The Founding of Walter Reed General Hospital and the Beginning of Modern Institutional Army Medical Care in the United States

Abstract

Henry Palmer, a Republican Congressman from Pennsylvania, was aghast as he addressed the United States House of Representatives in January 1904. His colleagues were advocating the allocation of what he thought an exorbitant sum of money for the construction of an army hospital in Washington, DC. “A work on this magnificent scale,” said Palmer, “the selection of a site and the preparation of plans and the expenditure of $400,000 for the purpose of establishing a new hospital   …   ought not to be undertaken without some amount of investigation   …   that will show the necessity for such work…   .”¹

In response, James Hay, a Democratic Representative of Virginia, submitted to the record a report from the Army Surgeon General. It maintained that a permanent military hospital near the nation's capital was necessary for various reasons. Among other things, it would serve as a base for the “treatment of special cases”; for the training of medical practitioners; and, generally, “to provide adequate accommodations on a good site.”²

In a way, Hay's was the harder case to prove. By 1904, military hospital admission rates had been steadily declining for more than five years, since the end of the Spanish-American War in 1898.³ But in spite of the seeming lack of pressing demographic need—about a year after the 1904 House debate, and almost 50 years after an Army Surgeon General first advocated for a large medical complex in Washington, DC—Congress approved funding for the establishment of what would become Walter Reed Army General Hospital.⁴

The story of the founding of one of the United States' premier military hospitals tells us much about the interplay between American medicine, science, militarism, and politics at the turn of the twentieth century. Scholars have noted that various aspects of military administration, structure, and goals underwent drastic changes in the Progressive Era, and that during that period the notion of a peacetime standing army became more acceptable to many Americans than it had been previously.⁵ But the long-term impact of concurrent transformations in ideals surrounding army hospital care is generally left out of such narratives. Meanwhile, some of the most careful studies of military medicine tend to focus on the nature and lasting effects of health services administered during wars rather than systemic changes that took place in times of peace.⁶ The formative histories of hospitals in the United States note that tremendous transformations took place in institutional care between the 1880s and 1920s, but focus on civilian, rather than military, facilities.⁷ While some studies acknowledge that army general hospitals were created around the turn of the century—and that Walter Reed constituted one of the most important American medical institutions of its time—they are not primarily aimed at providing context regarding the larger historical trends that helped bring them about.⁸

Justifications put forth for the necessity of a large-scale permanent hospital in the Eastern United States were shaped not only by a national commitment to “care for him who shall have borne the battle,” but also by ideals of thrift, pragmatism, and professional and imperial ambition.⁹ Such an institution, advocates argued, could serve as a model of scientific advancement following a period of warfare in Cuba and the Philippines that tarnished the reputation of the medical arm of the U.S. Army. The fight for funding for Walter Reed took place during a societal shift toward an urban, industrial economy and a scientific understanding of disease, which brought about an increasing reliance on hospitals as ideal environments for medical treatment. As health practitioners created a new sense of professionalism for themselves and their rising colleagues, Walter Reed Hospital was presented by its proponents as a prospective center of medical education and training. Advocates for the institution also argued that it would allow the United States to establish parity with European nations and more effectively pursue international public health diplomacy.

The tale of the establishment of Walter Reed highlights the notion that the turn of the twentieth century marked a period of accelerated change in military health care in the United States. Wounded and ill soldiers had long received first aid on the battlefield or in rudimentary field and camp hospitals that were aimed primarily at returning them intact to their units. But beginning in the late 1800s, as the military mirrored and built upon trends evident in civilian society, service members were treated in large-scale permanent army general hospital complexes with multifaceted missions that extended well beyond the provision of emergency treatment. These institutions helped lay the foundations of the modern army health care system.

During its one hundred years of existence, Walter Reed grew from an eighty-bed hospital meant to serve as a cradle for military medical training and the treatment of so-called “special cases” to a 5500-bed health care center incorporating various services for soldiers and veterans. Throughout the greater part of the twentieth century, it was the destination hospital for some of the army's most complex medical cases, and a pioneer in the integration of hospital care with medical education and research; in short, it was a flagship institution. In 2011, following reports of inept conditions at Walter Reed, and as part of a larger effort to trim military expenditures, the hospital's original site was closed and its services merged with the National Naval Medical Center in Bethesda, Maryland.¹⁰ By virtue of the number of patients who underwent treatment in Walter Reed's wards and its prominence as a model of scientific and medical advancement among American hospitals—both military and civilian—it can be viewed as a symbol, product, and shaper of perceptions of health care in the United States.¹¹ By placing the story of its founding within larger military, public health, and political frameworks, we gain a deeper understanding of a crucial American institution, and a sense of the principles, values, and historical conditions that shape the health services a society chooses to provide for its citizens.

THE INSTITUTIONALIZATION OF THE ARMY, THE SPANISH-AMERICAN WAR, AND A SEARCH FOR CONTROL

Between 1862, when Army Surgeon General William A. Hammond recommended that a hospital complex be built in Washington, DC, and 1905, when Congress approved funding for it, the military gradually received a larger share of the federal budget and modernized its infrastructure. During the Spanish-American War, the death toll from diseases such as yellow fever and typhoid far exceeded the number of casualties from battle, and the public was horrified to read news coverage of thousands of American soldiers lost to illness. By the early twentieth century, military officials saw a new general hospital as a means of maintaining and centralizing control over its personnel and the ravages of sickness.

