Covid-19, Savannah, Marine Hospitals and the Legacy of Port Cities
I currently live in Savannah, Georgia. While our city is known for a number of things—its stately architecture, rich history, Southern charm, and now the Savannah College of Art and Design and Gulfstream aircraft company—it has always been a port city since its colonial founding. And it still is: Savannah is ranked the United States’ busiest of ports, being the forth-busiest of container ports in the nation and having some of the top deepwater port capabilities of any US port. If you stand down on River Street and gaze out over the Savannah River towards Hutchison Island and South Carolina to the north, sooner or later a massive cargo ship will come by on its way upriver to the Garden City terminals or closer Ocean Terminal to unload cargo and then take more cargo aboard. Much of this work now is highly automated and the use of intermodal containers especially changed the face of international shipping, allowing these huge ships to be unloaded and re-loaded far more quickly and with far fewer personnel than in the days of multitudes of longshoremen and others being involved. Gone too, alas for sailors, are the long hours it took to discharge cargo which allowed sailors to explore ports of call. Now, everything can be done quite rapidly.
In the romantic heyday of shipping—let’s say from the founding of Savannah to the early twentieth century for our purposes here—ports tended less cargo in sheer numbers (dollar amounts or tons or any other measure) but the acute lives of sailors in port was felt in a far greater way. Sailors then did frequent bars, they may have roomed in boarding houses when ships were in port for extended lengths of time or between voyages. Ships’ chandlers provides the food and supplies that ships required for their voyages (this is still true today, but again, their work is less visible now). To provide for the health of these seamen, the US Marine Hospital Service operated hospitals for merchant sailors in most major US ports, including Savannah. This service, which I recently spoke about in depth in a paper I presented at the 2020 annual meeting of the Southern Association for the History of Medicine and Science in New Orleans, was the first federal-level action of the United States toward any sort of health care—the US Public Health Service and all attached to it grew out of this Marine Hospital Service. (This is why there is an anchor in the logo and flag even today of the Public Health Service and why the Surgeon General [and other officers] of the US Public Health Service Commissioned Corps wear uniforms very similar to those of the US Navy.)
The Marine Hospital in Savannah still stands and occupies a full city block downtown, though these days it is owned by SCAD and serves as administrative offices for the college. It is a building which always has fascinated me, and I learned it served as a low-income outpatient clinic for years after its 1960s closure as a Marine Hospital—with that clinic eventually closing and being moved elsewhere circa 1999-2000. While large, it is dwarfed by the Marine Hospitals of New Orleans, New York City, and San Francisco which were even larger. All ran extensive research programs as they transitioned into Public Health Services Hospitals in the early twentieth century and many larger ones served as training facilities for medicine interns, residents, and other health care workers and students. All the while, they still served merchant seamen, plus other populations.
Covid-19 seems half like something from a sci-fi movie and half like something either from a past century or a distant land
I think of these hospitals now—especially our local Savannah one—with Covid-19 causing the Mayor of Savannah to issue orders to shelter-in-place. His orders are clear and pragmatic: to stay home unless going about absolutely essential business such as work of an essential nature (police, doctors, nurses, plus others who make society work on the day to day basis) or attending to essential tasks such as grocery shopping. Covid-19 seems half like something from a sci-fi movie and half like something either from a past century or a distant land, some place maybe in Africa where tropical diseases are still a bane to existence. In the United States, we carelessly assume we’re past such outbreaks and contagious maladies, don’t we? The reality is, alas, we’re not. But the reality also is that Savannah interestingly long has played a role in keeping horrible diseases at bay. And it has had to so such: because of its port, because of its subtropical climate, because of its dewy involvement in the trade circles which took disease around the world long before airliners could do so in less than a full day.
Aside from the Marine Hospital, Savannah was home to the Henry Rose Carter Memorial Laboratory which was pioneering in malaria research and one of a handful of Georgia labs which gave rise to the Centers for Disease Control and Prevention (and the main reason that hallowed institution is in Atlanta, Georgia). It building also still stands, currently utilized for city engineering offices.
I write this in part to offer some history, but from a very personal and nearly poetic viewpoint. In the midst of the Covid-19 pandemic, Savannah feels a strangely apt place to be because there are these vestigial reminders of when disease was more commonly a serious, everyday, issue for America. And also, how transnational travel and shipment play a role in the propagation of communicable diseases. Port cities, this one included certainly, had to be very careful about diseases and that was in fact why the Marine Hospital Service was first founded. The demise of this service is perhaps even more important to know about and understand, however. So, in 1912 the Marine Hospital Service became the US Public Health Service in name to reflect a growing mission of diversity and not simply a focus on the health of sailors. By the 1960s under President Richard Nixon, there were questions—some perfectly valid—about whether these Marine Hospitals were overlapping the work of academic and charitable medical centers and other hospitals. If the Marine/Public Health Service hospitals were still necessary and worth funding.
