Monthly Archives: November 2010

Maritime Medicine and the Law of the Sea

Before the 20th century, individual navies and trading companies, to a greater or lesser extent, took responsibility for providing medical services to sailors in their employ. Very little seems to have been written in the west about the obligations of maritime nations with respect to medical care to enemy combatants or non-combatant personnel on the high seas until the 1907 Hague Convention added sailors to protections given to wounded soldiers under previous Geneva Conventions governing combatant nations.

Of the Geneva Conventions drafted in 1949, the second (“Geneva II”) provides for the amelioration of the condition of sick, wounded and shipwrecked members of armed forces (both combatant and neutral) at sea.  Geneva II also obligates its signatory nations to grant protections to medical personnel and chaplains at sea, and to hospital ships.  “Geneva IV”, also drafted in 1949, extended protections to civilians and civilian hospitals, in areas of conflict.

With the UN Conferences on the Law of the Sea (UNCLOS) of 1956, 1960 and 1973, nations of the world took significant steps toward establishing international jurisdiction of international waters by defining the rights and responsibilities of nations in their use of the oceans of the world.  Medical aspects of these international conventions derive indirectly, in part, from UNCLOS Article 98:

Article 98 Duty to render assistance
1. Every State shall require the master of a ship flying its flag, in so far as he can do so without serious danger to the ship, the crew or the passengers:  (a) to render assistance to any person found at sea in danger of being lost; (b) to proceed with all possible speed to the rescue of persons in distress, if informed of their need of assistance, in so far as such action may reasonably be expected of him; (c) after a collision, to render assistance to the other ship, its crew and its passengers and, where possible, to inform the other ship of the name of his own ship, its port of registry and the nearest port at which it will call.
2. Every coastal State shall promote the establishment, operation and maintenance of an adequate and effective search and rescue service regarding safety on and over the sea and, where circumstances so require, by way of mutual regional arrangements cooperate with neighbouring States for this purpose.

The modern alphabet soup of international maritime medical conventions and regulations involves the IMO (International Maritime organization), the ILO (International Labor Organization) and the WHO (World Health Organization).  The “ILO/WHO Committee on the Health of Seafarers”, established in 1948, was the first step in a process that developed international guidance on such matters as medical examination of seafarers, the ship medical chest, food, water and accommodation for seafarers aboard ship, hospital treatment, social welfare and the like.

More recently, several conventions dealing with aspects of maritime medicine have emerged.  These are Safety of Life at Sea [SOLAS] 1974–deals with life saving apparatus aboard ships; Standards of Training, Certification and Watchstanding of Seafarers [STCW] 1978–addresses health, training and competence requirements; International Marine Satellite Organization [INMARSAT] 1976–deals with emergency communications, including the Telemedical Maritime Assistance Services; International Convention on Search and Rescue [SAR] 1979–deals with maritime search and rescue; International Convention for the Safety of Fishing Vessels [SFV] 1977–deals with live saving appliances, emergency procedures and radio communications on fishing vessels.

A host of other conventions touch on such medically related topics as safe navigation (involving medical assessment of night vision, color vision and fatigue), watch schemes (fatigue), construction of ships (hospital construction, man-machine interfaces),  impact of work environment upon worker health, and the like.

Finally, while not in the form of a convention, the World Health Organization issues International health Regulations (IHR) which deal comprehensively with the prevention of, protection against, control of and public health response to the international spread of disease.  ILO, IMO and WHO collaborated in the development, in 1967, of the first “International Medical Guide for Ships” and has since developed international guidelines for pre-sea and periodic examination of seafarers (1997, with revisions) and the Medical First Aid Guide for Use in Accidents Involving Dangerous Goods [MFAG] (1982).

Today it might be accurately said that the international civilian maritime medicine establishment significantly outnumbers that of the navies of the world.

I depended very heavily on the Norwegian Centre for Maritime Medicine’s online Textbook of Maritime Medicine for my preparation of this post.


