|Building Style||Cottage Plan|
Firland Sanatorium, Seattle’s municipal tuberculosis hospital, opened on May 2, 1911, to help combat what was at the time Seattle’s leading cause of death. Firland was located on 34 acres in the Richmond Highlands area, 12 miles north of the then-border of Seattle (in 1995 this first Firland site became part of the newly incorporated City of Shoreline). The hospital served there until its move to a former Naval hospital (at 15th Avenue NE and 150th Street) in 1947, and continued to treat TB patients until its dissolution in 1973. A leading founder of Firland Sanatorium was the railroad magnate Horace C. Henry (1844-1928), whose son Walter had died of TB.
In 1908, the U.S. Office of Public Health had declared Seattle’s record of fighting tuberculosis to be the worst in the country. In 1909, a group of leading citizens, including Horace Henry, formed the Anti-Tuberculosis League of King County to combat it. A member of the League, J. V. Smith, declared that the city of Seattle was a tuberculosis camp. The League engaged a team of visiting nurses to bring TB sufferers to its attention, and uncovered at least 1,000 cases. In Seattle, the first attempt to set up a sanatorium on Queen Anne Hill met with neighborhood outrage, expressed by threats and waving broomsticks, at the idea of a resident "pesthouse." League president Horace Henry stepped forward with a donation of 34 acres of land 12 miles north of the (then) Seattle city limits in the Richmond Highlands area, along with $25,000 seed money. Firland was established on land bordered (2002) by Fremont Avenue N on the east, Palatine Avenue on the west, 195th Street on the north and 190th Street on the south. Seattle voters passed a $10,000 bond issue in the spring of 1910 to aid in construction costs. Dr. Robert M. Stith (1874-1943), whose mother had died of tuberculosis, was appointed Medical Director, a position he would hold until his death.
On May 2, 1911, the Henry Sanatorium accepted its first patients. They were housed in open-air cottages. Nursing staff was initially forced to sleep on the floor, since the only non-patient areas of the facility had no beds. Since no paved road connected Seattle and the hospital compound, supplies were sent via the Interurban trolley. From the trolley station at Richmond Highlands, they were transported by wheelbarrow to the Sanatorium. By 1913 the North Trunk Road, now Aurora Avenue N, was paved with bricks at the insistence of physicians so that they and patients’ families could have more ready access. Eventually, buses served Firland on the half-hour.
On July 13, 1913, ground was broken for the English Tudor-style Administration Building, also known as the Walter H. Henry Memorial Building. The Hospital Building, known as the Detweiler Building, and Jenner Hall were also built in 1913. Jenner Hall housed patients with non-tubercular infectious diseases. Although it was outside Firland’s scope, city health officials felt that having this municipal isolation hospital share Firland’s administrative staff would save money.
In 1920 the Koch and Nightingale buildings were completed and housed ambulant patients. A temporary structure built in 1913 to house children with TB (or with infected family members) was replaced in 1925 with a permanent facility, Josef House, named in honor of a deceased patient whose small financial legacy to Firland was used to furnish the facility. All buildings featured gentle ramps between levels rather than stairs, in order that ambulant patients not over-exert themselves, and were connected by underground tunnels. Large vegetable gardens and orchards served the facility. A power generating plant and a well rendered the sanatorium self-sufficient, although Firland was eventually served by the municipal water supply. Over the years more buildings were erected, among them a laboratory and a recreational/occupational therapy facility.
The tools with which Firland’s medical staff could forge a tubercular patient’s cure were extremely limited. “Rest -- more rest -- and still more rest. Rest is the keynote. Rest for the body, rest for the mind. Rest from involuntary as well as voluntary activity forms the basis on which the cure is built” (Firland, 31). (Rest is no longer seen as particularly curative for TB.) Fresh air was considered essential in the cure of TB, and screened windows were kept wide open year-round. Nourishing food was plentiful, and patients were expected to eat well to build their strength. Visiting hours were Thursdays and Sundays from 2-4. Patients were allowed three (adult) visitors only. Some patients were treated surgically, by injecting air into the space surrounding each lung (artificial pneumothorax) or by removing ribs so the chest wall sank in on the underlying lung (thoracoplasty). Both techniques were designed to keep the lungs more still. Because tubercular lungs could not be subjected to general anesthesia, this thoracic surgery was performed under local anesthesia using Novocain or sodium pentothal.
