1. The right of a seaman to maintenance and cure for an illness
which befalls him during his service may continue for a period
beyond the duration of the voyage, whether he be at home or abroad,
and even though the illness be not caused by the employment. P.
303 U. S.
529.
2. In the case of a seaman suffering from an incurable disease,
which manifested itself during his employment but was not caused by
it, the duty of the ship owner to furnish maintenance and cure does
not extend beyond a fair time after the voyage in which to effect
such improvement in the seaman's condition as reasonably may be
expected to result from nursing, care, and medical treatment. P.
303 U. S.
530.
3. In a suit brought by a seaman suffering from an incurable
disease, which manifested itself during his employment though not
caused thereby, an award of a lump sum in anticipation of a
continuing need of maintenance and cure for life (based on his life
expectancy) cannot be sustained. P.
303 U. S.
530.
4. The seaman's recovery in each such case must be measured by
the reasonable cost of that maintenance and cure to which he is
entitled at the time of the trial, including, in the discretion of
the court, such amounts as may be needful in the immediate future
for the maintenance and cure of a kind and for a period which can
be definitely ascertained. P.
303 U. S.
531.
92 F.2d 84 reversed.
Certiorari, 302 U.S. 681, to review a decree affirming an award
against the steamship company in a suit in admiralty for
maintenance and cure.
Page 303 U. S. 526
MR. JUSTICE STONE delivered the opinion of the Court.
The question for decision is whether the duty of a shipowner to
provide maintenance and cure for a seaman falling ill of an
incurable disease while in its employ extends to the payment of a
lump sum award sufficient to defray the cost of maintenance and
cure for the remainder of his life.
Respondent was a member of the crew of petitioner's steamship
Losmar. Following an injury to his foot, allegedly caused
by stubbing his toe against an object lying on the floor of the
boiler room where he was employed, respondent was found to be
afflicted with
thrombo angiitis obliterans, otherwise
known as Buerger's disease, an incurable malady of the veins and
arteries. It is attended by interruptions of the blood stream, with
consequent malnutrition of the affected parts, producing lesions,
deteriorating changes of the tissues, and gangrene. Medical
treatment and amputation of the affected parts may halt the advance
of the disease, but its manifestations are likely to recur in other
parts of the body, and medical opinion is that the disease tends to
be progressive, and may ultimately cause death . Care and treatment
at frequent intervals, with periodic medical observation of the
patient, are of aid in arresting its progress.
After February 12, 1935, when respondent was first hospitalized,
he was given treatment at various marine hospitals in the course of
which he suffered four amputations upon the right foot and leg. On
October 3, 1935, after his leg had been amputated below the knee,
he
Page 303 U. S. 527
was discharged to the "Outpatient Department to return at
intervals for reexamination, and later to be fitted with an
artificial limb." Petitioner, from time to time, paid respondent
small sums for maintenance and cure, continuing to do so until
March 10, 1936, when they totaled $487. At about this time,
respondent brought the present suit in admiralty to recover
maintenance and cure, and, in another count, for petitioner's
negligence in causing the injury. The trial court found that
petitioner was not negligent, but held that respondent is entitled
to recover the cost of maintenance and medical treatment so long as
such treatment is necessary, and that, as his affliction is
incurable, there should be a lump sum award based on his life
expectancy. Its decree awarding a recovery of $7,000 was affirmed
by the Court of Appeals. 92 F.2d 84. Because of the importance of
this question, we granted certiorari, 302 U.S. 681, but denied a
cross-petition to review the Court of Appeals' affirmance of the
decree for the shipowner on the negligence count,
post, p.
643.
The ancient duty of a vessel and her owner to provide
maintenance and cure for seamen injured or falling ill while in
service was recognized and, to some extent, defined, by this Court
in
The Osceola, 189 U. S. 158,
189 U. S. 175.
See also Chelentis v. Luckenbach S.S. Co., 247 U.
