John Shaw Billings: 
Science and Medicine 
in the Gilded Age 
JAMES H. CASSEDY John Shaw Billings John Shaw Billings 
Science and Medicine in the Gilded Age 
James H. Cassedy 
Bethesda, Maryland 2009 ISBN: Hardcover 978-1-4415-9518-8 
Softcover 978-1-4415-9517-1 
This book was printed in the United States of America. 
Front cover: John Shaw Billings, from a painting by Cecelia Beaux, photograph by 
R. Cohen. Courtesy of the National Library of Medicine, Bethesda, Maryland. 
Back cover: The author, photograph by Grace Goldin. Reproduced by permission of 
David Goldin. 
To order additional copies of this book, contact: 
Xlibris Corporation 
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68639 Contents 
Introduction 7 
Chapter 1: Thirty Years in the Army Medical Department 13 
Chapter 2: Hygiene in the Postwar Army 36 
Chapter 3: Army Models for the Johns Hopkins 
Medical Institutions 36 
Chapter 4: Army Stimuli of Medical Knowledge and Change 75 
Chapter 5: Ventilation Technology, Sanitary Politics, and 
Professionalism 101 
Chapter 6: The National Board of Health: A Painful Experiment ...T31 
Chapter 7: The Transformation of Vital Statistics 161 
Chapter 8: National Vital Statistics and the Great Census of 1890... 190 
Chapter 9: Billings in Organized Medicine and Science 216 
Epilogue: Outside the Army; Other Paths to Science 239 Introduction 
Much has been written about John Shaw Billings (1838-1913) as a 
founder and builder of two great American libraries—the Army 
Medical Library and the New York Public Library—and oi the pioneering 
Johns Hopkins Hospital. In fact, for various reasons, Billings’s biographers 
have concentrated their scholarly attentions very largely on the details of 
those particular career accomplishments, thus giving extremely short shrift 
to a cluster of other major accomplishments for which Billings also gained 
great distinction during his lifetime. This book is intended to supplement or 
reverse the emphasis of those early studies by focussing principally on those 
neglected initiatives and pursuits, most of them scientific in nature. 
Accordingly, the book is an exploration of Billings’s roles as one of 
the most productive scientific and administrative leaders of the so-called 
“medical revolution” and the often closely related public health movement 
of post-Civil War America. As part of this, I aim to portray Billings as a 
participant in and major exponent of the period’s substantially growing 
federal presence, specifically the expansion of federal authority in health 
policy, medical institution-forming, and scientific ventures. In addition, 
I have presented the scientifically knowledgeable bureaucrat Billings as an 
authoritative and persuasive link between these federal health initiatives and 
the often separate worlds of private medicine and local public health. His 
individual scientific contributions, meanwhile, were products of the private 
world as much as of the governmental environment. 
I have not intended the volume to be a new biography of John Shaw 
Billings except in a limited sense. It makes no pretense of digging into the 
lives of Billings’s forbears, of following the steps of his education, or of tracing 
very much of his family and social life. It does not deal in detail, either 
with his Civil War surgical and hospital experiences or with his post-1895 
activities with the New York Public Library and the Carnegie Institution 
of Washington. 
Instead, I have concentrated upon the thirty-year time span of Billings’s 
career as a medical officer in the Washington office of the Army Surgeon 8 
Introduction 
General between 1865 and 1895, a period in which he was no longer 
involved in providing medical care to the troops. Given that freedom, Billings 
was enabled, at intervals between several highly challenging special Army 
assignments, to take advantage of other exceptional career opportunities 
both within and outside of the federal government. Some of those gave him 
immense influence and authority nationwide. But to bring them about, he 
had to make himself into what was a rarity among medical men, in this 
case, a surgeon who ultimately combined in one person the productive 
scientist, the energetic administrator, the planner and builder, the organizer 
and expert of a number of large scale medical and public health activities 
and institutions. Wearing these many hats, and enjoying the authority of 
the military, Billings had an enviable succession of accomplishments during 
these years, achievements that brought an abundance of honors, at home 
and abroad. At the same time, for some contemporaries, his relentless search 
for medical and scientific books and his vigorous organizational methods 
inevitably suggested to some extent the acquisitive traits of gilcied age 
industrialists, bankers, and empire builders. 
I have not presented Billings’s medical, health-related, and scientific 
pursuits through this thirty-year period in a strictly chronological manner. 
Rather, the work is composed of a series of more or less independent essays 
or chapters that are linked by a number of themes. Among these motifs are 
those of the growing introduction of science, statistics, and technology in 
medicine and public health; the continuing positive support given to Billings 
by the Army Medical Department; the extension of health professionalism; 
and the processes of adjustment during the transition between the sanitary 
era and that of bacteriology. However, the dominant theme through the 
book will be that of Billings’s forceful, highly informed, and confident 
impact on his superiors as well as his peers, his energizing of change in 
American medicine and public health through a bulldog-like insistance on 
adopting scientific ideas and administrative solutions within the frameworks 
of government, society, and professions. 
I have made no effort to treat several of Billings’s most noted achievements 
or institutions exhaustively, particularly those that have previously received 
considerable scholarly attention. Rather, my handling of such topics has 
been selective or in summary form unless there were corrections to be 
made or original material to introduce. For i nstance, I have deliberately not 
discussed the early Johns Hopkins Hospital in its entirety, but principally as 
it demonstrated Billings’s interest in design as a health factor and also as it 
became a climax in the Army’s development of model hospitals. With the Introduction 
9 
Surgeon General’s Library, in turn, in contrast to many previous authors, I 
have not attempted to deal substantially either with Billings’s routine activities 
in the library or with his exceptional innovations as a bibliographer. Rather, 
I have emphasized the library’s importance to professionals in medicine 
and the health sciences as well as Billings’s roles as the library’s builder and 
continuing publicist. I have also emphasized the library’s critical role in 
medical change, particularly as a prime agent in circulating the impulses of 
the medical revolution in the United States. Acknoivledgments 
In preparing this book, I have relied especially upon the large 
collections of Billings’s papers and publications at the National 
Library of Medicine and the New York Public Library, and to a lesser extent 
on collections at other libraries. Access to these materials would have been 
difficult or impossible without the assistance of the librarians at all of them. 
I owe a large debt to the authors of the two principal biographies of 
Billings. Fielding H. Garrison, in his John Shaw Billings, A Memoir (1915), 
produced a literate, penetrating, and charmingly urbane account of the 
man and his times, one which gained in authenticity and interest with its 
extensive selections from the Billings papers, and thus became a valuable 
primary source in itself. The biography by Carleton Chapman, Order Out of 
Chaos: John Shaw Billings and America’s Coming of Age (1994), is likewise an 
invaluable source of much interesting, valuable, and hard-to-find detail from 
a broad range of sources. Both works made it possible for me to concentrate 
on portions of the Billings story that their authors were not concerned with 
to any significant extent. 
In addition to the biographies, a number of institutional histories contain 
long and valuable sections on special phases of Billings’s career. These include 
Phyllis Dain’s history of the New York Public Library and two works by 
Wyndham Miles, one of them a history of the National Library of Medicine, 
and the other a study of the National Board of Health. Among the journal 
articles and other secondary works, I cite a considerable number of the most 
important and useful in the end-notes of the respective chapters. 
Over a span of years, I have greatly valued the lively interest that scholars, 
past and present, have taken in the various portions of this project. In 
addition, I have welcomed the give and take of scholarly discussion and 
comments that resulted from the various papers on Billings that I have 
presented at professional meetings. 
I especially thank my colleagues in the History of Medicine Division of 
the National Library of Medicine for generous assistance of various kinds. 
Young Rhee has provided invaluable guidance on using my computer and 12 
Acknowledgments 
in keeping it running. Margaret Kaiser, Betsy Tunis, Stephen Greenberg, 
Karen Pitts, Roxanne Beatty, and others have made innumerable searches 
for Billings materials in the stacks, sometimes beyond the call of duty. Two 
former staff historians, Manfred Waserman and Wyndham Miles, have 
shared their extensive knowledge of Billings with me as well as important 
materials from their private collections. At the same time, a succession 
of the scholar-chiefs of the History of Medicine Division—John Blake, 
John Parascandola, and Elizabeth Fee,—together with Phil Teigen, have 
appreciated the importance of the Billings project and have gone out of their 
way to assist it. I am also grateful to them and to other officials of this library 
for making it possible for me to have the necessary time for research and 
writing and for providing the project with substantial material support. In 
addition, employees in other divisions of the library have been encouraging 
with their interest, often by attending my occasional seminars and lectures 
on the library’s founding father and icon, John Shaw Billings. Finally, I am 
grateful to Carol Clausen for endless support, both in and away from NLM. 
Not least, she listened patiently to ten years of Billings anecdotes. Chapter 1 
Thirty Years in the Army Medical Department 
Between 1865 and 1895, John Shaw Billings, a career army medical 
officer, occupied a senior staff position in Washington, D.C., in 
the office of the Surgeon-General of the American Army. In this position , 
along with a handful of other senior officers, he assisted a succession of 
surgeons-general in running the post-Civil War Army’s Medical Department, 
still the country’s largest medical or health-related organization. However, for 
all but the first few months of Billings’s period of service in it, the Medical 
Department could not be compared in budget and size of its operations 
with those of the gigantic wartime medical empire that it succeeded. It was, 
rather, a period of belt-tightening, of making do with less, of looking for 
expedients, of piling more work on talented and dedicated staff members. 
Despite the difficulties, the energies and creativeness of this small band 
of aides enabled the Surgeon-General’s office to remain a major center of 
medical and public health activity in late nineteenth century America. A 
large factor in making this possible proved to be the staff officers’ collective 
interest in and receptiveness to the century’s wave of new scientific 
discoveries, methods and ideas related to medicine and health. In this and 
other ways, the senior staff thus from the beginning provided Billings with 
a strong supportive environment, especially for his extensive science-related 
investigations and innovations. 
This chapter outlines the basic chronology of Billings’s lengthy Army 
life along with short profiles of some of those individuals with whom he 
was associated with at that time. As such, it is intended to indicate the 
institutional and human framework within which he carried out many of his 
professional and science-related activities. Because of its primary function as a 
reminder of dates and synthesis of mostly familiar information, I have drawn 
the chapter heavily from standard secondary sources. However, the selection, 
emphasis, arrangement, and interpretation of material is my own. 14 
Thirty Years in the Army Medical Department 
An Army Surgeon becomes a Medical Administrator 
At the very end of December 1864, the Union Army’s Surgeon-General, 
Joseph K. Barnes, transferred Billings, then a 26 year old Assistant Surgeon, 
from service elsewhere in the army to duty in his office in Washington, 
D.C. He by no means intended Billings to be his personal aide-de-camp. 
Rather, he badly needed an upper level administrator. Barnes evidently had 
given much thought to this selection. With the Civil War slowly drawing 
to a close, he especially needed someone who, in the beginning, would be 
able to organize and manage the imminent demobilization of the Medical 
Department, and who could later plan and assume the management of 
other large projects. John Billings was clearly an officer with many such 
capabilities, and Barnes already knew a good deal about them. 1 
Billings had come to the Medical Department early in the Civil War 
with a record of having made the most of his sparse opportunities as a youth 
and young man, most of them in midcile America. In the tiny community 
of Allensville, in rural southeast Indiana, he had voraciously read everything 
he could find that might illuminate the world beyond the limited economic, 
geographical, and intellectual confines of the family home and village, and 
he had made up his mind early that he did not want to be a farmer. As 
with many youths of his generation, Billings’s early education, according 
to Carleton Chapman, seems to have been “haphazard.” However, it was 
augmented through some tutoring in Latin and Greek by the family’s 
Presbyterian minister, who found Billings to be a rapid learner with an 
unusually retentive memory. With that preparation, and with tuition fees 
apparently scraped together with difficulty by his father, owner of a small 
general store, he went on, during the 1850s, to obtain a classical education 
at Miami University, a few miles away in Oxford, Ohio. After graduation, 
he spent a year earning enough money to be able to go to medical school. 
While Billings’s horizons were broadened by the years at Miami, they 
expanded still further between 1858 and 1861, in Cincinnati. There, 
for the first time, he lived in a sizeable urban center (160,000 in 1860), 
1 Except where otherwise indicated, many details in this chapter are drawn from 
or based upon Carleton B. Chapman, Order Out of Chaos: John Shaw Billings 
and America’s Coming of Age (Boston: Boston Medical Library, 1994); and on 
Fielding H. Garrison, John Shaw Billings: A Memoir (New York: G. P. Putnam’s 
Sons, 1915). Thirty Years in the Army Medical Department 
15 
one with abundant cultural and educational institutions, with passionate 
debates going on over the slavery issue and over religious matters, and with 
vigorous commercial and industrial activity. The city’s continuing growth, 
in fact, was attested to by the arrivals of foreign immigrants and other new 
inhabitants, facilitated by Cincinnati’s bustling river transport and by several 
major railway lines. 
Of special significance for Billings, Cincinnati was relatively well supplied 
with most of the resources then considered necessary for the formal study 
and pursuit of medicine. It had a number of hospitals and an active board 
of health. Physicians, not only the regulars but those belonging to the 
current irregular medical bodies—eclectics, homeopaths and others—met 
in their separate medical societies in the city, while one or more of these 
groups published medical journals. There were also three medical schools. 
