Cowboys Form a Health Cooperative:
The Fetterman Hospital Association and Health Care Coverage on the Range
By Phil Roberts
Wyoming would seem to be the last place with a history of cooperative health care. Yet, more than a century ago, that most rugged of individualist, the American cowboy, organized a cooperative health program on the Wyoming range. It was probably the first such organization of its kind in the United States even though it is largely forgotten.
In the earliest history of cooperative health care, an article written in 1945, author J. T. Richardson, noted that “one of the earliest” single-hospital plans was Hospital Service Association of Rockford, Illinois, formed as a cooperative in 1912.1 The Fetterman Hospital Association is not mentioned even though it predates the Illinois cooperative by more than a quarter century
In retrospect, it seems reasonable that cooperative health plans would exist on the Wyoming plains. Cowboying was a dangerous business. Cowboys rode in all kinds of weather, suffered from temperatures as low as -50 below in winter and 100 degree heat in the summer. The tough, range-born cattle had to be branded and herded across prairies unencumbered for miles in any direction by fences, barbed wire or otherwise.
His horse was his proudest possession, but a cowboy couldn’t always rely on staying in the saddle. The range horse could be spooked easily by a rattlesnake or its foot could go down in a badger or prairie dog hole, throwing the cowboy off, perhaps breaking his leg or arm.
The practice of medicine remained primitive even though the treatment of injuries had made great strides during and after the Civil War. Hospitals were no longer viewed as places reserved for the terminally ill. Such advances did not come without expense; neither did it filter beyond the larger populated areas. The few dozen medical doctors practicing in Wyoming territory in the 1880s were concentrated in the railroad towns—communities such as Cheyenne, Laramie, Rock Springs and Evanston that owed their existence to the Union Pacific Railroad. The company employed “surgeons” who were stationed at division points, many of whom did not treat railroad workers exclusively but branched out into private practice. Military forts usually had an assigned “post surgeon.” Several resigned their commissions over the years and remained in Wyoming as pioneer physicians.2
Compared to the railroad and the military forts, cattle companies employed relatively few workers. Lacking the control the railroad had over its employees and the responsibility the army had for its troops, it was not economical to provide doctors or hospitals for a few range cowboys.
During the early 1880s, resident managers of absentee-owned cattle companies and owners of smaller spreads in the area of present-day Converse County were participating in the great open-range boom. Cattle prices were at a 19th century high, as much as $4.75 a hundredweight, and more and more investors were betting on continued profitable of the industry. By the middle 1880s, the once nearly vacant plains were becoming overcrowded with thousands of cattle run by dozens of cattle companies.
Even though cowboying was a low-skill occupation, the prosperity caused the competitive wages to rise. Experienced cowhands were in demand throughout the industry. Non-monetary inducements were few in east central Wyoming. Culture, entertainment and such essentials as hospitals were distant. On the east central plains around present-day Douglas, the closest medical care for cowboys was more than 150 miles away in Laramie.
Ranch managers recognized the desirability of convenient medical help, not only for themselves and their families but also for their cowboys. But it could not be furnished by any one company or individual. It had to be a cooperative venture in which the cowboys would participate in providing such services.
