HISTORY OF NAVAL HEALTH SERVICE
Article published on 11 January 2024
last modification on 15 February 2024

FOUR HUNDRED YEARS OF NAVAL MEDICINE FROM THE SEVENTEENTH CENTURY TO THE PRESENT DAY

From the year 1434 onwards, the compass and the mariner’s card, marine compasses and caravels enable audacious western sailors to install trading posts and colonize overseas territories.

Henri IV is the first to realise the necessity of having a fleet available at all times and the need to maintain ports in good condition. From 1589 to 1606, Toulon is surrounded by protective ramparts and doted with a little naval dockyard while Brest, huddled up at the end of its harbour, strengthens its defence. On the 13th of January 1629, the Cardinal Duke of Richelieu, in his letter of advice to the king, declares: "The first thing to do is to be powerful at sea, which is the entry to all the world’s states". The founder of the permanent Royal Navy, he is the initiator of the "Administrative rules of the Royal Navy", signed on the 29th March 1631. For the first time, the general administrators, future officers, work together to maintain the ships, material and crew and the edict of 1642 orders the captains of ships and store ships (that can welcome the sick and the wounded) in the service of the king, to take with them "a very good surgeon to treat the crew". Thus an embryo of a body of "sailing surgeons" was officially established.

THE BIRTH OF THE NAVAL HEALTH SERVICE

Being conscious of the importance of power at sea, Louis XIV gives to his minister Jean-Baptiste Colbert the task of organizing, for His Greatest Glory, overseas commerce, the security of the coasts, of the colonies and the seaways that lead to them. He doesn’t want to forget the wellbeing of his subjects, The sailor (matelot – a word derived from Dutch which means someone who shares his bed, in actual fact a hammock); being a person as precious and difficult to recruit in spite of the class system introduced at Rochefort in 1668.

On the 22nd September 1673, Louis XIV signs the Edict of Nancy, creating the first mutual benefit social insurance, the Institution of Disabled Sailors, which is financed by a subscription taken from the pay of sailors on board ships.

Hospitals are established to treat the wounded and the sick: in 1674 in the peninsula of Saint-Mandrier, in front of the port of Toulon; in 1683 at Rochefort, a city reconstructed on the Atlantic front, whose "intermittent fevers" decimate a newly installed population; at Brest, in 1684 and finally in Port Louis in 1689. The Hospital of the Abbey of Cherbourg receives its first patients only in 1793.

Jean-Baptiste Colbert having expired on the 6th September 1683, his son, the Marquis of Seignelay, submits to the king the famous decree of the 15th April 1689 "For the marine forces and the naval dockyards" which defines in 23 books the organisation and functioning of the naval forces. The twentieth book deals with "the marine military hospitals and those on the ports together with the centres established for their direction and also for the chaplains on vessels".

At that time, the navy maintains three kinds of medical officers: physicians, surgeons and apothecaries. The first, having gone through a faculty of medicine, have obtained a doctorate. Followers of Hippocrates and Galen, they hold forth at length, in Latin, on the why and the how of pathologies which still guard their secrets. The very notion of disease begins to become clear and certain nosocomial entities are named. The port physician is the most important official of the service and the first of them is appointed to a post in Toulon about 1666. Surgeons, whose origins are often very modest, learn their job by practising with more experienced colleagues and, after many years of work, they can receive the title of "Master of Surgery". It is the same for apothecaries.

In the third heading, article ten, the decree declares that the commissioner in charge of health services : "will be present at examinations made by the physician and the chief surgeon of the port, the qualified and assistant surgeons and apothecaries who wish to serve in ships and in hospitals; he will see to it that only those who are capable of handling these duties will be admitted".

SCHOOLS OF NAVAL SURGERY

Accomplishing at the same time the tasks of a physician, a surgeon and an apothecary, the surgeon on the ship thus becomes the most important officer in the health service at sea. He receives gratitude but he is also the target of criticism by the administrative staff because of his insufficient training.

