1. “The Patient is first, and last…always”
A History of the Department of Pediatrics
at Walter Reed National Military Medical Center

2. Slide 1: Major Walter Reed, who identified the mosquito as the vector of Yellow Fever, was the consummate military physician. He was an officer, a physician, a researcher, and teacher. At the time of his death in 1902 however, it was unlikely that he realized the legacy his name have in the annals of pediatric medicine.

3. First Patients Admitted 1909
Slide 4: Construction of the Walter Reed was authorized by Congressional legislation and on May 1, 1909, the first patients were admitted. Initially there were only 10 patients and a capacity of 80 operating beds. The staff consisted of five medical officers, 62 corpsmen, and three civilian employees.

4. Slide 5: However, by World War I, hospital's capacity grew from 80 patient beds to 2,500 in a matter of months.

5. Early Pediatrics at Walter Reed
Slide 6: Following the War, pediatric care was only a minor aspect of the mission of Walter Reed Army Hospital since the Army was composed mostly of unmarried men. Between the 1920 and 1940, there were at most a dozen deliveries a month at Walter Reed Army Hospital infants born at Walter Reed in And prior to 1949, providing dependent medical care was strictly optional with hospital commanders, and thus availability varied with different facilities
12 deliveries/month between ; dependent care was optional

6. By the late 30’s and early 40’s, with the rise of dictatorships across the Atlantic, it was clear that America would inevitably be drawn into the conflict which raged across the continent of Europe.

8. Slide 8: By the end of World War II, however, the returning victorious soldiers soon began bringing home war brides, and with them, war babies. The number of dependents cared for by the US Army began to increase dramatically. From the end of World War II though June 5th 1946, over ten thousand infants and children were transported from the European and Mediterranean Theatres. (Bull US Army Med Dept, 1946; VI: )

9. War Brides and 10,000 infants transported to U. S
War Brides and 10,000 infants transported to U.S. in 1st year after VE Day

10. High Infant Mortality on the USNS Zebulon Vance
Slide 9: In 1946, on the US transport, the Zebulon B. Vance, (a ship similar to the one picture here, the USNS Chateau-Therrieu), six of the 19 infants aboard died from diarrheal disease while en route from Europe to Ft. Hamilton, New York. This incident launched an inquiry which called for the institution of greater care in the transportation of dependents to the United States. (Bull US Army Med Dept, 1946; VI: )
Sister ship to USNS Cateau-Therrieu pictured above

11. COL Ogden Bruton
Slide 10: . In 1946, COL Ogden C. Bruton, who served on active duty during World War II, was recalled as a consultant from private practice in North Carolina by the Surgeon General of the Army to improve health conditions and care for war brides and babies prior to and during their passage to the United States. Recognizing the need to improve training in pediatric medicine for Army Physicians, he developed a ninety-day course for physicians at Walter Reed in Still, by 1947, there were only two certified pediatricians on Regular Army status in the Army Medical Corps. (Callahan CW, Pediatrics. 1999; )

12. Pediatric Section Established March 1949
Slide 11: By signing Walter Reed Army Hospital General Order Number 2, MG Paul Streit authorized the establishment of the Pediatric section on 7 March 1949, to be organized by Dr. Ogden Bruton. Organizationally, it was placed under the Department of Medicine where it remained for the next 25 years. Continuing the tradition of the Walter Reed Hospital, he built his clinical service upon the cornerstones of patient care, medical education, and medical research.

13. Rapid Growth in Pediatrics from ’49-’57
Slide 12: With the establishment of the Pediatric Section, the clinical service grew rapidly, from 12,000 clinic visits and 371 inpatient admissions, in 1949; to nearly 30,000 clinic visits and 1,600 inpatient admissions in (Geppert LJ. Arm Forces Med ; )

14. Rapid Growth in Pediatrics from ’49-’57

15. Pediatric Clinic: Building 7, 2nd Floor
Slide 13: Initially the Pediatric service’s outpatient clinic was on the 2nd floor of Building 7, which today holds the Physical Disability Board.