S. 372;
Pacific S.S. Co. v. Peterson,
278 U. S. 130. The
duty, which arises from the contract of employment,
Cortes
v.Baltimore Insular Line, 287 U. S. 367,
287 U. S. 371,
does not rest upon negligence or culpability on the part of the
owner or master,
id; The City of Alexandria, 17 F. 390;
The Mars, 149 F. 729, 731;
Sorensen v. Alaska S.S.
Co., 243 F. 280,
aff'd, 247 F. 294;
Brown v. The
Bradish Johnson, Fed.Cas.No.1992, 1 Woods 301, nor is it
restricted to those cases where the seaman's employment is the
cause of the injury or illness,
The Wensleydale, 41
Page 303 U. S. 528
F. 829;
The Bouker No. 2, 241 F. 831. It is not an
award of compensation for the disability suffered,
The
Wanderer, 20 F. 140, 143, although breach of the duty may
render the owner liable for the consequential damages suffered by
the seaman,
Cortes v. Baltimore Insular Line, supra,
287 U. S. 371.
The maintenance exacted is comparable to that to which the seaman
is entitled while at sea,
The Henry B. Fiske, 141 F. 188,
192;
The Mars, 145 F. 446, 447,
aff'd, 149 F.
729;
The Bouker No. 2, supra, 836, and "cure" is care,
including nursing and medical attention during such period as the
duty continues,
Whitney v. Olsen, 108 F. 292, 297 and
cases cited;
Dougherty v. Thompson-Lockhart Co., 211 F.
224, 227.
In
The Osceola, supra, this Court reserved the point
whether the duty of maintenance and cure extends beyond the
duration of the voyage, and that question, so far as this Court is
concerned, remains an open one. The reasons underlying the rule, to
which reference must be made in defining it, are those enumerated
in the classic passage by Mr. Justice Story in
Harden v.
Gordon, Fed.Cas.No.6047: the protection of seamen, who, as a
class, are poor, friendless, and improvident from the hazards of
illness and abandonment while ill in foreign ports; the inducement
to masters and owners to protect the safety and health of seamen
while in service; the maintenance of a merchant marine for the
commercial service and maritime defense of the nation by inducing
men to accept employment in an arduous and perilous service.
It is plain that, in many cases, these purposes will not be
accomplished if the owner's duty to furnish maintenance and cure
ends with the voyage. If the injury or illness outlasts it, the
seaman may still be left helpless and uncared for in a foreign
port. Even if he is returned
Page 303 U. S. 529
to the home port, the inducement to the owner to care for the
health and safety of seamen during the voyage and the inducement to
seamen to take the necessary risks of a hazardous calling will be
materially lessened. The chances of their prompt restoration to a
service whose preservation is in the public interest will be
diminished if the right to maintenance and cure ends with the
voyage.
Tacit recognition is accorded these considerations in the great
number of cases in the lower federal courts sustaining the right to
maintenance and cure for a reasonable time after the voyage,
"reasonable time" being appraised with reference to the special
circumstances of each case.
The Bouker No. 2, supra, 835,
and cases cited at 834. It is true that, in most of these cases,
the efficient cause of the injury or illness was some proven act of
the seaman in the service of the ship, but there are others in
which it was deemed enough that he was incapacitated when subject
to the call of duty as a seaman, and that his incapacity continued
after the voyage had ended.
The Bouker No. 2, supra, 835;
The Wensleydale, supra.
We accept as supported by evidence the finding of the District
Court that respondent's disease and the amputations which he
suffered were not caused by the injury to his foot. But we think
that, even in such a case, whether the seaman is at home or abroad,
his right to maintenance and cure may outlast the voyage. The
policy underlying the obligation, so cogently stated by Justice
Story in
Harden v. Gordon, supra, and the liberality with
which admiralty courts have traditionally interpreted rules devised
for the benefit and protection of seamen who are its wards,
Robertson v. Baldwin, 165 U. S. 275,
165 U. S. 287;
Cortes v. Baltimore Insular Line, supra, 287 U. S. 377;
The Arizona v. Anelich, 298 U. S. 110,
298 U. S. 123,
call for some extension of the duty beyond the term of service. The
practical inconvenience and the attendant danger to seamen in the
application of a rule which would encourage
Page 303 U. S. 530
the attempt by master or owner to determine in advance of any
maintenance and cure, whether the illness was caused by the
employment, are manifest.