Quartermaster Begon, Administrator in Aunis and of the navy in Rochefort, is the first to react. Having noticed Jean Cochon-Dupuy, a young thirty-year-old physician, Doctor of the Faculty of Toulouse and the king’s doctor in the province, he proposes to him the second medical post in the navy. We are in 1704 and Cochon-Dupuy; who will never leave the city of Rochefort again, becomes its chief physician eight years later.

On the 13th of January 1715, he makes a report imagining a future to be hoped for : "naval hospitals would become asylums for the sick and schools for young surgeons where they could learn not only anatomy and surgical operations but also acquire knowledge about internal diseases and the composition of remedies and the doses in which they should be administered. In fact, it is not enough for ship surgeons to know the art of surgery alone because they are also obliged to act as physicians and apothecaries".

Plans and financial estimates are approved on the 12th of June 1721 and the inauguration of the amphitheatre takes place during the first weeks of the month of February 1722. The naval health corporation has just taken a decisive turn towards its future.

The supreme consecration is the decision of the king in 1735 that the surgeons will be appointed by royal command. Toulon has a school since 1725 but it is Jacques Philippe Boucault who is honoured for having obtained from the king the permission to transform it to The Royal College of Surgery in 1754. The beginnings are just as difficult in Brest and the school will really develop thanks to Etienne Chardon de Courcelles, in 1742.

Having become both universities and hospitals, they are soon provided with botanical gardens. The garden in Rochefort is inaugurated on the 30th December 1741, that in Brest in 1768 and that in Toulon in 1785.

The profession of the marine gardener is created in order to maintain the plantations and, when necessary, to teach gardening. These gardens are also used to acclimatize plants and vegetables that health officers bring back from their campaigns, and furnish a part of the material needed for stocking up the medicine cupboards.

Finally, a major event occurs that gives an unexpected boost to the functioning of the schools. By a royal edict of 27th September 1748, workers on galleys are reunited to the navy. In Marseille, the rowers, who are 4 000 galley slaves, are separated and sent into three places where there are penal colonies : Toulon from 1748 onwards, Brest the following year and to Rochefort in 1752. A penal colony hospital, managed by a chief physician, is established. Surgeons follow training courses there and the lecture halls of the school of surgery never lack anatomical material.

Penal colony hospital in Toulon

THE CREWS AND THEIR PATHOLOGY

After finishing their basic training, the sailors "would arrive at the ports completely naked, having, quite often, sold their togs on the way in order to keep alive, or having begged along the way. At their arrival, no measures were taken to confirm their validity for employment, and one often notices that many of them were still not suitable for service at the time they are embarked".

What’s more, ordinary fare varies little and consists of biscuits and salted meat and fish whose initial quality and state of preservation is inadequate. And on top of that, drinking water meanly metered out, that has been rotting in barrels. And also, being crammed between decks, unceasing humidity, vermin (lice, flees and bedbugs), ravaging creatures (cockroaches and rats abound) and the transport of living animals (sheep, poultry...) which make the air stink, air that is difficult to freshen. All the ingredients are united so that outbursts of deadly epidemics can prevail over all pathologies.

Thus scurvy is a permanent threat to the crews. Repeated embarkations and the bad health conditions of most of the persons on board, clearly shortens the period of the appearance of this vitamin deficiency which normally occurs after a four-month absence of fresh food.

Following the work done by Doctor Link from 1795, the English Navy makes "jus de citron" (lemon juice) obligatory, Sicilian lemon juice to which 10% of brandy has been added, a spoonful of which is given to each person once a day. Being aware of the good effects of stopping at a port of call and profiting from cool weather, the French realise the special benefits of lemon juice only in the 1850s.

In the month of January 1756, the lamentable Seven-Years war against England begins. On the 4th of November 1757, the first vessels of the squadron of M. Dubois de Lamotte, sailing back catastrophically from Louisbourg that they had been defending, arrive at the harbour in Brest. The other ships follow, some of which are directed towards the Aix harbour. The crews, exhausted by scurvy and decimated by typhus, this famous "ship fever’, are not capable of manoeuvring the vessels and the port staff have to intervene. Amidst conditions of grave disorder, the epidemic soon infects the population.

