Jennifer Cathey is an architectural historian and a restoration specialist with the North Carolina Department of Natural and Cultural Resources western office. She was invited by the Preservation Society of Asheville and Buncombe County to give a presentation on the history of Oteen, something she said is near and dear to her heart.

The origins of the VA hospital at Oteen lie in the United States’ mobilization for WWI. President Wilson declared war on Germany on April 2, 1917. Cathey said mobilization involved more than just raising troops—there was significant expansion of military infrastructure, including military camps and bases and the vast network of people and resources to support them.

“Talk of establishing a military training camp in Asheville arose in early June of 1917, with officials from the Asheville Board of Trade actively scouting acreage and consulting with government officials. The city committed to extend water lines to support a camp split into as many as three different locations, for there was not suitable acreage to accommodate a single training camp site,” Cathey said.

It was reported that Vanderbilt offered 120 acres of Biltmore Estate for the cause. By late June, it was determined that a training camp was not feasible, but a military hospital would be a better fit.

“Asheville gained prominence as a center for tuberculosis treatment starting in the 1870s, with the establishment of Dr. Gatchell’s Villa Sanitorium in what is now the Kenilworth neighborhood. By the 1910s numerous sanatoriums and boarding houses operated around town, including those operated by Drs. Westray Battle and Karl von Ruck, both innovative in diagnosis and treatment of the disease,” Cathey said.

It is estimated that 2,500-3,000 people with tuberculosis resided in Asheville in 1917. Though incidence of TB was in decline internationally by the early 20th century, the disease had spiked during the First World War.

“It was reckoned that by this time, the entire US population had been exposed to the TB bacterium, though most fought off the primary infection without displaying any symptoms. In those more unfortunate, the disease progressed to a secondary, more severe infection.

“Primary TB was difficult to recognize; secondary TB was only diagnosed once well advanced, with the patient experiencing the obvious symptoms of cough, fever, and weight loss. Secondary TB was highly contagious, with little effective treatment except for fresh air, good nutrition, and the rest cure,” Cathey said.

Though X-ray technology had been developed before the war, it was not in widespread use, particularly by local draft boards charged with inducting soldiers into service. Many recruits were turned away due to obvious infection, and many entered service with the illness undetected, or contracted TB while in service.

Cathey said solders diagnosed with TB were quarantined. Those stationed abroad were first treated at special wards at embarkation hospitals, and then transported back to the US. Early in the war, there were not enough hospitals to meet the need, triggering an aggressive drive to acquire and adapt existing facilities for hospital use, and to build new hospitals from the ground up. Soldiers with active TB were separated from service and treated at military hospitals—with treatment often lasting for months and even years.

“Asheville hospital planning proceeded in earnest through the winter of 1917. In December, the Westover Hotel in Asheville and the Kenilworth Inn were selected as temporary sites until a hospital could be built from the ground up. Jake Chiles, already engaged in reconstruction of the Kenilworth Inn and in developing the Kenilworth neighborhood, worked behind the scenes to procure land for the construction project, incorporating a business with partners Kennett Cowan and J. G. Adams,” Cathey said.

In the coming months, they reincorporated as the Azalea Company, purchasing multiple tracts along the Black Mountain Highway near Azalea. The Army assembled 346 acres, including 123 acres of cleared farmland, and 42 acres in intensive cultivation.

William Patton’s mid-19th century Swannanoa River estate was called Azalea, its seat located near the present-day site of the Lowe’s on Tunnel Road South. Cathey said this place name became associated with the Swannanoa corridor farther east, where the Southern Railway established a station called Azalea by the late 19th century.

“Railway access, proximity to the Black Mountain Highway, well drained upland acreage, the ability to draw water from North Fork, and Jake Chiles’ legwork presumably is what drew military planners to farmland near Azalea Station, and construction commenced in late March of 1918,” Cathey said.

Cathey said Major Jenkins, construction quartermaster in charge, supervised work at Azalea. A construction firm from Atlanta, Gude & Company contracted to construct the complex, sourcing building materials and labor from the Asheville area. By April, the Asheville Board of Trade announced that the Southern Railway would fund a shuttle train between Asheville and Azalea to carry men and supplies.

Buildings designed for the Azalea site were mostly one-story, considered semi-permanent in nature. They were wood frame, Army cantonment type, with weatherboard walls, tar roofs, wood pier foundations, and gypsum board interiors. Each ward accommodated 28 patients. Construction was completed on Sept. 4, 1918—that’s just under six months from the start date--104 buildings, 47 of them tuberculosis wards on site, and the facility into service as U.S. General Hospital No. 19 at Azalea.

Fifty medical officers, 100 nurses, 26 reconstruction aids, and 800 detachment men, treating 1200 patients, staffed the hospital.

“The facility provided the best and most innovative medical treatment possible and promoted a soldier’s return to active service or discharge to private life, a strategy that the military called Reconstruction The concept of Reconstruction—and the responsibility of patients at the reconstruction hospital—was often discussed by hospital leadership in the installation’s official weekly—The Oteen,” Cathey said.

“The Oteen publication in fact appears to have driven a change in whole identity of the hospital, and the name of the place in which it was situated. Until this point in time referred to General Hospital No. 19 at Azalea, or simply Azalea Hospital, the site quickly became known as the Oteen Hospital, and the node of development along the Black Mountain Highway as the Oteen community.”

The Oteen magazine itself, in a piece written by commanding officer Colonel Henry Hoagland, attributes the word Oteen to a Native American language, meaning “Chief Aim.” The word is not attributable to any known Native American tongue. But once coined, the word took on a meaning of honor, symbolizing the aspirations of military and medical staff, and patients alike, and the Asheville VA to this day cites “Chief Aim” as the true meaning of the word.

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