An Admiral From 100 Years Ago Warned Against Big Hospital Ships

America’s two gargantuan hospital ships, the 70,000 ton USNS Comfort (T-AH-20) and USNS Mercy (T-AH-19) are at the end of their service lives. Supersized, offering a thousand beds, these ships were procured in the Cold War to provide a floating medical backstop for NATO defense of Europe. Grand though they are, these old converted oil tankers need to be replaced with platforms capable of projecting relevant medical care forward. 

Many shipbuilders are busy presenting their own ideas, but, rather than have the Navy and other interested stakeholders reinvent the wheel—or decide to blindly recapitalize the two behemoths—it might be better to take a look back, to a time when hospital ships were critical fleet components. In World War I alone, before antibiotics, vaccinations and anti-malarial medicines reduced the casualty load, England fielded twenty-one naval and eighty-four military hospital ships. The grand navies of old knew hospital ships because, a Century ago, hospital ships were in the fleet, at sea, supporting sailors every single day. 

These venerable operators developed hospital ship doctrine that America’s Cold War-era hospital ship designers ignored. And as America struggled to employ two massive hospital ships in the fight against COVID-19, America may be well-served to look back at old hospital ship operations and concepts. They will discover that the golden age of hospital ships can do a lot to inform America’s quest for modern medical services afloat. 

A particularly interesting review comes from Surgeon Vice-Admiral Joseph Chambers, who, in a century-old Presidential Address published in the 1924 Proceedings of the Royal Society of Medicine, spelled out the British experience with hospital ships—a record that stretches from the end of the 17^th Century, well before the United States Navy got into the hospital ship business by converting, in 1862, a captured Confederate Ship, the Red Rover, into a floating hospital. 

In a prescient caution to future hospital ship designers, Vice-Admiral Chambers warned against fielding “super-sized” hospital ships—which in those days had displacements of around 53,000 tons—noting that “in spite of the proved usefulness of these leviathans” in moving large numbers of personnel and their “steadiness at sea, their use for the purpose is nevertheless attended by disadvantages.” 

America’s Mercy Class Hospital Ships confront similar challenges today. Like the USNS Mercy and Comfort, the large RMS Aquitania and RMS Britannic (converted cruise liners that were recommissioned as hospital ships) were too big to enter necessary harbors. Often the number of casualties was insufficient to fill the vessels, making it difficult to justify the voyage to higher-level care from various points on the front. Even worse, the logistical support requirements necessary to field the large ships was a enormous and underestimated challenge for those eager to support wounded vessels. 

Instead, the Vice-Admiral suggested “a draught shallow enough to enter ordinary harbors with sufficient tonnage to accommodate 300 or 400 patients.” That is a perfect fit for today’s Navy. Such a vessel would support the Navy’s need for surge casualty care while providing America with a hospital ship versatile enough to handle a range of potential ports and berthing situations around the globe.  

The Vice-Admiral re-emphasized the importance of patient throughput, or, as Chambers put it, “admissions or discharges in mass”. He noted that, at Gallipoli, he noted that “crowds of cases usually came in rushes” and noted that developing a “routine for the embarkation and disembarkation” was necessary. Having the ability to land numbers of casualty-carrying aircraft at once, or the ability to quickly embark and disembark wounded sailors merits real attention from future hospital ship stakeholders.

These are all points that remain true today. America could use smaller hospital ships that are both large enough to handle the high seas and large enough to handle several rotary wing aircraft at a time and yet small enough to not completely overwhelm smaller maritime partners.

But the fact remains that Vice-Admiral Chambers’ ideas on hospital ships have held up remarkably well to the test of time. Technology advances aside, the Vice-Admiral’s views on basic hospital ship design are as relevant now as they were one hundred years ago. Today’s hospital ship designers could do far worse than to mine old hospital ship essays and documents for tips and hints at how to build modern-day hospital ships that can evolve from being useless “While Elephants” into a platform that can serve in both war and peace.