Back to Table of Contents | March 2010

Clinical and Health Affairs

The History of Organized Medical Transport in Minneapolis

1867-1930

By Scott D. Thielen, M.S., M.D.

ABSTRACT
When Minneapolis officially became a city in 1867, there were no hospitals or ambulance services within its limits. Four years later, in 1871, the first hospital in the city, Cottage Hospital, opened its doors to the public, shifting medical care from the family home to the hospital. The need then developed for organized medical transport. The period between 1880 and 1890 marked the beginning of limited ambulance service in Minneapolis. Over the next 40 years, many public and private institutions developed their own transport services. During that same time, skilled medical transport in which physicians and/or nurses went along on calls began, and the transport of patients transitioned from horse and wagon to motorized ambulances. These developments would set the stage for future innovations in Minneapolis’ emergency medical system and ultimately improve patient care and survival.

Medical transport systems have become a necessary part of our lives and have revolutionized emergency medical care. Today’s ambulance services offer safe, efficient, and expedited trips to the hospital and, in most cases, provide skilled medical care along the way. That was not always the case. Early systems involved the use of litters or stretchers, then wagons pulled by horses or mules, and finally motorized vehicles (see “Early Medical Transport”).¹

The development of medical transport in Minneapolis follows the establishment of hospitals in the city. Prior to the 1871 opening of the first hospital in Minneapolis, Cottage Hospital, medical care was given primarily in the family home, and physicians usually traveled to see patients by foot, horse, or horse-drawn wagon. In the 1800s, it was noted somewhat in jest that the “physicians with the fastest horses always had the most patients.”² The construction of hospitals in the later part of the 1800s created the need for a way to transport the sick, as delivery of care changed from a home- or clinic-based system to a hybrid system of home visits, clinics visits, and hospital stays.

Early medical transport was operated by a combination of public organizations including the Minneapolis Board of Health, the city’s police department and public hospitals, and private hospitals and businesses. Two organizations—one public (the Minneapolis Board of Health) and one private (Minnesota College Hospital)—are believed to have operated the first ambulances in the city. This article will focus first on the history of medical transport by public hospitals and organizations and then by private hospitals and companies.

Public Medical Transport in Minneapolis

■Minneapolis Board of Health
The Minneapolis Board of Health was one of the first branches of city government dedicated to the health of the public. One of the board’s most important responsibilities was the control of infectious diseases such as tuberculosis and smallpox. In 1883, Minnesota law gave the city’s health department the power to operate a quarantine hospital (called a “pest-house”) near Lake Calhoun and to remove sick people from their homes and businesses and isolate them in order to prevent the spread of infectious disease.³

In the 1800s, Minnesota was a destination for those with tuberculosis (called “consumption” in those days). It was thought at that time that the Minnesota air was particularly good for those with TB. In the late 1800s, one newspaper in Boston noted that “Minnesota all the year round is one vast hospital. All her cities and towns, and many of her farm houses are crowded with those fleeing from the dread destroyer.”⁴ The “fabulous cures worked by the invigorating Minnesota air” were apparently thought to be “like a wine, so exhilarating is its effect on the system.”⁴

An editorial from the Minneapolis Tribune in September 1883 provides the earliest documentation of an ambulance operating in Minneapolis. The article discussed the detriments of locating the quarantine hospital near Lake Calhoun, noting that “the principal pleasure drive of the citizens, Hennepin Avenue, will be deserted, as pleasure driving and fever ambulances are not to be thought of…”⁵ as coexisting well on the same road. The term “fever ambulance” most likely is referring to an ambulance used to transport patients to the quarantine hospital.

Four years would pass before there was documentation by the Board of Health of the acquisition of a dedicated public ambulance for service in Minneapolis.⁶ Purchases noted in the Minneapolis Board of Health’s annual report for 1887 included “a horse and ambulance and cow.”⁶ There had been no mention of an ambulance or operating costs associated with one in prior reports, so it is unclear whether this acquisition replaced a rented ambulance or supplemented one already in use. In the early 1900s, the quarantine hospital was relocated near Minneapolis City Hospital. References to the Minneapolis Health Department ambulance are noted in Minneapolis City Hospital annual reports from 1902 and 1916,7,8 during which a restructuring of the ambulance service in the entire city was undertaken.