In the midst of the Civil War, Army Surgeon General William A. Hammond reported that “a hospital of a more permanent character than any now in [Washington, D.C.] is, I think, very necessary …   .” Hammond further recommended that a D.C. general hospital campus also contain facilities for an Army Medical School and an Army Medical Museum.¹² The suggestion indicated that, during the war between the North and South, “medical ideas” underwent a transition “from the ancient to the modern.”¹³

Although the Civil War profoundly affected the practice of military medicine—it led, for example, to advances in surgical training methods and increased knowledge of the effects of trauma—the enthusiastic reform impulse voiced by Hammond in 1862 was not immediately wholly realized. The government soon established the museum envisioned by the Surgeon General, but the larger complex he imagined, containing a medical school and hospital, proved an elusive goal.¹⁴ In the decade after the Civil War, Congress was wary of centralized military power and institutionalization. Even as European countries enhanced their military infrastructures in the 1870s, the United States embarked on a process of demilitarization following the bloodiest conflict in the young nation's history. A large-scale military hospital did not fit an “American army establishment that had been molded to fit a radically decentralized governmental order …   .”¹⁵

The situation began to change in the 1880s and early 1890s, when the army's leadership urged an expansion of American military power, both as a means of quelling widespread domestic labor conflicts, and as protection for the nation's burgeoning worldwide trade and economic interests.¹⁶ Between 1890 and 1920, as Samuel P. Huntington argued, the U.S. government and military officials had a “positive reaction to the end of isolation and a favorable response to the opportunity to play power politics.”¹⁷ During what Huntington referred to as the “Neo-Hamiltonian” period, legislators and army elites re-imagined American military ideals and structure. Of course, not all policy-makers were in the same ideological camp—some, in fact, were staunchly opposed to the expansion of a standing army, which they saw as a threat to republican values.¹⁸

In spite of objections from the latter group, the share of the federal budget spent on the military grew from 20 to 40 percent between 1880 and 1905. Although the greatest share of those funds went to the expanding navy (whose budget increased nearly eightfold in these years), the army fared relatively well: its budget tripled.¹⁹ Between 1902 and 1916, the reforms of Elihu Root, who was Secretary of War from 1899 through 1904, “laid the foundations for a modern army” and led to further growth.²⁰ In the years surrounding the Spanish-American War, as the army attempted to create a streamlined organizational structure and a sense of professionalism, it spent just 2 percent of its funding on the purchase of arms.²¹ Root's reforms ensured that the “other” 98 percent would be spent on institutionalizing the military beyond cannons and rifles. They not only provided more centralized control at the highest level of army administration and laid the groundwork for the modern-day National Guard, but also led to the 1903 creation of the Army War College and the enhancement of several military branches.²²

As the army gained more funding and structure, a primary proponent of the establishment of Walter Reed Hospital, William C. Borden, was making his way up the ranks as a surgeon. In all likelihood, the Surgeon General's report that Representative Hay cited on the House floor was devised, at least in part, by Borden. In a 1907 article in Military Surgeon, the army doctor laid out virtually identical points of reasoning for the development of a Washington, DC-based general hospital.²³ He also testified in hearings before the Senate Committee on Military Affairs in 1905 about its necessity, approximately one month before Congress approved funding.²⁴ Borden's advocacy was, in short, a primary driving force behind the eventual founding of Walter Reed General Hospital.

The son of an upstate New York farmer, Borden took a path typical of doctors of his day; he gained clinical experience in the office of an established physician, then went on to obtain his medical degree at Columbian College in Washington, DC Borden's military career between 1883, when he received his medical degree, and 1893 brings to light the fragmented nature of the medical care administered to an American army engaged in territorial wars with Indian tribes. Over the course of a decade, Borden undertook twenty-six railroad journeys, complying with orders to be stationed at post hospitals throughout the country, from Cheyenne, Wyoming, and Salt Lake City, Utah to San Antonio, Texas, and Newport, Rhode Island.²⁵ The conditions at some of the facilities where Borden was stationed were doubtless subpar. Following the Civil War, Army Medical Department officials had deemed large field and general hospitals havens of filth and disease, and advocated for smaller post hospitals of twelve, twenty-four, or forty-eight beds. The latter were severely underfunded, often in ill repair, and lacking in such sanitary measures as clean drinking water.²⁶

In September 1898, Borden was implicated in a scandal that likely heightened his—and the army's—desire for the order and centralization of control seemingly characteristic of a general hospital. Borden spent most of the Spanish-American War stationed in Florida. In late summer, 1898, after major hostilities in Cuba had ceased, he was placed in command of the ill-fated Shinnecock, a steamship that transported sick soldiers from Camp Wikoff at Montauk Point on Long Island, to hospitals in New York City. From its inception, Camp Wikoff was a health—and public relations—debacle. The land for the camp, 125 miles east of the city, was purchased by the government in June 1898 and intended to serve as a quarantine station where soldiers from Cuba would be detained until deemed free of yellow fever. However, it proved anything but a model of medical efficiency.