In 1858 Billings entered the oldest of these, The Medical School of Ohio, 
and over the next two years took the prescribed two full courses of lectures 
in the school buildings. He attended the surgical and clinical lectures at 
various hospitals, and during his second year served as interne at one of 
them, St. Johns Hotel for Invalids. Following graduation—he received his 
M.D. in March 1860—he was elected to the post of Resident Physician at 
Cincinnati’s Commercial Hospital, where he remained about six months. 
The Medical School of Ohio then appointed him to be demonstrator of 
anatomy, a position he held until the fall of 1861, when he resigned to apply 
for a commission in the medical corps of the Union army. 
Members of the Army Medical Department’s examining board that 
evaluated Billings’s application found that the instruction he had been 
provided with at the Ohio school ranked quite well compared with that 
at other American institutions. They held several of the school’s individual 
faculty members in high esteem, and they were impressed with the supporting 
testimonials that the latter sent for Billings. Even more impressive was 
Billings’s performance before the examining board in Washington, D.C. in 
November 1861, which gained top ranking for him among the candidates 
who were eventually accepted. Since the processing of new commissions was 
time consuming, he was first given a temporary appointment as a contract 
surgeon for a few months in early 1862. His ultimate commission as Assistant 
Surgeon and First Lieutenant, grades that he held throughout the war, was 
dated April 16 of that year. 
Much of Billings’s early experience in the Civil War was that of a military 
surgeon, though the authorities also often used him as a hospital administrator. 
He had varied assignments, first at back-of-the-lines general hospitals in or 16 
Thirty Years in the Army Medical Department 
near Washington and Philadelphia and later with front-line units of the 
Army of the Potomac that saw action at Gettysburg and Chancellorsville. 
However, in early 1864 he was removed almost entirely from further duty 
as surgeon or administrator of individual hospitals. In their place, he was 
given broader administrative duties on the staff of Thomas McParlin, Medical 
Director of the Army of the Potomac. His work there at first included some 
trouble-shooting tasks as an acting medical inspector. However, it steadily 
shifted to the sorting and analyzing of that Army’s hospital statistics and 
the preparation of its medical reports, tasks that he found interesting and 
challenging. Most important of these was the detailed report that Billings 
prepared for McParlin on the diseases and medical activities of the Army of 
the Potomac during 1864.2 It also proved significant in bringing more of 
his talents to the attention of Surgeon-General Barnes. In fact, it clinched 
the new position for him. 
Actually, by then, Billings had come to be known to his superiors as 
close to being the ideal army medical officer. He was valued as a first-class 
operating surgeon, one who was not only rapid in his operations but careful, 
as one who more than once drove himself to exhaustion. And, as hospital 
administrator, he was known to be systematic, disciplined, resourceful, 
and generally cool. Barnes himself had discovered that Billings was an 
officer on whom he could count, a self-starter who needed little direction 
or supervision. Other senior officers similarly marked his resourcefulness, 
self-assurance, and confidence. They also found him to be a dedicated and 
loyal officer, willing to take on any task, unsparing of himself. Some of the 
junior officers tended to resent him as an inevitable rival for promotions 
or as someone who tended to be invariably right about things. At the same 
time, still other junior officers were comfortable with his confident manner, 
competence, and projects for self-improvement, and became warm friends 
with him. Perfectionist that he clearly was, he could also be a charming 
companion for those who understood him and matched his tastes. And 
those who became his closest intimates might be invited to share one 
of his small-scale private pleasures; talks about good books or research 
instruments,celebratory events marked by drinks and cigars; occasional 
dinners at home with his wife and a few friends. 
2 Thomas McParlin, “Report of the Medical Director . . . January 14 to July 
31, 1864,” 11/28/1864, reprinted in The Medical and Surgical History of the 
Civil War, Vol. II (Wilmington, N.C.: Bradfoot, 1990), pp. 148-178. Thirty Years in the Army Medical Department 
17 
At the end of the Civil War the War Department recognized his various 
wartime services by brevetting Billings to the ranks of Captain, Major, and 
Lieutenant Colonel. And a year later, in 1866, his permanent rank was 
raised to Captain. Subsequent promotions, however, proved to be as slow 
in coming for him as for the rest of the regular officer corps, which then 
fluctuated between 150 and 200 or so surgeons nationwide. 
Billings reported for his new duties in the Surgeon-General’s Office the 
first week of January 1865. In assuming this position, he became one of 
the Medical Department’s most envied officers, for senior staff assignments 
seldom opened up. As early as 1863, he had wondered if he had any realistic 
chance of ever reaching and entering that “Elysium. ”3 Actual achievement 
of the goal meant various things to the fortunate career medical officers 
who were chosen. It represented an opportunity to work at the center of 
military medical power, and in some cases it enhanced an individual’s chances 
for eventual personal advancement. In addition, it offered opportunities 
for studying and doing research in the medical sciences. In Billings’s case, 
acceptance meant giving up further thoughts of a career in surgery or medical 
practice in favor of gaining an option to do scientific research as well as 
managing medical and public health activities. The Medical Department 
in 1865, and for some time to come, remained one of the few American 
medical enterprises large and complex enough to offer career opportunities 
to investigators as well as administrators.4 
For Billings, the new appointment also brought the opportunity to 
work closely with the Surgeon General himself, a man about whom he 
already knew much that was favorable. In 1865, Joseph K. Barnes was a 
large and impressively bearded man of forty-seven. At the beginning of the 
Civil War he had been a career medical officer with over twenty years of 
experience in the Medical Department. Some two years later, at the height 
3 Garrison, Billings, p. 46. 
4 For general histories of the Army Medical Department, see Mary C. Gillett, 
The Army Medical Department, 1818-1865 (Washington: Center of Military 
History, 1987); Mary C. Gillett, The Army Medical Department, 1865-1917 
(Washington: Center of Military History, 1995; James M. Phalen, Chiefs of 
the Medical Department, United States Army, 1775-1940 (Washington: Army 
Medical Library, 1940); and, for the medical museum, Robert S. Henry, The 
Armed Forces Institute of Pathology: Its First Century, 1862-1962 (Washington: 
Office of the Surgeon General, Department of the Army, 1964). 18 
Thirty Years in the Army Medical Department 
of the conflict, he became acting Surgeon-General to succeed the able but 
hot-tempered and controversial William A. Hammond, and in August 1864 
he was formally named to the post. Through the remainder of the war, Barnes 
demonstrated competence in running the Department, displayed flexibility 
and even-handedness in his leadership style, continued many of Hammond’s 
innovations, and, most important, put the Department on a solid basis 
through his excellent relations with the Secretary ofWar, Edwin M. Stanton. 
Fortunately for the Department, he was able to remain as Surgeon-General 
for seventeen years after the Civil War, until 1882, when he was retired for 
age. During that period the professional staff of the Surgeon-Generals Office 
found him to be supportive, firm without being oppressive, a superior who 
allowed his lieutenants to exercise much independent judgment. For Billings, 
Barnes also went on to become a primary role model as an administrator, one 
who exerted a greater influence on his career than any other single person, 
one who opened the way to incredible opportunities, and one whom the 
younger man regarded with much respect.5 
Notable among individuals already on Barnes’s staff when Billings arrived 
were three other career medical officers, each of whom remained in the office 
another fifteen or more years, dividing the principal administrative tasks 
with Billings and with him forming a productive if sometimes argumentative 
team. Charles H. Crane was a career military surgeon whose successive army 
appointments since 1847 included much administrative experience and, in 
the middle of the war, earned him appointment as Barnes’s principal assistant 
and then as his deputy. In turn, George A. Otis had brought to the office the 
intellectual advantage of a years medical study in Paris, together with civilian 
experience during the 1850s in private medical practice and as a medical editor; 
he had begun medical service in the Union army in 1861. The other member of 
this central body, Joseph J. Woodward, was appointed to the Surgeon-General’s 
staff in 1862 on the basis of experience in academic surgery as well as of his 
competence in microscopy and pathology; his early military duties had included 
the writing of official texts on camp diseases and on hospital management. 
Working sometimes separately and sometimes together during the war 
and then on postwar projects, these men of different talents and personalities 
were united by Barnes’s leadership and his confidence in their abilities. In 
7 There has been next to no historical attention given to Barnes or his work. 
For a short review, see Mary C. Gillett, “Joseph K. Barnes,” American National 
Biography (New York: Oxford University Press, 1999), Vol. 2, pp. 193-194. Thirty Years in the Army Medical Department 
19 
turn, they seem to have brought to their service in the Surgeon-General’s 
Office a fierce loyalty to Barnes and the Army, an unsparing work ethic, and 
a powerful commitment to the improvement both of the Department and ot 
medicine. From time to time other army surgeons appeared for assignments 
in the Office. While most of these remained only for short periods, Billings 
established lasting friendships with several of them, particularly Edward 
Curtis and Alfred A. Woodhull. Neither he nor the others were friendly 
with the over-pushy and ambitious senior surgeon Jedidiah Baxter, who was 
attached to the office for administrative reasons beginning in the 1870s.6 But 
it was the long-term team of four whose cumulative work counted most in 
support of Barnes’s efforts to maintain and update America’s postwar military 
medical establishment. And as such they were the ones most responsible for 
helping him to shape the Surgeon-General’s Office into a uniquely influential 
American center of medical and public health activity during the immediate 
post-Civil War decades. 
Billings’s earliest tasks for the Surgeon General included several familiar 
kinds of upper level office work, including assisting in the preparation and 
followup of Barnes’s orders and correspondence. However, virtually from 
the beginning Barnes began assigning him to special projects which gave 
him considerable administrative responsibility and independence. He also 
encouraged him to leave time for research. The overarching task facing 
Barnes and his staff in mid-1865 was the organizing and disposing of various 
medical loose ends of the Civil War even while starting to get on with the 
challenges of the present. The task had three large elements. One was to carry 
out the downsizing of the wartime Medical Department. Another consisted 
of ensuring the effective redeployment and servicing of the Department’s 
remaining medical forces and services that were to be attached to troop 
units country-wide. The third involved the continued development and 
management within the Surgeon-General’s Office itself of a number of 
scientific, editorial, and administrative projects and services. Barnes eventually 
gave Billings assignments in each of these three areas. As they unfolded, the 
assignments in time provided Billings with a rich base of experience and 
knowledge for the launching and management of even larger public health and 
medical institutions nationwide. They also provided him with opportunities 
for identifying and undertaking research in a range of sciences. 
6 Phelan, op.cit., pp. 62-65. 20 
Thirty Years in the Army Medical Department 
Downsizing the Civil War Armys Medical Department 
Billings’s first substantial administrative assignment was to settle the 
financial accounts of the War Departments numerous excess civilian contract 
surgeons who were being demobilized. This was a task that he carried out 
mainly in Washington. To handle it, Barnes gave Billings a force of clerks 
and found room for the unit in the Surgeon-General’s headquarters building. 
This was a rented structure across Pennsylvania Avenue from the United 
States Treasury, about as close to the geographical center of national power 
as one could get. There Billings worked intensively on this assignment for 
about two years and then on other assignments for another eighteen years, 
after which his offices were moved a few blocks away. 
Billings’s role with the contract surgeons involved supervising the 
detailed processing of forms and records, the satisfying of the requirements of 
legislators and auditors. He and his clerks worked with the contents of bulky 
bundles of official records shipped in from all over the United States. Their 
specific labors included verification of the details of each individual surgeon’s 
contract; sorting through affidavits of work actually performed; searching 
for certifications of payments made or due; spotting and correcting mistakes 
of spelling or arithmetic, and so on. All this was tedious and anything but 
heroic, but Billings seems to have been comfortable as well as competent in 
the work. Between January and June of 1865, his unit processed some 3500 
such accounts, and in the following year they completed another 1700 or 
so, but by 1867 this type of work tapered off to no more than a handful of 
accounts per year. 
The second and far larger of the downsizing assignments was that of 
managing the final disposal of the Department’s great wartime general 
hospitals. Within six months after the end of the war, virtually all of those 
institutions (there had been 193 in January 1865) had been emptied of 
patients, but the physical and administrative closure took longer. Initially, 
the winding up of the hospitals’ fiscal accounts had to be done. Increasingly, 
however, Billings’s unit had also to handle the disposition of the reusable or 
surplus hospital equipment, medical stores, and other property. The carrying 
out of these tasks again required close clerical scrutiny. It also involved 
extended correspondence, often with a variety of the former commanding 
officers, supply clerks, and others who had had property accountability at 
the hospitals. 
To get these things done, Barnes invested Billings with considerable 
special authority at various times during the 1860s and early ’70s to act for Thirty Years in the Army Medical Department 
21 
him in supervising or coordinating the medical supply system and disbursing 
activities. This included his filling in as acting Chief Medical Purveyor 
during extended periods when that official was absent. An important specific 
function was to direct the Department’s medical purveyors in inventorying 
and sorting the salvageable property of each of the general hospitals that were 
being closed in the latters’ respective districts. And when that was done, he 
made arrangements for disposition of the property, often by transfer from 
one medical depot to another. In addition, some of the property was turned 
over to the Army’s Quartermaster Corps, while much was sold at auction. 
