Just Fading Away? The Closing of Walter Reed
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《新英格兰医药杂志》
This summer, the Defense Base Reallocation and Closure (BRAC) Commission decided unanimously to close the venerable Walter Reed Army Medical Center in Washington, D.C. Long touted as the nation's flagship military medical center, Walter Reed opened its doors on May 1, 1909. In the 96 years that have passed, it has served hundreds of thousands of soldiers and a veritable parade of U.S. presidents, congressmen, Supreme Court justices, military leaders, and international dignitaries.
(Figure)
Courtesy of the National Library of Medicine.
Yet, like many aging medical centers throughout the country, Walter Reed is in need of intensive care. Its main hospital building was built in 1972 — an eternity ago, by contemporary medical standards. The antiquated plumbing, electrical, heating, and other infrastructural systems supporting the overcrowded, 12-city-block campus are decades older than that. The price tag for rehabilitating and reconfiguring the medical center for the 21st century is estimated to be $550 million.
The chairman of the BRAC Commission, former Secretary of Veterans Affairs Anthony Principi, explained the decision succinctly: "Kids coming back from Iraq and Afghanistan, all of them in harm's way, deserve to come back to 21st century medical care. It needs to be modernized."1
Once Congress accepts the recommendation to shutter Walter Reed, plans will be made to raze most of the buildings on the 113-acre campus and explore new uses for the complex. Some have suggested preserving the most historic buildings. Local officials hope the valuable real estate will be deeded to the District of Columbia for commercial development.
For more than a decade, a guiding principle of the modernization of the U.S. military forces has been a concept called "jointness." This doctrine seeks to advance the unique specialties of each service or unit while maximizing and expanding the functions that are in demand, reducing or eliminating those that are underused, and combining those that overlap.2 Given that the Defense Department's health care operations employ 132,000 people, comprise 76 hospitals and more than 500 clinics, and have an annual budget of $33 billion, there is a great deal of potential for streamlining.
At present, there are three tertiary care facilities in the national capital region — Walter Reed and the National Naval Medical Center at Bethesda are less than 7 miles apart, and the Malcolm Grow Medical Center at Andrews Air Force Base in Prince George's County, Maryland (which is also slated for closure) is about 30 miles away from both. To reduce excess capacity and improve on what will be demolished, the Defense Department proposes constructing a state-of-the-art 300-bed hospital, to be called the Walter Reed National Military Medical Center, that combines the Army and Navy medical corps on the grounds of the current National Naval Medical Center. A new 165-bed community hospital with modern facilities for outpatient and primary care services is slated for construction at Fort Belvoir in northern Virginia.
Among the many predicted assets of the new Walter Reed will be a medical center with strong intellectual and service connections to its near neighbors, the Uniformed Services University of the Health Sciences and the National Institutes of Health, as well as the nearby Departments of Health and Homeland Security. According to Dr. William Winkenwerder, the assistant secretary of defense for health affairs, the hope is to create a "state-of-the-art complex that rivals the very best institutions in American medicine." The old Walter Reed facility will, however, remain open for approximately five to six years before being replaced by the new hospital.
Although this hospital has not even been approved, let alone designed, experts working with the BRAC Commission predict that it will feature state-of-the-art programs in the treatment and management of amputations and other disabling injuries; mental health disorders related to warfare; and gunshot, burn, and radionuclear wounds. Also envisioned is a focus on improving the on-site management of battlefield injuries and the rapid transport of injured soldiers back to the United States for definitive treatment — an area in which impressive advances have become evident during the war in Iraq.3
Principi recognizes the emotional fallout created by his commission's recommendations but emphasizes the importance of moving forward. "I view this as the next phase of the Walter Reed tradition," said Principi. "As long as there is some memorial where it was and the name Walter Reed still exists, that makes me happy."
In the annals of the U.S. Army, Walter Reed is a special name indeed. The hospital's namesake was an Army physician who, in 1900, led an investigation that determined the critical role of mosquitoes in the transmission of yellow fever, a deadly scourge that flourished, especially in warmer climates, during the 19th century. On the basis of these findings, Reed prescribed aggressive quarantine and mosquito-eradication procedures that sharply diminished the incidence of yellow fever in Cuba and, a few years later, in Panama, where 50,000 laborers were building the canal.