Camp Wikoff's fate was largely decided by the mass publication of a letter, dated August 3, 1898, from Theodore Roosevelt, Assistant Secretary of the Navy, to Major General William Shafter, commander of the Cuba-based Fifth Army Corps. Roosevelt maintained: “If we are kept [in Santiago], it will in all human possibility mean an appalling disaster, for the surgeons here estimate that over half the army, if kept here during the sickly season, will die.” He suggested for his soldiers “six weeks on the Maine coast   …   or elsewhere where the yellow fever germ cannot possibly propagate.”²⁷ Roosevelt's letter was quoted in its entirety by the Associated Press, and published in numerous national and local newspapers alongside a “round robin” letter of agreement signed by seven other officers.²⁸ On the same day the letters went public, President William McKinley approved the immediate departure of service members from Santiago to an as yet underdeveloped Camp Wikoff, which would serve, at least in part, it was now clear, as a large-scale convalescent base for ailing soldiers. This belated action, according to one scholar, “convinced a number of Americans that a callous government had left brave soldiers to sicken and die and had acted to save them only after the officers on the scene by-passed regular channels and carried their case through the press to the people.”²⁹

The outcry would become more pronounced as service members began arriving in Montauk from the southern United States and Cuba, and journalists wrote reports of dire camp conditions. “The impossibility of providing adequate hospital accommodations in the brief time allowed – even had there not been added obstacles of striking laborers, congested transportation and heavy storms – is admitted,” reported The New York Sun.³⁰ Other accounts were even more damning: feverish soldiers slept in the rain due to an insufficient number of tents; clean drinking water and food were in short supply; quarantine rules were regularly disregarded as soldiers wandered freely through the camp. Many escaped and made their way to nearby railroad stations or New York City to beg for food and money, drawing public ire to the president and army leaders.³¹

In early September, the sensationalist New York Journal reported the arrival in New York City of a “horror ship from Montauk” under the command of General William C. Borden. The ship contained approximately three hundred sick soldiers being transported to New York hospitals from Camp Wikoff. “The story of their shipment to this city is a fresh chapter in the history of gross neglect and criminal carelessness that have characterized the treatment of the sick and wounded heroes of the Santiago campaign,” the Journal reported. The men were emaciated and weak; “many were near the point of death.” They were so hastily rushed on board, according to the newspaper, that their names and conditions were unknown to the ship's overseers. The Journal also suggested that the soldiers had been rushed out of Camp Wikoff in order to have the premises “cleaned up” before a visit from President McKinley, scheduled for the following day. William Borden, however, dismissed such claims. Those aboard the Shinnecock were evacuated from Montauk, he said, because “it was thought best to remove the men who could be moved to permanent hospitals in this city, so as to make more room for others who are arriving at Camp Wikoff.” Furthermore, according to Borden, the large majority of the transported men were not “nearly dead,” though he conceded, “about 20 men   …   although well enough to be moved, may die after being put in a hospital for a while.” The many others, he maintained, would likely recover after three to four weeks.³²

Perhaps the soldiers were better off in New York City than in Montauk: during its three months of operation, 250 veterans of the Spanish-American War died at Camp Wikoff.³³ The Long Island camp, although demonstrative of an extreme case of mismanagement, was not an anomaly. During the Spanish-American War, 369 soldiers died from combat, while 2061 died from disease. Yellow fever, malaria, typhoid, and dysentery were the most pervasive mortal dangers of war in Cuba and the Philippines.³⁴

Large, permanent army general hospitals like Walter Reed were, in part, products of an increasing desire to address the challenges of diseases while avoiding mishaps like the one at Camp Wikoff. Although by 1900 some domestic general hospitals founded in the Spanish-American War era had been closed, two continued to serve patients: the General Hospital at San Francisco (renamed Letterman General Hospital in 1911) and the Army General Hospital at Washington Barracks in Washington, DC, the predecessor to Walter Reed. Additionally, two specialty-care general hospitals admitted patients during and after the war. One, which focused largely on the treatment of tuberculosis, was opened in 1899 in Fort Bayard, New Mexico. The other—the oldest of all the permanent general hospitals—was founded in 1887 at Hot Springs, Arkansas, and served patients with conditions such as syphilis, rheumatism, neuralgia, and skin diseases, who might benefit from treatment with hot mineral waters.³⁵

Army doctors perceived a new general hospital near the nation's capital as an opportune locus of control. One of the main differences between an army general hospital and a post hospital was that the former was under the command of the Army Surgeon General while the latter was under the control of the post commander. The general hospital model, which typically allowed more autonomy for medical personnel, was the desirable site of employment from an army doctor's point of view, especially given the shaky status of health in the larger military model. In his account of field medicine in Cuba during the Spanish-American War, Graham A. Cosmas noted, “Surgeons in camp and field had no power to enforce their recommendations for sanitation, and commanders often brushed aside their warnings and suggestions and even belittled the medics as fussy old women who tried to coddle the soldiers.”³⁶