Numerous auctions were held from the winter of 1865 through the end of 
June 1866, while even up into the 1870s the purveyors continued to hold 
such events periodically in order to dispose of their surpluses. 
Billings and his unit also exerted financial control over the substantial 
funds that were realized from these sales. While the major portion was 
turned over to the Treasury, a certain amount was retained for Departmental 
operations. Billings managed both the accessions to and the disbursements 
from this account in the Surgeon-General’s office. At the same time, acting 
for Barnes, Billings maintained central inventory scrutiny over the surplus 
items that the Medical Department retained at the respective medical 
depots for current or future use. This required extended discussion and 
correspondence with the Chief Medical Purveyor in New York, when there 
was one, but also with the other purveyors, those who had charge of medical 
depots in St. Louis, San Francisco, Philadelphia, and New York, depots that 
were retained after the war. 
Billings’s role in the procurement of certain types of new equipment 
was of much importance for the Department’s other medical officers. 
Close scrutiny of such transactions was imperative due to the Department’s 
persistent fiscal precariousness, a situation brought on by continued 
Congressional slashing of Army budgets and exacerbated by the nation’s 
economic depression of the early 1870s. Billings gained recognition for 
the thoroughness of his control, but he proved to be flexible when it was 
possible. He was likewise a hard bargainer who made every effort to obtain 
high value and low prices for the government from suppliers, particularly of 
such items as drugs, instruments and other equipment, and medical books. 
To this end, he studied the merchants’ catalogs and manufacturers’ samples 
with care and solicited opinions of products from colleagues and friends. 
When considering the purchase of medicinal liquors or wines, for instance, 
he commonly wrote both to the medical purveyors and to surgeons at field 
posts for advice as to taste and quality. 22 
Thirty Years in the Army Medical Department 
Special requests of the Department’s surgeons for personal hooks or 
items of professional equipment often required extra handling. Processing of 
requests for instruments involved Billings in extended correspondence both 
with the surgeon and the manufacturer or dealer if some unusual feature was 
needed. More than once, such negotiations left one or more of the parties 
testy and offended. As one irritated field surgeon put his particular complaint 
to Billings, “I will not bother your office with another special requisition .. . 
unless [it] would be granted without any sense of annoyance." 
In addition to such personal requests, colleagues frequently suggested 
to Billings that a particular textbook or instrument be ordered in bulk 
for distribution to some or all of the Department’s surgeons or be made 
available as a standard item on the official supply table. For many years 
Billings remained actively involved in the process of making decisions about 
such requests. And such decisions were not made lightly, for Departmental 
approval of medical textbooks, for instance, could result in orders of several 
hundred copies of a title to any given printer or dealer, sales which were 
obviously much sought-after. 
As an administrator, Billings quickly proved himself to be efficient, 
expeditious, and even-handed in performing the various downsizing and 
supply functions. He also apparently carried them out with few if any 
complaints on his part. Contrary to some of his biographers, in fact, he not 
only was comfortable with such chores but welcomed the challenges they 
presented. As such, he was undoubtedly a joy to his superiors, Barnes and 
Crane, who thus became the readier to give him even larger and tougher 
assignments. 
The early tasks likewise provided Billings with opportunities to become 
familiar with most of the Medical Department’s operations. Through them 
he came to know virtually all of the Department’s medical professionals 
around the country, as well as a significant proportion of the nation’s 
civilian suppliers of medical instruments, equipment, and books. Also, 
remarkably soon, these varied contacts proved of value in facilitating Billings’s 
intimate involvement in what became two of the Surgeon-General’s Office’s 
most innovative and important postwar activities.8 One of them was the 
Warren Webster to JSB, 3/21/1871, JSB papers NLM. 
8 1 have reconstructed Billings’s activities regarding downsizing and supply 
matters from an examination of his manuscript official correspondence for 
the period with army personnel, JSB papers NLiM. Thirty Years in the Army Medical Department 
23 
resumption of his pursuit of medical science through microscopy; the other 
was the buildup of a medical library that could stimulate and support medical 
reform and research. 
The Pursuit of Science and the Microscope 
Among the activities of the Surgeon-General’s Office that Billings and 
Barnes had managed to exempt from downsizing or worse were the two large 
interlocking scientific projects that had been begun during the war by then 
Surgeon-General Hammond and which Barnes had pledged to continue. 
One of these was the day-to-day buildup and operation of the Army Medical 
Museum. The other was the preparation, utilizing the Medical Department’s 
enormous store of wartime records and artifacts, of a comprehensive analysis 
and history of all medical and surgical aspects of the Civil War.9 
In the Museum, Billings’s colleagues, Woodward and Otis, for considerable 
time divided the responsibility for the ongoing collecting of pathological 
and surgical specimens from the war, their sorting and processing, their 
extended scientific study, and their public display. Woodward had charge 
of the medical objects and Otis the surgical, and usually they had one or 
more junior medical officers helping them. At the same time, they also 
jointly supervised the technicians and clerks who were gathering and sorting 
material, preparing photographs and charts, and analyzing the enormous 
quantities of information and data that were intended for the publication, 
sometime in the future, of the great multi-volume history. Contrary to what 
several of his biographers have suggested, Billings did not play a direct or 
major part in the preparation of that work, which ultimately was entitled 
The Medical and Surgical History of the War of the Rebellion. However, the 
editors frequently sought his informal help, while they also incorporated a 
sizeable number of his wartime case records and reports in their successive 
published volumes. 
In pursuing these projects, Woodward, Otis, and others found that their 
most essential instrument was the microscope, while sometimes their routine 
9 For the early history of the medical museum and the medical and surgical 
history project, see Henry, op. cit., pp. 1-105. See also James H. Cassedy, 
“Numbering the Norths Medical Events: Humanitarian ism and Science in Civil 
War Statistics,’ Bull. Hist. Med., Vol. 66 (1992), pp. 210-233; and Blustein, 
Life of William A. Hammond, pp. 53-93. 24 
Thirty Years in the Army Medical Department 
labors led to individual or group research on that instrument. Woodward in 
particular became engaged in exhaustive studies using ever more powerful 
microscopes equipped with the finest available objective lenses. As a part of 
that research, he, together with Edward Curtis, developed photomicrography 
to a point where it enhanced many of the photographs published in the 
History and helped Woodward gain professional standing as one of Americas 
leading postwar scientists.10 
Billings obviously at an early date found his way to the workshops of the 
History and the Museum, where he used every opportunity to become an 
expert in microscopy. Although he had no responsibilities with either of those 
two projects, he was interested in how microscopes and other instruments 
were being used in them. Inevitably he learned a good deal from Woodward, 
but apparently he made no attempt to work closely with the other man. He 
found Woodward difficult, as well as being limited in his perception of what 
the microscope might do for medicine. Nevertheless, during the periods 
when he was a procurement official, Billings had to work with Woodward 
and the other scientists in obtaining scientific equipment. As such, he quickly 
became adept in dickering with optical suppliers for microscopes and other 
instruments as well as in the testing of those items that were furnished on 
approval.11 Inevitably he took advantage of this proximity to improve his 
skills as an operator. And typically, in the late 1860s, after a regular work 
day, he could be found with Curtis or some other professional at the medical 
museum, increasing his competence in microscopic observation or testing 
some new instrument.12 
Apart from helping supply the microscopes needed by his associates 
in Washington, Billings became aware that some of his medical colleagues 
at the Army’s field posts were also interested in the instrument. Typical of 
10 For varied treatments of Woodward, see G. L’E Turner, “Dr. J. J. Woodward, 
Microscopist,” Proceedings of the Royal Microscopical Society,\o\. 1 (1966), pp. 
33-39; Leonard D. Heaton and Joe M. Blumberg, “Lt. Col. Joseph J. Woodward 
(1833-1884): U. S. Army Pathologist—Researcher—Photomicroscopist,” Milit. 
Med., Vol 131(1966), pp. 530-538; and Mary C. Gillett, “A Tale of Two 
Surgeons,” Medical Heritage, Vol. 1(1985), pp. 404-413. 
11 Woodward to JSB, 6/20/1868; and W. H. Walmsley to JSB to JSB, 4/10/1872; 
both items in JSB papers NLM. 
12 For a series of Billings’s early journal notes about these and other professional 
activities, see Garrison, Billings, pp. 142-150. Thirty Years in the Army Medical Department 
25 
those surgeons, individuals who were anxious to continue their scientific 
“studies” even out in the bleaker areas of the west, was Surgeon W. H. 
Gardner, who in 1868 was stationed at Fort Abercrombie in Dakota 
Territory. Gardner protested at length that only a “few of the simpler and 
most common apparatus of the Laboratory [are] furnished to Medical 
Officers, especially those of us who are so far away from where these 
things can be obtained.”13 Certainly, few of the surgeons could afford to 
buy their own instruments. 
Responding to such complaints, Billings was able, despite the budgetary 
constraints, to obtain limited supplies of certain new items of scientific 
apparatus and have them listed in the Medical Departments supply table, 
thus making them available to interested surgeons. His most conspicuous 
success in this was in gaining funds to purchase twenty all-purpose 
microscopes that were sturdy enough for use along the frontier. In the 
instructions to his English agent, he ordered ten microscopes at a cost of 
between 18 and 20 pounds each and ten between 9 and 10 pounds. He 
explained that they were intended mainly for diagnostic work, but “I also 
want them [to include] enough accessories to stimulate Medical Officers to 
use the instruments in general scientific research.”14 
When the instruments arrived from London, Billings promptly had 
them advertised in the supply table of July 1868. In that document, he 
informed the interested surgeons that “applications for microscopes will be 
favorably considered provided the evidences be satisfactory that the officers 
will use the instruments for the benefit of science.”15 And, when selections 
were made, Billings provided for each successful applicant to receive a copy 
of Lionel Beale’s pamphlet, How to Work with the Microscope. 16 
Also in the fall of 1868, Billings, by then a proficient microscopist 
himself, was given a special assignment that utilized those skills. This came 
about soon after the outbreak of a damaging mid-West epidemic of cattle 
diseases, one of which was identified as Spanish fever or Texas cattle disease, 
while the other was pleuropneumonia. Responding to the emergency, 
13 Gardner to JSB, 7/8/1868, JSB papers NLM. 
14 JSB to R. S. Maddox, undated draft letter (probably 1867), JSB papers 
NLM. 
15 GeorgeS. Rose to JSB, 7/25/1871, JSB papers NLM. 
16 J. K. Barnes, Instructions for Medical Officers to Whom a Microscope is Furnished 
(Washington: Surgeon General’s Office, War Department, 1868). 26 
Thirty Years in the Army Medical Department 
Horace Capron, the United States Commissioner of Agriculture, engaged 
the London veterinary surgeon John Gamgee, already in the United States, 
to make a broad general investigation of the causes, distribution, and 
character of the diseases together with possible remedies or preventive 
measures. In addition, Capron turned to the Army to provide experts 
who would work with Gamgee on the core medical-scientific aspects of 
the investigation.1 
Billings and Curtis were the officers selected for this highly specific 
task, to investigate “the question of the possible cryptogamic origin of 
cattle diseases.” Over the next several months, as a necessary preliminary 
step, the two combed the Washington area for as many species of fungi 
as they could locate. At the same time, Gamgee, then in Texas, also 
collected fungi, together with numerous samples of the blood and 
secretions from diseased cattle as did Army medical officers from the 
Southwest.18 They then sent the samples by express to Billings and Curtis 
in Washington, who carried out a variety of microscopic tests. During 
the same period, Billings worked out travel arrangements for the South 
Carolina botanist Henry Ravenel to go to Texas to assist Gamgee in the 
gathering of fungi.19 
In the late summer of 1869, the two army men informed Capron and 
Gamgee that their findings were essentially negative. They had discovered no 
fungi in the samples of blood and secretions and found no other connections 
between fungi and diseased cattle. Moreover, they concluded that, given the 
limited current state of knowledge, both of the nature of infectious agents 
and of microscopic methods, at least for this particular research problem, 
17 Department of Agriculture, Reports on Diseases of Cattle in the United States 
(Washington: G.P.O., 1869). 
18 See, for example, H. McElderry to JSB, 7/16/1869, JSB papers NLM. Curtis 
himself, posted briefly to Iowa in the middle of the project to photograph a total 
solar eclipse, sent back a few fungi. Curtis to JSB, 7/11/1869 and 7/25/1869, 
both in JSB papers NLM. For brief accounts of Curtis, see “Edward Curtis,” 
in Howard A. Kelly and Walter L. Burrage, Dictionary of American Medical 
Biography (Boston: Milford House, 1971), pp. 275-276; and Henry, Armed 
Forces Institute, pp. 36-44, 53. 