The rooms in the Detweiler Building, where patients were the sickest, were divided by partitions that ended about a foot off the floor rather than by walls. The patients’ sense of each other was immediate and intense, since a bed against one side of a partition was only inches from the bed on the other side. Patients were housed two or four to a room. In the stillness of the resting ward, patients could hear each other cough, turn over, and even breathe. Pulmonary hemorrhages and nurses’ response to them could be heard throughout the ward. Patients in the final stages of the disease were moved into a single room close to the nurses’ station. Everyone knew that tuberculosis was often fatal. Death seemed to stalk among them: “Up and down the halls he went, never hurrying, knowing that we’d wait for him” (MacDonald, 161).
Children at Firland
Tuberculosis in children was usually an infection of the lymph nodes rather than the lungs, and was considered easier to cure under the proper conditions. Josef House, the juvenile tuberculosis facility at Firland, took patients from birth to age 15. Some patients had tuberculosis, while some were treated prophylactically as they came from homes (often low-income) where a family member had TB. Some of the children’s mothers were undergoing treatment at Firland and were therefore unable to care for their children. For these women, Josef House was a godsend. Children underwent a period of complete bed rest similar to that of adult patients, although usually of a shorter duration. The children wore minimal clothing year-round, indoors and out: light cotton shorts/trunks, hat, socks, and shoes. Older girls wore blouses. Josef House had a schoolroom, where the children were tutored and instructed in health and hygiene. When necessary, children were tutored at bedside. Birthdays were always celebrated with cake and candles. Supervised play, handwork, seasonal celebrations, picnics, and a large wading pool offered diversions from the business of resting, child-style. Josef House had beds for 40-50 children.
Patients who successfully demonstrated that their tuberculosis was arrested and their strength regained were ready for discharge, again at the discretion of Medical Director Stith. Departing patients were cautioned to continue getting as much rest as possible, to return regularly to the Firland Clinic for checkups, to consult with their doctor when considering type of employment, and to remain on vigilant watch for the return of any tuberculosis symptoms. Women were cautioned against becoming pregnant. The National Tuberculosis Association found that Firland had a higher incidence of patients living a normal life five years following discharge than any other sanatorium in the country.
The War Years
During World War II (1942-1945) Firland’s nursing staff, siphoned off to help with the war effort, was reduced to one-third of its pre-war level. Ragnar Westman, Seattle’s Commissioner of Health, considered Firland “barely operable” under such conditions (Westman, 146). Firland’s diagnostic case finding program was suspended due to lack of staff and funding. Firland patients in occupational therapy participated in a U.S. Navy program to produce scale-model aircraft for use as a teaching tool to train plane spotters to identify American and enemy planes. Patients with "time up" also knit for the war effort.
Admission, discharge, and birthday listings in wartime issues of PEP suggest that there was no mass discharge of patients of Japanese descent due to Executive Order 9066 (which forced West Coast people of Japanese descent into internment camps). Three patients with Japanese surnames were discharged in April 1942, one mid-war (possibly a death), and then no others until June 1945. Japanese names continued to appear on the monthly birthday list and on PEP’s masthead throughout the war. Throughout the war, Quaker peace activists Floyd and Ruth Schmoe visited the Japanese patients, whose families had been interned at Camp Minidoka (Roger Daniels, 117).