16. Slide 14: Then, just as today, the general outpatient clinic population was generally small, serving the needs of the Walter Reed military installation and the surrounding military organizations. In the beginning, there was one to two military physicians for the outpatient clinic but by the end of 50’s, a civilian physician, Dr. Eulaine Naiden, joined the department. Two years later, they were joined by Dr. Lillian Zeigler who continues to see patients with us today in our clinic. Together, the staff saw up to 130 children were seen daily in the outpatient clinic. (photo, Stripe. 4 Apr 54)

17. Inpatient Pediatrics, Building 1 Wards 16, 17 and 22
Slide 15: The inpatient service at Walter Reed, even its formative years became renown as a tertiary care center, a referral center for complex disorders. The pediatric inpatient wards were Ward 16, which held 20 children, and Ward 17 which had six beds. Additionally Ward 22 was shared with the orthopaedic service and held from children at a time. It was not uncommon for a house officer to carry up to 22 children at a time on his service.

18. Walter Reed Newborn Nursery, 1954
Slide 16: Approximately 175 babies were born every month at Walter Reed. Typically they were kept for three days before going home, a practice which lasted until the early 1990s. (photo, Stripe. 9 Apr 54)

19. Diagnostic Breakdown of Inpatient Admissions at Tokyo and Walter Reed, 1950s
Slide 17: Arthur G. Smith, a co-author of a manuscript written with Dr. Bruton, recollects in a letter written in 1992, that “Walter Reed was generally regarded as the ‘court of last appeals’ and there were waiting lists to get in. The beds were filled with unusual and hopeless cases such a leukemia, other malignancies, hydrocephalus, and poliomyelitis.” As shown on this table comparing admission diagnoses of Walter Reed and US Army Hospital in Tokyo, congenital anomalies and complex problems such as cancer comprised a disproportionate admissions compared to a general community hospital.

20. Primary Pediatric Medevac Site for the Western Hemisphere
Slide 18: The Walter Reed pediatric section received patients from throughout the region then as it does now. This is a photograph from 1952 showing a emergency medical evacuation flight from Bermuda as it touched down on the Forest Glen ball field carrying a 3 ½ yr old little girl.

21. Hospital for Foreign Dignitaries
Slide 19: Walter Reed pediatrics served not only the military community but dignitaries and the military world-wide. Shown here is Prince Mashhur Ibn Saud, son of the King of Saudi Arabia, begin discharged from Walter Reed in February The purpose of his lengthy hospitalization was to assess his physical disabilities. The conclusion was that he was a “healthy, happy child with the exception of cerebral palsy.”

22. Life on the Ward
Slide 20: Admissions in the 50’s through 70’s were lengthy affairs. Ironically, COL Leo Geppert, who formed the first pediatric service in the military at Brooke Army Hospital, later bemoaned the administrative workload imposed by pediatric admissions because of rapid patient turnover since the average length of stay was only seven days. Because of lengthy admissions and a high census, events such as birthday parties as shown here were common place on the wards.

23. Slide 21: To entertain the children, special guests were often brought in. Shown here is a local television celebrity, Hoppity-Skippity.

24. Slide 22: Because of the length of hospital admissions, tutors were employed by the District of Columbia school system and were assigned to Walter Reed Army Hospital. Children would spend up to 2 ½ hrs a day in tutored classes on the ward.

25. Slide 24: This work, both inpatient and outpatient, was performed by a remarkably small staff. In the early 50s, the medical staff consisted of COL Bruton, one or two other military physicians and the house officers. There were two interns, two first-year residents, and two second-year residents. Despite the clinical workload, Dr. Bruton never forgot his second focus, that of physician education. His efforts in teaching has left an educational legacy in which over 180 residents in pediatrics have graduated from Walter Reed Army Medical Center in the past fifty years.

26. “Frequent Flier” on the Inpatient Ward
Joseph S. Holtoner, son of a USAF Major General J. Stanley Holtoner
Slide 25: Dr. Bruton was an exemplary teacher and is truly a father of modern pediatrics. His clinical observations lead to seminal publications in areas as diverse as neonatology and immunology. Shown here is Jay Holtoner, the child in whom he identified agammabulinemia, a heretofore unidentified deficiency in the human immune system. MG Holtoner died in 2010.

27. Meanwhile, a few miles away….

28. NNMC Pediatrics Starts July 1948 under CAPT James T. Fowler

29. In 1938, the United States Congress appropriated funds for the acquisition of land for the
construction of a new Naval medical center, and President Franklin D. Roosevelt selected the p re
sent
site in Bethesda
on July 5, Ground was broken for the Naval Medical Center on June 29, 1939 and
President Rooseve
lt laid the cornerstone of the t
ower on Armistice Day, November 11, 1940.