19 See Arny R. Childs, ed., The PrivateJournal ofHenryW Ravenel 1859-1887{ Columbia: 
University of South Carolina Press, 1947), pp. 332-352. Thirty Years in the Army Medical Department 
27 
studies using simpler instruments would probably for the near future remain 
“more efficacious than the microscope and ‘culture apparatus’.”20 
Lacking positive findings from Billings and Curtis on the causes of the 
respective cattle diseases, Gamgee’s final report to the Agriculture Department 
had relatively little influence, at least as far as suggesting effective public 
health management was concerned. However, for Billings, the assignment 
was distinctly positive in nature, at least initially. It introduced him to a 
research topic that was both fascinating and timely, as well as potentially 
vast. He followed the project up by writing a few short articles on the minute 
fungi, particularly for The American Naturalist, which brought him many 
indications of interest and support. Commissioner Capron, moreover, when 
thanking him for his collaboration, expressed the hope that Billings would 
be able “to continue [his] researches for the benefit of science.”21 
This was very much in accordance with Billings’s career wishes at that 
particular moment. In fact, before he and Curtis had completed even that 
one initial and limited aspect of the work, they had begun circulating a 
plan to follow it up with an ambitious collaborative research project aimed 
at “positively proving or disproving the notion of the causation of disease 
by fungi or algae.” In the hope of obtaining the “concurrent testimony of 
great numbers of experiments and observations,” they laid out a plan to 
enlist numerous physicians around the country as voluntary investigators 
on the project. Those researchers were to perform standardized microscopic 
experiments and send their results to the coordinators, Curtis and Billings, 
at their laboratories in the Surgeon General’s Office. The two army men felt 
that such an effort would not require researchers who insisted on employing 
the “highest powers of the microscope,” but only those who were “competent 
and willing [to use] a good working glass.” And they warned would-be 
collaborators that the most difficult part of their study would come near the 
end, when and if they began an actual attempt to prove a possible causative 
relationship of a fungus with a specific disease. Paraphrasing but adapting 
Jakob Henle’s classic microbiological challenge, they emphasized that the 
experimenter “must aim, having found his fungus, to isolate it in the form 
in which it occurs in or enters the body, and then by administration or 
20 J. S. Billings and Edward Curtis, “Report of Results of Examinations of Fluids 
of Diseased Cattle with Reference to Presence of Cryptogamic Growths,” in 
Department of Agriculture, Reports on Diseases of Cattle, pp. 174-190. 
21 Horace Capron to JSB, 2/5/1870, JSB papers NLM. 28 
Thirty Years in the Army Medical Department 
inoculation of it alone, to reproduce the disease in question. Such alone 
would be a decisive test.”22 
This proposal—at once enthusiastic, astoundingly ambitious, and 
strikingly original for the American biomedical scene at the time—was made 
public in 1869 in the transactions of the American Medical Association. 
The communication provided the specifics of Billings’s hopes for a possible 
career in microbiology and laboratory research. And it clearly identified 
Billings both as Curtis’s co-initiator of the proposal and as the intended 
co-manager and co-leading investigator of what they hoped would be a 
major research enterprise.23 
Among those replying, a variety of AMA members expressed support 
for the project. However, it soon became apparent that there were not yet 
enough available medical men in the United States who had the necessary 
microscopic skills or equipment. And, even more damaging, at some point 
in the early or mid-1870s, support for the project was discontinued in the 
Surgeon General’s Office, apparently for other reasons. It is likely that the 
Medical Department could not afford a project of this size, while in addition 
Barnes, for a change, may have been unwilling for Billings to take on another 
complex and long-continuing undertaking, particularly one that might well 
jeopardize the continued buildup of the Surgeon General’s library. Moreover, 
the proposal may well have also been actively disputed by Woodward, who 
had already shown himself to be a fierce opponent of anything at all related 
to the germ theory of disease causation.24 
This decision permanently crushed what hopes Billings had of 
contributing significantly as a laboratory investigator to the period’s epic 
scientific effort to unravel the unknowns associated with microscopic 
organisms, their nature, and their relationships to both human and animal 
22 Edward Curtis, “Cryptogamic Origin of Disease, With Special Reference to 
Recent Microscopic Investigations on that Subject,” Trans. ofA.M.A., Vol. 20 
(1869), pp. 469-472. Henle had outlined his postulates in his Pathologische 
Untersuchungen of 1840, while Robert Koch’s more explicit postulates 
were not published until 1878 in his Untersuchungen uber die Aetiologie der 
Wundinfectionskrankheiten. 
23 Curtis, “Cryptogamic Origin,” loc. cit., pp. 467-472. 
24 See, for instance, Mary C. Gillett, Army Medical Department 1865-1917, pp. 
28-31. For Woodward’s etiological views, see Gillett, “ hale of Two Surgeons,” 
loc. cit., passim. Thirty Years in the Army Medical Department 
29 
diseases.25 It did not, however, diminish his interest in science or his readiness 
to spur its applications to American medicine and public health. Moreover, 
he had already commited himself to the development of another, totally 
different type of resource under the umbrella of the Surgeon-General’s office. 
Beginnings of the Surgeon-Generals Medical Library 
and Other Initiatives 
The launching of the medical museum and the medical and surgical 
history project during the Civil War were of course not intended to be of use 
while the fighting was going on but to stimulate long-term improvements 
in the quality of American army medicine. Another part of that plan had 
projected the creation of an army medical school, but that failed to gain 
approval until 1893. However, the concept of a fourth unit, a medical library, 
though not originally projected, began to be bruited around by Barnes’s 
staffers around the end of the war. 
When Billings joineci Barnes’s staff, he found that various of the staff 
officers, in the pursuit of their duties, were occasionally ordering professional 
books and journals to add to the existing small office collection of something 
over 2,000 volumes. Over the next few years, as he carried on other procurement 
activities, most of this literature acquisition activity was informally turned over 
to him, to his evident satisfaction. Sometime in 1867 Barnes gave Billings 
formal responsibility for managing the collection and its use, and by 1870 he 
had given him both the authority and some funds to proceed with a systematic 
if initially slow expansion and development into an actual library. 
The importance of the library to the personnel of the Medical 
Department was evident from its beginning. Its journals and monographs 
became ever more essential working tools not only for Barnes but for the 
scholarly compilers of the Medical and Surgical History, the scientists in the 
museum, and not least, for Billings himself. They also became increasingly 
available and useful to the Department’s field surgeons, a significant number 
of whom had their own specialties or scientific interests. Ultimately a number 
of those surgeons were able to cooperate in Billings’s country-wide searches 
for hard-to-find journals and in other library tasks. 
25 Two decades or so later, however, Billings’s name appeared as sponsor in a few 
instances on the reports of laboratory investigations conducted by younger 
scientist colleagues. 30 
Thirty Years in the Army Medical Department 
Reflecting the original mission of the Medical Department, the 
early purchases for the Surgeon General’s Library were largely confined 
to textbooks and journals that dealt with sanitation, epidemiology, vital 
statistics, hygiene, field hospitals, and other aspects of military medicine. 
However, beginning in the early 1870s, Billings began to expand those 
collections rapidly and in many directions.26 
In 1867, several of the appendages of the Surgeon-General’s 
Office—among them the medical museum, the history project, the budding 
library, and the voluminous Civil War medical records, along with some 
of the staff members—were moved a few blocks into a recently renovated 
building that had become a Washington landmark. This was the former 
Ford’s Theatre, notorious as the site of Abraham Lincoln’s assassination 
in April 1865. The symbolism of moving these particular functions into a 
structure that was so highly charged with national emotions and memories 
cannot have been lost upon the Medical Department’s employees. But, 
the pressures of their postwar jobs left them little time to dwell upon that 
coincidence. 
After Billings’s downsizing responsibilities ended, and despite his work 
in the Library, the Surgeon-General occasionally turned other large Medical 
Department projects over to him, including that of conducting a major 
health survey of the Army’s nu merous field posts. In addition to such internal 
projects, moreover, Barnes and other Surgeons-General over the years agreed 
to a series of extended loans of Billings’s part-time scientific services, both 
to other federal agencies and to private institutions. Between 1869 and 
1872 alone, he made the latter available for assignments of several months 
each to the Department of Agriculture, the Treasury Department, and the 
ninth census. And later, in the seventies and eighties, Billings was loaned 
out for a number of largely scientific tasks, each of which stretched out 
for several years. Of particular significance were his assignments to various 
congressional committees, the trustees of the Johns Hopkins Hospital, the 
Johns Hopkins Medical School, the National Board of Health, the tenth 
and eleventh censuses, and the University of Pennsylvania. I will expand at 
length on those assignments in later chapters. 
26 I examine the growth and influence of the library in its later broader Army 
framework in my chapter 4. For its detailed history until the mid-twentieth 
century, see Wyndham B. Miles, A History of the National Library of Medicine 
(Bethesda, Md.: National Library of Medicine, 1982), pp. 1-183. Thirty Years in the Army Medical Department 
31 
Army officials, taking into account only his considerable contributions 
to the government, in 1876 promoted Billings to the permanent ranks of 
Major and Surgeon. In 1883, with the death of Otis and terminal illness of 
Woodward, they gave him lurther recognition and responsibility by making 
him director of a new division of the Surgeon-Generals Office, one that 
incorporated the medical museum as well as the library. He remained in that 
capacity until retirement, though there were several attempts during these 
years, by supporters both in and out of the Army, to obtain his appointment 
as Surgeon General. In professional and scientific circles, Billings was seen 
not only as being far better qualified than any of the medical officers who 
occupied that post in succession between Barnes’s 1882 retirement and the 
selection of George Sternberg in 1893, but as playing far more important 
roles in American medicine than any of them. The truth of it was, in fact, 
that he was far better known, wielded far greater influence in Congress and 
elsewhere, and was far more fully informed of the Army’s work than any 
other candidate. Nevertheless, all of the attempts on his behalf failed, mainly 
due to his lack of sufficient seniority. However, he was promoted one final 
time, shortly before his retirement in 1893, to the grades of Lieutenant 
Colonel and Deputy Surgeon-General. 
In making his loan arrangements, Billings made certain not to be 
away from Washington more than a very few days at a time. This made it 
possible for him to perform the bulk of the extra tasks at his own desk. It 
was important for him to remain close to Washington most of the time, 
first of all because the Army required it, but also because he liked the varied 
activity of the city. Besides, as long as he was in the running to become 
Surgeon General, he had to stay in close touch with key federal politicians 
and Army brass. Only in the 1890s, as his children grew up and began to 
move away, did he drop his candidacy for that top position in the Medical 
Department. And only then did he begin to seriously consider giving up his 
activities in medicine and science or moving to some site outside Washington 
and the Army. 
At Home in Postwar Washington 
Throughout most of his army and professional careers, Billings also 
had family responsibilities. In the fall of 1861, soon after coming to 
Washington to take the examinations for his Army commission, he met 
Katherine Stevens, the daughter of a retired lawyer and one-time Michigan 
congressman who lived in Georgetown, adjoining Washington. For much 32 
Thirty Years in the Army Medical Department 
of 1862 Billings and Kate courted during whatever intervals they could 
find between the former’s hectic surgical stints in the local army hospitals. 
In September, faced with his imminent transfer to a Philadelphia army 
hospital, the couple were married at St. John’s Episcopal Church in 
Georgetown. Subsequently, Kate sometimes joined her husband when 
he was on duty in Philadelphia and later in New York. However, during 
much of his war service she was back at the Georgetown family home on 
Congress Street. Billings joined her there for short periods during the war, 
at least twice to recuperate from stress or other illness, and they remained 
in that house and another temporary residence for several years after the 
war. Their first child, a girl, was born in 1863, while over the following 
nine years they had three more girls and a boy. 
During the early postwar period, the city of Georgetown held mixed 
attractions as a place in which to live. Still important as a Potomac river 
port, the community included a lively area of docks, warehouses, stables, 
and the like. Not far away from those, there was a commercial area that 
included numerous shops, some offering products of good quality. It also 
had three hotels that catered, among other clients, to travellers on the 
Chesapeake and Ohio Canal. Close to both of those areas were the small 
houses of tradespersons, servants, and the poor, while a bit further off, up 
the hill, were the fine large houses and gardens of the well-to-do. Many of 
the Georgetown streets, including principal routes that led out of town, 
were chronically muddy, rutted, or dusty, as well as infested with dogs and 
sometimes clogged with livestock being driven to market. In addition to its 
white middle class majority, the population included a mix of some poor 
whites, two or three thousand blacks, and, for the moment, a lingering 
white elite that was strongly Southern and anti-black in its sentiments. 
Politically, as Mary Mitchell and other historians agree, the town was 
predominantly conservative and Democratic, and it resisted incorporation 
of its government with that of Washington as long as possible, i.e. until a 
Congressionally-imposed merger took effect in the 1870s.27 
This paragraph owes much to Mary Mitchell, Chronicles of Georgetown Life 
1865-1900 (Cabin John, MD., and Washington, D.C.: Seven Locks Press, 
1986); and, in broader ways, to the work of Constance McLaughlin Green, 
Washington: A History of the Capital, 1800-1950, 2 vols.in 1 (Princeton: 
Princeton University Press, 1976). Thirty Years in the Army Medical Department 
33 
While their family was growing, Billings and Kate had little time or money 
for a social life, either within or outside the home. In any case, Billings was 
nearly always more inclined to spend any spare time at self-improvement than 
at “sociar affairs per se. Soon after beginning work in the Surgeon-General’s 
Office, he formed the habit of borrowing books on all kinds of subjects 
from the Library of Congress. Frequently, during the ’60s, he and other staff 
officers, especially Curtis and Woodhull, got together after work to discuss 
their reading. At other times Billings worked late at the museum with them 
on some experiment or other. And sometimes, as Garrison relates, he took 
portions of dog, mouse, or other animal cadavers home, where he practiced 
dissections or other procedures before breakfast. 