The New Firland
In 1943 King County assumed responsibility for Firland, and on November 25, 1947, patients from Firland and the former King County tuberculosis sanatoria, Morningside and Meadows, were ferried by ambulances to the "new" Firland, a decommissioned Naval Hospital at 15th Avenue NE and 150th Street. This operation was termed “the greatest mass movement of patients from one tuberculosis sanatorium to another in the history of any United States civilian hospital” (Lerner, 44). The new Medical Director was Dr. Roberts Davies. The new facility had 1350 beds. The increased number of available beds meant that the entire waiting list could be admitted. For the first time in Firland’s history, anyone who needed a bed at Firland could be admitted. Many Seattleites decried the bunker-like facility, which had been intended for temporary use during the war and constructed accordingly. A wire fence surrounded the compound.
In any case, the Rest Cure was about to be supplanted: in 1947 Firland physicians gained access to the newly invented antibiotic wonder drugs. Streptomycin, followed by Para-amino Salicylic acid (PAS) and isoniazid, were used in combination to successfully combat tuberculosis. Firland physicians, mindful of the tubercle bacilli’s demonstrable ability to quickly become resistant to antibiotics, continued to stress rest and good nutrition as important components of the Cure. By 1954, the average time a patient spent at Firland had been cut in half. Mortality rates at Firland plummeted from 31 percent in 1948 to 6 percent in 1954. In 1957, a team of national officials evaluated Firland and proclaimed it one of the most outstanding sanatoria in the country. A 1948 affiliation with the University of Washington Medical School funneled a steady supply of medical students, nursing students, and resident physicians through Firland. This in turn attracted excellent medical personnel from around the country to Firland’s staff.
During the 1950s, Firland medical sociologist Joan K. Jackson addressed the problems of treating tuberculosis in alcoholics. A Firland chapter of Alcoholics Anonymous was founded in 1950. Concurrent to rehabilitation, however, Firland began to forcibly isolate alcoholics in order to prevent patients from leaving the institution against medical advice. “Known as Ward Six and located in the old naval brig … it was equipped with both locked doors and heavily screened windows. Included on the ward were seven locked cells, which contained only concrete slabs covered by thin mattresses. Patients admitted to Ward Six (most of whom were intoxicated) spent the first twenty-four hours in one of these cells for the purpose of sobering up or delousing” (Lerner, 121).
At first it was used sparingly, but by the mid-1950s fully 10 percent of Firland’s patients were involuntarily detained. Alcoholic patients who failed to adhere to antibiotic therapy after being discharged were often readmitted and operated upon prophylactically (with their consent, but in a manner generally thought to constitute overtreatment of the disease) and given a mandatory one year stay at Firland despite a negative sputum culture which would in a non-alcoholic patient have stimulated discharge. Detention at Firland took place without formal legal process, although within Health Department quarantine regulations in accordance with state laws passed in 1903 and 1907, previously unenforced due to lack of available beds.
"Difficult" patients were also placed on Ward Six in an attempt to maintain order, and as punishment for breaking rules. Firland staff wrote articles for medical journals detailing the use of Ward Six, and directors of sanatoria around the country traveled to Seattle to see it in action. In 1957, the Washington American Civil Liberties Union investigated Firland, but it was not until 1965, when District Court Judge Robert M. Elston began to hold monthly hearings addressing the needs of Ward Six inmates, that a system of due process was instituted. Still, in 1971, when the state of Washington assumed financial responsibility for Firland, one-third of Firland’s patients were under quarantine orders.
On October 30, 1973, Firland closed its doors. Washington had decided to consolidate the state’s tuberculosis treatment centers, and Firland’s 210 remaining patients were transferred to Mountain View Hospital in Tacoma. National trends encouraged integrating TB patients into mainstream hospitals, with most receiving outpatient antibiotic treatment under the supervision of private physicians or the Department of Health. The era of tubercular sanatoria, in which Firland had played such a crucial role for Seattle, was over. The area that was once the sanatorium has since been redeveloped and only a few traces remain.
Images of Firland Sanatorium
Main Image Gallery: Firland Sanatorium