Afifah’s Meeting Notes

1. Hospital Ships, Past and Present, Do They Have A Future?

By Orthopedic Surgeon Rear Admiral Mike Farquhason-Roberts CBE PhD MA FRCS

Though I expected to hear rousing stories of tremendous naval surgical successes on the high seas, our speaker was not singing the praises of this particular aspect of our nation’s history. Indeed he suggested that for the most part hospital ships have played only a small part in conflicts of the past few hundred years, much to my surprise.

As the English navy grew the need for professionalised hospital ships was deemed a necessity. One of the first, called The Goodwill, was used for transportation of sick and wounded seamen in 1608, and the excellently named Sick and Hurt Board, established during the Anglo Dutch Wars of 1665 to 1667, formalised this concept. Interestingly, the Commissioners of the Sick and Hurt Board included both John Evelyn and Samuel Pepys, who later became more famous for their literary works, than for their valuable bureaucratic labours. It is this organisation that is credited with the eradication of scurvy from the Royal Navy following application of the insightful ideas of Johann Bachstrom and James Lind.

The Hague Conventions of 1899 and then 1907 formalised the laws of armed conflict relating to the protection due to hospitals and to the wounded including those on hospital ships. Germany was a signatory to The Hague Convention, and to get round this in the early stages of First World War, they chose to use terrorist tactics in Belgium, i.e. mass executions, to get their way with the people there. They tried this out in England too but it didn’t have the desired effect on the folk of Scarborough!

The UK and USA used a great many ships as hospital ships, and others for troop transportation, according to international law. When the HMHS Llandovery Castle was torpedoed and sunk with the loss of 234 lives, including doctors, nurses and members of the Canadian Army Medical Corps, the world was shocked! Read about it here: Wikipedia – HMHS Llandovery Castle. Camouflage painting of ships was employed to prevent such tragedies. The HMHS Maid of Kent was sunk at the quayside in Dieppe by the Luftwaffe, just after casualties had been stretchered off, even though the ship and quayside had been clearly demarcated with huge red cross flag imagery, as the law required. Many lives were lost in this outrage.

WW2 saw hospital ships used as ambulances, rather than treatment centres, but there was a lot of waste of resources in moving these ships across oceans, only to do very little re the war effort, but during the time of the 1992 war between Britain and Argentina over the Falklands Islands, we still put a ship into use as a floating hospital, in this case it was The Uganda, which was hastily converted in six days (!) in Gibraltar from whence she sailed with the Task Force to the tip of South America. During that war 730 casualties (including some Argentinians) were treated on board, and, after 113 days, on August 9th 1982 she returned to Southampton to a hero’s welcome. Argentina also had a hospital ship, and Britain debated sinking it, as it broke the Geneva Convention by using it also for transportation and communications.

The USA has two hospital ships, one on the east cost, and one on the west. Neither are really fit for purpose, and have major layout weaknesses. They are The Mercy and The Comfort (gorgeous names!). One is going to be refitted soon, and the other will be decommissioned, as they are, essentially, not very useful. What is useful is small, super efficiently designed, almost ‘pop-up’, or ‘portable’ surgical hospitals, and this is the way things are going to go in the future.

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PORT-AU-PRINCE (April 11, 2009) The Military Sealift Command hospital ship USNS Comfort (T-AH 20) is anchored near Port-au-Prince supporting Continuing Promise 2009, a humanitarian and civic assistance mission to Latin America and the Caribbean. (U.S. Army photo by Spc. Landon Stephenson/Released)

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2. Haslar Royal Naval Hospital

by Eric Birbeck MVO

The second presentation was a delightful dive — though not a very deep one, because that would take far too long — but an enticing dip nevertheless into the wonder that was Haslar Royal Naval Hospital in Gosport.

The speaker, Eric Birbeck MVO has clearly immersed himself in Haslar’s history, purposes and circumstances, and was able to give us a real taste of this once-magnificent institution.

Haslar, was built as a naval hospital in 1753, close to Portsmouth where it would serve the Royal Navy for more two and a half centuries. The name ‘Haslar’ derives from the farmland it was built upon, which meant Hazel Bank in Anglo-Saxon. The land was bought by the Admiralty and the stupendous building designed by Theodore Jacobsen, a merchant-architect who has many outstanding buildings to his name, including the London Foundling Hospital and Trinity College, Dublin.

The budget for what was the largest brick building in Europe at the time, was originally £39,000, but in line with contemporary infrastructure planning inevitably escalated to £133,000 which would have been an astronomical sum at the time. In fact, according to the National Archive currency converter, equates to £13 billion in modern money or 28479 cows if you prefer (!) However, for that money they did get a delightful pedimented entrance in Portland stone that would have been a very impressive presence to the bedraggled sailors who benefitted from the largesse of the Admiralty. Haslar was finally completed in 1762.

James Lind (he of scurvy solution fame, mentioned above) was the senior physician at Haslar from 1758 for an impressive 27 years, and was clearly a man dedicated to experimental medicine and clinical trials. He arranged that the sickest men were on the top floor, and as their health returned, they were taken to the middle then the ground floor wards, from whence they could aspire to, and reach, the gardens with their fresh air and solace. That’s a novel idea. We also heard of the many shenanigans that went on with the smuggling in of alcohol, by the ladies who worked there, and occupied one wing of the building. Not exactly nurses, these ladies supplied all sorts of services. Much hilarity was, clearly, available at Haslar, which professionals and patients alike probably valued.

In WWI Haslar was used as a transition hospital, with injured troops arriving by ship and going by train to other parts of the country for treatment. In WW2 the blood transfusion service was founded here. A great deal of surgery was done in the cellars (which were three floors deep) as they worked 24 hours per day. A huge magnet was used to remove iron shrapnel imbedded in the poor injured soldiers and nurses that found themselves in the care of these heroic doctors. Far better than digging around trying to find metal shards. And it was not just our own service men that were treated. Foreign casualties were treated in large numbers, and some have their own grave yards.

Sadly for local patients, it no longer functions as a hospital at all, however, just before its closure in 2009, I met someone who had been there for a hip replacement. He explained that it was a wonderful hospital and so unlike the usual NHS experience, as it was super efficient, and run with military precision and discipline. I was left wondering why all of our hospitals can’t function like this. Know what I mean?

The building is now in private ownership, and has been converted into luxury apartments. Fittingly, many of the current residents have a naval background.