A later investigation reveals 10 000 dead in the population and, among the sailors, 3 600. The Health Service is seriously affected, losing five out of fifteen physicians, more than a hundred and fifty surgeons and apothecaries and two hundred nurses. This health catastrophe is comparable to the calamitous end of this battle when France lost many colonies like Canada and Mauritius.

So, in order to protect the ports from the spread of epidemics, the navy had, since the seventeenth century, established detention centres (lazarets): on the Brest harbour, on the peninsula of Saint-Mandrier, not far from the hospital. Navy crews, when they returned from overseas, were put in quarantine either on a peninsula or on the island of Porquerolles when there were not enough places, and it was necessary to wait till the expulsion of the Jesuits from Toulon for a chief navy hospital to be installed in the empty convent.

FROM THE FIRST UNIFORM TO THE STATUS OF THOSE ASSIMILATED INTO THE NAVY

The Paris treaty having been signed on the 10th of February 1763, the navy takes advantage of this time of peace to reorganize itself. At the head of the health service, it appoints an Inspector General of Medicine, of Pharmacy and Botany in all the ports and in the colonies. The first to occupy this post, Pierre Poissonnier, appoints his own brother, Antoine Poissonnier, known as Desperriéres, to be responsible for the colonies.

The advance towards a certain autonomy is confirmed with the ruling of 1765, which makes the chief surgeon of a ship a member of the administrative staff : he is received at the captain’s table.

Then, with the administrative order of the 30th November 1767, physicians and surgeons are furnished with uniforms, the famous grey costume. Ten years later, the interlaced anchor of Epidaure decorates the uniform buttons. Finally, on the 1st of March 1768, the rule for schools of surgery introduces the principle of competitive examinations.

On the 1st of February 1783, a school of practical medicine is created in Brest, in order to teach young physicians from faculties the elements of naval and tropical pathology: a sort of school for the application of knowledge. But, little by little, discontentment grows, which makes serious reforms necessary. It was, in fact, a Revolution.

In the midst of disorderliness, confusion and violence, the Naval Health Service, headed by a medical commissioner, Augustin Coulomb, adapts itself to the changing circumstances of the time, appoints in every port a Naval Health Committee, which becomes the Council of Sanitary Conditions on 21st April 1794 and the Health Council on the 27th of September 1799.

The first Consul creates the post of the Maritime Prefect on the 17th of April 1800 and then, depending on the Restorations, new organizations succeed one another in the navy and in its ports until the law of the 19th May 1834 on the status of the officer and the royal edict of the 17th July 1835 on the Naval Health Service and the colonies. The military status is at last recognised for health officers; they are "assimilated" into the body of naval officers.

It is the intelligence and skill of the Chief Inspector of Naval Health, Pierre-François Kéraudren, which led to this major advance.

The generation of health officers, having escaped the huge tempest, find themselves at the head of the health services in the ports. They have experienced the expedition into Egypt, the defeat of Aboukir and the horrors of the plague from 1798 to1801, the yellow fever of the Saint-Domingue expedition and then the drama of the Cape of Trafalgar where many surgeons lost their lives, shot to death by cannon fire or drowned when their vessel sank.

FROM VOYAGES OF CIRCUMNAVIGATION TO THE WARS OF THE SECOND EMPIRE

Since the expeditions of Louis Antoine de Bougainville (1766-1769) and those of Jean-François de Galaud de Lapérouse, tragically interrupted by the sinking of the Astrolabe and the Compass in the channels of Vanikoro in 1788, France has never ceased to participate in the exploration of the rest of the world by sending its best sailors and scientists all over the world’s seas.

