When the Northern Pacific Hospital in Tacoma was demolished in March 1973, the building represented one of the earliest and most enduring cooperative healthcare plans in America. National programs such as Medicare may have made the network seem redundant, but the Northern Pacific Beneficial Association, which maintained the Tacoma hospital, predated Medicare by 85 years. The lifespan of the Northern Pacific Hospital also mirrors the economic influence of the Northern Pacific Railroad in Washington, and the changing degree of danger it posed to its workforce over time.
Gen. Haupt's Proposal
The Northern Pacific Beneficial Association was first proposed by former civil engineer and Union Army General Herman Haupt, then acting as General Manager for the Northern Pacific in 1880. Haupt proposed a fund generated through a sliding scale of monthly dues, which would be paid out in case of sickness, disability, or death. The association led to the building of several hospitals along the railway's path to the west and back, all jointly owned by the company and its employees, first in Brainerd, Minnesota (1882), followed by Missoula, Montana (1883), and Tacoma in 1905.
While there are earlier American examples of "sickness funds" in fraternal organizations and "friendly societies," these were often more focused on covering burial costs or accident relief than anything resembling preventative care (Murray, 468). The majority of these plans were "lodge practices," wherein a single physician sees members in their fraternity building for a flat fee, rather than a separate hospital being built for these purposes (Schwartz, 452). Fraternities were also often based around ethnicity rather than profession, which meant access to medical technology varied depending on the stigmatization of that group in nineteenth-century America. Many of these fraternal insurance plans were, at best, not transparent about how funds were used by the administration, or at worst, Ponzi schemes, wherein younger members directly supported older members and only received coverage after recruiting others into the fold.
The insufficiency of these plans and the combination of high-risk labor in sparsely populated territories led to railroad companies forming some of the earliest prepaid insurance programs. The first was the Central Pacific Railroad in 1868, followed by the Southern Pacific, which opened a hospital in Sacramento in 1870. Unlike the NPBA, membership in these medical plans was obligatory, coverage didn't extend to family members as well as "venereal infection ... vicious acts ... or previous infirmity" (Death Rode The Rails, 157). Annual statements were rarely published, and employees had "no voice" in voting on board members, chief surgeons, and constitutional bylaws.
In contrast, the NPBA was designed as what we would later recognize as a nonprofit cooperative health organization, dependent on a majority of employee votes for planning and organization. In the first board meeting on August 16, 1882, it was established that the voluntary plan would be financed by taking 50 cents a month from employees earning less than $100 a month and a maximum of $2 for anyone earning over $100. Under the association's constitution, the plan was available for all Northern Pacific workers and their immediate family members.
Surgeons Along the Line
Why the railroad industry pioneered prepaid medical insurance had to do with the geography of the Western United States and the severity of railroad accidents. At its height in 1907, 8 in 1000 railroad laborers were killed on the job, the work becoming even more dangerous than coal mining. Because the workers of the Northern Pacific were necessarily situated in remote "Far West" areas of North Dakota, Montana, Idaho, and Washington, systems outside of the contemporary medical establishment needed to be developed to support industrial growth. Initially, rural physicians formed partnerships with railroad lines, treating injured workers on their way to and from their destinations in exchange for travel passes. Some companies like Southern Pacific designed traveling hospital cars with operating and dressing rooms, employing railway surgeons full-time. Like the "lodge practice" of fraternal organizations, railway surgeons worked outside of the American Medical Association, eventually forming the national Association of Railway Surgeons in 1888.
While the association published and circulated financial statements annually, other railroads were not as transparent in how funds were used, membership was often obligatory, and administrative actions weren't decided by the votes of workers. Historians have speculated insurance plans by companies such as the Southern Pacific, Union Pacific, and Illinois Central Railroad were also created as a means of identifying fraud, deflecting government regulation, and controlling narratives around the dangers of railroad travel for both workers and passengers. As an early examination of railroad relief funds noted in 1912, requiring workers to process accident reports internally gave companies greater legal control. The author notes these plans, "in matters purely surgical and medical serve the employee; in matters legal serve the company" (Allport, 55). Companies also noted how these plans could dissuade government regulation, discourage unionization, and avoid labor strikes during a period of rapid expansion. As an administrator for the Pennsylvania Railway noted in 1894, their voluntary mutual benefit society had a "wonderful restraining influence" on worker turnover and labor organization ("Train Wrecks to Typhoid Fever").
The establishment of the Northern Pacific Hospital in Tacoma was representative of a longstanding relationship. General Morton Matthew McCarver jockeyed for the NP to choose Tacoma as the "Western Terminus," utilizing the port city's access to the Puget Sound. In 1877, General McCarver drove the last spike into the track as the Northern Pacific Railroad reached Tacoma from the south, via Portland, Kalama, and Tenino, inspiring news outlets to predict Tacoma's future as the "central and radiating point of the whole of Washington Territory. Its future progress will be onward, sure and rapid" ("Northern Pacific Railroad"). The construction of the Stampede Pass tunnel in 1886 allowed a much straighter shot from Eastern Washington through the Cascade mountain range, ultimately making Seattle the economic center of the state and, eventually the gateway to the Pacific.
