Friday, May 13, 2005

Walter Reed To Close?

The BRAC base closure list had a hidden surprise for many in the medical arena -- Walter Reed Army Medical Center in Washington, D.C. is on the hit list! I have never been in the military, but I know plenty of physicians who spent at least part of their training there. It is quite an icon in our military and medical systems; founded in 1909 with a mere 80 beds, it quickly grew to 2,500 with the outbreak of World War I. Despite serving our troops for nearly a century, it is felt to be too expensive to keep open when the National Naval Medical Center in Bethesda is nearby.

"It is very expensive to run a hospital. It just did not make sense to have two tertiary facilities within seven miles of each other," Winkenwerder said in an interview yesterday afternoon.

Over 20 years, the Pentagon projects savings of $301 million. Construction at Fort Belvoir and Bethesda probably would not begin until about 2009, Winkenwerder said, and the last medical programs would have to move from Walter Reed by 2011.
Most physicians in this country are well acquainted with the facility's namesake. Dr. Reed's pioneering work in typhoid and especially yellow fever were of enormous importance to the military and to the US as a whole. Perhaps what is less well known is the method used to prove the method of transmission of yellow fever --- and the debt we owe to the volunteers involved (it's long, but worth it):
With the express permission of General Leonard Wood, Governor General of Cuba, Camp Lazear, named for their fallen comrade, was established on November 20, 1900. Moreover, General Wood authorized the Board to use and pay American and Spanish volunteers for the experiments since at this time yellow fever was thought to be a disease afflicting only humans. Dr. Carroll had exhausted the list of experimental animals, rats and the like normally used for scientific research, failing to produce any cases of the fever in them. In addition to the mosquito theory, Dr. Reed also desired to disprove the seemingly fallacious belief that yellow fever could be transmitted and induced from clothing and bedding soiled by the excrement of yellow fever sufferers. These articles were known as fomites and were commonly thought to carry the disease. Just as "everybody knew" that the mosquito theory was foolish, so "everybody knew" that fomites were dangerous.

In November, 1900, Camp Lazear was established one mile from Quemados and placed under strict quarantine. At this experimental station Private John R. Kissinger permitted himself to be bitten and promptly developed the first case of controlled experimental yellow fever. This case has been deemed as important to medical science as Robert Koch's discovery of the tubercle bacillus and the development of the diphtheria anti-toxin. Kissinger and John J. Moran had volunteered on condition that they would receive no gratuities, performing their service "solely in the interest of science and the cause of humanity."

Then, in order to prove the theory for all time and to destroy the fomite myth, two specially constructed buildings were erected in Camp Lazear. Building Number One, or the "Infected Clothing Building," was composed of one room, 14 x 20 feet heated by a stove to ninety-five degrees. For twenty nights Dr. Robert P. Cooke and Privates Folk and Jernegan hung offensive clothing and beefing around the walls. They slept on sheets and pillows befouled by the blood and vomit of yellow fever victims. Not one of the volunteers contracted the disease. On December 19, 1900, they were relieved by Privates Hanberry and England who, in turn, were finally relieved by Privates Hildebrand and Andrus. From November 30, 1900 to January 10, 1901 the experiment ran to completion, disproving the fomite theory of transmission and thereby demonstrating the uselessness of destroying the personal effects of yellow fever victims, thus saving thousands of dollars in property.

The second building was similarly constructed and was called the "Infected Mosquito Building." It was divided into two parts separated by a screen with screens on the windows as well. Mr. John Moran, a clerk in General Fitzhugh Lee's office, was bitten by fifteen infected mosquitoes, developed the fever and recovered. The other volunteers who were separated, and thereby protected by the screen, escaped infection. Ten cases were produced in this manner.

Yellow fever was produced in the bodies of twelve more American and Spanish volunteers either by direct mosquito bites or by injections of infected blood or blood serum. These injections proved that the specific agent of yellow fever is in the blood and that passage through the body of a mosquito is not necessary to its development.

The courage of the volunteers is inestimable. A unique honor helps keep alive the memory of the twenty-four gallant men who participated in this experiment. In 1929 Congress awarded a special gold medal to each man or his next of kin. Had it not been for Major Reed's fair and thoroughly scientific approach to the problem and misconceptions concerning the disease, especially the whole contagion theory, yellow fever might have continued for years.

There is one final twist to the story of Dr. Walter Reed. This major combatant against infectious disease ironically succumbed to peritonitis following an appendectomy in 1902.