Reed's scientific achievements inspired a vigorous campaign to memorialize him as a hero after his death in 1902. So in 1906, after Congress appropriated $100,000 and construction had begun on the first Georgian-style buildings, the War Department officially designated the complex the Walter Reed General Hospital.4
The number of patients admitted to Walter Reed has waxed and waned with the nation's engagement in various wars. When it opened, there were 10 patients, with 50 staff members on hand to take care of them. During World War I, the census climbed to 2500. Doctors and nurses stationed at Walter Reed in this era pioneered modern treatments for gunshot injuries, burns, and trench foot — the all-too-common consequence of standing for days with poorly shod feet in muddy, wet trenches. They also advanced the treatment and prevention of infectious diseases such as typhoid and influenza and contributed to pulmonary medicine by treating the short- and long-term effects of exposure to mustard gas, a new and highly toxic weapon.
World War II, as well as the Korean and Vietnam wars, led to the admission of thousands of wounded soldiers, the expansion of facilities, and clinical innovations in rehabilitation medicine — particularly in the operative and postoperative management of amputations. In the years since, advances have been made at the medical center in the recognition and treatment of post-traumatic stress disorder. And thousands of children and spouses of military personnel have received their pediatric and obstetric and gynecologic care at Walter Reed. Last year, more than 16,000 patients were treated at the medical center, including hundreds of soldiers with the most serious injuries from the wars in Iraq and Afghanistan, yet because of a reduced need for beds at Walter Reed, the daily inpatient census averaged well below 300.
Hospitals tend to develop unique cultures with their own traditions and esprit de corps. For almost a century, countless stories of crisis, caring, triumph, and tragedy have unfolded on Walter Reed's wards. It was, after all, the hospital where General Douglas MacArthur actually did die, despite having pledged, in his famous 1951 farewell address to Congress, to "just fade away"; where Dwight D. Eisenhower was treated for several serious illnesses during his presidency and ultimately died in 1969; and where General George S. Patton came on bended knee seeking the blessings of his mentor, and one of Walter Reed's most famous patients, General John "Black Jack" Pershing, before going off to fight in World War II.
The destruction of its physical plant has the potential to consign the preservation of Walter Reed's history to the memories of those who served or were patients there. Some describe the opposition to closing the hospital as one more battle in the eternal turf wars among the hidebound branches of the armed services; others cite real philosophical distinctions in their arguments for keeping the Army's premier medical center where it is.
Dr. John Pierce, a retired Army colonel who practiced for 15 years at Walter Reed and is researching the hospital's history, insists that the proposed closure portends the end of a cherished tradition of military medicine that will not be recaptured in the medical center's new incarnation. "There's a difference in the Army and Navy approach to medicine. Not at the bedside, but a difference nevertheless exists," said Pierce. "The Army, I believe, has been more cutting-edge, while the Navy has been a more primary care approach. We have had lots more fellowships, graduate medical education programs, and new technologies."
But Lieutenant General George Peach Taylor, Jr., M.D., the surgeon general of the U.S. Air Force and a chief architect of the medical portion of the BRAC report, disagrees: "The science is the same," he said. "How we run a hospital is the same. The method of applying medicine is the same. We are all part of the same military. We have had mergers of hospitals before, and they have worked. If different branches of the military are working jointly in the field, shouldn't we be doing this in the United States? Shouldn't we be running one bigger hospital rather than two smaller ones if it is more efficient and a more modern facility?"
The pace of advances in medical technology, spiraling costs, population shifts, and new approaches to patient care demand new facilities and present challenges for every medical center, civilian or military, in the United States. All aging hospitals have the potential to become dangerous places.
"Technology is moving so quickly in medicine," observed Principi, "that some hospitals are at risk of being museums of the past rather than healing centers of the future. With all this phenomenal change at breakneck speed, we must adapt, no matter how difficult , if we are to be true to our mission of providing the highest-quality care to our armed forces, their families, and veterans."
Source Information
Dr. Markel is a professor of the history of medicine and a professor of pediatrics and communicable diseases at the University of Michigan Medical School, Ann Arbor, where he directs the Center for the History of Medicine.
References
Base realignment and closure. Washington, D.C.: Department of Defense, 2005. (Accessed October 6, 2005, at http://www.dod.mil/brac/.)
Owens WA. Living jointness. Joint Forces Quarterly 1993-1994;3:7-14.