Consequently, in April 1885, during the height of the cattle boom, cattlemen and cowboys formed the Fetterman Hospital Association” on the Wyoming plains. The association was named for the east-central Wyoming town of Fetterman, a tiny collection of buildings that included a general store operated by C. H. King (President Gerald Ford’s grandfather).3 The “town” owed its existence to the army, which had established Fort Fetterman at the site June 19, 1867, on the south side of the North Platte River at the mouth of LaPrele Creek, northwest of modern Douglas, Wyoming. In the earliest days of the cattle boom, however, the need for the fort had disappeared, the post was closed and troops were permanently withdrawn on May 20, 1882.4
Purveyors of the “cowboy myth” do not mention the association. But even as the local newspaper, the Rowdy West, editorialized at the time, “Probably no institution in America of like magnitude and importance is as little known as ‘The Fetterman Hospital Association.’”5
According to the minute book of the association, held in the collections of the Pioneer Museum, Douglas, the organizing officers included several prominent central Wyoming stockmen.6 The idea for the association may have come from Ephraim Tillotson, the wealthy owner of the “Fiddleback Ranch,” who donated a building for the hospital.7 New York-born Tillotson had come to the area as an army lieutenant at nearby Fort Fetterman. A Civil War veteran, he left the army in 1870, became post sutler and began raising livestock. The local newspaper estimated that his “Fiddleback Ranch” ran between 15,000 to 20,000 cattle at the time the association was organized.8
During the formal organization meeting attended by several dozen cowboys and cattlemen on April 25, 1885, the association authorized its newly elected officers to search for a trained physician, someone willing to supervise the hospital and work exclusively for the association at a monthly salary of not more than $100. Details surrounding the hire are unknown but in May 1885, the association offered the job to Dr. Amos Barber, a graduate of the University of Pennsylvania Medical College.9 The association agreed to pay him $100 per month and also cover his moving costs from Philadelphia ($92.85) to Fetterman.10
Barber was an unlikely hire for the small cooperative located on the lightly populated, isolated high plains of Wyoming. When Barber arrived in cattle country on June 1,1885, he brought with him considerable medical experience. He had served as resident physician at five Philadelphia area hospitals.11 By all indications, he was competent, experienced and left a profitable practice to move west.
Even though the town had grown up around the now abandoned military post, the association did not obtain the old post hospital building that housed part of C. H. King’s mercantile company. Instead, Tillotson loaned use of an unused former army barracks, a two-story 40-by -50 foot building he apparently purchased soon after the army abandoned Fort Fetterman. It was not well suited for a hospital. The drafty barracks lacked insulation, proper heating and internal walls. Heating problems in the hospital were to plague the association throughout its existence.
Soon after Dr. Barber arrived, the association hired L. Mortinson as hospital steward. He was paid $174 for two month’s work but his duties also required that “he do all of the hospital laundry.”12 Later, the association hired a cook for $10 per month.13
The association’s constitution, adopted at the initial meeting, set the terms for “subscribing.” Cowboys who signed up had $1 per month deducted from their pay, a considerable amount given that the wage for a working cowboy at the time was, at the most, $80 per month.14 In return, the cowboy was guaranteed the full range of medical services—with some exceptions. According to the constitution, “All diseases and accidents will be treated except venereal diseases.”15 (Later, the association officers agreed venereal disease sufferers would be treated, but the $2.50 fee would not be covered as part of the benefits). Burial benefits were included but with the proviso that the association would pay only for burials “at this place.”16
During the first six months of operation, 219 individual cowboys signed on as “subscribers.”17 More important, however, were the group memberships paid by the 20 largest cattle operations in the area in the amount of $1 per month per employed cowboy. These amounts ranged from $25 from the Douglas-Willan Sartoris Cattle Company to $100 from the cattle partnership operated by J. M. Carey. (Carey later was Wyoming’s first United States Senator and, in 1911, governor of the state). Stockman D. H. Andrews, the association’s first president, enrolled all of his cowboys into membership and, on top of that, donated more than $200 to the hospital’s operations.18
Working on the open range in frontier Wyoming was a dangerous job and it is reflected in Dr. Barber’s report for the first season. Barber treated 149 patients, all but 14 of whom were association members.19 (Non-members were charged $2.50 per treatment and “extra for surgery.”) Cowboys were most commonly treated for broken bones, including five broken arms and one skull fracture. Four cowboys were treated for “cold”; two for “poisonings”; one each for gangrene and asthma.20 Barber treated six patients with gunshot wounds, one from heat exhaustion and two suffering from alcoholism. There were the usual range of respiratory diseases, several cases of “rheumatism” and, despite rules requiring additional payment for such maladies, four cases listed as “debauch.”
The local newspaper noted that Barber “not only did not lose a single case, but performed a successful cure in each and every instance.”21 Regardless of the association’s success, the executive committee voted to close the hospital during the winter months because of difficulty in heating the building.22
Although the association kept good records, officers frowned on excessive bureaucracy. In the association’s first year, a cowboy hired by prominent stockman Major Frank Wolcott was treated for a broken leg. The association secretary reported that Wolcott’s “subscription” payments for his cowboys had been received two days after the cowboy had been treated. Wolcott argued that his cowboy should be entitled to benefits because Wolcott and the association secretary had been negotiating a term at the time of the injury. He claimed that in his correspondence with the secretary, “there had been a delay in the answer” that caused missing the “subscription date.” The executive committee accepted Wolcott’s explanation and allowed coverage.23
In its second year of operation, the association raised the wages of both the doctor and the steward and hired a full-time nurse.24 It also began accepting “paupers” for treatment whose medical expenses were paid by the county at the rate of $3 per day, “surgery extra.”25 The hospital was located in what was then Albany County, some 150 miles from the county seat of Laramie.26 County patients never made up a significant portion of the total people treated. The high point was in June 1887 when the county was charged for eight patients.