During the Second Restoration, at the request of the heads of mission, like de Freycinet in 1817, the naturalists who sail forth are almost exclusively surgeons, pharmacists and specially-trained sailors. The medical schools of Brest, Rochefort and Toulon improve their teaching of zoology, botany and geology. The museums and botanical gardens of these schools then play a major role. Having become the information centre where the accounts of circumnavigations and the reports of health officers appear, the Naval and Colonial Annals print the lengthy recommendations of the professors of the Natural History Museum in Paris concerning the collection, the conservation and the transport of specimens that will enrich each of their collections.

This is one of the most glorious periods of the naval health service, which gave France the surgeons Jean René Constant Quoy and Paul Gaimard, the pharmacists René Primevère Lesson and Charles Gaudichard-Beaupré, members of the Academy of Medicine and the Academy of Science.

Considering it as its duty to follow the significant progress of medicine at the time when anatomical-clinical science proves its efficiency, the health service, decimated by yellow fever, malaria, cholera; dysenteries and tuberculosis, must obtain more workers imperatively, all the more as armaments multiply. Successive ministers are thus obliged to enrol significantly larger number of health officers, even as they leave school.

Following the war with Spain in 1823, the battle of Navarin in 1827 and that of Alger in 1830, the decree of 1835 decides on a definite squad of 272 physicians and surgeons that assistants will support according to operational necessities. The decree of the 25th March 1854, increases this projected level to 504, plus 54 pharmacists, creates the post of Director and reserves 25 posts of Chief Surgeon to those navigating, thus confirming their major role in economy of the service. The decree of the 31st May 1875 appoints 666 physicians and 84 pharmacists, the denomination of surgeon having disappeared since the decree of the 14th July 18 65. Thus the needs of the colonial service and the overseas commitments are taken into account.

Among the major conflicts of the Second Empire, special mention must be made of the war of the Allies against Russia. The navy battles on three fronts: the Baltic Sea, the peninsula of Kamtchatka and the Black Sea. It is towards the north of the latter that diverse episodes take place of what is called The Crimean War, during which, for the first time in its history, the whole of the Health Service, uses a technique that is going to revolutionize surgery : anaesthesia.

Invented less than ten years before in the United States, this procedure is adopted by naval surgeons from 1847 and Auguste-Adolphe Reynaud, a future Inspector General, elaborates in 1850 an "anaesthetic cone" containing chloroform, which was allowed to be used in 1856. During the affair of the Tractir Bridge, on the 16th of August 1855, at the request of the Chief Physician of the army, Joseph Scrive, the navy’s chief physician, Auguste Marroin, sends twelve naval surgeons to give a helping hand to their colleagues on land. One of these latter officers, the First Class Assistant Major, Albin Laforgue, notes, concerning this cone: "I immediately made one … and from the time I made my first intervention, it was adopted with cheers by my comrades; since then it has stood us in good stead". A beautiful example of army-navy technical collaboration.

THE PHENOMENON OF THE DRY COLICS

Already foreseen in the decree of 1689, the end-of-campaign medical report takes a new form. Perfectly codified, it comprises : a description of the vessel with a commentary of its hygienic conditions, an account of the pathological phenomena that occurred in the course of navigation, a description of the ports of call with precise details on the means and capacity of local hospitals, clinical files and both medico-surgical and meteorological statistics. In his turn, the chief surgeon addresses his report, signed by the commandant, to the Health Council of the port.

A first copy of the document, after analysis and appreciation, is preserved on the spot. A second is sent to the office of the admiral, director of the staff, who, after stamping it, transfers it to the Inspector General of the Health Service. The latter is thus always kept aware of the problems that crop up all over the planet, similar reports being made by the chiefs of the health service in the diverse colonies.

The most remarkable of these accomplishments are printed in the columns of the maritime and colonial annals and then, after 1864, they appear in the new review of the service, The Archives of Naval Medicine. It is thanks to this information system and the obstinacy of an individual that the matter of the dry colics finds a solution.