From time to time, Garrison also reported, Billings had dinner in town 
with one or more of his colleagues. Occasionally he went to their homes for 
cards, smoking, and often good conversation. However, when some of them 
went to Woodward’s, it generally seemed to be the host who “smoked and 
talked,” while the rest were reduced to smoking and listening. 
During the early 1870s, Billings and his family found their lives directly 
affected by local social change and politics. The District of Columbia’s 
new territorial government, now with jurisdiction over both Washington 
and Georgetown and under the ruthlessly energetic leadership of “Boss” 
Alexander Shepherd, launched a massive program of public works. By 1874 
the pursuit of this work had reduced the government to total bankruptcy 
and had forced Shepherd from office. However, in the process, the previously 
unprepossessing and sometimes squalid physical topography of large portions 
of the capital city, including Georgetown, had begun to be transformed. 
And with it, concrete evidences of the modern “sanitized” metropolis began 
to appear with the newly paved streets, sidewalks, parks, gas lights, and 
extended water, drainage and sewerage systems. 
At just this time, Billings and Kate, together with the latter’s sister and 
her husband, Oscar Stevens, decided to build adjoining twin houses in 
Georgetown to accommodate their increasing families. Begun in the fall or 
winter of 1872, the houses were completed in the spring of the next year. 
The families moved in immediately, though only to have to put up with the 
noisy and lengthy disruption caused by the coming of Shepherd’s sewer, water 
main, and paving construction to their block of Gay Street (later renamed 
N Street) soon afterward. Once the public works were completed, however, 
Gay Street and adjoining streets fairly rapidly became attractive, convenient, 
and congenial addresses for the growing numbers of professionals, army 34 
Thirty Years in the Army Medical Department 
officers, scientists, and middle-level bureaucrats who began moving into 
Georgetown.28 
In their new house, the Billingses, like many other career army couples, 
worked long and hard to raise their children decently on a meager salary.29 
They appear to have succeeded over the long run, but it was at a cost. For 
Billings himself, it was not a great sacrifice to do without most luxury items, 
and he got along throughout the entire period without owning horses and 
carriage. He liked cigars, and he took an occasional glass of whisky, but 
his single major indulgence in the new house seems to have been having 
a separate library room. As things turned out, the library seemed to have 
been rarely used for pleasurable or reflective reading, either by Billings or 
any other family member. Rather, it early became a room in which Billings 
closed himself up night after night away from the rest of the family to do 
work that he brought home from the office. Rosenberg has documented the 
permanent anguish that this compulsive pursuit of the work ethic inflicted 
on Billings’s son, while Chapman and other authors have suggested the 
probability of there having been even broader "ugly vistas of stress” in the 
relationships of the entire immediate Billings household.30 At least, given 
the demands of the situation, some such family arrangements and p roblems 
seem to have been prices that Billings elected to pay in exchange for success 
in his professional and public life. 
In this, of course, Billings differed little from many other men of his 
generation. In other respects, however, he stood out. His intimates, for 
instance, saw him as a husband with a deep love for his wife, a person who 
28 See account in Mitchell, Chronicles, passim. Billings and Stevens seem to have 
jointly drawn up the plans for the houses. During the 1870s and early 80s, 
they also were among several partners in the Washington Chemical Works, a 
venture which ended badly for all. Billings ultimately admitted to having had 
losses of over $5,000, while Stevens was said to have been completely ruined. 
JSB to E. L. Dubarry, 5/4/1885, JSB papers NLM. 
For a glimpse into some ot the family’s modest patterns of consumption, see 
“Household Account Book, 1874-1882,” JSB papers NYPL. See also Mitchell, 
Chronicle, p. 97, for a note on the involvement of Billings and his daughters 
in the Georgetown Assembly, where the social graces were taught. 
30 Charles E. Rosenberg, “Making it in Urban Medicine: A Career in the Age 
of Scientific Medicine," Bull. Hist. Med., Vol. 64 (1990), p. 185. Chapman, 
Order Out of Chaos, pp. 333-335. Thirty Years in the Army Medical Department 
was highly loyal to family and friends as well as to supervisors and professional 
associates. His friends were also sometimes treated to his humor. However, it 
remained that, with his relentless work ethic, he was not always easy either 
to live or work with. He expected others to live up to his own high standards 
and did not suffer laggards or fools gladly. 
Throughout his army career as well as in his involvements with 
other branches of government, academia, and the professions, Billings 
demonstrated high levels of focus and drive. It was also widely agreed that 
he cut an impressive figure. Possessed of a commanding physical appearance, 
a supreme self-confidence, and an awesome command of facts, he had an 
extraordinary presence as a leader. He was persuasive as a speaker, disciplined 
and self controlled almost always. He rarely displayed anger, discomfort, or 
pain. Not a religious man, Billings respected the beliefs of others. However, 
he was a veritable bulldog in pursuing his personal mission for the betterment 
of medicine and science. He also impressed his contemporaries with his 
ability to bridge the worlds of practical affairs and action with those of 
books and knowledge.31 
Billings’s resignation from the Army in 1895 marked the approaching 
end of his long period as an investigator and administrator in public health, 
medicine, and science, though he resumed science administration a few years 
later. He did not leave the army until after his children had reached adulthood 
and also not until he had carried out his objectives for the Surgeon-General 
and his Library as well as his commitments to other Washington agencies. 
I summarize his post-1895 activities briefly in an Epilogue. 
31 More extensive assessments of Billings as a person can be found in Garrison, 
Billings, and Chapman, Order Out of Chaos, and see also the numerous 
obituaries, many of which are cited in Frank B. Rogers, comp., Selected Papers 
of John Shaw Billings (Baltimore: Medical Library Association, 1965), pp. 
11-13. Chapter 2 
Hygiene in the Postivar Army 
By the end of 1866 Billings had substantially completed the downsizing 
of the Medical Department, but he did not yet have official clearance 
to go ahead with the library project. Actually, Barnes badly needed his help 
at just that time for another large project, charting the peacetime course 
of another of the Department’s major responsibilities. Specifically, new 
information had to be gathered pertaining to the Army’s arrangements for 
the medical care of the troops, now including those serving in the area of the 
former Confederacy as well as those in previous Union areas and in the vast 
territories of the West. As a result, over the next several years, Billings was 
managing a large fact-finding inquiry of the Department’s field activities in 
both public health and curative medicine, and in the process extended his 
inquiry much further than Barnes had in mind. His subsequent reports on 
his findings were, in fact, useful both to the postwar Army’s commanders and 
surgeons as well as to civilian physicians and sanitarians. 
Preventive Medicine as an Army Concern 
American Army medicine had traditionally consisted mainly in whatever 
curative measures and facilities the Medical Department had available 
for the sick or wounded soldiers, and those services in themselves needed 
constant attention and improvement. But Barnes, like Hammond, was one 
of those nineteenth century army medics who were convinced that curative 
medicine needed to be significantly supplemented by preventive medicine 
and hygiene. Further preventive measures, if carried out energetically, 
could conceivably allow Departmental budgets to go further. They might 
also offset some of the painful effects on the Department of downsizing, 
declining congressional appropriations, and numerous postwar resignations 
ot career medical officers. Hygiene in the Postwar Army 
37 
Prior to the Civil War, the individual post or field surgeons of the 
American Army’s Medical Department were responsible for hygienic 
measures only to a limited extent. Such surgeons had periodically vaccinated 
the troops in their units, and since 1819 they had kept standard records 
of diseases, deaths, and weather conditions, all of which were regularly 
reported to the Surgeon General. For the most part, however, it was only 
during epidemics or other sickly periods that they gave much attention to 
environmental conditions, contaminations of food and drink, inadequate 
clothing or bedding, ventilation of housing, or even to provisions for camp 
drainage and the disposal of human and animal wastes. Exacerbating this 
was the fact that medical advice offered by the army surgeons to their 
post commanders on these matters seems often to have been disregarded. 
Moreover, long established policy had placed the responsibility for some 
aspects of sanitation outside the Medical Department, particularly in the 
Quartermaster’s Department. 
Whatever the reason, apart from an occasional individual surgeon 
stationed at posts in or near large cities, the antebellum Army Medical 
Department seems to have shown no awareness of and taken no official role 
in America’s public health movement. In fact, even the national quarantine 
and sanitary conventions that were held between 1857 and I860 failed to 
obtain the participation of the Surgeon General or anyone from his office, 
either as delegate or participant. The Civil War, however, made possible the 
emergence of a large new appreciation of prevention within the Medical 
Department. Much of this resulted from the crusading impact of the civilians 
who made up the United States Sanitary Commission. Those individuals 
were considerably motivated by the example of Florence Nightingale and 
the information she had helped disseminate about the high rate of mortality 
of the British military forces in the Crimean War from rampant disease, a 
catastrophe that was widely attributed to gross unsanitary conditions. In 
an effort to prevent such a disaster in the United States, they persuaded 
some of the Union officials to accept their offer of sanitary advice, medical 
supplies, and humane services for the troops, and they ultimately got 
the Department to institute hygienic improvements in camp sanitation, 
hospital design, individual cleanliness and the like throughout the armies. 
Most important, probably, the Commission early in the war obtained the 
selection of William A. Hammond as the new Surgeon General. Despite 
his relatively short time in that post (one and a half years), Hammond had 
considerable success in implementing these sanitary measures even as he 38 
Hygiene in the Postwar Army 
organized the medical museum, planned the medical and surgical history, 
and initiated other changes.1 
Hammond also found time to write a primer on military medicine. In 
this 1863 work, his Treatise on Hygiene, he summarized current hygienic 
knowledge and health care methods for troops, particularly practices in the 
British, French, German, and other European armies. He also described 
preventive and sanitary procedures that he had already begun introducing 
in hospitals, barracks, and elsewhere in the Union’s wartime Medical 
Department, and which Barnes went on to continue. This text was a work 
that Billings and the other career medical officers and contract surgeons 
had been expected to read and follow as far as was feasible under battle 
conditions. With it, America’s large wartime military medical establishment 
went some distance toward endorsing and adopting the philosophy of 
military sanitation and preventive medicine that had taken root in England 
and on the European continent during the decades since John Pringle and 
since later hygienists of the Napoleonic era. However, after the ending of 
the war, it still remained for those principles to take widespread permanent 
hold in the peacetime army of the United States. Moreover, American 
military surgeons in any significant number, particularly those at the top, 
had yet to form effective links with the civilian leaders and institutions of 
1 See Blustein, Life of William A. Hammond, pp 53-93. Among useful general 
works, see Mary C. Gillett, The Army Medical Department, 1818-1865 
(Washington: Center of Military History, U. S. Army, 1987); Mary C. 
Gillett, The Army Medical Department, 1865-1917 (Washington: Center 
of Military History, U. S. Army, 1995); P. M. Ashburn, A History of the 
Medical Department of the United States Army {Boston: Houghton Mifflin, 
1929); and Stanhope Bayne-Jones, The Evolution of Preventive Medicine in the 
United States Army, 1607-1939 (Washington: G.P.O., 1968). For the Civil 
War, see Charles J. Stille, History of the United States Sanitary Commission 
(Philadelphia: Lippincott, 1866); William Q. Maxwell, Lincolns Fifth Wheel: 
The Political History of the United States Sanitary Commission (New York: 
Longman’s Green, 1956); and James H. Cassedy, “Numbering the North’s 
Medical Events: Humanitarianism and Science in Civil War Statistics,” Bull. 
Hist. Med., Vol. 66 (1992), pp. 210-233. For public health, see John Duffy, 
The Sanitarians: A History of American Public Health (Urbana: University of 
Illinois Press, 1990); and Wilson G. Smillie, Public Health: Its Promise for 
the Future (New York: Macmillan, 1955). Hygiene in the Postwar Army 
39 
the country’s public health movement.2 Billings, as it turned out, quickly 
assumed considerable leadership, both scientific and administrative, of that 
civilian movement even as he was helping to solidify the Army’s interest in 
preventive medicine. 
Sanitation of the Army Posts: A National Survey 
In 1867 Barnes began the process of extending the sanitary and hygienic 
practices of the Civil War armies to the numerous but mostly smaller field 
installations of the postwar army. He initially assigned Billings to look 
through the office files of reports from field medical officers for information 
about existing preventive practices. When very little turned up, he assigned 
Billings, very likely on the latter’s suggestion, to design and carry out what 
became in effect a comprehensive two-part survey of the situation, to suggest 
changes, and to edit and organize the collected material for publication. This 
survey, which Billings conducted principally in Washington from his desk 
in the Pennsylvania Avenue building, occupied large amounts of his time 
for the next seven years.3 
Some officers of the post-Civil War Army, of course, already had 
experience in or were newly involved in various kinds of surveys and other 
information-gathering enterprises, particularly in the West. Army engineers 
2 William A. Hammond, A Treatise on Hygiene, with Special Reference to the 
Military Service (Philadelphia: Lippincott, 1863). At the end of the war, Frank 
H. Hamilton dealt with the same subject in his A Treatise on Military Surgery 
and Hygiene (New York: Bailliere, 1865). A number of antebellum Americas 
civilian physicians and reformers had been interested in both personal and 
public hygiene, and several, among them John Bell, John Griscom, and Edward 
Jarvis, wrote on the subject. See discussion in James H. Cassedy, American 
Medicine and Statistical Thinking, 1800-1860 (Cambridge, Mass.: Harvard 
University Press, 1984), pp. 103-119. 
