Having no hospital, Cleveland found itself in a poor position to deal with the illness and large numbers of riverboat accidents resulting from its position as a hub to the American West. The outbreak of the American Civil War presented the additional dilemma of treating returning soldiers who had been wounded in battle, needing immediate medical attention and long term nursing care. After discussion between Rappe and Bissonette, along with Gustave E. Weber, a prominent retired Army surgeon, it was felt that the time was opportune to open another hospital.