August 21, 2011
by Dr. Martin Rozear
Although hospitals were well
known in ancient Greece
and Renaissance Europe, they were a relatively late development in the
burgeoning British Colonies. The first was Pennsylvania
founded in 1755.
institutions followed...New York
(1775) and Massachusetts General Hospital
hospitals were virtually unheard of in the South before the Civil War.
were treated in homes, barracks, monasteries, or whatever shelter
occasion ( “derived hospitals”).
residential dwellings to “proprietary hospitals,” a
practice that persisted and
evolved into the twentieth century. However, the phenomenon of a
planned, constructed, and used as a hospital (“designed
hospital”) did not
exist in North
until the fifth decade of the nineteenth century.
would guess that North Carolina’s
hospital might have been built in a large metropolis, such as Raleigh
In fact, Dorothea Dix opened its doors to patients in Raleigh
in 1856. Charlotte
transferred patients from a building originally used as a military
designated hospital in North Carolina
built in 1846-1847 in what is now a ghost town; Portsmouth,
adjacent to Ocracoke Island and
its hey day, the 1850s, a
population of almost 700 and an active commerce flourished there.
the population declined. In 1958 Portsmouth
claimed only three residents, and by 1972 there was none. Now two dozen
buildings, maintained by the National Park Service, stare out at Pamlico Sound and Ocracoke
Inlet. They seem to be waiting
for someone to come home. All that remains of the hospital is a brick
and a fragmented fireplace foundation.
is instructive to visit this bleak
island and reflect on humble beginnings (and endings). Inaccessible now
except by privately-owned boat or aircraft [the grass airstrip has since been closed], Portsmouth
possesses all the eerie beauty one
could wish for in a ghost town; roads that are dark tunnels meandering
sighing cedars, and crumbling cemeteries with scary old-fashioned
leaning wearily in the sandy loam. And silence.
was contrived by the colonial government in 1753 to fill a crucial need
facilitation of the practice of “lightering.” Bound
as the state is by the
Outer Banks, which are cut by treacherous, changing inlets, maritime
had from the beginning avoided North
harbors for Charleston
and deeper Chesapeake
ships drew too much water to
manage the systems of bars, swashes, shoals, and sounds. Ships fit for
within the sounds were too small for trans-oceanic work. The best
the time was to “lighter” (lighten) large ships
arriving from Europe, New
England, and the West Indies.
Near the inlets,
portions of the cargoes were transferred to smaller ships,
could then be distributed to interior towns.
lightened and therefore
drawing less water, the larger ships could enter the inlets to lie at
the relative protection of the islands, take on provisions, give crews
leave, etc. This business, cumbersome, labor-intensive, and dangerous
was, actually worked. Reliable observers of the early 1800s described
many as “30 to 60 sail of ship” in the roadsteads
at one time.
required locals to
pilot the ships in and out of the inlets, hands to assist with cargo
wharves, warehouses, and other storage facilities, and all the
furniture of a busy port town- which soon appeared at Portsmouth.
lightering and coasting trade
brought another element to this busy, lucrative scene; sick seamen.
from abroad, as well as from interior towns, with scurvy, smallpox,
fractures, infected wounds, venereal disease, insanity, yellow fever,
miasmas. (They rarely lived long enough to have strokes, heart attacks,
unfit for duty (many posed
potential quarantine problems for their ships at the next port of
sick sailors were “dumped” on the island more or
less to fend for themselves.
Generally poor, filthy, and graceless, they made a sorry sight and were
problem for the islanders. Care, such as it was for these wretches, was
provided in homes, haphazardly. There was no physician within 40 miles
The Marine Hospital
following a British
practice, established a system providing “Relief for Sick and
by an act of July 16, 1798, signed into law by President John Adams.
in reality, a compulsory, payroll deduction, health insurance scheme.
the plan, $20 was deducted
by the ships’ masters from the monthly pay of each seaman
and paid to the Collector of Customs at each port of entry. The
turn, disbursed the funds, procuring for sick and disabled seamen,
the form of medical care, nursing, medicines, lodging, and board, such
be available locally.
was made a port of entry
in 1806. James Taylor was appointed the first collector. The collectors
Ocracoke, many of whom resided at Portsmouth,
managed the medical care of seamen in these two towns.
one might imagine, this system
was not a great improvement on the old- with two exceptions. First, the
who assisted beneficiaries of the fund were rewarded for their trouble.
in 1828, collector Joshua Taylor was able to attract a physician to Portsmouth,
Dr. John W.
