HHH Column: How an Oral History Project Unravels Details of the Medical Training of Dutch Merchant Marine Officers by Mia Vrijens
The HHH column is a monthly blog where members, researchers, and historians interested in themes related to history, health and healing share their thoughts on research, current affairs, or anything related to the history of medicine. Each edition features a different contributor, this month the column is written by Mia Vrijens, freelance researcher Medical History specialising in the history of (district) nursing. However this column centers on a different topic which Mia worked on as Prof J.C.M. Warnsinck Fellow at the National Maritime Museum in Amsterdam: the medical training of Dutch merchant marine officers. In this blog the outcomes of the oral history project that was part of her research will take center stage.
How an Oral History Project Unravels Details of the Medical Training of Dutch Merchant Marine Officers
By Mia Vrijens
Outside the wind is blowing at 10 Beaufort slowly increasing to 11, one of the crew members of the ship has an inflamed appendix. The nearest harbour is 14 days sailing away in either direction. The captain takes a surgical knife and starts making an incision for the removal of the appendix. Does this seem like a realistic situation or an urban myth? Maybe a nautical myth instead? Since 1877, hygiene, health and safety were part of the formal tasks of captains of merchant marine and sea fishery vessels.[1] However, captains were not necessarily schooled as doctors nor as nurses, they were well-trained layman according one of the interviewees who took part in the oral history project ‘Health at Sea: Merchant Marine Nursing in the second half of the 20th century’ for the Dutch National Maritime Museum in Amsterdam.[2] In this project interviewees reflected on the first aid education offered at the Dutch maritime schools and specifically the internships at hospital emergency rooms, which were part of the training to be promoted to the rank of first mate.[3] This internship and a medical guide written by dr Henri Boonacker, or ‘The Boonacker’ as the book was known, would both become crucial parts of the medical training at Dutch maritime schools[4] and knowledge of hygiene and health care of crew members in the 20th century. In this blog, I discuss why participants in maritime medical training experienced the internship and the guide as essential parts of their education.
First aid and Dutch Maritime Education
In the 1890s every sea fishing boat was equipped with a medicine box, a toolkit to provide medical assistance, filled with medical equipment, bandages and medicine. How to use such a box was not explained at all, as far as the year reports of the Council for Sea Fishery[5] at the end of the nineteenth century suggest. The report of 1899 is the first to explicitly mention poorly equipped medicine boxes, a lack of knowledge of basic first aid knowledge and skills among crew members, and poor hygienic conditions. The report stated that this situation had to change.[6] This happened very quickly, only a year later first aid courses were organised in the various harbours along the Dutch coast.[7]
These early first aid trainings were intended to increase the knowledge among the head crew members (captain and first mate) of the medicine box which was a mandatory part of the nautical equipment on board of the fishing vessels. This box was filled with bandages, medicines, and medical instruments to administer basic first aid. During the course, instructions on how and when to use this material, which medicines were used under which circumstances, and how to perform nursing actions in general were given.
In Maassluis, a small harbour town in the Rotterdam port area, Henri Boonacker, local general practitioner and quarantine doctor was one of the instructors of these trainings. He wrote a complementary guide for the sea fishing crew members, a leaflet of 48 pages, which was published in 1901.[8] This would be the start of Boonacker’s lifetime dedication to instructing first aid and hygiene measures among crew members of both sea fishing vessels and merchant marine ships. This first small guide of 1901 was followed by additional small instruction guides in the 1910s. From the 1930s onwards, another book of Boonacker became part of the required medical equipment for all vessels. This book about Medical care on board, ‘Geneeskundige hulp aan boord’[9], was not only part of the equipment, but it also functioned as an instruction book at all educational levels of the Dutch maritime schools between 1930s till early 1990s. Therefore, this book defined the knowledge of medical and nursing assistance of Dutch nautical training and continued to be used throughout the 20th century.
Internship and Oral History project ‘Health at Sea’
Maritime law instructs that the captain is responsible for everything that takes place on board the ship, including the health and welfare of the crew members. The captain would delegate the health care to the first mate, the crew member one rank below the captain. Both had received the same maritime education and therefore had similar knowledge of health conditions on board. Additionally, next to the training at the maritime schools, from the 1960s onwards most of the Dutch captains and first mates had undergone hospital training as well.
In the early 1960s the Dutch Maritime Shipping Inspectorate[10] obligated first mates to follow an internship in a hospital, preferably the emergency room.[11] This was to instruct them and give them an idea (‘touch and feel’) of real-life medical situations. These internships were considered the ‘proof of the pudding’ to get more comfortable in delivering medical care since there is a huge difference in inserting a needle in an orange to practice or into a living body that talks back, shivers or cries. Being trained in a medical environment by medical professionals on how to deal with such situations gave the interns the opportunity to test themselves and gain confidence as preparation for situations in which they would be on their own.
