With the exception of the period of 1861 through 1865, the presence of United States Army troops in Texas has been continuous since 1845, when the first U.S. troops came to Texas with the entry of the Republic of Texas into the United States of America. During the frontier and Indian Wars period the U.S. Army Eighth Military Department, and subsequent Department of Texas, covered the state of Texas and Indian Territory (present-day Oklahoma). Accompanying these soldiers, the Army Medical Department cared for the sick and wounded. But, they did much more. Typically in the context of post hospitals, surgeons and hospital stewards were all very much part of the unit and shared in the deprivations of frontier life. A typical frontier hospital consisted of an office, minor operating room, patient ward, dispensary, and kitchen all encapsulated by an open porch. The hospital staff normally consisted of a surgeon/assistant surgeon/acting assistant surgeon (contract surgeon), hospital steward, and, if the hospital was large enough, a hospital matron. Commanding generals gave assignments, and local commanders directed the day-to-day supervision of doctors. As typical for this time period, the biggest enemy to health was disease and not battle wounds. In addition to monthly sanitary reports and inspections to the commander, frontier medical staff reported on their activities directly to the Army Surgeon General back in Washington, D.C. These reports consisted of statistical data on patient status and meteorological data throughout the army. This information on sickness and mortality, in addition to the weather data, formed the first national set of public health statistics and historical weather patterns. As men of observation and the emerging medical science, medical personnel were also large contributors to the ornithological record through organizations such as the Smithsonian Institution and British Museum of Natural History.
Rigorous examinations were administered to candidates wishing to serve as army doctors. Unlike their civilian contemporaries, ranked medical corps officers were required to pass the exams—of most, only one third passed. During this time, in April 1887, the United States Army issued General Orders No. 29 establishing the Hospital Corps. This functionally re-established from the Civil War, and made permanent, the position of the hospital steward, acting hospital steward, and hospital private on the muster rolls. Before this order, assisting the surgeon in the hospital was a collateral duty. Now tested men were trained, and their jobs included duty as “wardmasters, cooks, nurses, and attendants in hospitals, and as stretcher-bearers, litter-bearers, and ambulance attendants in the field.” Assistant Surgeon John Vance Lauderdale, while stationed at Fort Clark, journaled that the stewards would be “uniformed in black like the Medical Officers and distinguished also from other soldiers by a green stripe on the outer seam of their pants and the usual chevrons in green on their coat sleeve.” He lobbied for men who would take an interest in their patients and get to know the diseases afflicting them. A prime outlet for upward mobility, Lauderdale advocated the position because the steward had advantages that included the chance “to read the cream of medical literature, besides having a chance to study disease” and attend medical lectures all while saving up money from his enlistment. This, in turn, would be the stepping stone to become a U. S. Army Medical Corps officer or a physician in civilian practice.
The westward expansion of forts in Texas had three phases for army posts and the hospitals within them. The first line was established in the late 1840s during and after the Mexican War to protect the newly-formed United States border with Mexico along the Rio Grande from Brownsville and north to Fort Worth. As Anglo settlement moved west, another line of permanent forts from Laredo west toward the Davis Mountains and north up to Indian Territory (Oklahoma) was established to protect westward migratory routes and the new settlers against raiding Indians in the 1850s. After the Civil War in the late 1860s and early 1880s, the final line of posts was established to reinforce the growing permanent structures moving northwest following the Anglo movement west. With each period of growth, temporary hospitals were replaced with permanent structures. Some frontier posts had more than one hospital building location because of growth and improvements, in addition to, modifications of older hospitals updated to new standards.
In 1870 Assistant Surgeon John Shaw Billings working in the Surgeon General’s office, consolidated field reports into Circular No.4, A Report on Barracks and Hospitals with Descriptions of Military Posts. He extolled the efforts to maintain the health of sick soldiers from the British in Crimea and the Union Army during the “late war.” The pavilion-style hospital made for much better air exchange which had proven more effective for recovery and maintaining health. The standard of constructing built-in ventilation was lauded as the preferred model for army hospitals. Citing Fort Davis as an example, Billings commented that even after War Department orders were issued, hospitals were often not constructed. However, since the implementation of directives in 1867, quality examples of hospital construction existed as manifested in Fort Brown. Like the previous consolidated record, Billings’s Circular No.8, A Report on the Hygiene of the United States Army, with Descriptions of Military Posts, from 1875, detailed important observations that reveal information about the frontier hospitals in Texas. In reality, most army hospitals were the barrack or temporary hospitals containing twelve to twenty-four beds. Most hospitals were built with local resources, such as sandstone. Mass produced items like doors, window sashes, and ceiling boards were procured from the quartermaster depot in San Antonio. A veranda contributed to the effort to increase ventilation within the wards when windows and doors were open. Likewise, open fireplaces and wood stoves, provided heat during the mild winters.
Army hospitals built under a “square-plan” mostly resembled the model for a house. These types of hospitals were built from 1855 to 1870. An example of a post hospital under this model exists today at Fort McIntosh (1867). It was later improved and modified.
The Army Surgeon General provided plans for twelve, twenty-four, and forty-eight-bed hospitals under the instructions of Circular No. 4, 1867. Most of the wards built under this directive used the twelve-bed layout. These facilities were T-shaped with a central administrative section along with a porch. An example of a post hospital under this model exists today at Fort Brown (1869). The hospital included a veranda to increase ventilation in addition to the normal windows and doors. Latticework was added much later to vent the wards.
Hospital designs in U. S. Army Circular No. 10 issued in 1870 served as improvements in ventilation from the previously-issued Circular No.4 and were built from the late 1870s to the early 1880s. These improvements came from active involvement in the redesign by surgeons and hospital stewards who pressed for verandas and floor-to roof ventilation from floor slats and stoves. Like its predecessor, it utilized a T-shaped plan, porch and a central administrative block. Steward’s quarters, office space, kitchen, and mess (behind the administrative section) were on the first floor. The preferred twelve-bed ward, twenty-four-bed if required, was continued on the second floor. The Fort Bliss hospital had a one-story building containing the dead house (morgue) that was connected to the main building with a veranda.
As of 2019 Texas has several well-preserved and/or restored frontier hospitals. Most buildings are repurposed, but some still depict frontier army medicine, and are located at Fort Richardson, Fort Concho (Robert Wood Johnson Museum of Frontier Medicine), Fort McKavett, Fort Clark, Fort Brown, Fort Ringgold, Fort McIntosh, Fort Davis (hospital interpretation by the National Park Service), and Fort Bliss.