Navy Medicine in Araby – Then and Now (Episode 1)

I gave this paper at the annual Congress of the Naval Order of the United States last October. The theme of the Congress was “The Navy and the Battle Against Terrorism”. The article fairly long, so I will post it in Episodes. Herewith, “Navy Medicine in Araby – Then and Now” (Episode 1) [look for subsequent episodes to appear every couple of weeks or so):

When Naval Order Commander General Michele Lockwood asked me to talk about Navy medicine in our wars in the Mediterranean and Middle East, I jumped at the chance!

First, a word about the term “Araby”. While dictionaries refer to the term as an archaic or romantic term for Arabia, I expand the connotation of the term to include the larger world of Arabs.

This paper is intended to be a “compare and contrast” study of medical care and its delivery in our Navy during the Barbary Wars of the early 19th century and what we experience in the Middle East and Afghanistan in the 21st century.


Responsibility for the care of injured or ill sailors is a long-established tradition in the west. The earliest “laws” of the sea are dated by tradition and some evidence to the era when the Greek island of Rhodes dominated the primitive Mediterranean sea-trade starting around 1000 years BCE. One iteration of this compilation of sea-tradition rules, for instance, requires the ship’s master to pay for medical care if a sailor suffers injury – in this case the loss of an eye or a hernia – at the captain’s hand.[1]

The eminent medical historian Vivian Nutton tells us that the Roman navy of the turn of the last millennium assigned doctors (medici), apparently at double a crewman’s pay, to ships – or perhaps squadrons – of the fleet. While the nature of naval medical or surgical practice is not well understood, a rather good literature describes in detail the Roman army’s approach to health care, including quite sophisticated surgical management of wounds, as a pragmatic matter of keeping sick or injured soldiers in the service rather than sending them on the long, arduous and dangerous trip to their homes, where medical care traditionally was carried out.[2]

With the decline of the Roman Empire, military medicine – and medical practice in general – went into decline. But by the eleventh century, under the influence of maritime tradition and sea-law represented by the Consulates of the Sea, men of war carried barbers – the surgeons of the era – to care for sick and injured or wounded sailors and embarked soldiers. It was only with the rediscovery of Greek and Roman medical writing – in part a result of the fall of Constantinople and the resultant refugeeing of scholars of Greek and Latin – that a re-emergence of medical and surgical skills slowly began. By the twelfth century, ships of the Venician Republic carried both physicians and surgeons, and the Republic maintained an organized maritime medical service.[3]

The Renaissance saw a proliferation of Laws of the Sea as published by cities and other jurisdictions with seagoing trade. Our own traditions can be seen to emerge from the so-called “Rule (or Laws) of Oléron” named for a commercial island off the Atlantic coast of France. One version of the Rule specifies that a ship’s master shall put a sick sailor ashore and pay for his care and feeding until he recover, and that if he should die, his wife or near relatives should receive his back pay.[4] A half century after Eleanor of Aquitaine’s husband was crowned the English king Henry II, the Oléron body of rules was adopted into British law[5], and, modified and enlarged through the ages, resulted in the evolution of a British naval medical service, and ultimately, the construction of hospitals and homes for the care of sick and injured sailors.

This tradition in law came down to us as a British colony, where after 1729, any seaman, whether a colonial or Englishman, who landed in American ports, was taxed to support the great maritime hospital at Greenwich, England. In 1780, the colony of Virginia approved establishment of a hospital to care for sick and injured sailors of the Virginia navy, and provided for its finance through a tax on both naval and commercial sailors. Several other states made similar arrangements, but it was not until 1798 that Congress approved legislation that provided for the care of sick and injured merchant seamen by means of a deduction of 20 cents a month from their pay; Congress extended this provision to sailors, officers and marines of the navy a year later.[6]

[1] McFee, William, The Law of the Sea, New York, J B Lippincott, 1950, p 300.

[2] Nutton, Vivian, Ancient Medicine, London, Routledge, 2004, pp 181, 182.

[3] Mann, Commander W L, The Origin and Early Development of Naval Medicine, U.S. Naval Institute Proceedings, Volume 55 (Sept 1929), pp 773-4

[4] McFee, op. cit., p 306.

[5] Keevil, J J, Medicine and the Navy, 1200-1900, Volume 1, London, Livingston, 1957, pp 1-5

[6] Langley, Harold D, A History of Medicine in the Early U.S. Navy, Baltimore, Johns Hopkins Press, 1995, pp 8-17.

(c)2016, 2017 Thomas L Snyder

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