The Navy Department schedules reactivation of hospital ship Repose (AH-16). 1st hospital ship activated for service during the Vietnam Conflict.
Below is an article from Proceedings March, 1946 called “The Function of a Hospital Ship” written by Captain Howard K. Gray (M.C.), U.S. Naval Reserve.
Adequate care for the sick and wounded of naval and military land forces has been a problem as long as man has relied on the diabolically conceived instrument of war to settle disputes between nations. That the solution has been attained more easily when forces are opposed on land than at sea is apparent, for first aid, collection, evacuation, definitive treatment and subsequent disposition of casualties may be accomplished with greater facility under most circumstances in terrestrial than in naval warfare. The vicissitudes of weather may prove to be only a handicap to land operations whereas similar atmospheric conditions at sea may constitute an impediment of the first magnitude. The presence of the sick and particularly of the wounded has a markedly detrimental effect upon the morale of the remaining members of a combat unit. On land, the advancing forces may leave such unfortunate persons behind or they may be taken to the rear if the forward lines become static. At sea, this cannot be accomplished unless means be provided by utilizing combat vessels, cargo vessels, transports, ambulance transports, or hospital ships. Only in rare instances is it possible to evacuate sick and wounded by air from the most forward areas of naval or amphibious operations, although invaluable service has been rendered by this means from advanced bases from which the casualties have been flown to bases further removed.
Through the courtesy and generosity of Rear Admiral Lucius W. Johnson, Medical Corps, United States Navy, I have had access to the manuscript of a most interesting and instructive book entitled Hospital Ships; Their History, Development, Characteristics, and Employment in Peace and War. This work is an exhaustive study and it is to be regretted that time will permit only a few cursory references to selected sections.
To compare the modern hospital ship with a hospital ship of the middle eighteenth century, I should like to quote from Admiral Johnson’s book a reference to a certain Tobias Smollett) who sailed in Admiral Edward Vernon’s fleet from Port Royal in the last week of January, 1741:
Tobias Smollett, both as historian and as novelist, has painted for us a striking picture of conditions in the sick bays and hospital ships of that fleet during and after the unsuccessful attack on the city of Cartagena in March and April of that year . While his descriptions were doubtless somewhat colored by his partisanship in the violent controversy which raged between the adherents of Admiral Vernon and those of General Wentworth over the responsibility for the failure to complete the capture of the city, yet we have evidence from other sources that his statements did not greatly exaggerate the facts.
It is of interest to note that among the men of this expedition were some 3,600 troops from the American Colonies known as Wentworth’s Virginians. One of their officers was Colonel Lawrence Washington, and it was because of his admiration for Admiral Vernon that he gave the name of Mount Vernon to his estate on the Potomac River. This estate later came into the possession of his half brother, the first President of the United States. Admiral Vernon was most humane and considerate of the men serving under him and was affectionately known as “Old Grog” because he always wore grosgrain breeches. When he ordered that the rum served daily to the men before the noon meal be diluted with water, this attenuated drink was named “grog,” a term which has persisted to this day.
Smollett was a surgeon’s mate in this expedition, having duty during the campaign in several ships, including the flagship. In a vein of savage satire he has described the condition of the wounded in the hospital ships after the failure of the military to capture the citadel. “As for the sick and wounded, they were next day sent on board the transports and vessels called hospital ships: where they languished in want of every necessary comfort and accommodation. They were destitute of surgeons, nurses, cooks, and proper provision; they were pent-up between decks in small vessels where they had not room to sit upright; they wallowed in filth; myriads of maggots were hatched in the putrefaction of their sores, which had no other dressing than that of being washed by themselves in their own allowance of brandy; and nothing was heard but groans, lamentations, and the language of despair, invoking death to deliver them from their miseries. What served to encourage this despondence was the prospect of those poor wretches who had strength and opportunity to look around them; for there they beheld the naked bodies of their fellow soldiers and comrades floating up and down the harbor, affording prey to the carrion-crows and sharks which tore them in pieces without interruption, and contributing by their stench to the mortality that prevailed!
“This picture cannot fail to be shocking to the humane reader, especially when he is informed that while those miserable objects cried in vain for assistance, and actually perished for want of proper attendance, every ship of war in the fleet could have spared a couple of surgeons for their relief; and many young gentlemen of that profession solicited their captains in vain for leave to go and administer help to the sick and wounded. The necessities of the poor people were well known; the remedy was easy and apparent; but the discord between the chiefs was inflamed to such a degree of diabolical rancour that the one chose rather to see his men perish than ask help of the other, who disdained to offer his assistance unasked, though it might have saved the lives of his fellow subjects.”