In 1900, however, Tacoma was still the Northern Pacific's primary concern, and the lack of medical facilities on the West Coast was becoming an expense. Claims agents were being sent out from Missoula or Pasco to investigate injuries and mortalities, sometimes days after they took place. Investigations relied on eyewitness accounts to distinguish fraudulent claims from legitimate ones if the laborer survived the accident or determine the cause of death if they did not. Generally, claims agents would settle medical bills with local physicians, but patients with prolonged illnesses would need to be moved nearly 500 miles to the nearest association hospital in Missoula, not always surviving the trip.
The decision to build the Tacoma hospital was confirmed during the annual NPBA board meeting in St. Paul in June 1902 and authorized by General Manager Thomas Cooper in 1903 for $100,000. A team of engineers eventually decided on a plot located at what is now 801 East Wright Avenue, just south of McKinley Park. After touring the grounds with a team of NP executives, Cooper praised the "view of the bay and the city and Olympic Mountains to the north, and the Cascade Range and Mount Tacoma (Rainier) to the south ... entirely free and unobstructed" ("New NP Hospital"). Cooper hired St. Paul architects Charles Aldrich Reed and Allen H. Stem to design the hospital. The firm had worked with the Northern Pacific once before on a passenger depot in Livingston, Montana, but would contribute five more buildings for the company, including Tacoma's Union Station in 1909. Regarding their design, Northern Pacific workers "openly expressed their displeasure" for the red brick used in the building rather than an "imposing" neoclassical white pressed brick popular at the time. Despite protests that the material would be "a blot on the landscape and seascape to rear a solemn and severe building of monotonous red" the architects moved forward with the more affordable materials ("Employees Want an Imposing Building").
Built on an incline, the hospital had three full levels and a sloping half basement. The first floor was devoted to reception, examination, X-Ray and dressing rooms, as well as a dispensary, laboratory, and three dining rooms. The second and third floors were mainly devoted to patient wards. In contrast to the conventional hospital design of the period, which housed between 12 and 20 patients at a time in one ward, the 75 beds in the hospital were divided into four bedrooms. The Tacoma Daily Ledger attributed this "radical change" to the ethnicities of the workforce, noting "the Northern Pacific has in its employ Japanese, Italians, Greeks and laborers of almost every nationality, and these will be separated as far as it is possible to do so ("Railway Men's New Hospital").
Fresh Air and a Fine Operating Room
Dr. Hamilton Allen, the hospital's first Chief Surgeon, prioritized ventilation in the design of the building. Fresh air was pulled in through fans and finely screened windows in the basement, passed over ventilators where it was heated or cooled, and forced into specific rooms throughout the hospital. "Foul air" was expelled through the top of the building by exhaust fans so it was "constantly supplied with fresh and changing air" ("Plans for Northern Pacific"). Ventilation was considered in the interior design, with walls finished in rounded plaster instead of wood panel right angles to prevent the accumulation of dust.
The building also featured a private telephone line, an "automatic" button elevator system familiar today ("more to be relied upon than the average elevator boy") and "the finest operating room in the west" located on the second floor ("Railway Men's New Hospital"). Responding to employee demand, the building also featured an obstetrics-gynecology department on the third floor for the wives of employees, a departure from services provided in Brainerd and Missoula.
Only a year after the first cornerstone was laid, 500 Northern Pacific employees gathered to celebrate the opening of the hospital on August 26, 1905. Decorated trolleys provided by the Tacoma Railway & Power Co. transported visitors to the grounds, where they were directed to the building by a massive locomotive headlight wired to the main entrance. Dr. Hamilton Allen greeted visitors and members of the reception committee guided NPBA members through the facility, where nurses and hospital attendants were stationed to field questions about "every surgical appliance and ... peculiar architectural features" ("New Hospital's Formal Opening"). Tacoma mayor George P. Wright and two reverends spoke, followed by an extensive musical program of Beethoven, Schumann, and Chopin on the hospital grounds, concluding with "a short program of popular music" in McKinley Park ("Program Now is Complete").
Allen appears to have been well connected in Tacoma, elected multiple times as the president of the Pierce County Medical Society and a Commander in Chief of Tacoma's Scottish Rite Masons. Perhaps not coincidentally, Allen won first prize at Tacoma dog shows for Rob Roy, his Scotch Collie. Dr. S. W. Mowers, a surgeon in the Fifteenth Minnesota regiment in the Spanish-American War and assistant surgeon at the Brainerd Hospital, became Chief Surgeon in 1907. Like Allen, he would become president of the Pierce County Medical Society, in 1917, and also enjoyed participating in local contests, regularly taking first place in the Tacoma Dahlia Society's annual floral competitions. Dr. Paul Remington succeeded Mowers in the 1920s, followed by Dr. Robert Hause Beach from 1925 to 1931, Dr. John W. Gullickson from 1941 to 1965, and Dr. Edward R. Anderson until the closing of the institution in 1969.
