John Shaw Billings: The Early Years & the National Medical Library (NLM, 1983)

John Shaw Billings: The Early Years & the National Medical Library (NLM, 1983)


[Music] [Narrator:] The era from the Civil War to
World War One was a time of dramatic change, vitality, and productivity. Historians have described these years as the “Age of Energy,” the “Rise of the City,” the “Age of Reform,” and the “Search for Order. It was a period that witnessed the expansion
of urban centers, with their unparalleled growth in population,
the rise of modern industry, commerce, and banking, the emergence of organized labor,
and the crusade for women’s rights. There was also an increase in new colleges
and universities, the development of the modern library movement, and numerous efforts to further government
participation in public health and welfare. This was the time when the modern concept
of medicine and public health came into being through revolutionary changes in the fields
of bacteriology and chemistry, laboratory medicine, medical education, and
public health methodology. One of the remarkable personalities who was
instrumental in making these important changes and helped shape the future twentieth century
America, was John Shaw Billings. John Shaw Billings was born in Switzerland
County, Indiana, on April 12, 1838, one of five children born to James and Abby
Shaw Billings. By the age of 14, young Billings was ready
for college. [Voiceover:] I then went on to fit myself
to pass the entrance examination for the sub-freshman class at Miami University
in Oxford, Ohio, and passed the examination in the fall of
1852. Most of my time was spent in reading the books
in the college library. I was omnivorous, and read everything. Philosophy, theology, natural science, history,
travels, and fiction. [Narrator:] Years later, Billings recalled, [Voiceover:] When I was in college, the library
was not recognized as a part of a system of instruction. No professor ever referred the students to
it or suggested any use of the books in it. I always found it easy to get half a dozen
or more students to give me permission to borrow for them, so that I usually left
with as many books as I could carry. [Narrator:] Billings ranked second in his
graduating class at Miami University and decided to study medicine. He worked for a year to save some money and entered the Medical College of Ohio in the fall of 1858. While he would have no problems with his studies,
his limited funds caused hardship. By becoming custodian of the school’s dissecting
room, Billings could live in the hospital, and thereby
avoided having to pay rent. Billings’ education was very different from
the more modern medical education that he helped to promote in the late nineteenth
century. [Voiceover:] In those days, they taught us
medicine as you teach boys to swim. By throwing them into the water. I graduated in medicine in a two years’ course, with the lecture being precisely the same
for each year. I did not attend the systematic lectures very
regularly. I found that, by reading the textbooks, I
could get more in the same time, and with very much less trouble. I practically lived in the dissecting room
and in the clinics. [Narrator:] In 1860, after completing his
thesis on the surgical treatment of epilepsy, Billings received his medical degree. He had planned to enter medical practice with
one of his former instructors, but on April 12th, 1861, which also happened to be Billings’ twenty-third birthday, Fort Sumter was shelled and the Civil War
began. That September, Billings went to Washington and took a three-day examination for admission to the United States Army Medical
Corps. He passed with the highest possible grade,
ranking first among the candidates, and was immediately appointed a contract surgeon. Several months later, he was made first lieutenant
and assistant surgeon. Thus, Billings began an association with the
medical department of the Army, which would last for thirty-three years. Billings’ first assignment was to transfer
the patients, hospital staff, and equipment from the Union Hotel Hospital
in Georgetown to the cavalry barracks at Cliffburne in Washington and transform the barracks into a hospital. Billings found the barracks in an extremely
filthy and dilapidated condition with no drainage whatever, no sinks, and no
water within half a mile. Displaying a particular genius for hospital
construction, Billings supervised new construction and modification
of existing buildings, installed hygienic and sanitary facilities, and produced a one-thousand bed hospital which
housed Confederate and Union wounded. Billings later remembered how the people in
the area came to visit the wounded. [Voiceover:] The old residents of Georgetown
and Washington were mostly in sympathy with the Confederates, and came out bringing good things to eat and
drink for the Confederates. On the other hand, the ladies and families
of the members of Congress, and of officers in the department were enthusiastic
for the northern side. And they also came with good things, but specified
that none should go to the rebels. We would not receive gifts from either party
on these terms. But after a little explanation, they were
left to be used for those who needed them most. [Narrator:] It was during this Washington