About the Society for the History of Navy Medicine

The Society for the History of Navy Medicine (sponsor of this blog) was founded in 2006.  It came into being as result of conversations between co-founder and Executive Director Tom Snyder, a retired surgeon and retired Navy Reservist, who was then making regular visits to the historical library at the Office of the Historian of the U S Navy Bureau of Medicine and Surgery (BuMed) for a research project, and co-founder Andrè Sobocinski, Deputy Historian in that Office.  On several occasions Mr Sobocinski remarked that many historical researchers come through his office, and that there seemed to be no scholarly “home” for this group of people who are interested in research, study and publication on all matters relating to the history of medicine in the maritime environment.  Captain Snyder eagerly agreed to take on the project of creating this scholarly home.

A few months later, the Society’s founding meeting took place at 7 AM on a Sunday morning at the Halifax meeting of the American Association for the History of Medicine (AAHM), when Captain Snyder and four other stalwarts* gathered over coffee and donuts to launch the effort.  The five adopted a Vision and Mission Statement, and the Society officially took life.

While it is an entirely independent organization, the Society has enjoyed a mutually supportive relationship with the Office of the Historian since its inception.  That Office has been an active source for member referrals–visitors and researchers who have the interests noted–and has kindly electronically provided its bimonthly publication, The Grog Ration, to Society members.  For its part, the Society provides a repository of past editions of the Ration on its website,, and has undertaken to promote publications, movies and other activities of the Office of the historian.  One of the Society’s true “angels”, from its inception, has been retired medical Rear Admiral Fred Sanford, until recently the Executive Director of the Association of Military Surgeons of the United States.  He continues to be an indispensable supporter and guide.

In its early years, the Society carried on business as a nearly completely “virtual” organization, sponsoring panels in conjunction with the AAHM, of which it is a constituent member.  It did this with no income and no budget, the occasional expenses being covered by “donations” from Snyder and Sobocinski.  In 2008 the Foundation for the History of Navy Medicine was incorporated as a tax-exempt 501(c)(3) public benefit corporation.  Its purpose is to raise funds from tax-deductible donations to promote the preservation of the history of Navy medicine.  It uses the Society as a means to that end, inasmuch as the Society shares this common goal with the Foundation.

One of the first initiatives undertaken by the Foundation Board of Directors was a move to broaden the reach of the Society by rotating its annual meetings among three “constituencies”–its “home” of medical historians, the AAHM; and adding the community of military medical professionals as embodied in the Association of Military Surgeons of the United States; and the community of military / naval historians.  As a result, the Society mounted a very successful panel at the AMSUS meeting in Phoenix in November 2010; it aims to mount a panel at the U S Naval Academy History Symposium in September 2011.

Early in 2010, the Society and the Foundation instituted a program of tax deductible $20 voluntary annual dues-donations and $250 Life Memberships.  These are opportunities for Society members and others who support its mission an opportunity to do so financially.  In the autumn of 2010 the Society announced the first result of this financial support, a Travel Grant Program which offers one $750 grant each year to an undergraduate or graduate student whose paper is accepted for presentation at the Society’s annual meeting.

As it approaches its fifth year, the Society boasts an international membership of more than 150 academics, medical professionals and others interested in supporting its mission, and is proud of its role as a place of Community, Collaboration and Camaraderie for people interested in our little corner of scholarship in history.

*  The 7 AM Stalwarts, in addition to Captain Snyder, Society Executive Director and blogger-in-chief , were:  Alan Hawk, currently manager of  historical collections at the National Museum of Health and Medicine; Dale Smith, currently Professor and Chairman of the Department of Medical History at the Uniformed Services University of Health Sciences; L G Walker, a former Navy medical officer, Emeritus Clinical Professor of Surgery at the University of North Carolina and published medical historian; and Ely Robert Tandeter, practicing internist with an interest in medical history.

18 November 2010

In Honor of the Marine Corps–Medical Doctrine for Amphibious Warfare

Today we observe the 235th birthday of the U S Marine Corps.