These internships and the accompanying hospital training became the research topic of the oral history project ‘Health at Sea: Merchant Marine Nursing in the second half of the 20th century’ at the National Maritime Museum in Amsterdam in 2025. For this project interviews were conducted to collect the stories about the medical internships and the first aid education for maritime crews. The main angle of the interviews was the instruction book of dr Boonacker[12], which was used as a guide to complement the medical box on board ship, and as handbook during the first aid training at the maritime schools.
The interviews gave an insight in how the internship was perceived and which responsibilities were handed over to the interns. The interns were able to perform quite a lot of nursing and/or medical actions independently, examples mentioned were stitching, inserting urinary catheters or applying infusions, which were tasks normally executed by a trained nurse or doctor. The interviewees only recalled a limited number of accidents on board that needed the execution of these medical actions. They were all however very much aware that small accidents, if not treated properly, could become a serious health hazard. For example, those working in the engine room of a steamship at sea did not necessarily enjoy optimal hygienic working conditions. This meant that it was important that even small wounds would be treated immediately.
The internships were highly valued by all interviewees, although they also acknowledged that they differed content-wise depending on supervisors and transfer of responsibilities. Lack of similar learning outcomes was one of the main reasons the internships were stopped and replaced by a two-week safety-training. Other reasons were the introduction of the Health Care Professionals Act[13] of 1993 after which hospitals no longer allowed laymen at the bedside, and the fact that the merchant marine companies were less keen to offer the first mate the possibility of being in training for a couple of weeks.
Conclusion
Appendix removal at sea was an urban or nautical myth. No interviewee could recall a situation of surgical removals of any body parts. However, accidents did happen and removal of body parts like limbs or fingers as direct consequences of these accidents (e.g. crew members lost part of leg in the ropes) would be a situation in which stitching to stop the bleeding was needed. The first mate would be the crew member assigned to do so as they had followed training in a hospital emergency room. During these situations, the captain would take over the first mates’ tasks at the bridge and leave the medical care to the first mate unless he was very keen to provide the care himself. Therefore, it was essential that crew members were trained in the importance of hygiene and received thorough first aid training. Boonacker’s guide was at the core of this training and also present on board the ships. The guide may have been basic and, in some situations, outdated, but it remained useful for decades. Even if its instructions were never used, they offered reassurance by serving as a safety net in case they were ever needed.
[1] R.P. Cleveringa, Zeerecht (4e druk, Zwolle, 1961) 293, footnote 1.
[2] https://www.hetscheepvaartmuseum.nl/collectie/onderzoek/fellowships/fellowship-2025/mia-vrijens (June 30 2026).
[3] In Dutch: Eerste Stuurman
[4] In Dutch: Zeevaartscholen
[5] In Dutch: College voor Zeevisscherij
[6] College voor de Zeevisscherijen, Verslag van den Staat der Nederlandsche Zeevisscherijen over 1898 (’s Gravenhage-Leiden, 1899), 45.
[7] College voor de Zeevisscherijen, Verslag van den Staat der Nederlandsche Zeevisscherijen over 1899 (’s Gravenhage-Leiden, 1900), 61-66.
[8] H.J.M. Boonacker, Geneeskundige hulp aan boord van zeevisschersvaartuigen : handleiding ten gebruike bij de verband- en medicijnkist, ingericht volg. aanwijzing van het Coll. voor de Zeevisscherijen (Maassluis 1901).
[9] H.J.M. Boonacker, Geneeskundige hulp aan boord van zeeschepen van minder dan 500 registertonnen bruto inhoud en van zeevissersvaartuigen (Den Haag 1937).
[10] In Dutch: Scheepvaartinspectie
[11] A. Bakker, ‘Het grote belang van het lopen van een ziekenhuisstage, voor de stuurman-dokter’, De Zee. Zeevaartkundig Tijdschrift 87 5 (Amsterdam, 1966) 199-203, 199.
[12] H.J.M. Boonacker, ‘Geneeskundige hulp aan boord van zeeschepen van minder dan 500 registertonnen bruto inhoud en van zeevissersvaartuigen’ (Den Haag 1937) edition 1 till 14 (1977) except 13 (unavailable).
[13] In Dutch: Wet BIG, Beroepen Individuele Gezondheidszorg, Wet BIG | Regelhulp – Ministerie van VWS (June 30, 2026).