3 Billings’s biographers have touched only superficially if at all upon this project. 
For example, see Chapman, Order out of Chaos, pp. 83-85- My account of 
the survey is based largely on the two large reports by Billings: A Report on 
Barracks and Hospitals, with Descriptions of Military Posts, Circular No. 4, U.S. 
Surgeon-General’s Office (Washington: G.P.O., 1870); and A Report on the 
Hygiene of the United States Army, with Descriptions of Military Posts, Circular 
No. 8, U.S. Surgeon-General’s Office (Washington: G.P.O., 1875). 40 
FIygiene in the Postwar Army 
above all were in much demand to participate in official explorations and 
mapping expeditions, in the surveying of railway routes, and sometimes to 
support geological surveys and other scientific ventures. Moreover, surveys 
of army health were by means unknown in the Medical Department. 
To a certain extent, Barnes and Billings seem to have liked the idea 
of the survey as a means of providing general orientation material for 
medical officers going to new posts. They also viewed it as a means for the 
headquarters staff to improve its controls over the Department’s medical 
field operations around the United States. It was likewise thought of as a 
potential contribution to medical science and, as such, as a direct successor to 
three earlier Army health inquiries. Mandated by Surgeon-General Thomas 
Lawson, the first of those previous surveys had been conducted in 1840 by 
Samuel Forry and the others in 1856 and 1860 by Richard H. Coolidge.4 
Like those antebellum undertakings, the bulk of the material intended for 
inclusion in the new survey was to come from narrative, statistical, or other 
descriptions supplied by surgeons at the various army posts. 
Billings, as editor, however, was left free to expand or otherwise modify 
the post accounts as desired, as well as to comment upon their general 
significance. 
In the process his survey differed importantly from the earlier surveys 
in scientific purpose and in content. Forry and Coolidge had shaped their 
surveys to satisfy Lawson’s desire for exhaustive information on the medical 
climatology and topography of the posts and, by extension, of the various 
regions of the United States. They had intended them to shed light on and 
hopefully confirm some of the presumed relationships between disease and 
the physical environment through correlations of the posts’ vital statistics 
with their relevant meteorological data. As such, their reports had become 
4 Samuel Forry, Statistical Report on the Sickness and Mortality in the Army of 
the United States. . .from January, 1819, to January, 1839 (Washington: Jacob 
Gideon, 1840); Richard H. Coolidge, Statistical Report on the Sickness and 
Mortality in the Army of the United States . . . from January, 1839 to January, 
1855 (Washington: Nicholson, 1855); and Richard H. Coolidge, Statistical 
Report on the Sickness and Mortality in the Army of the United States . . . from 
January, 1855 to January, 1860 (Washington: Bowman, I860). An excellent 
study of the findings of those surveys for antebellum Texas posts is James O. 
Breeden, “Health of Early Texas: The Military Frontier,” Southwestern Hist. 
Q., Vol. LXXX (April 1977), pp. 357-398. Hygiene in the Postwar Army 
41 
parts of a landmark antebellum scientific study, one which brought the Army 
Medical Department much credit at the time. However, their material left 
more medical questions unanswered than they answered. By the Civil War, 
the army posts’ reports on climate, weather, and disease were proving far 
more useful to agriculture and commerce than they were to epidemiology. 
By the late 1860s, in fact, the Army had begun planning for a gradual 
transfer of the entire meteorological operation—the collection of data, 
reporting, collating, and publication—to the new Signal Office that was 
being organized elsewhere in the War Department.’ 
Billings therefore had considerable incentive to give a new thrust to his 
survey, though he did not at once repudiate all of the assumptions of the 
medical climatologists or topographers. In his basic plan, in fact, he allowed 
the field surgeons to incorporate in their reports a wide variety of traditional 
environmental background information about the posts: geographical 
settings, local flora and fauna, geological features, prevailing climates, and 
so on, including up-to-date mortality, morbidity, and meteorological data. 
But such information was no longer enough. Unlike Forry and Coolidge, 
therefore, Billings did not direct his main focus upon the climatic influences 
on health but on man-made influences. He based his inquiries less on 
abstract theories of disease than on specific measures intended to prevent 
disease. His general objective in the postwar period was still to uncover 
“facts bearing upon the hygiene of the posts and the sanitary condition of 
the troops,” but the thrust was to be a limited one, the targetting of selected 
kinds of facts.6 
To enhance the narrative accounts that were sent in, Billings went to 
some lengths to obtain in-scale drawings of the physical layouts of as many 
as possible of the posts, particularly the new ones in the west. Typical of 
the features that were indicated on these drawings were the posts’ barracks, 
officers’ quarters, stables, guard house, hospital, laundresses quarters, 
storage facilities, and post administrative office. Some also included 
cisterns or reservoirs, privies, wells, shops, parade grounds, and prominent 
topographical features, such as streams or hills. 
5 Edward Erskine Hume, “The Foundation of American Meteorology by the 
United States Army Medical Department,” Bull. Hist. Med., Vol. 8 (1940), 
pp. 202-238; James H. Cassedy, Medicine and American Growth, 1800-1860 
(Madison: University ol Wisconsin Press, 1986), pp. 29-32, 44-50. 
6 Billings, Barracks and Hospitals, p. vi. 42 
Hygiene in the Postwar Army 
Billings carried out his survey in two stages, the first between 1868 and 1870 
and the other immediately afterward during the years up to 1875. In each stage 
he focussed on certain selected problems of military preventive medicine, hardly 
touching at all upon sanitary matters for which the field surgeons were not then 
primarily responsible, such as water supply, drainage, and disposal of wastes. For 
the first stage of the investigation, Billings initially called upon the field surgeons 
to submit detailed information on the hygienic status of the post barracks and 
hospitals. He then spent nearly two years obtaining supplementary details on 
these matters from the posts as well as from the Surgeon-Generals Library and 
other Washington sources, and ultimately in editing the contributions and 
preparing his own introductory commentary on them. 
The reports that reached Billings generally confirmed outsiders’ impressions 
of the Army’s field posts as being frequently cramped, often pervaded by the 
noises and smells of animals, and sometimes filthy as places to live in. But no 
parts of the posts, he thought, posed as much danger healthwise as the barracks 
that were provided for enlisted men. From his own experience as well as from 
the reports, Billings picked out a number of barracks-related deficiencies for 
particular comment. Among them he briefly noted the frequent inadequacy of 
bathing facilities, the crude state both of the ou tdoor latrines and the occasional 
indoor toilets, and the extensive continued use of double-decked bunks, 
contrary to medical advice. But he was concerned above all by the presumed 
threat to health posed by excessive overcrowding and poor ventilation of 
barracks at many of the posts. As a result, he devoted his introductory essay 
for the first survey report largely to those dangers. 
In formulating his opinions on this matter, Billings drew on some of 
the best authorities of the day. The Surgeon-General’s Library already had 
some of the relevant works by French, German, and other continental 
hygienists. But he relied particularly upon the British findings, notably 
reports on ventilation standards that had been developed by Edmund A. 
Parkes of Britain’s Army Medical School and by a series of British government 
barracks commissions during the 1860s. Among American investigations, 
he drew upon some of the early findings of Morrill Wyman, but he gave his 
conclusions timeliness by commissioning up-to-date chemical tests and air 
space measurements at barracks on selected American posts. 
EdmundA. Parkes, A Manual of Practical Hygiene, 1st. Ed. (London: Churchill, 
1864); Sanitary Report on Barracks and Hospitals (London: 1861); Great 
Britain, Barrack and Hospital Improvement Commission, General Report [on] Hygiene in the Postwar Army 
43 
Billings’s survey confirmed that overcrowding and poor ventilation were 
indeed extremely widespread in America’s post-Civil War barracks. In brief, 
out of the 146 active army posts for which reports were submitted during 
the first phase of the survey, he found that only in 39 did the barracks 
meet or exceed the minimum of 600 cubic feet of air space per man that 
had become standard for the British. By the same standard, he deemed the 
space allowance in 61 other posts “insufficient”, while in another 46 it was 
“decidedly insufficient.” All in all, he concluded, the deficiencies clearly 
suggested an urgent need for hygienic “reform” in the American army, i.e. 
for improved design and construction of barracks.8 
While such statistics were compelling, the Army of 1870 had few funds 
to provide its barracks with better flues, ventilation systems, or stoves, let 
alone allocating more space per soldier. What money there was for such 
purposes had to be reserved for those posts that had the most sickness from 
overcrowding and poor ventilation but which were also strategically and 
geographically crucial to the Army’s current pursuit of the Indian wars. 
Billings’s survey results provided the army with a basis for selecting those 
posts. And in his 1870 report he outlined some of the reasoning by which 
these criteria had been applied to the Army’s four main types or classes of 
military posts.9 Most forts in the oldest class, he pointed out, the coastal 
defense installations along the Atlantic and Gulf coasts and the Great Lakes, 
would ordinarily have demanded attention because of the well-known 
unhealthfulness of their typically damp and cramped barracks in stone 
casemates. However, in 1870, many such posts, located far from the areas of 
current hostilities, were no longer active. Accordingly, having been stripped 
of all but a few caretaker troops, for the time being they had virtually no 
claim to priority for sanitary improvement. 
Forts of the other three classes, well over half of those reported on, were 
highly active since they were mostly located in the West, close to or in the 
the Sanitary Condition of Barracks and Hospitals (London: H.M. Stationery 
Office, 1861-1863); Morrill Wyman, A Practical Treatise on Ventilation 
(Boston: Munroe, 1846). Billings also acknowledged the influence of Florence 
Nightingale and various of her publications, including her Notes on Hospitals, 
3rd. Ed. (London: Longman’s Green, 1863). See Billings, Barracks and 
Hospitals, pp. v-xxxiii. 
8 Ibid., pp. xiv-xv. 
9 Ibid., p. xv. 44 
Hygiene in the Postwar Army 
midst of the active fighting against the Indians. This location alone gave them 
special significance and prominence in both portions of Billings’s survey. 
His second class included depots for recruits and staging sites for the troops 
that were being moved from the South and East to the West or from one 
place to another in the West. The records showed that these posts habitually 
experienced the worst overcrowding and most frequent disease outbreaks 
and should thus have high priority attention. Fortunately, Billings thought, 
these conditions could be easily and inexpensively improved, principally by 
building more barracks. 
In the third class of posts were the permanent and semi-permanent 
cantonments of the frontier areas, each of them accommodating from two to 
six companies of troops. These also suffered much illness from overcrowding 
and poorly constructed barracks. And here, too, Billings felt that at that 
time, adding more and better barracks was the only remedy that was feasible 
as well as effective. 
The fourth class of army installation consisted of the rough temporary 
garrisons or camps that were built hastily near points of Indian warfare and 
often just as quickly abandoned. Under these conditions, there was little one 
could do to improve the barracks at such posts, even though they tended to 
be badly overcrowded and smoke-filled, while the chinks in their walls made 
them bitterly cold in the winter. However, Billings felt that the resulting 
abundance of fresh air in such barracks could be regarded as a significant 
hygienic compensation. 
He also pointed out the fact that under the fast-moving military 
circumstances, the current construction needs of front-line Army units 
were for carpenters rather than architects. But he reminded his superiors 
that the eventual end of hostilities would require the adoption of informed 
hygienic barracks planning and design in the West as well as elsewhere. His 
first survey report therefore included much detail on the principles of air 
circulation, devices for ventilating barracks in both warm and cold weather, 
and illustrations of recommended stoves, flues, and other equipment. In 
the process, he outlined the basics of a functional barracks design: simple, 
practical, and economical, as well as presumably effective in minimizing 
or warding off the common communicable diseases, according to the age’s 
etiological beliefs,. However, while making these observations Billings 
had to tread carefully in making significant criticisms. This was necessary 
because the army agency in charge of barracks design and construction was 
not the Medical Department but the Quartermaster’s Department; and the 
Quartermaster General, Montgomery C. Meigs, with his eminence as an Hygiene in the Postwar Army 
45 
engineer and architect, understandably retained much proprietary interest 
in such matters.10 
The hygienic situations of post hospitals differed little from those of the 
barracks, at least as shown in the first phase of Billings’s survey. They, too, 
were affected by the various combinations of geography, military strategy, 
and army turf politics, as well as by epidemiological considerations. And 
with such buildings as well, he was above all concerned with structural 
factors, with matters of design, amounts of air space per occupant, 
and provisions for ventilation or, in short, with achieving the planned 
prevention of hospital infection. Post surgeons at new and temporary 
camps in the West used their reports to draw Washington’s attention to 
the often inadequate makeshift hospital structures in which they had to 
function, variously with leaking roofs, dirt floors, and poor facilities. 
However, Billings particularly aimed in his first stage report to illuminate 
the health status of those army hospitals that had been planned and for 
which builders’ designs existed. Thus, to augment the post surgeons’ 
narrative descriptions of those hospitals, he went out of his way to illustrate 
the accounts with floor plans where they could be found. The result was 
an unusual collective summation of the hygienic status and experience of 
a considerable chain of very small hospitals. 