It is quite apparent from the foregoing that the construction and usefulness of a hospital ship have come a long way in two centuries. The modern hospital ship represents the combined thought and effort of distinguished physicians, surgeons, and naval engineers toward the creation of a facility in which the sick and injured may receive treatment comparable to that offered in the finest of shore-based hospitals.
The mission of a Navy hospital ship is the mission of the Medical Corps of the Navy; for example, “To keep as many men at as many guns as many days as possible.” The function of a hospital ship is diversified. In time of peace, the hospital ship will provide complete hospital facilities for the fleet, a function which adds materially to the efficiency of the fleet by removing the sick and injured from the limited areas assigned to sick bays aboard the combat vessels and the other vessels of the train. The staff of specialists in clinical and laboratory fields serve in a consulting capacity and the ship’s large hold contains abundant stores of medical supplies from which the diminished stores of other vessels and shore establishments may be augmented.
In time of war, the function of a hospital ship may be threefold. The first of these functions is similar to that in time of peace, for example: to provide hospital facilities while the vessels of the fleet remain in port and occasionally to accept an injured or sick patient at sea. Upon the establishment of a new base, the hospital ship may be called upon to stand by until adequate hospital establishments are available on the beach and thus act as a station hospital. The third function, and perhaps the most important, certainly the most interesting, is to transport sick and injured to a base hospital from the fleet, from an advanced base, or from the forward areas in which a naval or amphibious force is operating. In addition to these three general functions in the care of the sick and injured, the staff of a hospital ship is charged with the training of corpsmen and with the utilization of the vast facilities for clinical investigation and pure research which are second to none, particularly when operating in the advanced areas. Unfortunately, these opportunities can be realized only partially because of the limited number of hands available to carry the enormous load that is applied in the short period of time during which such investigative work would be the most valuable.
During my tour of duty on a hospital ship and since being detached, many questions have been asked regarding the general function of a hospital ship and in particular regarding international agreements relating to hospital ships. Questions have been similar to the following: “Are hospital ships governed by the provisions of The Hague Convention or the Geneva Convention?” “Can a hospital ship be captured?” “Can a hospital ship be detained and searched?” “Can the enemy remove their own sick and wounded from a hospital ship?” “Can the sick and wounded of the enemy be removed from a hospital ship as prisoners?” “Can hospital ships carry firearms of any nature?” “Can the medical or hospital staff of a hospital ship be made prisoners of war should the ship be captured as a result of deliberate or inadvertent violation of neutrality provisions?” “Is a hospital ship designated by any special marking day and night?” “What is the risk a hospital ship runs by entering the forward areas during and immediately after an engagement?” “What was the stimulus behind the Geneva Convention?”
In answer to the last question, I shall quote again from Admiral Johnson’s book.
We have it on the authority of no less a personage than Sir John Pringle that, in 1743, before the battle of Dettingen, the Earl of Stair proposed to the Duke of Noailles, of whose humanity he was well assured, that both the English and French hospitals should be considered as sanctuaries for the sick, and mutually protected. This was readily agreed to by the French general, who took the first opportunity to show a particular regard for this engagement and it was strictly observed on both sides. The idea continued to spread and finally, through the efforts of Mons. Henri Dunant, a Swiss, culminated in the Geneva Convention of 1864.
The various conventions and conferences that have been called to formulate regulations relating to the conduct of maritime warfare were characterized by a sincerity of purpose on the part of most delegates, but it has been quite plain that selfish nationalistic interests have motivated some individuals. This presumption has assumed the stature of fact by the conduct of some nations in the interpretation of certain articles which have been laid down as rules to serve selfish ends. A leading authority on the interpretation of the treaties relating to hospital ships is Captain F. L. Pleadwell (M.C.), U. S. Navy (Retired), and I am deeply grateful to him for the use of personal papers and reprints of commentaries which he has graciously loaned to me.
