In the introduction to the Scarlet Letter, Nathaniel Hawthorne offers a snapshot of the old Salem customhouse. “Here, before his own wife has greeted him,” writes Hawthorne, was the “sea-flushed ship-master, just in port, with his vessel’s papers under his arm in a tarnished box.” Nearby, too, was the anxious merchant, about to learn the fate of “his scheme.” Fresh from the countinghouse, “the smart young clerk, who gets a taste of traffic as a wolf-cub does of blood,” hovered about. “Cluster all these individuals together,” concludes Hawthorne, and “it made the Custom-House a stirring scene.”
Also nearby was the merchant mariner—a crucial laborer in an early American economy that was deeply dependent on foreign commerce. Sailors helped carry American produce to European, Caribbean, and Asian markets. They also brought foreign goods back home to the United States. But seafaring was extremely dangerous work. Storms and plagues frequently struck Atlantic waterways. Falling crates and crashing barrels caused great harm to life and limb. Indeed as Hawthorne observed, these working conditions often left returning sailors “pale and feeble.”
In Salem, and elsewhere in the young United States, merchant mariners thus appeared at the customhouse in search of “a passport to the hospital.” In 1799 the federal government established these hospitals, or marine hospitals, in most ports throughout the country to care for sick and disabled merchant mariners. The government financed the hospitals by a tax on sailors’ monthly wages. As ships returned to port, customs officials collected the marine hospital tax and forwarded it to the federal Treasury Department in Washington, D.C. The Treasury then distributed these funds to customs officials to hire doctors and nurses to care for merchant mariners. In larger ports, such as Boston, Philadelphia, Baltimore, Charleston, and New Orleans, the federal government operated its own hospitals. Throughout the nineteenth century the marine hospitals grew westward with the nation. By 1900 the hospitals had treated hundreds of thousands of merchant mariners.
That the federal government created this health care system for merchant mariners in the early American republic will surprise many. This is due in no small measure to the tenor of political debate about health care in American society. Advocates of government structured, universal health care plans claim that the times are too fast and costs too high to return to the old days of “pay-as-you-go” care. Deregulationists counter that only by removing the stamp of government from health care can society relive the great success of decades and centuries past. Both sides presuppose that government regulation and provision of health care is a new development. But the story of the marine hospitals in the early American republic suggests that the United States has a long history of using institutions to manage public health. Through the marine hospitals, the federal government used health care to regulate a crucial labor force in an age of maritime commerce. Treating sick and disabled merchant mariners helped stabilize the maritime labor force. More broadly, through the marine hospitals, we witness the actual points of interaction between government, community, and individuals. A glimpse within hospital walls reveals the rich, diverse personal experiences of working in, or being treated in, an early federal marine hospital. To be sure the marine hospitals were effective instruments of politics and policy. But within the marine hospitals, medical practice and administration was far more than an abstract tool of political economy. Rather, the stories of sickness, injury, admission, treatment, resistance, and regulation that characterized life within the marine hospitals reveal how the federal government shaped the social, economic, and political order of the early republic to a degree scholars have only just now begun to appreciate.