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In 1965, the Yarmouth Castle, a cruise ship that was laden with American tourists, burned and sank en route to Nassau. The rescue effort and the fight to save the many badly burned survivors was centered at the Princess Margaret Hospital (PMH) in The Bahamas. The final toll of 90 lives lost made this one of the worst maritime disasters in North American history. The story of the Yarmouth Castle disaster is a part of the fabric of the story of PMH, a story that begins in the 1780s with the opening of the African Hospital in Nassau. We trace the evolution of the Poor House on Shirley Street into the Bahamas General Hospital, forerunner of the PMH. Along the way we describe a commission of inquiry into hospital corruption (1915), a disruptive doctors strike and even the murder of a hospital nurse on the private ward. We knew that our investigations were probing sensitive areas when officials had difficulty locating reports and photographs. Nevertheless, research trumped resistance. We interviewed pioneers and disaster survivors, studied documents in the National Archives of the Bahamas, the Supreme Court registry, the Ministry of Health and even the library of the United States Coast Guard. Princess Margaret Hospital is much more than a sleepy account of the construction of an old hospital. It is a story of disaster, recovery, survival, philanthropy and genius.