By the time of the organization’s general meeting in March 1887, more than 340 patients (all but 23, subscribers) were being treated annually.27 Also, for the first time, the association paid for subscriber burials. Three patients had died during the previous year.
The severe winter threatened the financial health of many of its members, however. Cattle prices plummeted after 1885 from as much as $4.75 per hundredweight to as low as a dollar. Little rain fell during the summer of 1886, parching what little plains grass that remained. Adding to the problem was the serious overgrazing of the open range as cattlemen tried to keep their herds off the market until prices improved. The misfortune culminated in disaster when a succession of blizzards swept over the plains in November and snow, buffeted by high winds, continued to fall in record amounts well into April 1887.
Many cattle outfits struggled to keep afloat by making substantial cuts in expenses. Most no longer retained the services of range cowboys beyond the roundup seasons. The cowboys became small near-subsistence ranchers themselves or eked out their existence doing casual labor. Many, unable to find work, left the area.28
At the same time that the cattle companies were suffering reverses, Barber’s string of medical “successes” came to an end. On June 20, 1887, the county was charged $15 for “digging graves for William Parks and Gus Tyler,” as well as $22 for their respective coffins, $9.20 for the lumber contained in them, and $4 for “transportation to the cemetery.”29
Within two years, many of the large cattle companies were insolvent, victims of harsh weather, over-grazing and the arrival of fencing. The association survived by enrolling members of the general public. To drum up potential “subscribers,” the Executive Committee agreed to “send out circulars to stockmen, foremen and the general public” during their meeting of April 24, 1888. Announcements were also placed in area newspapers as far away as Cheyenne.30 Two coal mining companies signed up their employees although the numbers were far less than those once employed by the cattle barons.31
Hard times wreaked havoc on the town of Fetterman. Hints of a fatal end came in early 1886 when the Fremont, Elkhorn and Missouri Railroad chose to build to Douglas, a half dozen miles to the southeast. Within two years, most businesses had made the move, including C. H. King whose mercantile store became the first in the new railroad town.32
Sometime in 1889, Dr. Barber moved to Douglas and opened a private practice. He offered to see association patients under the same conditions as his earlier contracts.33 Later, the executive committee voted to move the hospital itself to the new county seat of Converse County, “as soon as a building can be provided.”34 The town of Fetterman faded out of existence.
With the demise of the cattle companies and the town of Fetterman, the association had lost its initial membership, the range cowboys—the rugged individualists who brought cooperative health care to frontier Wyoming. Yet, despite the adversities and the poor state of the economy, the association still counted 30 paying subscribers in 1889. Prominent local ranchers still served as officers. DeForest Richards, who was elected as a delegate to the State Constitutional Convention that year, served as association president. (In 1898, Richards was elected governor of Wyoming).
The membership base was too small and the hospital finally closed. The last entry in the association record books is for May 11, 1889. It was not insolvent.35 Nonetheless, for the first time subscriptions were insufficient in themselves to cover the expenses. The report to the annual meeting in 1889 showed $1,401.28 taken in from subscriptions, but expenses were listed as $1,545.39, not including $750 of salary owed to Dr. Barber. The association had a carry-over cash surplus of about $750, just enough to pay Barber’s annual salary. There is no further record of the organization.36
Barber temporarily left medical practice in 1890 to serve as the new state of Wyoming’s first Secretary of State. Soon after his term began, Gov. Francis E. Warren resigned to accept election to the U. S. Senate, making Barber the acting governor. Barber was serving in that office during the so-called Johnson County War. He allied with the cattle baron-invaders, which included Major Frank Wolcott, the cattleman whose coverage by the association had been debated.37 Barber remained loyal to the large cattle companies. At the end of the “invasion,” when it became clear that the invaders were losing, Barber made frantic calls to Washington, begging President Benjamin Harrison to order in federal troops. His cattle baron friends were “arrested”—actually rescued from the armed and angry Johnson County residents.38
Official biographies incorrectly state that Barber came to Wyoming as an army surgeon stationed at Fort Fetterman. Even his obituary contains the error.39 He apparently never spoke of his role as the supervising physician of America’s first health cooperative.