Little if any effective American effort at military hospital standardization 
had been made prior to the Civil ’War.11 While Hammond had first 
spurred this process, it was Barnes again who continued this impetus 
and carried it into the postwar period. Joseph J. Woodward emerged as 
Barnes’s principal hospital planner during the war.12 Subsequently, in the 
10 H. C. Abbot, "Montgomery C. Meigs,” in National Academy of Sciences, 
Biographical Memoirs, Vol. Ill, 1895. 
11 Various suggestions for improved military hospital design and ventilation 
were made by military surgeons of the Revolutionary and early Republican 
periods, among them Edward Cutbush and James Tilton. However, few if any 
were tested sufficiently to gain acceptance as official standards. For a short 
commentary, see Cassedy, Medicine and American Growth, pp. 14-23. 
12 Woodward gained authority in this area through his two wartime volumes: 
Outline of the Chief Camp Diseases of the United States Armies (Philadelphia: 
Lippincott, 1863); and The Hospital Stewards Manual (Philadelphia: Lippincott, 
1863). See also, Woodward, “Hospital Organization and Construction,” in 
Surgeon-General’s Office, Circular No. G(Philadelphia: Lippincott, 1865); and 46 
Hygiene in the Postwar Army 
mid-1860s and 1870s, Woodward was joined by Billings and others in the 
Surgeon-General’s Office in drafting successive official documents on the 
subject. These circulars provided standard specifications for various sizes 
of small hospitals, though most of those actually built during the period 
were for 12 or 24 beds. 
Around 1870 these planning activities gained added significance by 
attempts within the Medical Department to take over from the Quartermaster’s 
Department at least some of the authority to build and repair hospitals.13 In 
any case, in 1870, in his first survey report, Billings urged all Army hospital 
builders to follow the Surgeon-General’s Circular No.4 of 1867. This was 
a document that he and his colleagues had participated in preparing. And 
now it was their “Bible”, a document that they then believed “embodied the 
true of hospital construction.’’ Drawing from that document, he 
endorsed the pavilion style of Florence Nightingale as well as of the French 
and British authorities as the “model” for American military hospitals. Fie 
went on to review that style’s by-then familiar specifications: a small isolated 
structure or cluster of small structures, built if possible with non-absorbent 
walls and floors with no cracks, but well-ventilated, and generously provided 
with at least 1200 cubic feet of air space for each bed. 
When he examined the post reports and hospital plans, Billings found 
that only a few American army hospitals met or came close to those European 
standards. He dismissed the plans of others as examples of “how not to 
do it.” In some post-war hospitals the standards and specifications proved 
to have actually been altered or ignored by outside building contractors, 
particular where there had been no medical advice or supervision. However, 
by far the largest number, he observed, were built according to no special 
plan at all. Nevertheless, whatever their defects, even those structures, being 
mostly small in size and presumably not conducive to far-reaching hospital 
infections, could still be regarded as being as satisfactory as the typical 
cottage hospital of the English. This conclusion was borne out, he argued, 
by the overall mortality statistics of the American military hospitals, which 
actually compared favorably with data of private hospitals in the United 
States and Europe.14 
United States Surgeon-General’s Office, Approved Plans and Specifications for 
Post Hospitals (Washington: Surgeon-General’s Office, 1871). 
13 Gillett, Medical Department, 1865-1917’, p. 4. 
14 Billings, Barracks and Hospitals, pp. xx-xxiii. Hygiene in the Postwar Army 
47 
In 1870 Billings completed the editing and publishing of the information 
he had assembled during this first phase of his survey. This done, he 
immediately began collecting material for the second phase. In this latter 
phase, he aimed to draw attention to two additional aspects of military 
hygiene, food and clothing, and to a lesser extent on the almost non-existant 
hygiene of guard-houses, while he also updated some of his earlier findings 
on hospitals and barracks. He had little fault to find with Army clothing, 
which seemed to have been steadily improving in quality. And the same was 
true of food, in sharp contrast with the state of barracks hygiene. Billings 
here in effect continued to be of the opinion that in America “we have the 
best-fed and the worst-housed Army in the world.”13 While he found that 
the use of double-deck bunks was becoming much less and also that other 
improvements had been made in barracks, overcrowding continued to be 
a grave problem. Yet, even within the Army leadership, there were some 
planners who did not yet take that problem seriously. One new proposal for 
barracks construction that he found being circulated at this time not only 
provided for sub-standard amounts of air space in the barracks but made 
“no arrangements for ventilation and no provision for bath-rooms.”16 
At the same time, some of Billings’s initial assumptions about these 
matters were being overtaken by new knowledge. In fact, almost before the 
ink was dry on the 1870 report, the Army’s official position on hospital 
hygiene had to be reformulated in some fundamental respects. This was 
necessitated by the completion in the Surgeon-General’s Office of analyses 
of Civil War statistics of hospital morbidity and mortality, together with 
the publication abroad of similar data on European wars. As he worked up 
his second report, then, Billings had to admit that Nightingale’s pavilion 
plan, “which for a time was supposed to be a perfect panacea against all evil, 
has been found, by sad experience, to furnish no security against the evils 
[of] ‘hospitalism’.” Admitting also, along with physicians everywhere, the 
continuing basic lack of factual knowledge about the causation and spread 
of communicable diseases, he had to explain that for the time being any 
specifications for hospitals would have to remain provisional. Thus the new 
provisional model in the American Army was to be the “barrack hospital,” 
of which Billings considered the chief virtue to be the fact that they would 
be “temporary wooden structures.” Intended to last but ten or twelve years, 
13 Ibid., p.xxxii. 
16 Billings, Report on Hygiene, p.ix. 48 
Hygiene in the Postwar Army 
they offered the hope of keeping the dangers of hospital infections to a 
minimum, at least in the small western garrisons.17 
When Billings summed up matters in 1875, at the end of the surveys 
second phase, he felt that the hygienic outlook for the field posts had already 
been improved, especially by two War Department administrative changes 
made partly as a result of the exposes and recommendations of the 1870 report. 
Through the first, post commanders were now required to give at least some 
consideration to the suggestions of post surgeons for hospital construction 
or repair and to their other medical advice. But even more significant, he 
thought, was a 1874 order that began to broaden the work of those surgeons 
by giving them additional duties as “sanitary officers”, with oversight not 
merely within the hospitals but over all aspects of post hygiene.18 
Whatever his own views on preventive medicine and hygiene were when 
he began his survey in 1868, Billings came to believe that army line officers 
as well as medical officers had responsibilities along those lines. He did 
not claim that cleanliness was next to godliness. Nevertheless, he argued, 
passionately for him, that the modern Army must embrace all aspects of 
Victorian hygienic idealism, if possible even at the most remote frontier posts: 
“Next to fresh air and proper food, personal cleanliness is the 
most important agent in preserving the mind and body in proper 
working order, and it is not only a duty, but in the highest degree 
good policy and economy, on the part of the Government, to 
provide the necessary facilities. A dirty man will, in most cases, be 
a discontented, disagreeable, and dissolute man; for the condition 
of his skin has much more to do with a man’s morals than is 
generally supposed.”19 
Physical Location, Morale, and Health Calculus of 
the Western Posts 
The official reports that the post surgeons sent to Washington for the 
post health survey did not, of course, reveal the senders’ personal feelings or 
mental states. However, the reports did include information having to do 
17 Ibid., pp. liv-lv. 
18 Ibid., pp. v-vii, xviii-xix, liv. 
19 Ibid., p. x. Hygiene in the Postwar Army 
49 
with post locations and communications arrangements, factors that often 
influenced those feelings or states. Moreover, the reports were significantly 
supplemented, at least as historical records, by the extensive informal 
correspondence during the same period between Billings and the individual 
military surgeons at posts all around the United States, many of whom 
were his long-term service colleagues and friends. Since the operations of 
the Medical Department as well as of the Army generally were so heavily 
centered in the West during this period, I will limit my discussion here to 
morale problems of that regions posts as revealed in the correspondence of 
selecteci surgeons.20 
These letters reveal Billings managing his survey of western military 
medicine almost entirely from his desk in Washington. And, taken together, 
they hint at his feelings about the West. They suggest an unromantic man 
who, having earlier in life escaped from the hardships and cultural aridity 
of rural Indiana, not far back of the frontier, had no desire to go back to the 
West. At the same time, however, the letters reveal that the career surgeons 
in the West had a very considerable admiration for, confidence in, and 
dependence on Billings, so much that they often felt free to lay bare to him 
some of their most personal emotions, problems, and needs. 
William Goetzmann, a few years ago, characterized post-Civil War 
military service along the Western frontier as a new chance for the professional 
soldier to gain glory or at least to take part in “a great and inevitable epic 
adventure.”21 But western service in the Army’s Medical Department seems 
to have offered a much more restricted range of opportunities. Perhaps a 
few surgeons did hope to gain glory. And some were undoubtedly happy to 
get the occasional chance to look for specimens of the local flora and fauna 
or to explore the geology. However, a substantial proportion were known 
to have predominantly negative sentiments about their western experience. 
In particular, those who had scholarly pretensions or medical ambitions 
made no secret of their feeling that assignments to such duty were like being 
sentenced to exile. Among them, those whose medical tasks were largely 
20 These manuscripts are in the JSB papers, NLM. 
21 William H. Goetzmann, Exploration and Empire: The Explorer and the Scientist 
in the Winning of the West (New York: Knopf, 1966), p. 391. For other 
dimensions of the western military presence during this period, see Robert 
Utley, Frontier Regulars: The United States Army and the Indians, 1866-1890 
(New York: 1973). 50 
Hygiene in the Postwar Army 
confined to the tiny frontier garrisons found their lives severely circumscribed 
and filled with drab routine. 
Accordingly, the letters of such surgeons to Billings were often gloomy 
and pessimistic, dwelling on such matters as the harshness of the weather, 
the spartan character of their living accommodations, their isolation from 
the medical life and “civilization” of the East and North, and the frequent 
barrenness of the landscapes. The surgeons also wrote him about such things 
as the depressions they went through when separated for long periods from 
families and friends; about the intermittent frightful deaths of colleagues 
in military ambushes or engagements; but, more often, about the pervasive 
boredom of it all. 
Well aware of Billings’s influential position in procurement and supply 
matters, some of the surgeons complained about the chronically decrepit 
state of their hospitals and made sure to refer in their personal letters to their 
pending official requisitions for clinical thermometers, steam atomizers, 
surgical instruments, and other equipment. Others lamented the built-in 
obstacles that the frontier posts posed to scientific activity or professional 
improvement of any kind and begged Billings to help them somehow. In sum, 
as Surgeon Ely McClellan scribbled to Billings in 1869 from Fort Garland 
in Colorado Territory, “one gets wonderfully demoralized out here.” Like 
not a few of his colleagues around the frontier, McClellan added that from 
time to time he found himself wondering if he would “ever be fortunate 
enough to return to paradise,” i.e. to the East, or whether he might somehow 
be forgotten by Washington and left in permanent exile.22 
Through these postwar years, then, Billings was the confidant and 
advisor of many of these field surgeons, and sometimes he served as an 
intermediary for the exchange of news about distant army colleagues. Often 
he was called on to explain the fine points of new departmental regulations, 
to find out what he could about the surgeons’ chances of getting leave or 
being reassigned to some new post, or to do more tangible favors. Among the 
latter, when it was possible, he ordered needed books, got broken instruments 
repaired or replaced, or needled the Quartermaster’s Department to carry 
out promised repairs to post hospitals. Billings became known to frontier 
surgeons as their most useful and authoritative contact back in Washington, 
22 McClellan to JSB, April 4, 1869,JSB papers, NLM. For other aspects of frontier 
medicine, see James O. Breeden, ed., Medicine in the West (Manhattan, Kansas: 
Sunflower University Press, 1982). Hygiene in the Postwar Army 
51 
often simply because he was “located at the focus of all official intelligence.” 
One correspondent wrote that Billings’s favors were “vitally important to the 
happiness and success ol a frontier officer.” And arrivals of his letters were 
in themselves welcome events because they brought news of the outside 
world to the many who felt that “we are almost out of the world here.” As 
time went by, however, during the 1870s, both their frequency and their 
personal warmth tapered off to some extent as Billings’s other assignments 
multiplied and consumed more of his time.23 
Central to the depression and sense of isolation that weighed on many 
of the western surgeons throughout the 1860s and ’70s, just as before the 
war, were the great distances of most of the posts from each other as well 
as from sizeable civilian communities. A large part of the problem was the 
painfully slow pace of moving to and Irom or otherwise communicating with 
that outside “civilized” world. Back in Washington, Billings early realized 
that these same factors compounded the difficulties of gathering accurate 
and timely information for his surveys. It was evident, moreover, that at 
least for the present, adverse geographical and logistical situations seriously 
interfered with his efforts as purveying coordinator to get even the most 
basic medical supply items to the western posts on any regular or expeditious 
basis. They also made it unrealistic for him to expect to be able to bring 
about any extensive hygienic improvement at field installations overnight. 
Nevertheless, in the hope of stimulating some kind of improvement in the 
situation, he planned the surveys so as to make the existing physical realities 
and limitations of medicine at such posts perfectly clear to other military 
planners in Washington. 