As a matter of fact, aboard ships destined to serve along the western coasts of Africa, there appears, since 1820, more and more frequent cases of very painful and disabling colics which sometimes end by a death. These colics are sometimes said to be dry because non-productive, sometimes vegetal. Very soon, two opinions oppose each other. In his report of 1846, the First Class surgeon Louis Raoul writes: "this disease is so similar to that of lead-poisoning that one is tempted to ascribe the same cause to it". The other side is led by Jean-Baptiste Fonssagrives, a future Chief Professor of Naval Hygiene. In his thesis of 1852, he writes: "the theory that attaches vegetal colic to lead-poisoning has no foundation".

The last word belongs to the director of the Brest Health Service, who, having closely studied hundreds of reports and corresponded with surgeons, orders every trace of lead on board to be removed, in particular the pipes in contact with drinking water. These measures having been taken, dry colics disappear. In 1858, Amédée Lefèvre is appointed Commander of the Legion of Honour. His work devoted to this matter, published the following year, remains a model for epidemiologists. In the second edition of his Treatise on Naval Hygiene, in 1877, Fonssagrive admits he had been wrong.

1889-1890, THREE FOUNDATIONS, A NEW ERA

This end of the nineteenth century, full of progress in the field of medical science and stimulated by an irresistible spirit of conquest, sees the formation of three structures that have to do with the Naval Health Service : a particular health service for the colonies; an unique school of the health service connected to a faculty of medicine; the creation of the Pasteur Institute.

After multiple efforts, since 1858, to obtain, from the Minister of the Navy, autonomy in the direction of the colonies, a Secretariat of State for the colonies is established in 1881. The following year, Professor Georges Treille is appointed to a post next to the President of the Higher Council of the Naval Health Service, Béranger-Féraud. Having become chief physician in 1886, Treille introduces himself to Eugène Etienne, an influential politician and Secretary of State for the Colonies.

In spite of strong resistance from the navy, on the 7th of January 1890, there appears the decree which includes "The constitution and organization of the health corps in the colonies and protectorates", a joint work of Etienne and Treille. Albert Calmette*, on duty at Saint-Pierre and Miquelon, is among the first to support the new corps.

The second major event is the result of the law of the 10th April 1890, bearing the title "The creation of a school of the naval health service and three annexes". The doctorate having become obligatory for practising medicine, the schools of Brest, Rochefort and Toulon are limited to preparing students for the competitive entrance examinations for entry into the Principal School which the decree of the 22nd July has established next to the Faculty of Bordeaux. Its interior rules and uniforms being modelled on those of the Naval School of Brest, it naturally becomes "Naval Health", whence will emerge physicians and pharmacists whose duty will be to serve at sea and overseas.

The third foundation, contemporaneous with the other two, is going to be intimately involved in the lives of the physicians graduated from this Bordeaux school whose appointments are resolutely turned towards overseas. After the tremendous success of the vaccine against rabies, contributions increase which enable Louis Pasteur to witness the construction of the Institute that bears his name, Inaugurated on the 14th of November 1888, the Pasteur Institute opens a course on "microbic technique" under the direction of Emile Roux with, as assistant, Alexandre Yersin. From the very first session, the physicians and pharmacists of the army, the navy and the colonies are among the auditors.

These three foundations lead to the reorganisation of overseas health structures. Since its settlement in the colonies, the navy maintained hospitals like the one in Saint-Louis in Senegal or Saigon in Cochin-China. These structures, like the overseas Pasteur Institutes, will be directed from now on by physicians in the colonies. However, the navy will maintain, till the decolonization of the sixties, a hospital in North Africa.

France having made Tunisia one of its protectorates, the Navy builds, since 1900, a naval base in Bizerte. At the end of the lake, connected to the sea through a canal, an arsenal comes into existence at Sidi Abdallah whose neighbouring village becomes Ferryville. On the 21st of August 1905, the last overseas naval hospital is inaugurated. It will render great services during the two world wars.

In 1944, the health service of the American troops brings with it three precious novelties: lytic cocktails, penicillin and DDT.

It is at the hospital of Ferryville that the young naval surgeon, Henri Laborit, does his first experiments; which end up with his concept of hibernation.

