Government-Run Hospitals in Early Americaby Denise Early on Apr. 26, 2011, under Health
Excerpts from Sailors’ Health and National Wealth, Marine hospitals in the early republic
Written by PhD student (at the time) Gautham Rao
The United States’ approach to health care for maritime laborers built upon British and colonial antecedents. Since Elizabethan times, Great Britain supported hospitals—the “Chatham Chest” and Greenwich Hospital—by taxing naval and merchant mariners’ monthly wages. In 1710, Virginia imposed a small tax on tobacco exports to England to fund a hospital for mariners at Hampton, Virginia. Nineteen years later Parliament ordered Pennsylvania to tax seamen’s wages for a marine hospital in Philadelphia. In 1749 Charleston, South Carolina, ordered churchwardens to create a hospital for sick and disabled sailors. Finally, voluntary “marine associations” in Boston (1742) and New York (1769) also cared for ailing sailors.
….This concern for the health of merchant mariners loomed large in postcolonial America. During the American Revolution, some dreamed of a self-sufficient economy that would not rely upon distant and often politically problematic European markets. But during the 1790s such utopianism gave way to a hard, and ultimately lucrative, reality: the United States economy remained tethered to European markets and long-distance maritime trade. Great profits awaited American merchants who did business in England, France, and the colonial ports of the West Indies. Now again society realized the great significance of the merchant marine.
Commentators of every political stripe—editors such as John Fenno, political economists such as Pelatiah Webster, and physicians such as Benjamin Rush and Samuel Latham Mitchill—found common ground in their advocacy of a system of marine hospitals. Importantly, the United States Constitution mandated a uniform, national system. Dr. Mitchill, soon to be elected to Congress, made this clear in a 1799 petition to Congress. Since “the regulation of commerce belong[s] exclusively to the National Legislature,” only Congress and the federal government could handle the problem of maritime labor that had once fallen to the individual colonies.
In 1798, Congress thus enacted a law “for the relief of sick and disabled seamen.” The bill taxed mariners’ wages—at the rate of twenty cents per month—to finance health care for ailing sailors in ports throughout the country. The gentlemen attorneys and merchants who wrote this legislation did not trust mariners to personally pay hospital taxes. Rather ship captains garnished the wages and paid them directly to federal customs officials. In this sense the marine hospital tax was a progenitor of the payroll tax.
…The marine hospitals grew rapidly in the early republic. A system that included twenty-six facilities in 1818 expanded to include ninety-five by 1858.
…By 1860, new marine hospitals were to be found in western ports, such as Napoleon, Ark., Evansville, Ind., and San Francisco; on the hubs of the Great Lakes, such as Cleveland, Chicago, and Galena, Ill.; and even in some aging eastern ports, such as Burlington, Vt., Portland, Me., and Ocracoke, N.C. Annual hospital admissions, which ranged in the low hundreds throughout the first decade of the nineteenth century, consistently exceeded ten thousand during the 1850s.
…The marine hospitals’ rapid westward expansion illustrates the durability and significance of this federal institution in a changing economy and polity. By the Jacksonian era, the center of the American economy had shifted away from foreign commerce, into domestic agriculture and manufacturing. Merchant sailors aboard river steamboats, rather than Atlantic schooners, were crucial links in this new American economy. But these laborers remained mariners nonetheless. Thus cities such as Paducah, Kentucky, demanded only a “NATIONAL HOSPITAL, with national funds, and administered by national functionaries.”