In fact, the desire for centralized control was at the heart of one of the Surgeon General's justifications for a new general hospital based in Washington, DC: the need for a base for the “treatment of special cases.” Special cases were defined according to the interests of both the soldier and the government. “Cases of illness and injury are constantly arising in the military service which require special skill and special appliances for their treatment in order to save the men to the service, to reduce the pension list, and to give men disabled in the service of their country the benefit of the most advanced medical and surgical knowledge,” said the 1902 Surgeon General's report. As was the case in the civilian medical world, the report continued, it was impossible to outfit every hospital with the proper equipment and medical personnel to treat every patient. In civilian life, patients from the country and small towns and cities were regularly sent to medical centers with “specially trained medical men in attendance.”³⁷ A similar model should exist in the military, according to the Surgeon General; complicated medical cases of officers and enlisted men should be overseen within the army infrastructure, not outsourced to large civilian hospitals—as had been done in the case of Camp Wikoff. “The military service,” according to the report, should “hold control of its own cases.”³⁸

One of the central functions of the proposed general hospital would be to review cases of officers seeking discharge due to disability. “[Officers'] real physical condition when claim of permanent disability is made is often a matter of conjecture,” the Army Surgeon General maintained. “It is important that if disability is not permanent that this fact be ascertained and the officer saved to the government.” The Surgeon General's report acknowledged that transport to a Washington, DC general hospital from posts scattered throughout the country for assessment would mean an “increased expenditure for mileage.” But soldiers and officers would never come from further west than the Rocky Mountains; personnel who sought medical attention from that region would be sent to the general hospital at San Francisco. In any case, the Surgeon General noted, the cost of transport was “insignificant when compared with the saving of a trained officer or man to the service who would otherwise either die or have to be supported for the rest of his life on the retired list or as a pensioner.”³⁹ It was a powerful claim to make at a time when payouts to Civil War veterans and their dependents was—much to the chagrin of many Congressional representatives—consuming an ever-greater portion of the federal budget.⁴⁰

The Surgeon General's pragmatic language was consistent with the tenets of the ethics of military medicine, which remained consistent between the 1860s and 1930s, even as standards for institutional care changed. “The fundamental reason for military sanitation is not humanitarian, but increased military efficiency and the application of sanitary principles adapted to the requirements of the military machine to assist in the struggle for victory,” wrote Edgar Erskine Hume, a member of the Army Medical Department from 1917 through 1952. Hume contrasted the duties of civilian medical personnel with those of military doctors noting that “the civil health officer knows no higher law than the preservation of human life and health…   . But in the army the military necessity must come first.” The principle applied less in times of peace than during war, Hume said, but it unconditionally applied nonetheless.⁴¹ Hume's sentiment was similar to that expressed by William A. Hammond, Surgeon General of the U.S. Army during the early 1860s. In his 1863 Treatise on Military Hygiene, Hammond wrote, “a weak, malformed, or sickly soldier is not only useless, but a positive incumbrance [sic].”⁴² He also noted that “to put a soldier into the field costs the government nearly four-hundred dollars; should he die, or become permanently disabled in service, a pension is given.” Therefore, Hammond argued, “looking at the matter   …   merely in a financial point of view   …   every means should be taken to preserve the lives and health of those who come forward to fight the battles of their country.”⁴³

A number of conditions surrounding the army and its medical care system created the possibility for the founding of Walter Reed General Hospital. The military gained structure and funding as the United States pursued imperial interests in Cuba and the Philippines. Negative experiences with a fragmented system of army medical services during the Spanish-American War, such as the mismanagement and inefficiency of the operation of Camp Wikoff, helped pave the way for Borden and others to advocate for centralization of control through the establishment of a large Washington, DC hospital. By the early 1900s, every annual Surgeon General's report adamantly stated the need for a new army general hospital near the capital. While serving as a base for the treatment of “special cases,” and as a means of guarding against the further growth of an already expansive pension system, its advocates maintained, the institution would benefit both soldier and state. More generally, its mission would be predicated on the ethics of military medicine, as well as an increasingly scientific understanding of disease, and medical professionalization.

MEDICAL EDUCATION, PROFESSIONALIZATION, AND THE GLOBAL HEALTH VIEW

Military medicine was distinct from civilian care, although it was influenced by larger trends in health services and medical science. In the years surrounding the establishment of Walter Reed, Americans became accustomed to the idea of accessing health care in hospitals instead of at home. This cultural shift was due to scientific advances and the mobilization of an increasingly powerful community of medical practitioners—both civilian and military—who advocated, as William Borden did, for the centralization and institutionalization of professional control. Looking beyond domestic health care structures, Walter Reed Hospital, modeled in part on similar institutions in France and England, represented a means by which the United States would demonstrate its competitiveness with other world powers. By affiliating with the Army Medical School, advocates of the general hospital argued, Walter Reed would serve not simply as a care-giving institution but as an internationally renowned nexus of scientific knowledge and an internationally renowned center of public health diplomacy.

