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Long before the first white settlers arrived in what is now Virginia, the Native Americans called the Eastern Shore by the name Accawmacke ---meaning the "across the water place". Accawmacke was settled very early by the English. According to history, the natives on the Eastern Shore were friendly and access to the area was easy. The word Chesapeake is the modern English spelling of the native term for "great water". To the early settlers, this "great water" made for easier travel than trying to go into the interior of the New World. So, early settlement was concentrated in the coastal areas.

The original shire of Accomac, created in 1634, covered the entire Eastern Shore. The name of the shire was changed to Northampton in 1642. This name change was part of an effort by the English to eliminate "heathen" names in the New World. So, an English name, Northampton, was chosen.

By the year 1663, many, many settlers has chosen the Eastern Shore as their new home. It was decided that the area should be divided into two counties. So, the northern half got back its original name--- but spelled Accomac.

Accomac County was abolished for a time in 1670. Governor William Berkeley, wanted to arrest Col. Edmund Scarburgh for the murders of some native chiefs. This was one of the incidents that led to Bacon's Rebellion in 1676. Scarburgh claimed to be a Burgess for Accomac, and members of the General Assembly were immune to arrest. So, to circumvent this situation, Governor Berkeley nullified the law that created the county. This eliminated Scarburgh's protection from being arrested. When Scarburgh died in 1671, the General Assembly re-created Accomac County.

Accomac County officially became Accomack in 1940, when the General Assembly resolved that the county name would be spelled with the "k".