■Minneapolis City Hospital Ambulance Service
Following a scathing 1891 report on prehospital care by its superintendent,⁹ Minneapolis City Hospital (later Minneapolis General Hospital and now Hennepin County Medical Center) received an ambulance of its own in 1894.¹⁰ The 1891 report concluded that the “great and evident need of the department is some better means of conveying the sick and injured to the Hospital than those now employed.”⁹

The superintendent based these findings on the rather poor state of some patients upon hospital admission after transport in a variety of suitable and unsuitable vehicles. For example, he stated that the city’s system of using private wagons and police patrol wagons delivered patients to the hospital “so thoroughly chilled that it is next to impossible to establish reaction much less to think of operating successfully.”¹⁰

The daily operations of the new Minneapolis City Hospital Ambulance Service (Figure 1, Figure 2) were contracted out to a local man, Thomas Gavin, and his son, who housed both the ambulance and the horses that pulled it. He was paid $1.50 for each round-trip run and maintained the horses and wagons at his own expense. Some 200 ambulance trips were completed from late summer through the end of 1894. At some point that year, storage of the ambulance was moved to the hospital grounds as the hospital’s superintendent felt that some patients might leave sooner if the ambulance were available to transport them home.¹⁰

■Minneapolis Police Patrol Wagons
From the late 1870s through the early 1900s, the Minneapolis police operated a patrol wagon that was used to bring accident victims to the hospital. Although not a formal ambulance, the patrol wagon was used to transport patients and prisoners, and for street patrols. The first police patrol wagon was authorized for purchase by the city of Minneapolis’ Committee on Police in 1879 for the sum of $300.¹¹ The police chief at the time apparently did not want the patrol wagon to be a police expense and instead hired a horse and wagon on an as-needed basis. The first mention of the purchase of a patrol wagon and a set of horses was found in the police department’s expense reports from 1886.¹¹ It appears that City Hall became a central point for calling an ambulance for accident victims.¹² In 1890, the police wagons transported 91 people to various hospitals.¹³ In Minneapolis, the early fire department did not have any transport capabilities for the wounded or ill and relied on the police wagons or hospital/private ambulance services for patient transport. Firefighters did receive some medical training beginning in the 1920s and carried some resuscitation equipment after that.

Private Medical Transport in Minneapolis

■Minnesota College Hospital
A photograph of the Minnesota College Hospital from the early 1880s shows what is possibly the first dedicated ambulance in the city of Minneapolis. (The image is not shown here because the details were too small to be visible in print.) Although this ambulance might predate the Minneapolis Board of Health’s, documentation of exactly when the ambulance service began is lacking. Dr. Frederick Dunsmoor and colleagues opened College Hospital or Minnesota Hospital, as it was called then, in the old Winslow House Hotel in 1881, when they moved the St. Paul Medical College to Minneapolis. The Winslow House was torn down in 1887, thus the photograph must have been taken prior to this date.¹⁴

The Minnesota College Hospital reorganized in 1885 and moved to St. Barnabas Hospital under the new name, Minnesota Hospital College. It used St. Barnabas Hospital for teaching purposes but had an outpatient clinic on Sixth Street. Minnesota College Hospital, St. Paul Medical College, and the Minnesota College of Homeopathic Medicine merged with the University of Minnesota in 1888 to form the new University of Minnesota Medical School.¹⁵

■Cottage Hospital
Cottage Hospital was a private hospital founded by the Rev. David B. Knickerbacker in 1871, four years after the city of Minneapolis was incorporated.¹⁶ Its name was changed to St. Barnabas Hospital in 1881. The first private ambulance for Cottage Hospital was purchased in 1890 for $320 and recorded a profit of around $20 during its first year of operation.¹⁷ Although these items were carefully recorded in the 1891 St. Barnabas annual report, there is no supporting documentation of the initial purchase of the ambulance in the board minutes.¹⁸ This is interesting, considering the ambulance service represented a major shift in the prehospital care of patients and a new source of revenue for the hospital.

■Swedish Hospital
Established in 1898 by Swedish immigrants, Swedish Hospital operated its own ambulance service in the early 1900s, although it is unclear exactly when the service began.¹⁶ The Swedish Hospital ambulance consisted of a white wagon and two white horses, which contrasted with the black wagons and horses used by St. Barnabas Hospital. Located next to one another, these two facilities would eventually merge in 1970 after many years of sharing services.

■Northwestern Hospital for Women and Children
Northwestern Hospital for Women and Children was founded in 1882 and struggled for years to pay off debt. In 1897, an ambulance was donated to the hospital. The annual report for that year notes, “Aside from the very liberal contributions of money toward paying our indebtedness, many valuable donations have been received. Conspicuous among them are an ambulance long needed and much appreciated, from Mr. T.B. Walker…”¹⁹ A surviving photograph (Figure 3) from 1895 does show an ambulance. Considering the hospital’s financial situation and the lack of mention of the ambulance in previous annual reports, it is likely misdated.²⁰

■Asbury Methodist Hospital
A surviving photograph from the 1890s shows an ambulance from Asbury Methodist Hospital in Minneapolis, the early forerunner of Methodist Hospital in St. Louis Park. This ambulance has the words “Free Ambulance” written on its side (Figure 4), in contrast to most other ambulance services of the time, which charged for transport. The free ambulance kept with the hospital’s mission of doing charity work. Donated by the Hennepin Avenue Sunday School in 1893, the ambulance, which cost $275, brought patients to hospitals, homes, and other locations. Its driver, Walter Chapman, was usually accompanied by a doctor and/or a nurse. This would be the first documented example of skilled medical transport in Minneapolis.²¹

■Private Companies
The early 1900s also saw the development of private ambulance services that were not connected to any one hospital. The Olsen Ambulance Service started around 1910 and served many of the private hospitals including Swedish, Northwestern, St. Barnabas, and Fairview. The Olsen Service took over or supplemented services already in use at these hospitals.²² Other private ambulance services based in Minneapolis around this time included the Emergency Ambulance Company.