According to instructions for the Navy of the United States governing maritime and aerial warfare relating to hospital ships, officers will be governed by the provisions of Convention 3, Hague, 1899 and Convention 10, Hague, 1907, for the adaptation to maritime warfare of the principles of the Geneva Convention of August 22, 1864, previously alluded to. The original convention at Geneva contained no article specifically referable to the marine and it was not until later, at the time of the Geneva Convention of 1868, that additional articles relating to maritime warfare were provided. In 1899, a peace conference was held at The Hague for the purpose of adapting to maritime warfare the principles of the Geneva Convention of 1864. This convention was ratified by 27 signatory powers and was adhered to by 19 other powers. A similar convention was held at The Hague in 1907 and was a revision of Convention 3 of 1899. It was ratified by only 26 signatory powers, 17 signatory powers have not yet ratified (November 22, 1939), and it has been adhered to by three powers. It is interesting to note that Germany, Italy, and Japan ratified Convention 10 of 1907, and as they indicated no desire to denounce or withdraw from the agreement, it was assumed that they wished to adhere to the provisions of the two Hague conventions. Although the United States is a party to Convention 10 of 1907, that convention does not represent universally accepted rules and evidently does not have the standing of Convention 3 of 1899 which has been regarded by our naval authorities as universally accepted international law. It may be interesting to enumerate briefly some of the more important articles of these conventions that pertain specifically to hospital ships, for by so doing some of the questions most frequently asked may be answered and others anticipated.
Military hospital ships, that is to say, ships constructed or fitted out by States specially and solely with a view to assisting the wounded, sick, and shipwrecked, the names of which shall have been communicated to the belligerent Powers at the commencement of hostilities, and in any case before they are employed, shall be respected and cannot be captured while hostilities last.
Similar protection is afforded ships equipped wholly or in part at the expense of private individuals or official1y recognized relief societies of a belligerent country or of a neutral country providing certain conditions of registry have been complied with. These hospital ships are directed to afford relief and assistance to the wounded, sick, and shipwrecked of the belligerents without distinction of nationality. The governments are enjoined against the use of these ships for any military purpose and they shall not in any way hamper the movements of the combatants. During and after an engagement, they act at their own risk and peril. The belligerents shall have the right to control them and search them. They can refuse their assistance, order them off, make them take a certain course and put a commissioner on board. They can even detain them, if the gravity of the circumstances requires it. Military hospital ships shall be distinguished by being painted white outside with a horizontal band of green about a meter and a half in breadth. Those ships sponsored by private individuals or recognized relief societies of neutral or belligerent countries shall be distinguished in a similar manner but with a horizontal stripe of red rather than green. The boats of these ships shall be painted in similar manner.
All hospital ships shall make themselves known by hoisting, with their national flag, the white flag with a red cross provided by the Geneva Convention. In order to ensure by night the freedom from interference to which they are entitled, the ships and small boats must, subject to the assent of the belligerent they are accompanying, take the necessary measures to render their special painting sufficiently plain. Hospital ships and sick wards of vessels are no longer entitled to protection if they are employed for the purpose of injuring the enemy. Neither the fact of the personnel of these ships and sick wards being armed for main training order and for defending the sick and wounded nor the presence of wireless telegraph apparatus on board is sufficient reason for withdrawing protection.
The religious, medical, and hospital staff of any captured ship is inviolable, and its members cannot be made prisoners of war. On leaving the ship they take away with them the objects and surgical instruments which are their own private property. The staff is directed to discharge its duties while necessary and can afterward leave, when the commander in chief considers it possible.
Sailors and soldiers on board, when sick and wounded, as wel1 as other persons officially attached to fleets or armies, to whatever nation they belong, shall be respected and cared for by the captors. Any vessel of war belonging to a belligerent may demand the delivery of sick, wounded, or shipwrecked men on board hospital ships whatever the nationality of these vessels. The shipwrecked, sick, or wounded of one of the belligerents who fall into the power of the other are prisoners of war.
In compliance with a resolution of the fourteenth International Red Cross conference, held in Brussels in 1930, the national Red Cross societies were called upon to make suggestions for revision of treaties then extant and a questionnaire and a suggested revision of the tenth Hague Convention were drawn up. These were submitted to all national Red Cross societies with an invitation to send representatives to a conference of naval experts. This conference of naval experts met in Paris on June 15, 1937, completed the draft, and submitted it to the sixteenth International Red Cross conference in London, June, 1938. This report rearranged the material of previous conventions so as to include problems arising in the care of the sick and wounded of warfare in the third of the natural elements, namely, the air. It is most unfortunate that the invasion of Poland by Germany in 1939 precipitated World War II before sufficient time had elapsed for the text of the draft adopted by the commission of naval experts to be considered thoroughly by the diplomatic representatives of the several nations and for this vastly improved document to be submitted to the respective official governing bodies for ratification, adherence, or rejection. It is for this reason that during World War II we had to depend on the provisions of older conventions, but with the hope that all belligerents would adhere to the principles of the original Geneva Convention in decisions of conduct peculiar to this war.