An epidemic of plague having begun its ravages, the first class physician Jean Brisou demonstrates experimentally the efficacy of sulphonamides, thus saving many diseased people, while penicillin, so efficient against recurrent illnesses, is quite without effect on the Yersinia bacillus. As for insecticide, it becomes a major asset against malaria.

SHIPS AND SAILING HOSPITALS

The inaugural decree of the 15th of April 1689, foresaw, following the construction of fighting vessels, a hospital in the ship for 10 of the vessels. Besides the chaplain and the writer, the staff consisted of a capable and experienced master-surgeon, a chief apothecary and two assistants, The material consisted of surgical tool chests, medicine chests, packing cases (and not hammocks) for lying down; linen, as well as suitable nourishment for the bedridden. Since that time, many vessels rigged as hospitals followed the various squadrons, even during the American War of Independence.

In the Nineteenth Century, the re-conquest of the colonies and the extensions of overseas positions force the navy to adapt itself to operational needs, establishing, here and there, floating hospitals. Thus, in October 1859, the Caravane is anchored in the estuary of Gabon to serves as a hospital and a source of food for the naval division of the West African Coast. Having lowered its masts, it is also used for the direction of the port and as barracks for sailors.

However, the most numerous and the most used are the sailing transport hospitals, vessels for all purposes, which escort, besides the sick and the wounded, families, troops and their horses. As soon as the penitentiaries in Guiana are opened, these vessels are also responsible for transporting the condemned prisoners who are kept in closed cages. The chief physicians of these vessels, constantly sailing around between Senegal, the Salvation Islands, the West Indies and Metropolitan France, do not fail to condemn this procedure which strongly infringes the elementary rules of hygiene.

In order to deal with the needs of the fighting forces during the conquest and then the pacification of Annam and Tonkin, the navy is obliged to hire ships belonging to private companies. Thus, from 1886 to 1895, besides state vessels such as the Vinh-Long, the Annamite, the Bien-Hoa and the Mytho, are hired the Chandernagor, the Comorin, the Canton, the Colombo and the Cachar, to commute between the Far East and France.

If the First World War does not, at its beginning, require naval means for evacuating the wounded, the needs appear to be considerable during the operations in the East. The case of the Dardanelles alone mobilizes, in addition to the old Tonquin, renamed Duguay-Trouin, five other requisitioned ships. Repatriations for health reasons from the eastern front to metropolitan France or North Africa; in particular towards the Naval Hospital of Sidi-Abdallah, mobilize even the biggest French steamship, the France, of the CGT.

During the Second World War, two veteran merchant ships, the Canada and the Sphinx, are mobilized. They will commute between England and Toulon. The second will be captured by the Italians.

MODERN TIMES

On the 6th and 9th of August 1945, the United Stares reduces Japan to silence by annihilating Hiroshima and Nagasaki with atomic bombs. The world enters a new era. The Army, Navy, Air force and Marine Troup Health Services combine. For its part, the naval health service had participated, since its beginning, in aeronautic and sub-marine adventures which, in the 1950s, become more frequent.

Air and sea bases become more numerous and the Navy moves from the aircraft carrier Béarn to the Clémenceau and soon to the nuclear-powered Charles-de-Gaulle. Physicians get on this path by following a training course at the Pensacola base in the United States in order to acquire a diploma in navigation and specific medical competence. A centre for expert evaluation of the sailing staff begins to function. The navy being responsible for security on the sea, its physicians take part in the supervision of fishing as well as going to the assistance of the sick and wounded, sometimes at the risk of having to be rescued, together with them, by a helicopter.

As we pass on to nuclear power, submarines, whether they are attacking or shooting missiles, need a special medical service of which the physicians, voluntary and selected, follow courses in the Atomic School of Cherbourg and learn general surgery as well as dentistry, while participating in hospital training courses.