At the Society’s Fourth Annual Meeting last week, Steve Oreck, a retired U S Navy medical officer who worked most of his career with Marines , gave a reprise of his recently completed Master’s degree thesis.  His topic:  The Development of Medical Doctrine for Amphibious Warfare by the United States Marine Corps and the United States Navy, 1920-1939.

In his paper, Captain Oreck points out that the main impetus for developing this doctrine was an appreciation by planners looking at Operation Orange (the war plans for conflict with Japan) that taking or retaking Pacific islands would require a renewed emphasis upon amphibious warfare.  The only prior 20th century amphibious operations available for study were the British-French experience at Gallipoli, and some small German amphibious assaults of  Baltic islands, both in World War I.  In both these operations, but especially the Gallipoli campaign, coordination of medical care between combat units ashore and naval units at sea was non-existent, resulting in “medical disaster”.  Some US planners saw this problem, and realized that medical contingencies must be attended to.  Given that the Navy assigns its medical personnel to support the Marines, line Marine officers quite naturally assumed that planning for the care of Marine casualties was a “Navy problem”.  In the 1920s and ’30s, the Bureau of Medicine and Surgery put no special emphasis on the problem of medical support of Marine amphibious operations.  And so the problem was left a few dedicated officers.

Almost simultaneously in 1923-24, Major S N Raynor, USMC, and Lieutenant Commander William L Mann, MC, USN, published a series of articles looking at the matter of medical support for Marine operations in the  United States Navy Medical Bulletin.  Interestingly, at this early date, neither author mentioned amphibious operations.  Throughout the rest of the ’20s, planning officers made rudimentary medical plans, but these really did not look at medical support unique to amphibious operations in any comprehensive way.

It was only with the advent of amphibious exercises in the mid-’30s that the need for adequate training of medical personnel at all levels, and for medical equipment especially designed for amphibious operations (e.g., water-proof, light weight or capable of breakdown to man-portable size) became apparent; these problems found their way into after-action reports–repeatedly.  Medical officers still struggled with a lack tasking either from the Commandant of the Marine Corps or from BuMed.  Finally, in 1937, the Navy established a review board to look at medical equipment for Marine operations, and in 1938, promulgated Fleet Training Publication 167 (FTP-167), “Landing Operations Doctrine”.  This document, with fairly sparse medical chapters, was the operative doctrine at the outset of World War II.  It contained several key elements of medical planning for amphibious operations, but failed to define responsibilities for key surgeons on the amphibious team.

Fortunately, a small team of dedicated medical officers, many with combat experience with Marines in Nicaragua and elsewhere, were given pretty much free rein to work out the doctrine that carried us into the war.  According to Captain Oreck, even with changes  made as a result of the huge World War II experience, today’s medical amphibious doctrine would still be recognized by the pioneers who developed the doctrine nearly 80 years ago–a doctrine responsible for saving Marines’ lives.

Semper Fidelis!

AMSUS in Phoenix

Your blogger is in Phoenix for the 116th annual meeting of the Association of Military Surgeons of the United States (AMSUS).


The Society for the History of Navy History, sponsor of this blog, held its Fourth Annual Meeting and Papers Session as a panel today, Wednesday 3 November.  It was a historic first both for the Society and for AMSUS.

The Society is a constituent of the American Association for the History of Medicine and, for its first three years, held its meeting in conjunction with that Association.  This year, we decided to start reaching out to our other “constituencies”–for 2010, the community of military medical professionals.  In 2011, we hope to mount our panel at the Naval Academy History Symposium, thereby reaching out to the military / naval history community.

Our meeting this afternoon was a great success.  Three papers and commentary were well received. I will post more details about the meeting on the Society website at


Speakers Lud Deppisch, Dan Grabo and Steve Oreck backed by Commentator, Navy Medicine's Historian Jan Herman

Navy Surgeon General Vice Admiral Adam Robinson stopped by to greet the 30+ attendees, and to emphasize the importance of our history as a guide to our future.