period that Billings met his future wife, Catherine Mary Stevens, daughter of former Michigan Congressman, Hestor
Lockhart Stevens. They were married in September, 1862, in the
St. John’s Church in Georgetown, and had a close and affectionate relationship
which lasted the rest of their lives. In the autumn of 1862, Billings was assigned
to Philadelphia’s Satterlee General Hospital, which was receiving the casualties from the Battles of Fair Oaks, Malvern Hill, and the second Bull Run. In March, 1863, he reported to Dr. Jonathan
Letterman, medical director of the Potomac in camps near Fredericksburg, not far from where General Joseph Hooker was
about to engage General Lee in the battle of Chancellorsville. After Chancellorsville, Billings saw duty
at Gettysburg. Here, he remained on the battlefield for nearly
three weeks, caring for over one thousand wounded. About six a.m., July 2, 1863… [Voiceover:] I accompanied my regiment until
they were under fire and was then ordered to repair to a large
stone house and barn near the base of Round Top, and there establish a field hospital. On entering the house, I found evident traces
of hasty desertion. In five minutes, I was joined by the other
medical officers. The ambulance train reported to me fifteen
minutes later, and by the time the operating tables were up and the materials for dressing arranged,
the wounded began to pour in. I performed a large number of operations of
various kinds, received and fed seven hundred and fifty wounded. Most of the wounds were in the lower extremities. Of three exsections of the shoulder joint,
all were successful, insofar as that the patients recovered. Five cases of gunshot fracture of the cranium
came under my notice. Four of these involved the occipital bone
and all were fatal. Two cases occurred of gunshot fracture of
the femur in the upper third. Both were treated by Smith’s anterior splint,
and one died. In no case of fracture of the long bones,
did I attempt any formal resection, but confined myself to removing splinters
and foreign bodies, and cutting off very sharp projecting points. [Narrator:] On July 6, Billings wrote to his
wife. [Voiceover:] I am utterly exhausted, mentally
and physically… have been operating night and day. I have been left here, in charge of seven
hundred wounded, with no supplies. Our division lost terribly. Over thirty percent were killed or wounded. I had my left ear just touched with a ball. [Narrator:] Three days later, he again wrote
to Mrs. Billings. [Voiceover:] I am covered with blood and am
tired out, almost completely, and can only say that I wish I was with you
tonight, and could lie down and sleep for sixteen hours
without stopping. I have been operating all day long and have
got the chief part of the butchering done in satisfactory manner. [Narrator:] In August, 1864, Billings was
relieved from field duty and reported to the Medical Director of the
Army of the Potomac in Washington. His assignment was to arrange and analyze the Army’s wartime reports, a project that led to the publication of the
six-volume Medical and Surgical History of the War of the Rebellion. Four months later, Billings, age 26 years, was transferred to the Office of the Surgeon
and promoted to Lieutenant-Colonel. He would remain with this office for the next
thirty years. Here, he would build a National Medical Library, publish its Index Catalog and Index Medicus, and using the library as a base of operations, he would make extraordinary contributions in various areas of public health, to hospital construction, and to the development
of modern medical education. The library of the Surgeon General’s office
had its origin in a small collection of books and journals in the office of the first Surgeon General,
Joseph Lovell. When Lovell died, in 1836, he was succeeded by Thomas Lawson who, in 1840, issued the first catalog of the library, a
manuscript listing 134 titles. The collection continued to grow under Lawson’s
successors, Surgeons General Clement Findley and William
Hammond. And in 1864, when Joseph Barnes assumed the
office, the library’s first published catalog contained 485 titles. Surgeon General Barnes felt that the growing collection should be under the charge of an officer. and in 1865, Billings was given the job. From 1862 through 1866, this modest library in Washington was housed in the Riggs Bank Building at the
corner of Fifteenth St. and Pennsylvania Ave. These facilities, however, soon proved inadequate,
and Ford’s Theatre, purchased by the national government after
President Lincoln was assassinated, became the library’s next home. Its interior was remodeled, and in 1867, the
books and journals were transferred from Riggs to the second floor of Ford’s Theatre. On the third floor was the department’s medical
museum. Billings’ goal was to make the library, in his words, “as complete as possible.” He sought all forms of publications pertaining to medicine and public health: monographs, journals, reports of hospitals,
institutions, and health agencies, pamphlets, doctoral dissertations, medical works from
the sixteenth, seventeenth, and eighteenth centuries, and incunabula, books printed before 1501. When the library published its third catalogue
in 1868, its holdings were three times what they had
