Firland opened on May 2, 1911, in what is now the city of Shoreline, under the original name Henry Sanatorium. Horace Henry, a railroad magnate and one of Seattle's wealthiest citizens, donated 34 acres of land and $25,000 for its construction. Seattle residents approved a $10,000 bond to supplement the gift. The first patients slept in open-air cottages, their windows flung wide to the Pacific Northwest weather on the theory that fresh air was essential to healing. By 1913, three more buildings had been added: the Walter H. Henry Memorial Building for administration, the Detweiler Building for tubercular patients, and Jenner Hall for those with other infectious diseases. In 1920, the Koch and Nightingale buildings arrived for ambulatory patients. Josef House followed in 1925, specifically for children with tuberculosis or family members of the afflicted.

Firland's treatment philosophy centered on absolute rest. Upon admission, every patient entered the bedrest hospital. Reading was forbidden. Writing was forbidden. Speaking was forbidden. Coughing was permitted only to produce sputum samples for testing. Windows stayed open year-round, even through Seattle's gray, wet winters, because fresh air was considered medicine. Nourishment was the other pillar: hearty meals, as much as patients could eat, to give their bodies the resources to fight the infection. Character and willpower were considered therapeutic tools, not just moral qualities. The sanatorium functioned on the belief that tuberculosis could be starved out by a body that was simultaneously overfed and utterly still.

World War II drained Firland's nursing staff to a third of its previous size. The occupational therapy program pivoted to the war effort: patients built scale-model aircraft as teaching tools for identifying enemy planes, while others knitted clothing for soldiers. But the real transformation came in 1947, when three antibiotic drugs -- streptomycin, para-amino salicylic acid, and isoniazid -- arrived. Tuberculosis proved quick to develop resistance, so rest and nutrition remained on the treatment plan, but by 1954, the average stay had been cut in half and mortality rates had plummeted from 31 percent to 6 percent. National officials called Firland "one of the most outstanding sanatoria in the country." Patients, emboldened by rising survival rates and postwar social change, began pushing back against ward rules. The extreme separation of sexes was relaxed. Social workers and psychiatrists were hired.

As cure became possible, doctors pursued total eradication -- treating every case of tuberculosis whether patients cooperated or not. In the 1950s, alcoholic patients posed a particular challenge: they were unlikely to complete treatment voluntarily and could spread the disease to others. Firland formed an Alcoholics Anonymous chapter in 1950, but also created Ward Six, a locked unit with screened windows, heavy doors, and concrete slabs for beds. The rooms were called cells. Alcoholic patients were held for a year, even if their sputum tests came back negative. By the mid-1950s, ten percent of Firland's patients were involuntarily detained. Patients classified as "difficult" were also sent to Ward Six as punishment for breaking rules. In 1957, the Washington chapter of the American Civil Liberties Union launched an investigation. By 1965, monthly hearings before District Court Judge Robert M. Elston were established to review the cases of patients confined to the ward. When Washington State assumed financial responsibility for Firland in 1971, a third of its patients were being forcibly quarantined. The sanatorium closed on October 30, 1973, its patients consolidated with those at Mountain View Hospital in Tacoma. Tuberculosis had become treatable on an outpatient basis. The era of rest, silence, and locked wards was over.