There remain the questions whether, in the case of a chronic
illness, the duty continues so long as medical attendance and care
are beneficial, until death if the need lasts so long, and whether
a lump sum may be awarded to defray the cost of meeting the
anticipated need.
In answering the first, we lay to one side those cases where the
incapacity is caused by the employment. As to them, considerations
not present here may apply which might be thought to require a more
liberal application of the rule than we think is called for in this
case.
Cf. Reed v. Canfield, Fed.Cas.No.11641, with the
comments of Judge, later Justice, Brown in
The J. F. Card,
43 F. 92,
and see those of Judge Hough in
The Bouker
No. 2, supra, at 834. But we find no support in the policies
which have generated the doctrine for holding that it imposes on
the shipowner an indefinitely continuing obligation to furnish
medical care to a seaman afflicted with an incurable disease, which
manifests itself during his employment, but is not caused by it. So
far as we are advised, it is without support in the authorities. We
can find no basis for saying that, if the disease proves to be
incurable, the duty extends beyond a fair time after the voyage in
which to effect such improvement in the seaman's condition as
reasonably may be expected to result from nursing, care, and
medical treatment. This would satisfy such demands of policy as
underlie the imposition of the obligation. Beyond this, we think
there is no duty, at least where the illness is not caused by the
seaman's service.
The award of a lump sum in anticipation of the continuing need
of maintenance and cure for life or an indefinite period is without
support in judicial decision. Awards of small amounts to cover
future maintenance
Page 303 U. S. 531
and cure of a kind and for a period definitely ascertained or
ascertainable have occasionally been made.
The Mars, 149
F. 729, 730;
Wilson v. Manhattan Canning Co., 205 F. 996,
997. But the award here seems to us to be inconsistent with the
measure of the duty and the purposes to be effected by its
performance. The duty does not extend beyond the seaman's need.
Raymond v. The Ella S. Thayer, 40 F. 902, 903;
The J.
F. Card, supra, at 95;
The Bouker No. 2, supra, at
835;
The Santa Barbara, 263 F. 369, 371;
Stewart v.
United States, 25 F.2d
869, 870;
Marshall v. International Mercantile Marine
Co., 39 F.2d 551, 553;
cf. Holt v. Cummings, 102 Pa.
212;
contra, Reed v. Canfield, supra. The amount and
character of medical care which will be required in the case of an
affliction, as well defined even as Buerger's disease, cannot be
measured by reference to mortality tables. Moreover, courts take
cognizance of the marine hospital service where seamen may be
treated at minimum expense, in some cases without expense, and they
limit recovery to the expense of such maintenance and cure as is
not at the disposal of the seaman through recourse to that service.
The Bouker No. 2, supra, at 835;
Marshall v.
International Mercantile Marine Co., supra, at 553, and cases
cited. Furthermore, a duty imposed to safeguard the seaman from the
danger of illness without succor, and to safeguard him, in case of
illness, against the consequences of his improvidence, would hardly
be performed by the payment of a lump sum to cover the cost of
medical attendance during life.
The seaman's recovery must therefore be measured in each case by
the reasonable cost of that maintenance and cure to which he is
entitled at the time of trial, including, in the discretion of the
court, such amounts as may be needful in the immediate future for
the maintenance
Page 303 U. S. 532
and cure of a kind and for a period which can be definitely
ascertained.
The courts below have made no findings sufficient to enable us
to fix the amount which respondent is entitled to recover. The
decree is accordingly reversed, and the cause remanded to the
District Court for further proceedings in conformity with this
opinion, and without prejudice to any later suit by respondent to
recover maintenance and cure to which he may then be entitled.
Reversed.
MR. JUSTICE BLACK is of opinion that the judgment should be
affirmed.
MR. JUSTICE CARDOZO took no part in the consideration or
decision of this case.