During the late nineteenth century, new understandings of bacteriology, changing economic and demographic conditions, the after-effects of a devastating war, and emerging ideas regarding how hospitals should be designed fostered the expansion of institutional care. The advent of the germ theory in the final decades of the 1800s altered the Victorian-era notion that illness was a form of retribution for social deviance. In addition to bringing about changes in the structure of medical care, it fostered ongoing improvements in public health measures and eventually helped chronic diseases overtake acute epidemic illnesses as leading health threats.⁴⁴ The Civil War, too, had a tremendous effect on both civilian and military health services in a variety of ways, including the perception of hospitals. Before the war, civilian hospitals were viewed as places reserved primarily for the needy, but “after   …   almost everyone in America knew something about [them] through the personal experience of someone they knew.”⁴⁵ Not only was the idea of seeking care in a hospital more familiar in the late nineteenth century, but it was also less maligned. Many post-Civil War institutions (including Borden's vision of a permanent and modern facility in Washington, DC) were products of evolving notions of hospital design, which dictated that providing a certain type of physical environment—enough space between beds and sufficient fresh air and light, for example—could serve as the first line of defense against disease.⁴⁶ Seeking care in such institutions (as opposed to in the home) fit a societal order in which an increasing number of people—many of them immigrants with limited family circles in the United Sates—lived in cities.⁴⁷ By the turn of the twentieth century, both rich and poor accessed care in hospitals, which were by then thought to provide amenities unattainable elsewhere: a sanitary environment and medical technologies, such as the X ray. In 1873, 178 hospitals existed in the United States. By 1909, the year Walter Reed General Hospital opened its doors, there were more than 4300.⁴⁸

These turn-of-the-century institutions served as important sites of instruction within an increasingly structured model of medical professionalization. Beginning in 1847, with the formation of the American Medical Association, physicians banded together to promote standard models of certification.⁴⁹ Abram Flexner's 1910 report on medical education, which argued for the necessity of universal degree requirements for physicians, articulated some of the primary concerns of a newly powerful interest group.⁵⁰ Scholars have pointed out three major outcomes of Flexner's report: it led to the shutting down of “mediocre” medical schools, including many with predominantly African-American and female student populations, thus making formal instruction accessible only to a select few; it successfully argued that analytic reasoning should serve as the basis for medical education, and finally, it established that clinical practice would constitute a critical phase of medical training. The latter had the larger affect of accelerating a trend that was already underway—the affiliation of medical schools with hospitals.⁵¹

The health care infrastructure of the U.S. Army was embedded in this larger medical culture. Around the turn of the twentieth century, reports of the Army Surgeon General focused not only on acute illnesses that threatened soldiers during war, but also on the chronic ailments—heart disease and “insanity,” for example—that plagued them during relatively peaceful times.⁵² At the same time, military medicine was increasingly professionalized, and centered on ever-stricter standards for education. Army doctors fought vigorously for respect and professional legitimacy—both within military infrastructure and the civilian medical world. They struggled to obtain commissioned status, as opposed to serving as “contract surgeons,” and strongly supported the establishment of a large general hospital in Washington, DC. The facility would be an educational asset, they argued. It could be used in the instruction of the Hospital Corps, founded in 1886 to train soldiers to serve as wardmasters, nurses, cooks, and orderlies, as well as in the curriculum for students of the Army Medical School, founded in 1893 to train Medical Officers.⁵³

A permanent army hospital would constitute “a complete medico-military establishment for medical and educational purposes which would be of inestimable value to the medical department and through it, to the army as a whole,” noted one Surgeon General's report.⁵⁴ “A general hospital with its varied medical and surgical work is especially adapted to practical training,” noted another.⁵⁵ Army Quartermaster C. F. Humphrey reiterated such points, arguing that “a large general hospital is a necessary part of the equipment of the Army Medical School, to enable student officers to become familiar with the method of administration, of hospital inspection, the use of the Roentgen ray (X ray), and other diagnostic apparatus, and to instruct them in medical surgical procedures.”⁵⁶

William C. Borden could not have agreed more. In 1898, soon after his Spanish-American War service aboard the Shinnecock, he was placed in command of the Army General Hospital at Washington Barracks in Washington, DC. Although that facility had been declared a general hospital on September 8, 1898, and was therefore under the jurisdiction of the Surgeon General and not the post commander, Borden still believed he was “subject to occasional interference from the artillery chief who felt that the hospital was a part of his official domain,” according to an account by Borden's son, Daniel. The “situation,” the younger Borden noted, “led to friction…   .” It was around this time that William Borden began advocating for the establishment of a new army general hospital with “a reservation of its own, free from outside interference…   .”⁵⁷ He bemoaned the inadequacy of Washington Barracks, claiming that the facility was “not [originally] intended for, and therefore could not entirely fill, the requirements of a general hospital.”⁵⁸

