Naval Warfare in the Middle Ages & Renaissance

    The modern history of maritime medicine starts with a legendary figure in history, Eleanor of Aquitaine.  While on crusade with her husband King Louis VII of France in 1149, she tarried at the court of King Baldwin of Jerusalem.  There she became familiar with the Maritime Assizes of the Kingdom of Jerusalem, a code of maritime laws which was the descendant of the ancient Byzantine maritime legal code Lex Rhodia, and on her return to Aquitaine she implemented these rules for her duchy. Her code became known as the Law of Oléron after the Isle d’Oléron, a hub of Atlantic ship traffic and the seat of her new maritime court of law.  After her marriage to Henry II, she brought these laws to England in 1154.  The specified rules include detailed directions for ship captains and owners, including lists of the captain’s duties in case of shipwreck, a warning that the captain cannot sell the ship without the permission of the owners, and a dispensation that captains can throw merchants’ cargo overboard if it is necessary to prevent the ship from sinking.  Of all the items in the code, only one concerns medical care for sailors.  This clause does not provide for onboard medical attention; instead the ill sailor is to be taken off the ship as soon as possible.

“It happens that sickness attacks one of the ship's company, or two or three, and the sick man can do nothing in the ship, as he is so ill; the master ought to put him ashore, and seek a lodging for him, and furnish him with tallow or a candle, and supply him with one of the ship's boys to tend him, or hire a woman to nurse him, and he ought to provide him with such food as is used on the ship, that is to say, with as much as he had when he was in health, and nothing more, unless he pleases. If the sick man wishes to have more delicate food the master is not bound to find it, unless it be at his [the sailor's] expense: and the ship ought not to delay her voyage for him; on the contrary she should proceed on it, and if he should recover he ought to have his wages for the whole voyage; and if he should die, his wife or his near relatives ought to have them [wages] for him. This is the judgement.”  (Twiss)

Although these rules were primarily intended to govern the behavior of the merchant fleet, the distinction between merchant and naval vessel during this period was indistinct.  Lacking a true royal navy, the merchant fleet was pressed into service during times of war, and the Law of Oléron was applied to all types of vessels.  At this point in the early 13^th century, the typical vessel was a long oar-powered galley, with only several dozen sailors and soldiers.  Ship-to-ship warfare required close proximity as shipboard guns had not yet been developed.  After a barrage of bows and spears, fighting switched to axes and swords for hand-to-hand combat as the ships closed on each other and the aggressor’s crew prepared to board the weaker vessel.  Men who were injured during these disputes had to wait until the ship returned to shore to receive any medical attention, and many did not survive. 

The small size of the seagoing English vessels in the Middle Ages and their generally short voyages meant little need existed for an onboard medical practitioner.  The greater need at that time was for adequate facilities in the receiving harbor.  The injured were usually received in religious institutions and almhouses in the harbor, where there may or may not have been a medical practitioner available to treat them. There were no almshouses or hospitals solely dedicated to mariners in England until seagoing members of the Guild of the Blessed Trinity founded the first at Kingston-upon-Hull in 1457.  Even then, the house was dedicated not to the acute care of the injured, but to the housing of disabled mariners “which by infortune of the sea, shall hap to fall in poverty by loss of goods.” (Keevil 10)  Similarly, a guild of mariners made an arrangement in 1445 to pay the Hospital of St Bartholomew a regular donation from ships’ harbor fees in exchange for the dedication of 12 beds to the care of mariners making port in Bristol (Keevil 10).

Unprecendented changes in the English navy during the 15^th century profoundly altered the nature of naval medicine.  The long, oar powered galley began to disappear in favor of more maneuverable vessels, first cogs and then later carracks (1) (Rose 73).  More importantly for the tale of medicine at sea, the new ship designs allowed an innovation that would change the history of naval combat—the shipboard cannon.  By 1485, guns are included in the inventory of every English royal warship (Rose 97).  This meant that ship-to-ship combat could occur at a much greater engagement distance.  An additional advantage to the new designs was their reliance on sails instead of oars.  This freed sailors to take up more of the fighting duties that previously required a separate complement of soldiers, and allowed for longer voyages farther from the coastline (Fowler 27).  Because of these changes as well as the desire of the monarchy to display their awesome power, warships became progressively larger to accommodate increasing numbers of guns, cannons, and fighting men.  This trend reached its pinnacle with the reign of Henry VIII.  Henry was the first to commission warships that contained rows of guns mounted in gunports on the lower decks in addition to the top deck, increasing overall firepower (Fowler 26).  His flagship Henry Grace a Dieu, completed in 1512, weighed an impressive 1,000 tons and carried up to 1,000 men, and its launch marked the beginning of a true royal navy of great warships.  The high density of inhabitants in the great ships led to an increase in infectious disease and the need for on-board medical personnel.  This need was recognized in the warrant of the wages of naval personnel issued in 1512 by Sir Edward Howard, the Lord Admiral.  For the first time, surgeons were listed as expected members of the shipboard complement.  The chief surgeon was to receive thirteen shillings and fourpence a month, other expert surgeons to receive ten shillings, and all other surgeons in the navy eight shillings.  Thus by the Tudor era sailors could now expect a shipboard doctor to tend to medical needs (Keevil 59).

(Marsden 9).  After several decades of service, she suddenly sank during a naval action in 1545.  In 1974, the Mary Rose was rediscovered, and the painstaking excavation and recovery have preserved the daily routines of the mariners aboard the warship.  On the main deck, a cabin was found containing items that appear to belong to the shipboard medical practitioner, the barber-surgeon.  These items include both personal items such as his professional coif, as well as a variety of instruments and medicinals stored in containers and chests.  These findings lead us to ask, who were the barber-surgeons?