Tillotson’s ranch survived the “bust” in the cattle industry. Following his death at the turn of the century, the ranch was sold to a corporation headed by Roscoe Crary, a principal in Texaco.40 Tillotson’s widow occasionally wrote to friends from homes in Chicago and New Jersey.41 No record exists as to when the “hospital” structure was demolished. At any rate, the building no longer stands. The cowboys, once subscribers to the unique association, dispersed and left no record of their memories of the cooperative.
The existence of the Fetterman Hospital Association demonstrates that the American cowboy recognized the medical hazards of his work and welcomed cooperative efforts to provide “health benefits” if accidents or illness did arrive. The cowboy might have been a “rugged individualist” but even on the open range of 19th century Wyoming, he was hardly a fool when it came to his health.
1 “The Origin and Development of Group Hospitalization in the United States, 1890-1940,” University of Missouri Studies 20 (1945), 14-15.
2 Examples include Dr. John Finfrock, originally the post surgeon at Fort Halleck and a pioneer Laramie doctor and Dr. Thomas Maghee, post surgeon at Camp Brown (Fort Stambaugh) and, later, a Rawlins physician who pioneered plastic surgery. For Finfrock’s career, see Dr. Anthony Palmieri and Chris Humberson, “Medical Incidents in the Life of Dr. John H. Finfrock,” Annals of Wyoming 53 (Fall 1981), 64-69.
3 King’s business, offering “the largest stock west of Omaha,” is advertised in The Rowdy West, June 2, 1886, 2, next to the article on “Fetterman’s Hospital.” For the family relationship to President Ford, see Phil Roberts, Buffalo Bones: Stories From Wyoming’s Past. (Cheyenne: Wyoming State AMH Department, 1980). King is mentioned only obliquely in Ford’s autobiography, A Time to Heal. (New York: Harper and Row, 1979), 47.
4 David P. Robrock, “A History of Fort Fetterman, Wyoming, 1867-1882,” Annals of Wyoming 48 (Spring, 1976), 72.
5“Fetterman’s Hospital,” The Rowdy West (Fetterman, Wyoming), June 2, 1886, p. 1, c. 1
6 At least four signers of the Wyoming Constitution served on the association board: DeForest Richards, Frederick H. Harvey, William C. Irvine and H. E. Teschemacher. For biographies of the four men, see Virginia Cole Trenholm, ed. Wyoming Blue Book, I (Cheyenne: State Archives and Historical Department, 1974), 545, 546, 553, 555. For Richards’ election as association president and board memberships of the other three men, see Fetterman Hospital Association Minute Book, p. 69, held in the collections of the Wyoming Pioneer Museum, Douglas, Wyoming, and henceforth noted as “Minute Book.”
7 The Rowdy West, June 2, 1886, p. 2, c. 4-5.
8 Tillotson’s military record is summarized in Francis B. Heitman. Historical Register and Dictionary of the United States Army. Vol. 1. (Washington: Government Printing Office, 1903), 952. The Rowdy West, June 2, 1886, p. 2, c. 1, inaccurately described Tillotson as a “West Point graduate” which he was not. For a brief history of the Fiddleback Ranch, see John R. Pexton, “Fiddleback Ranch,” in Pages from Converse County’s Past. (Casper: Wyoming Historical Press, 1986), 664-665.
9 The salary figure is listed in the association minutes for April 28, 1885. Minute Book, 1.
10 The moving expenses are listed in the association minutes for Aug. 2, 1885, Minute Book, 9.
11 Oddly, Barber never mentioned his connection to the association in later biographical sketches. His obituary in the New York Times incorrectly suggests that he came to Wyoming with the army: “He was appointed military surgeon of Fort Fetterman, shortly after going to Wyoming.” New York Times, May 20, 1915, p. 11, c. 5.