Such “requirements” expanded under Borden's watch. When he was made Professor of Military Surgery at the Army Medical School in 1901, the hospital at Washington Barracks was placed “in direct connection with the school   …   [and] utilized for the clinical instruction of the students.” Similarly, since the Hospital Corps Company of Instruction at Washington Barracks was under Borden's sole jurisdiction (not under the control of the post commander), it could “be used for work connected with the Army Medical School without any clash of authority, and with the fullest efficiency …   .” Borden argued that, given the array of activities taking place under his command at Washington Barracks, the facility was not merely a hospital, but “a military post, having the functions of an educational institution for enlisted men and for students at the Army Medical School.” Washington Barracks had, however, “extemporized buildings, many of which were poorly constructed for temporary use only,” and which, he said, “were inadequate for such purposes.⁵⁹ Therefore, as the 1904 Surgeon General's report put it, “the necessity of a new general hospital site and building is more urgent now than ever before.”⁶⁰

The image of the Army Medical School and overall funding, recruitment, and retention issues were a source of great concern for Borden, whose December 1900 testimony before the Senate Committee on Military Affairs presented a cogent case for increasing the salaries of army doctors: “If the emoluments are increased, the number of men who will present themselves for those examinations will be increased and better men will come up, and consequently there will be a larger class of men to select from.”⁶¹ The 1907 Surgeon General's report took on the matter with an alarmist bent, and reflected the global perspective of Borden and his associates: unless compensation could be raised, the report said, “it will be impossible to fill vacancies in the Medical Corps without lowering the present standard of examination, a resort which, if adopted, would leave us distinctly outclassed by the Medical Corps of the armies of all other civilized countries.”⁶²

This sense of internationalism was a major impetus for the establishment of Walter Reed General Hospital. As it sought structure, the U.S. Army cast its eye abroad to the military models of powerful European countries and found medical complexes where hospital services were combined with medical schools. The 1902 Surgeon General's report lamented: “In England, the Royal Victoria Hospital, which cares for disabled men returned from all the outlying colonies, is practically an attachment to the Army Medical School at Netley, but our Army Medical School has at present no such great advantage as an associated hospital for army diseases from distant and tropical service.”⁶³ During the first decade of the twentieth century, the pages of The Military Surgeon were replete with articles regarding the medical infrastructures of foreign armies. In 1907, for example, readers learned of the “French Society of Military Medicine,” the “Military Medical Service of the Teutonic Order,” “The Medical Department in the Southwest African Uprising of 1904–1905,” “Medical Service in Manchuria,” and “Instruction in the Sanitation in the British Army.”⁶⁴ International references were also found in Surgeon General William Hammond's 1863 Treatise on Hygiene, which pointed out strengths and shortfalls of existing hospitals, and diagrammed the floor plans of institutions not only in South Carolina and Pennsylvania, but in Paris, Manchester, and London as well.⁶⁵ The report submitted by James Hay to the Congressional Record in 1904 describing why a large army hospital was necessary in Washington, DC further conveyed the global perspective of the Army Medical Department: “[The general hospital] should afford a home for the Army Medical School. The combination of these two institutions, as is the case with the English army and school established after the Crimean War at Netley, and the celebrated French hospital and school at Val-de-Grace at Paris, offers advantages which are great and evident …   .”⁶⁶

One of the great advantages to which the report likely referred was the prospect of advancements in scientific and medical research. In the nineteenth century, domestic bureaucratic “expert” agencies, such as the National Institutes of Health, were either nonexistent or relatively anemic.⁶⁷ The federal government thus turned to the army as the sole bureaucracy that was expansive, dependable, and professionalized enough to assist in carrying out land and resource conservation measures as the nation moved toward continental empire.⁶⁸ Similarly, at the turn of the twentieth century, it endorsed the efforts of the Army Medical Department not only to provide health care to soldiers, but also to define and bolster ideological priorities of a unique sort of public health imperialism.⁶⁹ While generally prioritizing the health of U.S. service members as opposed to local citizens, army doctors undertook fruitful campaigns abroad aimed at the eradication of some of the primary health threats of the time: yellow fever, hookworm, and typhoid, among others.⁷⁰

As medical professionals gained a deeper understanding of the causes of epidemic diseases, trade regulations, and medical facilities such as Walter Reed Army General Hospital were established in an effort to cleanse both borders and individuals of illness. In 1902, the Pan American Health Organization was founded, which brought together scientists, health experts, and government officials from the United States and various Latin American republics to devise standardized measures to contain diseases such as the plague, cholera, and yellow fever, and facilitate a more efficient system of regional trade. The United States' pursuit of international agreements and warfare in Cuba and the Philippines had clear scientific and medical consequences. In 1907, Daniel Borden argued: “With the extension of our possessions to the tropics, the subject of tropical medicine, which is not extensively taught in the civil schools, must be given due attention in the Army Medical School.”⁷¹ As the United States gained power abroad, Walter Reed General Hospital would become a knowledge-gathering center. American military doctors could pursue health research in countries throughout Latin America then bring newfound knowledge to a Washington, DC medical complex.

Walter Reed was established amidst an emerging scientific understanding of disease, a societal push toward medical institutionalization and professionalization, and a desire for a central base for public health diplomacy. It demonstrated the government's tendency to use the army as a professional bureaucracy that could bolster the physical and ideological ambitions of empire. But justifications for a hospital based on a necessity for centralization of control and a need to measure up to other world powers would not have gotten very far without some political wrangling.

