He had been bleeding from his subclavian artery and heard them leave him for dead in his shell-hole. When, after two days, he belonged to this world again, I got Capt. Nor was orthopedic inventiveness beyond the pale. But they improvised as well. Kate Derr provides an example of the ingenious contraption rigged up by war nurses for a soldier with badly damaged joints. Even admitting his recovery, which seemed impossible, he would be obliged to go about on the points of his toes, the knees being permanently stiff.

A board about 14 inches square was padded with cotton and swathed neatly in a bandage.

This was laid vertical against the soles of the feet which I tried to place as nearly as possible in a normal position. Then I attached a bandage having no elastic, which would have been better to the head rail of the bed on one side, passed it around the board and up the other side, fastening it again to the rail as taut as possible. The knot was tightened twice a day. Result — in two weeks those refractory feet had regained a proper attitude. Such dedication to severely injured patients persisted in the face of bombings that reached and sometimes destroyed the clearing stations and field hospitals in which the nurses worked.

He concludes with a measured assessment of what we have gained, but also what we have lost, in the death of the postwar GP who cared for individuals and their families from birth to death. In so doing, he challenges us to reflect anew on what we need, what we want, and what we can reasonably expect, from our physicians. Copyright permissions requests, translation rights requests, and queries regarding purchase of bulk quantities should be directed to info keynote-books. William Stepansky … in this memoir older physicians will relive their youth, while young ones will find a model for behavior.

An enjoyable read for everyone, medical students and those planning to become physicians will find in Dr. William Stepansky an exemplary and inspiring role model. In learning about the life of Dr.