12 Minute Book, 11.
13 “Newton Doggett, cook,” Record of Checks, Fetterman Hospital Association, 4. The Record is held in the collections of the Wyoming Pioneer Museum, Douglas, Wyoming, and, henceforth, will be referred to as Record of Checks. W. H. Tucker “and wife” were hired and paid $60 for the month of March 1889, but the purpose for hiring them is not disclosed. Minute Book, 71. Only Barber had the authority to order supplies, including “cots and necessary bedding” and “40 cords of green wood.” Minute Book, 25, 33.
14 The estimate is based on inspections of various ranch company records held in the collections of the American Heritage Center, University of Wyoming.
15 Fetterman Hospital Association Constitution, Article IX. A handwritten copy of the constitution is included in the Minute Book, 1-2. It is printed in full in The Rowdy West, June 2, 1886, 2. For the charge for venereal disease treatment, see “Resolution,” June 4, 1885, Minute Book, 4.
16 Constitution, Article X.
17 The Rowdy West, June 2, 1886, p. 2, c. 3.
18 The names are taken from Minute Book as well as from a list printed in The Rowdy West, June 2, 1886, p. 2, c. 3. The Douglas-Willan Sartoris Company represents a typical cattle operation of the time which was controlled by British investors. For ranch finance during the period, see Gene M. Gressley, Bankers and Cattlemen. (New York: Knopf, 1966; rptd. Lincoln: University of Nebraska Press, 1971).
19 Minute Book, 18.
20 Lists of surgical and medical cases treated by Barber and the numbers of each type are included in “Fetterman’s Hospital,” The Rowdy West, June 2, 1886, p. 2, c. 3, as well as in the Minute Book. Oddly, no cases of snake-bite are listed although Barber gained a national reputation for his treatment of such injuries. New York Times, May 20, 1915, p. 11, c. 5.
21 The Rowdy West, June 2, 1886, 2.
22 For the decision on winter closure, see meeting of Oct. 5, 1885, Minutes, 14.
23 Minute Book, 11.
24 Miss Lizzie Ragsdale was paid $20, apparently for the month for her services. Record of Checks, April 30, 1887, 14.
25 Record of Checks, June 20, 1887, 35. Two “patients without means”, from the nearby towns of Douglas and Glenrock, are reported in the record, but apparently the county was not charged for their care. Minute Book, 63.
26 Fetterman was included in Converse County when the legislature carved the new county from Albany and Laramie counties on March 8, 1888.
27 “Report to the General Meeting,” March 28, 1887, Minute Book, 45.
28 For the impact of the weather on the cattle companies, see Helena Huntington Smith, The War on Powder River: The History of an Insurrection. (Lincoln: University of Nebraska Press, 1966), 35-48; and T. A. Larson, History of Wyoming. (Lincoln: University of Nebraska Press, 2nd rev. ed., 1978), chapter 7.
29 Record of Checks, June 20, 1887, 35.
30 Minute Book, 65.
31 The Fetterman Coal Company and the Glenrock Coal Company, both with few employees, subscribed in that month. Minute Book, 66. In both cases, the association insisted that it be “allowed to inspect the payroll at any time.”
32 See Robrock, 72-73; A. R. Merritt, “50th Anniversary Edition,” Douglas Enterprise, June 23, 1936.
33 Minute Book, 49.
34 Minute Book, 70.
35 Minute Book, 31. In December 1886, assets of $1,884 were listed along with liabilities of $1,565.42.
36 Minute Book, 70.
37 Wolcott was one of the leaders of the cattle barons in the “Johnson County War” of 1892. See Smith for details of Wolcott’s involvement, particularly pp. 196-197, on his leadership.
38 For Barber’s role in the Johnson County War, see Smith, particularly pp. 221-225.
39 “He was appointed military surgeon of Fort Fetterman, shortly after going to Wyoming.” New York Times, May 20, 1915, p. 11, c. 5.
40 Pages from Converse County’s History, 664.
41 See correspondence from Mrs. Tillotson, numerous dates, filed in the Wyoming Stockgrowers Association collection #14, American Heritage Center, University of Wyoming. Thanks to Carol Bowers for bringing the letters to my attention.