"The need for medical care has been a constant since the day the first merchant ship sailed centuries ago. Concern for the health of merchant mariners has, from the beginning, been a part of our nation’s history. In the 1700’s, legislation mandated that a Medicine Chest be carried on each American Flag vessel of more than 150 tons, provided it had a crew of ten or more. By 1798, a loose network of marine hospitals, mainly in port cities, was established by Congress to care for sick and disabled American merchant seamen. Called the Marine Hospital Service, later the Public Health and Marine Hospital Service, and finally the Public Health Service, these federal entities continued to provide healthcare to merchant seamen until 1981.

The Ship’s Medicine Chest and Medical Aid at Sea has been a part of much of this maritime history. This edition has evolved through many previous editions. The Public Health Service published the first Medicine Chest in 1881 under the title, Handbook for the Ship’s Medicine Chest.

The early editions of the Medicine Chest provided step-by-step instructions on how to treat a variety of illnesses that might be expected underway when the ship was days from shore, and had limited communication with land. The master or designated crewmember had to independently manage whatever injury or illness might occur.

Fortunately, for the health of all merchant seamen and others at sea, the world has changed. Modern technology allows for nearly continual “real-time” communication between the ship and shore. With this, real-time access to medical consultation is nearly always available. In today’s world, serious medical problems underway will be managed via communication with shore-based physicians and other medical resources. More sophisticated tele-medicine capabilities, often including video as well as audio components, are also continually being expanded.

As a result of these changes in technology and medical practice, this edition has limited the “how to” aspects of medical management. Instead, it identifies when medical consultation may be needed, and describes how to do a basic physical exam and then how to communicate these medical findings to shore-based experts. As in any aspect of treatment or consultation, effective communication is key to quality healthcare."

"Another focus of this edition is prevention. Prevention, of both acute and chronic disease, will improve the quality of the merchant mariner’s life while at sea, and also many years into retirement. Prevention will also maximize the productivity of the crew and its ability to meet its missions.

The edition, like past editions, has many audiences. The appendices on U.S. Coast Guard health capability requirements will be of particular value to merchant mariners. Much of the public health information has a much broader audience, and will be of value to those with private craft as well. Where possible, websites have been provided to assist in reaching additional reliable resources of information.

Ensuring your health and safety, as our merchant mariners, is a priority to all of us who greatly benefit from your service – we thank you for what you have and will do for America! And may you have fair winds and following seas…."


This photograph was taken at the U.S. Merchant Marine Academy, Kings Point, New York by James A. Calderwood, Jr.



DHHS Publication No. (PHS) 03-2024
U.S. Department of Health and Human Services
Public Health Service
Office of the Surgeon General
2003 Edition

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