Early Changes in the Public Medical Transport System

As previously noted, in the 1890s, Asbury Methodist Hospital had a nurse or doctor present on many ambulance trips. In 1900, Minneapolis City Hospital required that a physician intern ride with the ambulance on all trips.¹⁰ This represented a major shift in medical transport from merely providing transportation to also giving patients skilled medical care on the way to the hospital. The tradition of hospital interns riding along on ambulance trips from Minneapolis City/General Hospital continued until the early 1960s.²³ Another development was the use of the telephone beginning in 1902 to notify Minneapolis City Hospital that an ambulance would be arriving; this allowed the hospital to prepare for the patient, further improving care.¹³

The invention of the automobile also changed medical transportation. Until 1911, ambulance service consisted of a horse and wagon with a driver and a physician intern. In 1911, the first automobile ambulance was purchased by the Board of Charities and Corrections for use by Minneapolis City Hospital.²³ This Electric Winton ambulance (Figure 5) could travel at a maximum speed of 20 miles per hour and ushered out the era of horse-drawn ambulance service.

Consolidation and Reorganization of the Public Medical Transport System By the early 1900s, the public medical transport system for the city of Minneapolis included hospital ambulances, police ambulances, and the Health Department’s quarantine ambulances. The confusion brought by these frequently overlapping services was initially addressed in a Minneapolis City Hospital report in 1902 in which the hospital directed that all cases of possible contagious disease be transported only in the quarantine ambulances rather than in those belonging to Minneapolis City Hospital.¹⁰

The year 1916 saw a significant restructuring of the public ambulance service in Minneapolis. It appears that there were significant delays, continued confusion, and friction regarding the three entities that ran ambulance services taking patients to Minneapolis City Hospital. There also were complaints from the public about ambulance operators fighting over who should respond to a particular call. In 1916, at the suggestion of the superintendent of Minneapolis City Hospital, Dr. Herbert G. Collins, the entire system was reorganized, and the Health Department and police ambulances were transferred to City Hospital.¹⁰

After the consolidation of the public ambulance services, assistant city physicians employed by City Hospital were put in charge of the public ambulance service for the entire city and given the title “ambulance surgeons.” These physicians were chosen from the hospital’s recently graduated class of interns and were given an annual salary of $1,200. They worked eight-hour shifts and were required to be present in the receiving department of the outpatient clinic (a forerunner of the modern-day emergency department) to see patients who presented to the hospital for treatment, to provide care for ambulance cases already brought to the hospital, and to accompany the ambulance on calls.²⁴

During the next 20 years, the use of the ambulance service was further defined by Minneapolis City Hospital. By 1919, store owners and private homeowners were no longer allowed to call the city’s ambulance service to move people between places or to private hospitals.¹⁰ It was directed that private ambulances should be hired for these cases. In 1923, the city ambulance was no longer allowed to transport patients between city hospitals and the nearby Glen Lake Sanatorium. In 1926, the transport of patients outside the city limits was restricted unless the village in which the person needing transport lived was willing to pay the cost.²³

The period between 1910 and 1930 saw tremendous growth in the number of ambulance trips in Minneapolis. In 1903, the Minneapolis City Hospital ambulance made 601 trips. In 1915, just prior to the reorganization of the city’s ambulances, it made 1,923 trips. Two years after the ambulance service reorganization ordinance of 1916, the number of ambulance trips jumped to 3,448. In 1930, the city ambulance service made more than 6,800 trips.²⁵ Today, the Hennepin County Medical Center Ambulance Service responds to approximately 55,000 calls per year.²⁶

Summary

Organized medical transport in the city of Minneapolis dates back to the late 1800s after the first hospitals in the area were established. The evolution of patient care from a home-based to a hospital-centered system fostered the development of ambulance services. A mix of public and private enterprise, ambulance services evolved in order to improve efficiency, decrease transport time, and provide skilled services en route to the hospital. These developments revolutionized prehospital care and fostered further innovations that would improve the lives of those needing emergency care. MM

Scott Thielen is an emergency physician with Emergency Physician Professional Association. He practices at Fairview Ridges Hospital in Burnsville. A portion of this paper was prepared when he did an elective in the history of medicine program at the University of Minnesota during his medical training. The paper was completed during the author’s emergency medicine residency at Regions Hospital in St. Paul.
 

The author would like to thank John Eyler, Ph.D., for his assistance in the preparation of this manuscript and the staff of the Wangensteen Historical Library, Minnesota Historical Society, Hennepin County Library Special Collections Department, and Metropolitan Medical Center Historical Library for their invaluable assistance in the research for this article.

References
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