been in 1865. Purchases by the library depended primarily
on the monies appropriated by Congress. And since there were never enough funds to
acquire everything Billings wanted, Billings encouraged gifts, and traded duplicates and unwanted material for items the library needed. He wrote letters to physicians, publishers,
editors, health officials, society officers, librarians, and friends, hoping to receive donations, arrange exchanges, or buy publications at a low price. Dr. Oliver Wendell Holmes once described how
Billings, while visiting his home, entered his library and immediately swooped
down on the most valuable things on his bookshelves. “Doctor Billings,” said Holmes, “is a bibliophile of such eminence that I regard him as a positive danger to the owner of a library, if he is ever let loose in it alone.” When the library published its 1873 catalogue, it consisted of two volumes, plus a supplement,
and Billings wrote… [Voiceover:] The library now contains about
25,000 volumes and 15,000 single pamphlets, including about seven hundred volumes of theses
of the Schools of Paris, Montpelier, and Strasbourg. As the existence in objects of the collection have become more widely known to the medical profession of the country, a steadily increasing interest in its progress
and completeness has been manifested. Not only did donations to the library increase, its patrons did, also. Many physicians from out of town came to use the library, some from as far away as Chicago. Billings also started to have exhibits displaying
some of the library’s treasures. One visitor was so impressed at seeing a
display of pamphlets which had belonged to the great French scientist, Claude Bernard, that he wrote an account for the 1878 Boston
Surgical and Medical Journal. Billings did not merely want to collect books,
he wanted the library’s collections used. The 1873 catalogue allowed readers to find
books, theses, and pamphlets by author, but it was not helpful for locating periodical
articles by subject. Billings’ next project, therefore, was to produce an Index Catalogue of the library’s holdings listing, in dictionary order, both monographs and periodical articles, the
books by author and subject, and the articles by subject only, in a single
alphabet. For Billings, it was a matter of making the
resources of the National Medical Library available to all physicians and scholars who
wanted to use them. Helping Billings and his staff in compiling
the Index Catalogue was Doctor Robert Fletcher, a scholarly gentleman who had emigrated from Great Britain to the United States in the 1840s, and joined the library in 1876. Fletcher became Billings’ chief assistant
and the two had a close working relationship for the next twenty years. Billings conceived and planned the work and Fletcher suggested the title, Index Medicus, a Monthly Classified Record of Current Medical
Literature of the World. Billings and Fletcher became co-editors of
the new journal, the first issue of which was dated January 31, 1879. In the introduction, Billings wrote… [Voiceover:] The Index Medicus will record
the titles of all new publications in Medicine, Surgery, and the collateral branches, received during the preceding month. These will be classed under subject headings, and will be followed by the titles of valuable
original articles upon the same subject. At the close of each yearly volume, a double
index of authors and subjects will be added, forming a complete bibliography of medicine
for the preceding year. [Narrator:] The Index Medicus would become the most widely used medical index in the world. Publication of the work was never a financially profitable venture, and, at times, this index to the world’s medical literature
almost ceased to exist. However, financial support from the Carnegie
Institution of Washington and the interest of the American Medical Association
assured its survival until the early 1960s, when the National Library of Medicine resumed
publication of the journal. Billings instituted a forerunner of today’s
inter-library loan system. On deposit of $50, physicians outside Washington
were allowed to borrow books from the library. William Osler, Howard Kelly, William Halstead,
Reginald Fitz, Walter Reed, Rudolph Mathis, and George Kriel were among those who took advantage of that privilege. Volume One of Billings’ Index Catalogue of
the library appeared in 1880. Consisting of 888 pages of text, preceded
by a 126-page list of the journals indexed, the volume contained only the entries from
“A” to “Berlinski.” Still, it included 9,090 author titles, representing
8,000 volumes and 6,000 pamphlets as well as 9,000 subject titles of books and
pamphlets, and 34,000 subject titles of articles in periodicals. By 1880, the collections of the National Medical
Library had grown so much, there was neither storage space nor working
room in the converted Ford’s Theatre Building. The medical museum on the third floor was
filling up with specimens, while the first floor was being used by clerks
searching Civil War records for pension applicants. Furthermore, although the building had brick
walls and concrete floors, the structure itself was not fireproof. Billings felt it was essential that the library
