| 22 November 2005 Quarantine It is wild and blowing out there, cold rain. It is a fine day for the memorial of President John Kennedy's murder: dark and filled with raw power that is above any mortal's ability to control. I do not recall the temperature in suburban Detroit that day, which is where I heard the news. I know that the light was bright but thin, and it seemed to us in the middle school that something had gone wrong with the world. I'm sure that it was an aberration of the peace that reigned supreme in the 1950s. When Ike had his heart attack in April of 1955 I think I can recall being frightened. But I would have been very small then, and perhaps it is only the recollection of recalling something. Ike did have other cardiac events, and it was the ticker that finally killed him in 1969. He had a good run, though, almost eighty years old when he passed at the Walter Reed Army Medical Center here in the District. You would expect the retired General of the Army to expect top care from his beloved service. The Army and the Navy were in competition in providing medical services to the elected elites of the government. It was good for the larger business. Over time, Bethesda Naval Hospital became the gold standard for many members of Congress and the Executive Branch. It has a snazzy design, said to have been sketched by FDR on a cocktail napkin. Secretary of Defense James Forrestal threw himself from the tower when he was 57. he was embroiled in a conflict with the newly-created Department of the Air Force, and he apparently thought he was being followed around by Israeli agents. JFK's autopsy was done there, as well, and the Doctors who are still alive and participated in it are still nervous about the work that they did. It is curious that with a war in progress, and the real threat of pandemic disease, the Defense Department has decided to close Walter Reed. The recommendation of the Base Reallocation and Closure Commission was that there was excess capacity in the two medical campuses, and that all military medicine should be consolidated at the Navy's Bethesda campus. It seems logical. The National Institutes of Health are right across the street. There is land to build, and the Joint Service Medical School is right there. Walter Reed is in a seedy neighborhood inside the District Line a few miles away. Parking is hard to come by, and the plant facility is aging. But of all the things we should be closing, it seems to me that major medical centers should not be on the list. When my son shattered his left hand, it was the trauma surgeons at Walter Reed who put it back together. I was impressed by the professionalism and quality of their surgical art, even if the bedside manners were a bit brusque. Who cares about manner, if the care is good? Walter Reed is named for the famed Army doctor who pioneered the control of typhoid and yellow fever. During the Spanish-American War in 1898, he became chief of a commission to study the origin and spread of typhoid fever in Army camps, and he helped turn the Army's approach to infectious medicine around. He carried on a series of daring experiments in which he volunteered to be infected by yellow fever germs to study the course of the disease. He lived, and he successfully identified the method of transmission of the disease. At the height of his power, he contacted peritonitis after an appendectomy, and died in Washington in 1902. He was fifty-one. The Army has a vested interest in infectious disease, since soldiers live necessarily in close quarters, and deployed to pest holes around the world. The US Army Medical Research Institute of Infectious Disease is one of the premier institutions in the world for the study and prevention of disease, and a worthy successor to Walter Reed. They partner with the Center for Disease Control and the World Health Organization. They are lucky to be located at Fort Dietrich and not in the District. They did not get BRACed. My concern about closing Walter Reed goes back to something that started on the morning of March 11, 1918, at Camp Funston , Kansas . A company cook named Albert Mitchell reported to the infirmary with typical flu-like symptoms. He had a low-grade fever, mild sore throat, slight headache, and muscle aches. He presented symptoms that we all exhibit at least a couple times a year. Bed rest was recommended. But Albert had something that could not be remedied by going back to bed. By noon, 107 soldiers were sick. Within two days, 522 people were sick. Many developed severe pneumonia, and they began to die from it. Then reports started coming in from other military bases around the country. It jumped to the civilian population, of course, and spread through the militaries that were mobilized around the world. By the time the Spanish Flu was done with America , over 800,000 were dead, more than three hundred times the cost of 9/11. The institutional response was to strengthen the ability to quarantine people and keep the disease contained. It is not a new concept; the response to the Black Death in Venice had been to restrict visiting ships to anchor for a period of forty days to prove they were disease-free. In Italian, “quaranta giorni,” or “forty days” is the origin of the term quarantine . The quarantine program essentially died in the 1970's with the eradication of smallpox and other communicable diseases. It was wrong-headed, of course, born of an optimism that medical science and anti-biotic could cure anything. AIDS began to spread in earnest right around the quarantine program was being killed. There is talk about invigorating the program once more, and expanding the short list of diseases for which the Federal Government can take action. Like Tip O'Neil said about politics, it is mostly local. The City and State medical departments are the ones with the authority to act. The United States had not posted medical officer in the stations for more than 40 years. But since the anthrax attacks and the SARS outbreak, that has turned around. The avian flu could jump suddenly to humans, and there are a dozen exotic diseases that we need to be looking for. And I don't think we ought to be closing Walter Reed any time soon. But I defer to the Secretary of Defense on that. I understand he has a formula that he uses for these things. Copyright 2005 Vic Socotra www.vicsoctra.com |