THE POLITICS BEHIND A MILITARY HOSPITAL

Funding for Walter Reed was vigorously fought for by William C. Borden, and won thanks to a widespread political determination to accomplish maximum military efficiency—a cause that even anti-imperialist policy-makers could support. The idea of a large-scale army general hospital was perceived by legislators with a wide range of backgrounds as separate and apart from a general expansion of military power. Representatives and senators across the political spectrum, from Northern Republicans to Southern Democrats favored its establishment. At least some of these men had reputations for adherence to ideals of limited military power and states' rights. Although the notion of a state-of-the-art hospital for soldiers appealed to politicians of a range of ideologies, some did suggest that it represented an overstepping of the bounds of federal power. But in the end, justifications put forth by Borden and the Army Surgeon General for the usefulness of Walter Reed Hospital were adopted as policy; they jibed with the developing image of the United States as a world power embracing modernity.

The tale of how Borden and fellow hospital advocates accomplished the politically challenging feat of obtaining federal funding for a new army general hospital is, in various accounts, masked in some mystery. Multiple authors report that, during one of many trips to Congress, Borden met a man described as “the doorkeeper” of the Senate, a Civil War veteran whose arm had been amputated following a battle injury.⁷² When the veteran complained to Borden of pain in his arm, the doctor admitted him to the hospital at Washington Barracks. As Borden's son, Daniel recalled in a tale that takes on a somewhat mythological tenor:

On the day of his discharge from the hospital, the old man came to thank Major Borden for his kindness. Looking around him and seeing the coast clear, he volunteered the following information. “Major, you have helped me and I believe in you and your dream [of a general hospital].” On the day of his discharge from the hospital, the old man came to thank Major Borden for his kindness. Looking around him and seeing the coast clear, he volunteered the following information. “Major, you have helped me and I believe in you and your dream [of a general hospital] … In my position as doorkeeper I have noticed that any bill dealing with real estate introduced by a certain senator (giving his name) gets recognition. If you can reach this senator I feel reasonably sure that you may succeed in getting your bill through Congress.”⁷³ This bit of information from this grateful patient proved to be the combination that opened the doors of Congress to the earnest plea of a determined man.

On January 25, 1904, the Surgeon General's proposal for funding for a Washington-based general hospital came up in the House, prompting a debate that centered, in part, on the question of appropriate limitations of federal power in the health care realm. Democratic Representative Henry Palmer was wholly against honoring the request for $400,000 on a “new building” that would house a medical school intended to educate “student officers in the science of medicine” and be used in order to treat “old army officers who are to be retired on account of disability   …   and say whether they are really entitled to be retired.” “I do not believe,” Palmer said “that the United States government ought to go into the business of running a medical school or a medical college; I do not believe we ought to spend $400,000 for the purpose of establishing a place where the student officers can learn the use of the Roentgen rays [X rays] …   .”⁷⁴

Palmer's skepticism was resisted by his colleagues in the House, Republican John Hull, and Virginia Democrat, James Hay. A general hospital would have long-term financial benefits, Hull pointed out, citing the Surgeon General's report. It would prevent premature disability leave and government pension disbursals. The Washington Barracks facility was too dilapidated to serve such a purpose on any large scale, he said. James Hay bolstered Hull's argument by bringing up the Surgeon General's point that Washington Barracks was “always crowded” to the extent that nurses were forced to sleep outside and there were no private rooms for officers or “special cases.” Furthermore, Hay said, the low grounds of Washington Barracks, where heat was “excessive in summer,” were unsuitable for a hospital.⁷⁵

For his part, Indiana Republican, James A. Hemenway, pointed out the existence of a Civil-War era statute, which stated that the federal government could allot no more than $20,000 for the “continuation of a work in progress.” This is just what Borden and other advocates had been arguing a new general hospital constituted; to put it forth as an entirely new project would have required Congressional “special authority” separate and apart from a larger army general appropriations bill. Representatives Hay and Hull scoffed at this notion, pointing out that the definition of the term “continuation of a work in progress” had been expanded in the case of various recent army projects, including the construction of a military academy at West Point, New York and the Army War College in Carlisle, Pennsylvania. The House Chairman acknowledged so much was true, but eventually agreed with Hemenway: allotting $400,000 for the construction of a general hospital would require special authority.⁷⁶

William Borden remained determined to win funding for his hospital and continued to lobby in the Senate. On February 16, 1904, less than a month after the House debate, he appeared before the Subcommittee of the Committee on Military Affairs, where he encountered Republican Joseph V. Quarles of Wisconsin and Alabama Democrat Edmund W. Pettus. Both were decidedly sympathetic to his cause. Pettus seconded Borden's point that Washington Barracks was in shoddy condition: “That hospital,” he said, “looks like it was located for the purpose of breeding disease.”⁷⁷

