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It's hard now to imagine a Seattle without skyscrapers or the Kingdome, 1-5 or the Space Needle.

But there was a time, and not too long ago, when these monuments were not part of our urban consciousness. In fact, in the late 1940s, Seattle was just beginning to stir. The war was over. Babies were booming. And so was the North End of Seattle.

The move to the suburbs had begun. In 1940, the population north of the Ship Canal and south of the Snohomish County line was about 148,000. By 1950, it was 217,000, and expected to grow by 160,000 by 1970. Northgate Shopping Center, the first of its kind in the country, was open for business in 1950. Subdivisions were popping up all over the place.

Memories of World War II were still fresh in everyone's minds, however. As children huddled under their desks during air raid drills, civic leaders planned for the civil defense. We may laugh now at what seems like near hysteria, but in those days the fear was very real.

So, too was the fear that thousands of lives would be lost simply because of inadequate hospital facilities. A 1948 study published by the Washington State Department of Health, in cooperation with the U.S. Public Health Service, found the Seattle area 683 beds short of acceptable levels.

Doctors didn't need a study to tell them there weren't enough beds. Hospitals were getting more crowded. Soon they would have to book rooms two and three weeks in advance. By 1958, they would be telling horror stories of tragedies and near-tragedies caused by this shortage. People were actually dying, they said, for lack of hospital space.

Worse yet, of the eight general hospitals in Seattle, seven were downtown. If the worst happened, if Seattle were under atomic attack, these hospitals would be destroyed, but in any kind of disaster, say an earthquake or a flood, they would probably be impossible to get to on the few bridges linking the North End to downtown (assuming, of course, that these bridges were left standing). Traffic was getting to be a problem under normal circumstances. For these reasons, state health planners recommended building new hospitals in the suburbs, where the people were now living, instead of building more facilities downtown. The Atomic Energy Commission advised decentralization, too.

Obstetrician Reuben Nelson, M.D., had been well aware of the problems for years. He remembered the situation right after Pearl Harbor, when rumors of enemy submarines lurking in Puget Sound abounded.

At the time, he recalled, the only medical facilities north of the ship canal were on the second floor of a building on Market Street in Ballard and on an upper floor of a building on 45th Street and Brooklyn in the University District. They would certainly not be adequate for a major emergency, and if the bridges were destroyed by sabotage or attack, physicians would have no way of getting civilian casualties to hospitals downtown.

The Seattle Civilian Defense council asked Dr. Nelson to devise a plan for just such an emergency. He organized fleets of makeshift ambulances and recruited boat owners to ferry casualties across the Ship Canal.

Fortunately, his plans were never put to the test, but in the process of laying them Dr. Nelson became acutely aware of the need for medical facilities in the North End. He served in the Army until the end of the war, and returned to Seattle determined to build a hospital.

Forty years later, this idea, born of makeshift ambulances and emergency ferryboats, is a 280-bed hospital with a reputation for innovation and sensitive patient care: Northwest Hospital.

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