30. Bethesda Naval Hospital, 1957
LCDR Howard Pearson
CAPT Thomas
Cone
LT Charles
Waite
Captain Tom Cone, Chief of Pediatrics at Bethesda Naval Hospital; a child whose name and future are unknown; Lieutenant Howard Pearson, a resident in pediatrics; and Commander Charlie Waite, assistant chief of pediatrics at Bethesda. CAPT Cone retired from the Navy in 1963 and went on to become a clinical professor of pediatrics at Harvard and then professor emeritus of pediatrics. His T.E.C., Jr. historical notes appeared well over 400 times in Pediatrics.
Bethesda Naval Hospital, 1957

31. CAPT Andy Margileth Father of Pediatric Dermatology

32. Walter Reed Expands in the 1960s
Slide 31: By the late 60’s, pediatric staff now numbered six. Most of the staff were subspecialists—oncology, neonatology, nephrology and cardiology. There were now three residents per year group. Pediatrics, like the rest of the clinical services at Walter Reed was outgrowing its confines in the original hospital and planning began in 1967 for a new modern medical treatment facility.

34. Slide 34: In 1977, the pediatric outpatient clinic moved from Building 7 to the new Medical Treatment Facility. A year later, the inpatient services moved from…
Slide 35: …Ward 16 and 17 in the old hospital to…
Slide 36: …Ward 51 of the new hospital.

35. COL James Bass – Chief of Pediatrics 1975-1981
Slide 38: The first chairman of the Department of Pediatrics was Dr. Jim Bass who at that time also sat as the chief of Pediatrics at Walter Reed. Dr. Bass, a superb clinician and researcher remained at the helm of pediatrics until he left to become chief of Pediatrics at Tripler Army Medical Center in Honolulu.

36. 1st Female Intern in the Army
Women Pediatricians
Mid 1960s
Dr. Eve Kimball
1st Female Intern in the Army
Madigan AMC
1975
Dr. Donna Schuster
1st Female Graduate
Walter Reed

37. COL Erroll Alden Chief of Pediatrics, 1983-1987
Slide 39: COL George Hansen lead the department from 1981 through COL Hansen first conceived of the idea of a triservice regional care system to encompass the resources of the Army, Navy, and Air Force, but he proved a bit ahead of the times.
Slide 40: COL Errol Alden then took the reins of the department in 1983, serving as the chief of pediatrics at Walter Reed, the chairman of Pediatrics at the Uniformed Services University and the Pediatric Consultant to the Surgeon General of the Army. Following his retirement, he became the deputy executive director of the American Academy of Pediatrics.

38. Walter Reed has continued to be a leader in medical research
Walter Reed has continued to be a leader in medical research. The first report closure of a PDA by coil embolization was performed by Walter Reed cardiologists in Much of the research in the prophylaxis and treatment of RSV infections in neonates were performed by neonatologists working at Walter Reed, Bethesda, and USUHS. Today, the endocrinology section has one of the best known programs in thyroid cancer research.

39. First Flight & Infant Botulism 1992

42. Base Realignment and Closure - 1995
Two residencies combined as the National Capital Consortium
NICU and Newborn Services – NNMC
PICU, Inpatient Pediatrics – WRAMC
Subspecialty Clinics – WRAMC (mostly)
Primary Care Clinics - Both

43. USAF Trainees Occasional USAF Pediatric Residents since 1956
B.J. Beard swaps spots with Jill Emerick in 2002
First class of USAF pediatric interns starts 2006

44. Base Realignment and Closure, Round 2 2005
On May 13th, 2005, the next chapter of Walter Reed Pediatrics was announced when the Base Realignment and Closure Commission announced the integration Walter Reed Army Medical Center and National Naval Medical Center together into the joint service Walter Reed National Military Medical Center, continuing the legacy of the Walter Reed name and the tradition he established of excellence in military medicine, education, and ground-breaking research. As Walter Reed continues into the 21st century, pediatrics will continue to be part of that tradition.

46. New Construction 2017

47. New Construction

52. Why Military Pediatricians? (for combatant personnel)

53. 1. There are more troops in the age-range of *our* wheelhouse

54. 2. 90% of combat-zone medical issues and medevacs are for ‘Disease Non-Battle Injuries’ aka ambulatory care – which we do often & well
>>

55. 3. We are a specialty focused on Preventive Care of healthy patients – what combatant commanders know as ‘medical readiness ‘

56. 4. We are an adaptable specialty used to making do with equipment & patients of different sizes/ages – a valuable trait in austere and chaotic environments