Senator Edmund Pettus and Representative James Hay were somewhat unlikely supporters of the general hospital idea. Hay, for example, “consistently opposed the efforts of reform-minded Republicans to ‘modernize’ the United States Army,” since he “considered their proposals expensive, unnecessary and militaristic.”⁷⁸ His support of Walter Reed Hospital was, apparently, an anomoly. Likewise, Pettus was typically “troubled by   …   the apparent conflict between states' rights and the new trend toward the regulation of economic and social matters by the federal government”⁷⁹ These anti-federalist tendencies took on anti-imperialist overtones in 1903, when Pettus denounced what he deemed complicity by the Roosevelt administration in the secession of Panama from Colombia. “Has all this power,” Pettus pondered, “been entrusted to us by our Master that we should abuse it like a bully?”⁸⁰ In spite of his beliefs in states' rights and anti-imperialism, Pettus did not see a large-scale army hospital sponsored by taxpayers as an over-extension of federal power. He and his colleagues likely shared President Theodore Roosevelt's view that such an institution corresponded with the ideal that the U.S. Army “need not be large, but that it should, in every part, be brought to the highest point of efficiency.”⁸¹

Funding for a Washington-based general hospital was included in a 1905 civil appropriations bill under a section entitled “Miscellaneous Objects, War Department.” A sum of $100,000 was allotted for the purchase of the site, and $200,000 more for hospital construction.⁸² Approximately four months later, in October, 1905, the War Department passed a general order dictating that the institution would be known as the Walter Reed United States Army General Hospital, “in honor of the late Major Walter Reed [italics in original], surgeon, United States Army, whose demonstration of the mode of transmission of yellow fever is of the highest public importance.”⁸³

Walter Reed's career was emblematic of many of the supposed triumphs of turn-of-the-century medicine; he earned his two MD degrees within the emerging domestic medical education system and worked at hospitals and the Board of Health in New York City before joining the increasingly professionalized U.S. Army Medical Corps. As an army doctor, he became a noted researcher and professor, and led one of the military's best-known international public health missions.⁸⁴ In commemorating Reed, the hospital's name thus honored the ideals that underlay its founding: the modernization and standardization of medical education and services, an increasing reliance on hospitals as ideal medical care settings, and expanding imperial aspirations.⁸⁵

CONCLUSION

The story of the early years of Walter Reed reflects the fact that the physical repair of United States soldiers was only one among many organizing principles of a nascent modern military health care system that meant different things to different groups. When the hospital's Georgian-style main building was erected in 1908 containing eighty beds, The Washington Post praised it as being “modern in every detail” and “of stately Colonial style.”⁸⁶ From the government's perspective, “modern” and efficient army health care could bolster an image of military and scientific prowess. From the army's perspective, it could maximize the possibility of a seasoned soldier's return to duty. For doctors and other health care personnel, military medical practice could provide an opportunity not only to help patients, but also a forum for professional and scientific advancement. Soldiers, given their varying wartime experiences and array of injuries and illnesses, developed multi-dimensional understandings of the purpose of military medicine, and thus reacted differently to governmental, army, and professional efforts in the health care realm.⁸⁷ Eventually, Americans of color and white women (as both caregivers and soldiers) used the army and its medical institutions to advance their own claims on professional and citizenship rights.

Various forces came together at the turn of the twentieth century to lay the groundwork for the establishment of a large-scale military hospital in Washington, DC—forces that were not in place in the 1860s, when Army Surgeon General William Hammond first recommended that the government build the complex. As an increasingly bureaucratized army experienced an invigorated presence in the American state, and the medical world became ever more focused on institutionalized health care and standardized education, Walter Reed was founded to serve as a symbol of American international hegemony and scientific prowess, and a beacon for learning. A permanent army hospital in Washington, DC, according to advocates for the establishment of the institution, would allow an emerging world power to remain globally competitive while fulfilling the contemporary goal of medical modernization. The hospital's design and mission were based upon emerging ideas regarding disease transmission and pragmatic tenets of the ethics of military medicine that placed considerations regarding army efficiency and the necessity of trimming spending on veterans' pensions at least on par with individual patient care.

Even so, the establishment of Walter Reed marked a defining moment in the allocation of government-sponsored benefits to soldiers. It indicated a commitment on the part of the federal government not only to ensuring that service members would receive medical care intended to ready them for battle, but also that the care would encompass longer-term goals: from World War I through the wars of the early twenty-first century, Walter Reed served as a crucial institutional center in a massive army medical program that offered soldiers varied and extensive health and rehabilitation services. The social climate during the years surrounding the Spanish–American War allowed the Surgeon General and army doctors to effectively argue that such facilities were not only functional units unto themselves, but also rich and important displays of American modernity.

FUNDING

This work was supported by grants and fellowships from Columbia University, the Doris G. Quinn Foundation, the Institute for Political History, and the United States Army Military History Institute.

Acknowledgments

I would like to thank Alan Brinkley, Thai Jones, Alice Kessler-Harris, and David Rosner for their valuable feedback. I am also indebted to John R. Pierce, who generously provided materials he gathered regarding William C. Borden and the history of Walter Reed Army Medical Center. Earlier versions of this paper were presented at the Mephistos Graduate Student Conference and the Walter Reed Army Medical Center Centennial Symposium. I am grateful to the attendees of those events for their comments.