Begun in the nineteenth century with the diving bell, performing tasks underwater is the source of many accidents. Very soon, physicians and pharmacists take part in research inspired by these underwater interventions. The heavy diving suits are followed by autonomous diving suits whose first trials, related to the performances of Cousteau and Gagnan, take place in the 1940s in the harbour of Toulon. Diving apparatuses improve and gas mixtures are brought up to date in naval research centres and then in the health centre, the CERB and the centres of selection, expert evaluation and the observation of progress of the staff are put in place. Decompression accidents befalling the divers in spite of respecting time tables and the stages of swimming back to the surface, on land and on board vessels for the detection and destruction of deep mines, recompression boxes are installed which a specialized trained medical and paramedical staff may have to use.

Among these divers, combating swimmers have an eminent place in marine fusiliers and their physicians share the same constricting training process as they do. In the open sea of Somaliland, on the 11th of April 2008, during the recent rescue of the luxurious sailing ship, the Ponant, from the claws of pirates, the men of the commando Hubert had their physician with them : not a job you can do just like that, without being prepared for it.

Finally, the Geneva Convention imposing too many constraints, the time of hospital ships, which proudly showed off red crosses on their flanks, comes to an end. For a long time, war vessels of huge tonnage have contained an authentic hospital. The last of these ships, the projection and command vessels Mistral and Tonnerre, the BPC, transporting 20000 tons, have exceptional "health" facilities. Able to receive teams of specialists who have come, on occasion, from army hospitals, to strengthen its staff, such a vessel represents the health security of a task force. Le vessel on board which this service operates is provided with a system for sending medical information electronically. The first attempts to transmit X-ray and echocardiography images were made on the 28th and 29th of September 1993, between the X-ray service of the Army Education Hospital Sainte Anne in Toulon and the academic cruiser, Jeanne d’Arc: the naval physician of the twenty-first century is no longer an isolated practitioner as were, for a long time, those who worked before, the sailing surgeons.

The black vessels watch out, lurking at the bottom of the oceans, assuring "dissuasion", that is to say, "no war". The time is over when there were battles between squadrons and the projections of military force have become a joint effort of armies and even allies: the health service has prepared itself for it.

However, the sea preserves its rights, and the navy, responsible for the projection platforms, for security and the sailing routes, public service in coastal areas, the fight against illegal immigration and drug traffic on the sea, must maintain,, as it does today, the physicians who, by vocation and training, must be in its service.

Created with the guarantee of the administrative staff of the navy and the directional headquarters of the health service, the diploma of naval medicine is awarded, with its badge, since the 28th of November 2007, to physicians who have undergone training at the Institute of Naval Medicine, thus recognizing their specificity.

For further information :

– Lefèvre A. Histoire du service de santé de la marine militaire et des écoles de médecine navale en France. Paris : J.-B. Baillière et fils ; 1867.
– Brisou B. « Du service de santé de la marine au service de santé pour la marine ». Carnet de la Sabretache 2004, nouvelle série ; n° 162 : 169-178.
– Sardet M. Naturalistes et explorateurs du Service de santé de la marine au XIXe siècle. Paris : Pharmathèmes ; 2007.
– Brisou B. « Débuts de l’anesthésie générale dans la marine de guerre ». Médecine et armées 1997 ; 25 : 543-550.
– Brisou B. Catalogue raisonné des rapports médicaux annuels ou de fin de campagne des médecins et chirurgiens de la marine d’Etat, 1790-1914. Orléans : Service historique de la marine/Service de santé des armées ; 2003.
– Brisou B. « Amédée Lefèvre, éminent hygiéniste naval de Rochefort ». Médecine et armées 2003 ; 31 : 516-524.
– Brisou B. « Naissance du service de santé des colonies : dix ans de drames ». Médecine et armées 1996 ; 24 : 423-431.
– Brisou B. « Le service de santé pour la marine au début du XXIe siècle ». Académie de Marine - Communications et mémoires 2001-2002 ; n°2 : 23-40.
– Brisou B. et Sardet M. Dictionnaire des médecins, chirurgiens et pharmaciens de la marine. Service historique de la Défense, Vincennes, 2010.