In the end, site visits were conducted to all the hospitals still in service (a few already had been closed) and many of those including Savannah it was decided should be shut down and transferred over to community governments for their own purposes or sale. A few, notably the one in San Francisco, remained in service as Public Health Service Hospitals into the 1980s. As I discovered speaking about the Marine Hospitals to medical historians, even these professionals—people who hold graduate degrees in history and teach the history of medicine—were somewhat foggy on exactly what the Marine Hospital Service was and what it did. And that’s ok, because it’s something of a footnote to American medical history today, I suppose, but a key juncture was when in the 1960s it was decided these hospitals were no longer needed because something else happened then, too: it was decided in that same action that federal hospitals beyond military and Veterans’ Administration facilities were no longer how the United States would provide medicine care. That universities, charities, and private companies and not the federal government would take on the duties of hospital-based care and research.
It can be argued in either direction, that losing these federal hospitals was a mistake, that the US Public Health Service Commissioned Corps needs hospitals of its own in the event of dire epidemics such as Covid-19 or in converse, that America’s health care has moved in another direction and these hospitals would in non-emergency times simply be redundant capacities.
In the midst of the Covid-19 pandemic, Savannah feels a strangely apt place to be because there are these vestigial reminders of when disease was more commonly a serious, everyday, issue for America. And also, how transnational travel and shipment play a role in the propagation of communicable diseases.
Yet their closure, and what lead up to it, represents something else as I discovered researching them for my conference paper. Even as the site visits were being conducted in the 1960s to determine the viability of closing these institutions, the Public Health Service had put forth in 1961 a new film publicizing the research work done at the same hospitals. In the film, the New Orleans hospital was especially featured and a good deal of its research work plus its benefits to local patients were extolled (aside from sailors and government personnel, these hospitals served as tertiary care referral facilities for local populations). Between this film and the site visit report, which was later cited in the Congressional committee on the closures, a picture emerges—a picture that while serving different end goals (promoting the hospitals vs closing them) is coherent in presenting the state of American allopathic medicine and medical research as one triumphant over horrible diseases such as malaria or polio. Such horrors now, it seems, are regulated to less-fortunate nations and America’s own fortunes are in turn evident, resplendent, can-do, wealthy, science-driven success. Despite prestigious partnerships with university medical centers, it was those institutions and not federal ones where medical research would leap forward from here on out and that was a fact made too clear reading between the lines even of reports flattering to the Marine/Public Health Services hospitals.
Part of the problem was that while the PHS hospitals did research on cardiac diseases and blood transfusions as well as many other areas of inquiry vital to large numbers of patients and medicine in general, there was still an imperative to do work beneficial to seaman or tropical medicine or military medicine. Work which otherwise was pretty much the providence of military research centers alone, such as the Letterman Army institute of Research at the Presidio in San Francisco. It was an effort, outside of its military context, even at the apex of the Cold War seen as somewhat archaic.
And this in a roundabout manner returns us to today, to Savannah. You can tell the Marine Hospital here, now known as Bradley Hall of SCAD, was not built for the college it now serves nor was it an elementary school or bank or office building repurposed for that duty. Clearly, the block-long Mediterranean-style building with enclosed porches and several monumental entrances was something unique. Its design is in part due to the fact it was expanded to its full block a few years after its original stage was completed and its architectural style is distinct from that of most of its peers in the Marine Hospital Service, with most larger ones being of a modified Kirkbride plan. Not too far away from this building stands the Seaman’s House, which is a religious, charitable organization for merchant mariners. And not far from that, the Pirates’ House, which is a restaurant popular with tourists and supposedly the former hideaway of pirates—and they say, those pirates’ ghosts haunt the premises today, with secret tunnels leading from its cellar directly to the riverfront. All of this, all of these places (pirate legends even include), is part of a circular material loop of maritime history. The Marine Hospital is also the history of disease, and the history of how port cities once were, when the port was right front and center at River Street where now bars and gift shops stand. That hospital also needed to be close by.
Today, with Covid-19 we wonder if we will have enough hospital beds and enough clinical staff, especially those experienced with the rigors of an epidemic pathogenic disease. Perhaps retaining the Marine Hospitals would have made no difference: most of these facilities pale in contrast to the bed count of modern academic medical centers, anyways. But what having a specialized hospital in the middle of downtown represented conceptually in the first place cannot be lost to us anymore: that frontline defenses against communicable disease were long a necessary aspect of American society, especially in our port cities. Hopefully, we are not headed back to the days of multiple communicable scourges but in any case, a warning shot has been fired across the bow: the pathogens are still evolving, dangerous, and prolific—and our measures against them have to evolve apace.
Mike Walker is a journalist, translator, and MFA student at the Savannah College of Art and Design. His journalism focuses mainly on Russia and the former Soviet states, soccer, and the built environment. His work has appeared in a variety of American, Russian, Croatian, Serbian, and Belarusian publications including: The ATA Chronicle, The Bold Italic, The Moscow Times, InSerbia, CroatiaToday, Slate, Gently Read Literature, Večernji list, SEE: A Fortnight in Review, The San Francisco Chronicle, the Tottenville Review, Coal Hill Review, Translation Journal, Multilingual Computing and Technology and elsewhere.