Gawande A. Casualties of war -- military care for the wounded from Iraq and Afghanistan. N Engl J Med 2004;351:2471-2475.
Truby AE. Memoir of Walter Reed: the yellow fever episode. New York: P.B. Hoeber, 1943.(Howard Markel, M.D., Ph.D)
(Figure)
Courtesy of the National Library of Medicine.
Yet, like many aging medical centers throughout the country, Walter Reed is in need of intensive care. Its main hospital building was built in 1972 — an eternity ago, by contemporary medical standards. The antiquated plumbing, electrical, heating, and other infrastructural systems supporting the overcrowded, 12-city-block campus are decades older than that. The price tag for rehabilitating and reconfiguring the medical center for the 21st century is estimated to be $550 million.
The chairman of the BRAC Commission, former Secretary of Veterans Affairs Anthony Principi, explained the decision succinctly: "Kids coming back from Iraq and Afghanistan, all of them in harm's way, deserve to come back to 21st century medical care. It needs to be modernized."1
Once Congress accepts the recommendation to shutter Walter Reed, plans will be made to raze most of the buildings on the 113-acre campus and explore new uses for the complex. Some have suggested preserving the most historic buildings. Local officials hope the valuable real estate will be deeded to the District of Columbia for commercial development.
For more than a decade, a guiding principle of the modernization of the U.S. military forces has been a concept called "jointness." This doctrine seeks to advance the unique specialties of each service or unit while maximizing and expanding the functions that are in demand, reducing or eliminating those that are underused, and combining those that overlap.2 Given that the Defense Department's health care operations employ 132,000 people, comprise 76 hospitals and more than 500 clinics, and have an annual budget of $33 billion, there is a great deal of potential for streamlining.
At present, there are three tertiary care facilities in the national capital region — Walter Reed and the National Naval Medical Center at Bethesda are less than 7 miles apart, and the Malcolm Grow Medical Center at Andrews Air Force Base in Prince George's County, Maryland (which is also slated for closure) is about 30 miles away from both. To reduce excess capacity and improve on what will be demolished, the Defense Department proposes constructing a state-of-the-art 300-bed hospital, to be called the Walter Reed National Military Medical Center, that combines the Army and Navy medical corps on the grounds of the current National Naval Medical Center. A new 165-bed community hospital with modern facilities for outpatient and primary care services is slated for construction at Fort Belvoir in northern Virginia.
Among the many predicted assets of the new Walter Reed will be a medical center with strong intellectual and service connections to its near neighbors, the Uniformed Services University of the Health Sciences and the National Institutes of Health, as well as the nearby Departments of Health and Homeland Security. According to Dr. William Winkenwerder, the assistant secretary of defense for health affairs, the hope is to create a "state-of-the-art complex that rivals the very best institutions in American medicine." The old Walter Reed facility will, however, remain open for approximately five to six years before being replaced by the new hospital.
Although this hospital has not even been approved, let alone designed, experts working with the BRAC Commission predict that it will feature state-of-the-art programs in the treatment and management of amputations and other disabling injuries; mental health disorders related to warfare; and gunshot, burn, and radionuclear wounds. Also envisioned is a focus on improving the on-site management of battlefield injuries and the rapid transport of injured soldiers back to the United States for definitive treatment — an area in which impressive advances have become evident during the war in Iraq.3
Principi recognizes the emotional fallout created by his commission's recommendations but emphasizes the importance of moving forward. "I view this as the next phase of the Walter Reed tradition," said Principi. "As long as there is some memorial where it was and the name Walter Reed still exists, that makes me happy."
In the annals of the U.S. Army, Walter Reed is a special name indeed. The hospital's namesake was an Army physician who, in 1900, led an investigation that determined the critical role of mosquitoes in the transmission of yellow fever, a deadly scourge that flourished, especially in warmer climates, during the 19th century. On the basis of these findings, Reed prescribed aggressive quarantine and mosquito-eradication procedures that sharply diminished the incidence of yellow fever in Cuba and, a few years later, in Panama, where 50,000 laborers were building the canal.