and museum have a new building. In order to urge Congress to pass legislation for the construction of a new building, Billings organized a lobbying campaign by
the medical profession which lasted more than three years. Finally, in 1885, Congress approved a bill
authorizing a new structure. Designed by Billings, the library museum building
was erected on the southeast corner of Seventh and Independence Avenue, today the site of the Hirshhorn Museum. And in August, 1887, Billings and his staff
moved in. This would be the home of the National Medical
Library for the next 75 years, until 1962, when it moved into its new quarters in Bethesda,
Maryland. A few years after the new library was opened
in 1891, Billings hired a young man who would soon
make his own contributions to medical bibliography and the history of
medicine. This was Fielding H. Garrison, who became
co-editor of the Index Medicus, editor of the Index Catalogue, and who published over 200 papers, including the well-known monograph, An Introduction to the History of Medicine. Billings had called the Index Catalogue project
his labor of love and in 1895, the final volume of the first series was published. William Osler considered the catalogue Billings float down to posterity. By this time, the library had more than 308,000
books and pamphlets and a survey revealed that the library’s holdings had surpassed those of all other medical repositories in the country. The Index Catalogue, therefore, provided access
to a truly great body of medical literature. William Osler declared that, “While the catalogue
only represents the contents of the library, it really is an exhaustive index of medical literature. So general were Dr. Billings’ interests, that
all departments of medicine are represented, and there is not a subject, as there is scarcely an author of note, ancient or modern, not in the catalogue.” In 1914, William H. Welch wrote, in the Johns Hopkins Hospital Bulletin, “I questioned whether America has made any larger contribution to medicine than that made by Billings in building up and developing the library
and in the publication of the Index Catalogue and the Index Medicus. That, in my judgment, is our greatest contribution
to medicine. And we owe it to this extraordinary man.” Billings’ work established his reputation
internationally and brought him numerous honors. In 1895, Colonel Billings retired from the
army and left the library. In Philadelphia, some two hundred fifty physicians
gathered to honor this remarkable individual with a testimonial. And, in a final tribute, they presented him
with a silver container, on which was engraved, “To John S. Billings, from 259 physicians of the United States and Great Britain in grateful recognition of his services to
medical scholars.” Inside was a check for ten thousand dollars. The three decades Billings spent building
the National Medical Library were not devoted only to the library and medical
bibliography. Billings also had other official assignments and was engaged in many other projects advancing
American medicine and public health. He was a member and Vice President of the1879
National Board of Health. He helped to reorganize the Marine Hospital
Service, the forerunner of the U.S. Public Health Service. From 1880 to 1912, he was consultant for the10th,
11th, and 12th U.S. Census. It was at the time of the 10th census in 1880,
that Billings proposed to Herman Hollerith, a special agent of the census office, the idea that led to the development of punch
card tabulation. Some years later, Hollerith formed the Tabulating
Machine Company, which eventually became the IBM Corporation. In 1883, the Army Medical Museum came under
Billings’ charge. And among his contributions here was the creation of the largest historical collection of microscopes in the world. Billings contributed significantly to the
field of medical education. He was Chief Medical Advisor to the President
of The Johns Hopkins University, and was instrumental in bringing Doctors William
Welch and William Osler to Johns Hopkins. He designed the Johns Hopkins Hospital and the Peter Bent Brigham Hospital in Boston, and he taught courses in the history of medicine. He planned the Laboratory of Hygiene at the University of Pennsylvania, and for a short period in 1895, he was Professor of Hygiene at that institution. Billings was also an influential member of
the Carnegie Institution of Washington for many years. Finally, after Billings left Washington, he
helped organize the New York Public Library. He designed its central building, became its first director, and induced Andrew Carnegie to support the institution, which Billings
then developed into the most prestigious public library system in the country. Endowed with uncommon qualities of leadership,
Billings’ achievements had a major impact on the development of American medicine and
public health. Billings had ideas, and he was a mover. In 1913, John Shaw Billings died and his friend
of many years, S. Weir Mitchell, recalled, “What was most exceptional in this man was the unfailing fund of energy on which he drew for every novel duty, and an industry which never seemed to need the refreshment of idleness. He had that rare gift: the industry of the minute.” [Music]

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