Dangerous and Deadly Work
The most documented surgeon in the hospital was its first intern, Dr. H. S. Argue, a Tacoma native who began working for the hospital soon after it opened. The early photographs by James M. "Jimmy" Fredrickson document Argue attending to child patients and candidly operating on a distressed but conscious laborer. Argue never rose higher than the rank of assistant to chief surgeon, surfacing frequently in newspaper reports as the hospital's on-call physician, fielding a barrage of accidents, disease, and violence during the railroad's most dangerous period in history.
According to hospital records from the first seven years of the institution, the leading cause of death was typhoid fever, followed by pneumonia, and then variations of "crushing injuries" ("Northern Pacific Beneficial Association Hospital Records"). These were most frequently caused by laborers or switchmen being caught between two railroad cars while coupling them together, referred to as being "car bit" ("Safety First ..."). In Railway Surgery, A Handbook on the Management of Injuries (1899), author Dr. Clinton B. Herrick notes how the railroad industry created damage to the human body previously unfamiliar to physicians. Slow-moving bumper accidents, where small areas of the worker were caught between 120 tons of steel, could reportedly "pulpify" specific regions of the body, while adjacent tissue would look otherwise unaffected (Herrick, 25).
The most dangerous position during this period was "laborer," a catch-all term for unskilled work most frequently assigned to immigrants, including Irish, Norwegian, Italian, German, Swedish, and Japanese, in descending order of mortality rates. Although it is never discussed in the constitution, Chinese workers do not appear to have been allowed to join the association. The 1882 Chinese Exclusion Act was still in effect, and while many Chinese still found ways to enter and work in the U.S., the regulation barred them from participating in these early forms of healthcare. Even pre-dating the Exclusion Act, Chinese workers were barred from medical plans provided by the Central and Southern Pacific railroads. Archeological excavations of former mining and railroad camps in Washington indicate that Chinese workers created self-sufficient healthcare practices outside of these standardized systems.
The influence of employee votes on the conditions and organization of services set Northern Pacific's medical program apart from its peers. Complaints were addressed judiciously. In 1915 Tacoma's S. W. Mowers and the head of the NPBA from St. Paul descended on Pasco to investigate company surgeons for incompetence, ultimately interviewing 150 patients. In 1919, 35,000 Northern Pacific workers voted to restructure the association so a hospital's board of managers would vote to select a Chief Surgeon rather than the association's president. A board of managers stated that this previous arrangement was "such that the management is too far removed from the members whose monthly dues keep the association in existence" ("Get Vote of 35,000 N.P. Men").
Expansion and Decline
The association once again commissioned St. Paul architects Reed & Stem to build a three-story addition to the hospital in 1910, featuring an "exhaust vacuum cleaning system," sun parlors, and an underground ambulance driveway ("Big Addition to Hospital"). This was followed by a $60,000 reconstruction of the north wing of the hospital in 1926, which included new equipment, tile flooring, and a raised capacity of 135 beds. Despite these improvements, the association was gradually returning its attention eastward. The opening of hospitals in Glendive, Montana, in 1913; Staples, Minnesota in 1919; and the association's final hospital in St. Paul, Minnesota, represented the needs of an aging workforce in the company's Midwestern birthplace.
The Northern Pacific Hospital seems to have been well funded and maintained right up until it transferred the final patients to Mountain View General Hospital on July 2, 1969. The key factor in the closing of the hospital appears to be the Northern Pacific merging with seven other railroad lines to become the Burlington Northern on March 2, 1970. Additionally, the purpose of the Northern Pacific Beneficial Association insurance program became unclear in a post-Medicare landscape. An editorial from a nurse at the Missoula hospital defended against accusations that the association's insurance was substandard to Medicare and/or a form of social security double dipping.
Following the closure of the hospital, Tacoma City Manager Floyd Oles proposed that the site be used for an East Side County City Hall in May 1970. This concept gradually shifted to the building being used as a drug rehabilitation "Humanities Center" sponsored by Opportunity Development Inc. This plan was approved by the NPBA board of trustees in St. Paul but protested to a halt by McKinley residents who felt the neighborhood was not "a proper location for treatment of narcotics addicts" and would "expose the children of this community to unnecessary hazards and dangers" ("ODI Seeks NP Hospital"). The building remained extant but derelict for another two years before being demolished, following the final active NPBA branch in St. Paul changing ownership and becoming the Samaritan Hospital.
In October 1947, Harry E. Leonard submitted an editorial to the Minneapolis Star to illustrate differences between earlier cooperative medical plans and the national programs, which were increasingly becoming dominant. Leonard, a member of the International Brotherhood of Electrical Workers, noted that the Blue Cross Association represented "a progressive step and that much good can come of it. On the other hand, you should point out that the lead was first taken by laymen."
Leonard noted "numerous benefit organizations which have been in the field for years; to mention one, the Northern Pacific Beneficial Association ... Lay groups interested in the problem long ago came to the conclusion that good medical care requires the direct service type of organization, with the advantages of clinical practice, early and accurate diagnosis, and a professional staff whose income does not depend upon the misfortune of people" ("Pioneers of Prepaid Healthcare").