Reed's scientific achievements inspired a vigorous campaign to memorialize him as a hero after his death in 1902. So in 1906, after Congress appropriated $100,000 and construction had begun on the first Georgian-style buildings, the War Department officially designated the complex the Walter Reed General Hospital.4
The number of patients admitted to Walter Reed has waxed and waned with the nation's engagement in various wars. When it opened, there were 10 patients, with 50 staff members on hand to take care of them. During World War I, the census climbed to 2500. Doctors and nurses stationed at Walter Reed in this era pioneered modern treatments for gunshot injuries, burns, and trench foot — the all-too-common consequence of standing for days with poorly shod feet in muddy, wet trenches. They also advanced the treatment and prevention of infectious diseases such as typhoid and influenza and contributed to pulmonary medicine by treating the short- and long-term effects of exposure to mustard gas, a new and highly toxic weapon.
World War II, as well as the Korean and Vietnam wars, led to the admission of thousands of wounded soldiers, the expansion of facilities, and clinical innovations in rehabilitation medicine — particularly in the operative and postoperative management of amputations. In the years since, advances have been made at the medical center in the recognition and treatment of post-traumatic stress disorder. And thousands of children and spouses of military personnel have received their pediatric and obstetric and gynecologic care at Walter Reed. Last year, more than 16,000 patients were treated at the medical center, including hundreds of soldiers with the most serious injuries from the wars in Iraq and Afghanistan, yet because of a reduced need for beds at Walter Reed, the daily inpatient census averaged well below 300.
Hospitals tend to develop unique cultures with their own traditions and esprit de corps. For almost a century, countless stories of crisis, caring, triumph, and tragedy have unfolded on Walter Reed's wards. It was, after all, the hospital where General Douglas MacArthur actually did die, despite having pledged, in his famous 1951 farewell address to Congress, to "just fade away"; where Dwight D. Eisenhower was treated for several serious illnesses during his presidency and ultimately died in 1969; and where General George S. Patton came on bended knee seeking the blessings of his mentor, and one of Walter Reed's most famous patients, General John "Black Jack" Pershing, before going off to fight in World War II.
The destruction of its physical plant has the potential to consign the preservation of Walter Reed's history to the memories of those who served or were patients there. Some describe the opposition to closing the hospital as one more battle in the eternal turf wars among the hidebound branches of the armed services; others cite real philosophical distinctions in their arguments for keeping the Army's premier medical center where it is.
Dr. John Pierce, a retired Army colonel who practiced for 15 years at Walter Reed and is researching the hospital's history, insists that the proposed closure portends the end of a cherished tradition of military medicine that will not be recaptured in the medical center's new incarnation. "There's a difference in the Army and Navy approach to medicine. Not at the bedside, but a difference nevertheless exists," said Pierce. "The Army, I believe, has been more cutting-edge, while the Navy has been a more primary care approach. We have had lots more fellowships, graduate medical education programs, and new technologies."
But Lieutenant General George Peach Taylor, Jr., M.D., the surgeon general of the U.S. Air Force and a chief architect of the medical portion of the BRAC report, disagrees: "The science is the same," he said. "How we run a hospital is the same. The method of applying medicine is the same. We are all part of the same military. We have had mergers of hospitals before, and they have worked. If different branches of the military are working jointly in the field, shouldn't we be doing this in the United States? Shouldn't we be running one bigger hospital rather than two smaller ones if it is more efficient and a more modern facility?"
The pace of advances in medical technology, spiraling costs, population shifts, and new approaches to patient care demand new facilities and present challenges for every medical center, civilian or military, in the United States. All aging hospitals have the potential to become dangerous places.
"Technology is moving so quickly in medicine," observed Principi, "that some hospitals are at risk of being museums of the past rather than healing centers of the future. With all this phenomenal change at breakneck speed, we must adapt, no matter how difficult , if we are to be true to our mission of providing the highest-quality care to our armed forces, their families, and veterans."
Source Information
Dr. Markel is a professor of the history of medicine and a professor of pediatrics and communicable diseases at the University of Michigan Medical School, Ann Arbor, where he directs the Center for the History of Medicine.
References
Base realignment and closure. Washington, D.C.: Department of Defense, 2005. (Accessed October 6, 2005, at http://www.dod.mil/brac/.)
Owens WA. Living jointness. Joint Forces Quarterly 1993-1994;3:7-14.
Gawande A. Casualties of war -- military care for the wounded from Iraq and Afghanistan. N Engl J Med 2004;351:2471-2475.
Truby AE. Memoir of Walter Reed: the yellow fever episode. New York: P.B. Hoeber, 1943.(Howard Markel, M.D., Ph.D)