Potts, who signed a contract to be hospital physician for an annual
the time, the island’s
population was about 300. The pickings being lean, Dr. Potts quickly
maintaining a hospital at this remote location, even with a private
the side, was a grim proposition. He subcontracted with Dr. Samuel
followed a series of
physicians working out of a small, rented, two-room dwelling in the
primitive circumstances. With high tides and storms, sea water flowed
floors of the “hospital.” Drinking water, described
as “brackish and bitter,”
was obtained from a shallow hole dug in the sand.
could see this was an
intolerable situation. The lightering business kept building, and the
disabled seamen kept coming.
The Hospital at Portsmouth
that marine hospitals had
been built in Norfolk,
the collectors and other prominent citizens barraged a succession of
Secretaries of the Treasury and other officials for a real hospital at Portsmouth.
supporters envisaged a facility that could be a referral center.
one point the collector
complained that he had 17 seriously ill seamen whom he has to put up in
boathouse. Finally, an 1842 act of Congress appropriated $8,500 to
hospital. A lengthy process of legal contortions over title to the
planning, bidding, contracting, inspecting, and provisioning delayed
the hospital until 1847.
was a very substantial
two-story structure, built on piers, with a fireplace in each room,
running water, spacious “piazzas” (porches), and
separate quarters for the
hospital physician, and at times, a “medical
student.” Two plans submitted
during the bidding for this structure were recently found in the
the Collectors of Customs to the Secretary of the Treasury at the
Front View of Portsmouth
on picture to view a larger image.)
Floor Plan of Hospital Rooms
(Note fireplace in each room):
on picture to view a larger image.)
hospital had a brief existence-
as a hospital. The practice of lightering peaked about the time the
doors opened. With the arrival of rail service and other improvements
traditional deep-water ports, such as Wilmington
and Beaufort, the lightering business at Ocracoke Inlet began to fall
never to recover.
the 1850s a varied, but
steadily dwindling, patient population sought relief at the United States Marine
At times during the last half of
the decade, the beds were empty. The expense of maintaining such a
this remote and meteorologically hostile site became apparent to
plans were started to construct North
“main” marine hospital at Wilmington.
The Civil War put an end to both endeavors.
the Civil War, Confederate
forces occupied the Outer Banks but were easily dislodged by Federals
1861. Most Portsmouth Island
residents fled to
interior towns; less than half returned after the war.
for fishing, subsistence
farming, and active involvement in the U.S. Lifesaving Service after
economy continued to dwindle. The hospital building, never used as a
after the war and abandoned by the federal government by 1872, was put
variety of uses- among them dance hall, weather station, and telegraph
building burned in 1894. All
that is left of the hospital is the cistern. Following a practice which
still used by many Outer Banks residents, rainwater was collected from
roofs by gutters and carried through downspouts to large tanks for
hospital’s original wooden cistern quickly showed an annoying
tendency to leak
and by 1852 had rotted irreversibly.
the usual series of pleas,
bids, contracts, deals, and inspections, a fine brick/masonry cistern
in 1853 for $150. This structure, about nine feet in diameter, stands a
yards southwest of the lifesaving station. Presently impounding a few
of green slime and countless million mosquito larvae; it once contained
sweetest water” on the island. Nearby, in the sand, are
fragments of brick
work, probably one of the hospital’s fireplace footings.
Service continued to grow. It was extensively reorganized in 1870, and
the United States Public Health and Marine Hospital Service in 1902 and
United States Public Health Service in 1912.
the addition of the National
Institutes of Health, the U.S.P.H.S. grew to the multi-billion dollar
know today. The crumbling remains of one of the first U.S. Marine
of North Carolina’s first hospital stand in mysteriously
Village; a silent witness to the humble origins of great health care
the state and nation.
article was originally published in the North Carolina Medical Journal,
volume 52, Number 6 (June, 1991). It was reprinted in Tributaries, A
Publication of the North Carolina Maritime History Council, October,
1996, Number 6. We reprint it here with permission from the North
Carolina Medical Journal.