For the first phase of his survey, then, between 1868 and 1870, Billings 
urged the field surgeons to include in their reports and letters all possible 
data pertaining to the geographical situations and medical logistics of the 
posts. The latter responded with an abundance of data that made clear the 
still formidable distances to or from the closest cities, to the nearest posts 
that could be called upon in emergencies, and from the regional medical 
supply depots. They also provided information about the mail service and 
other modes of communication and transport. And some mentioned the 
presence or absence of railroads. 
23 Warren Webster to JSB, Jan. 28, 1869, and July 24, 1868; H. Stille to JSB, 
April 30, 1868; all in JSB papers, NLM. 52 
Hygiene in the Postwar Army 
Whether it was acknowledged as such or not, the post-Civil War prospect 
of the coming of the railroad into trans-Mississippi America quickly became 
a central consideration, alternately hopeful and discouraging, in the thinking 
and reporting of the western surgeons. It likewise became an increasingly 
potent ingredient for Billings and others at the Surgeon-General’s office who 
were involved in the army’s medical planning for the Indian wars. The general 
symbiotic relationship of the army and the railroads in the process of opening 
up of the West is, of course, well known. Railroad builders depended on 
detachments of Army troops for protection during the construction stages, 
while Army commanders looked forward to ever more rapid rail transport 
to hasten the movement of troops and supplies into the area and generally 
to prosecute the wars. 
In turn, military medical personnel at all levels also had a stake in the 
rapid coming of the railroad. Front line medical officers in particular saw 
it not as some abstract symbol of the changing West but as a concrete 
agent that could help in offsetting if not eradicating the harsh and hostile 
features of the frontier, for themselves as well as for the troops. At that early 
date, before the various rail lines were completed and began taking large 
quantities of people into the area, the medical officers and planners were 
not yet concerned with the threatening potential of those lines for the rapid 
spread of epidemic disease. Rather, from Billings and the Surgeon-General 
to the western departmental medical directors and individual post surgeons, 
the advancement of the railroads was a marker on the way to a substantial 
hoped-for improvement of western military medicine. It marked the status 
of Washington’s efforts to maintain medical supply and communication 
links with the western posts, to upgrade the barracks and hospitals, to 
gradually improve professional opportunities for western army surgeons, 
and to facilitate the spread among the latter of the era’s new medical and 
scientific ideas.24 
Among the earliest western posts to benefit from proximity to the new 
railroads were those whose troops actually guarded the construction of the 
Union Pacific Railroad as it pushed across the prairies during these same 
years. From Ft. Sanders in Wyoming Territory, for instance, Surgeon J. H. 
Frantz wrote that the railroad had reached them in 1868, that they now 
24 For a general account of this country’s railway history, see Maury Klein, 
Unfinished Business: The Railroad in American Life (Boston: University Press 
of New England, 1994). Hygiene in the Postwar Army 
53 
received mail every day, and that they were now only thirty hours away 
from the headquarters of the Military Department of the Platte.25 During 
the seven years of Billings’s survey, the thrust of trans-Mississippi railway 
construction continued to proceed spiderlike and with remarkable rapidity 
into some of the territories covered or touched by the western military 
empire. As this occurred, additional surgeons could report that their posts 
were now on railway lines or had fairly easy access to them. The morale of 
some, like those at Fort Garland (in Colorado Territory) in 1875, was thus 
immensely boosted by the news that railway construction would reach to 
within fifty miles of their post in another year.26 However, a large proportion 
of the western posts, in 1875 as in 1868, remained several years away from 
gaining the improved communications, security, and access to medical and 
other resources, and hence also to achieving the improved morale that the 
railroad was promising to make possible in the area. 
Reports to Billings from posts in Texas illustrate the varieties of logistical 
problems and medical communication conditions that continued to be 
revealed by the survey. Surgeons at Austin considered that their assignments 
in that city were enhanced by the city’s pleasant climate, abundant water 
supply, and general healthfulness. However, in 1869 they also had to put up 
with such frustrations as the fact that the city was still 100 miles from the 
nearest railroad terminus, near Brenham, while medical supplies, which were 
shipped from distant New Orleans, often took as much as three months to 
arrive. Fort Griffin in 1869 was 150 miles away from any other fort, and so 
far out into the wilds of Texas that its precise geographical location had not 
yet been ascertained. Fort McIntosh, almost as remote, was supposed to have 
weekly mail delivery, but actual service was often delayed two to three weeks 
by floods or Indian attacks, while the nearest railway terminus, 350 miles 
away, was not expected to get closer in the near future. Fort Concho, like 
other posts, still obtained most of its medical and other supplies by heavy 
army wagons laboriously hauled over rutted dirt roads for long distances. 
The quartermaster depot at San Antonio was 230 miles away, and the next 
closest city was 550 miles away. And, as surgeon W. M. Notson advised 
Billings, “when the rainy season sets in, communication [to or from Fort 
Concho] almost ceases.”27 
In Billings, Barracks and Hospitals, pp. 353-356. 
26 Billings, Report on Hygiene, pp. 257-262. 
’ Billings, Barracks and Hospitals, pp. 177-181, 194-202, 215-217. 54 
Hygiene in the Postwar Army 
Fort Gibson, in Indian Territory, while having less malaria now than 
before the Civil War, still retained the unenviable reputation of being “the 
charnel-house of the frontier.” Located near a vast swampy area, moreover, 
it still had in 1870 to rely almost exclusively upon boats for its contacts 
with the outside world. Many of the fort’s foods and general supplies came 
by this mode of transport from the Army’s quartermaster depot at Fort 
Leavenworth some 297 miles distant, while medical supplies had to travel 
even further, from the medical purveyor’s depot at St. Louis. As long as they 
were carefully packed, the supplies could make their way to Fort Gibson 
safely if slowly via the Arkansas River. However, the operation required 
considerable advance planning, since that river was normally open to traffic 
only six months of each year.28 
The delays and uncertainties caused by such conditions often forced 
medical staff officials in Washington to send repeated followup messages 
in their efforts to confirm receipt of supply shipments or otherwise to 
communicate with frontier posts. Billings, like the others, chafed under 
communications delays, particularly those occurring when he was trying 
to adjust apparent discrepancies in information sent from the posts for his 
survey. When there was a lack of news, he sometimes assumed that the post 
surgeons were to blame. But Surgeon Warren Webster in Texas, for one, did 
not let him get away with that assumption: “If you appreciate our want of 
railroads and regular mail communication, you will understand the great 
delay in supplying your office with corrected statements.”29 
The geographical and medical-logistical data that actually did reach 
Washington enhanced the administrative value of Billings’s two survey 
publications. In both works, the large numbers of sanitary reports from 
western posts—114 out of the 188 that reported in 1875—continued to 
reflect the Army’s heavy concentration of strength in the West for its pursuit 
of the Indian wars. They also revealed how thinly the posts were spread over 
the vast western territory, and above all, how sparse were the numbers of 
surgeons and other medical personnel serving that territory. 
In both of his reports, Billings grouped the various posts according to 
their location in the respective military departments. However, in 1875, he 
gave increased emphasis to the geographical, administrative, and medical 
significance of those departments, particularly those in the West. For them, 
28 Ibid., pp. 263-267. 
29 Webster to JSB, 1/25/1869, JSB papers, NLM. Hygiene in the Postwar Army 
55 
he provided a foldout map which indicated the locations of the military 
posts and and any sizeable settlements or towns as well as of the region’s 
principal communication routes, their navigable rivers, stage routes, wagon 
roads, and railroads. Elsewhere through that report he inserted mileage 
charts of each department, at least in part as reminders to medical planners 
both in Washington and in the West of the always crippling distances from 
almost every western post to the other posts and supply depots in the same 
department. And in some instances he was able to get the medical directors 
of the departments to contribute general summaries of or commentaries on 
the medical facilities or problems of the posts in their jurisdictions. 
As Billings’s earliest major publications, the survey reports of 1870 and 
1875 were instrumental in focusing the Army’s attention upon a wide range 
of its post-Civil War field health conditions, problems, and goals. They 
confirmed the value of disseminating preventive medical concepts among 
commanding officers as well as medical officers. They likewise helped the 
army fashion a leaner, more efficient, and more centralized medical empire 
for the 1870s and 1880s.30 
The reports were of even greater importance in bringing Billings and his 
scientific work to the attention of medical professionals and officials outside 
the Army, both in other governmental agencies and in civilian circles around 
the country. Gaining the most attention initially were his studies of hospital 
hygiene. In fact, well before he even finished his final survey report, his 
services as hospital planner were already being solicited outside the Army. 
His acceptance of an invitation to do such work for the trustees of the Johns 
Hopkins Hospital during the 1870’s and ’80s in themselves brought him 
immense prestige. Moreover, his parallel appointment as consultant for the 
Johns Hopkins University led to further attention with his radically daring 
academic plans for the medical school. 
30 JSB to the Surgeon General (draft), 5/13/1886, JSB papers, NLM. Chapter 3 
Army Models for the Johns Hopkins Medical Institutions 
In early 1876, leaders of the Army Medical Department readied the 
objects that they planned to show off at the forthcoming international 
centennial exhibition in Philadelphia. Their actual display turned out to 
be both substantial and impressive. Included, for instance, were Civil War 
photographs and other objects from the Army Medical Museum; medical 
instruments and equipment used by the field surgeons; volumes published 
thus far in the Medical and Surgical History project; copies of the Department’s 
other recent publications, including Billings’s two survey reports as well as 
his prospectus for the forthcoming catalogue of the Surgeon-General’s 
Library; and examples or models of artificial limbs, medical wagons, and 
modes of transporting the wounded, including litters, ambulances, railway 
cars, and steamships. 
Particularly prominent in the Department’s exhibit were examples and 
models of the American army hospitals. One of the exhibit rooms displayed 
a number of models built to scale by Washington architects and builders. 
Four of them represented actual hospitals that had been built during the 
Civil War, while a fifth represented the standard 12-bed peacetime barrack 
ward that had evolved since the war. Meanwhile, the structure which housed 
these and most of the other displays was a full-sized and completely outfitted 
standard peacetime post hospital for twenty-four beds.1 
1 J. J. Woodward, Hospital of Medical Department, United States Army. Description 
of the Models of Hospitals (Philadelphia: International Exhibition of 1876, 
1876). Army Models for the Johns Hopkins Medical Institutions 
57 
Army Hospitals, the Johns Hopkins Hospital, and Beyond: 
The army’s hospital displays may well have had the effect, at least 
indirectly, of stimulating public interest in obtaining hospitals in the many 
American communities that still lacked them. Moreover, even before the 
Philadelphia exhibition, Billings had turned some of his attention to the 
shaping of civilian or non-military federal hospitals. 
As early as 1869, at the request of George S. Boutwell, the Secretary 
of the Treasury, the Army officials detailed Billings to survey the Treasury 
Department’s small and at the time admittedly shabby network of marine 
hospitals. During the next year, the latter, with a Treasury official, William 
D. Stewart, made a number of quick visits to some two dozen or so 
government-owned institutions and rented facilities scattered along the 
coasts and interior waterways. Some of these structures had been already 
closed, and Billings suggested that various others, found to be poorly located 
or otherwise unsuitable, be sold. At several locations, he examined plans for 
modifications of existing hospitals or for new buildings. And he urged the 
responsible officials, where possible, to eliminate the traditional permanent 
masonry structures in favor of the temporary wooden barrack hospitals 
that the Army was leaning toward. Actually, Billings’s survey was rapidly 
completed, and it ended with the conclusion that, among the remaining 
ten hospitals that were in active use, almost all had physical, administrative, 
and/or hygienic deficiencies that required attention. 
Back in Washington, Billings’s report to Secretary Boutwell necessarily 
detailed those deficiencies. However, as its central feature, he presented a 
two-part plan for the Treasury Department not just to improve the individual 
hospitals but to elevate them drastically in function and status. His idea was 
first to create a central supervisory unit to standardize and administer the 
various hospitals, and then to insure the unit’s success by effectively removing 
each of the hospitals as soon as possible from local politics. 
While no full copies of Billings’s report have survived, it is known that 
Boutwell accepted most or all of it and promptly obtained legislation to 
implement the suggested changes. Boutwell originally favored Billings for 
appointment to the new position of Supervising Surgeon of what was to 
be called the Marine Hospital Service, and Billings was almost certainly 
interested in being asked to take on the task, perhaps as an added part of 58 
Army Models for the Johns Hopkins Medical Institutions 
his Army duties. However, Congress, in the enabling legislation, voted to 
make Army officers ineligible for the post.2 
The actual First head of the new agency, John M. Woodworth, a 
competent and ambitious former army officer, almost from the beginning 
steered the Service onto a course that quickly came into conflict with some 
of the public health interests and programs being shaped for the Army 
by Billings. However, the latter’s continuing work on hospital design and 
hygiene does not appear to have been negatively affected by what became a 
nasty inter-agency rivalry.3 Fortuitously, in fact, several major opportunities 
that came to Billings during the 1870s enabled him to satisfy much of 
postwar Americas urgent need for leadership in hospital design and building, 
both military and civilian. His particular contribution during that period 
was his insistance on significant new levels of hygienic specifications and 
technological standards. 
A crucial step in this was Billings’s decision, after getting necessary 
clearance, to turn some of his attention away from the hygiene of the small 
army hospitals of the frontier and to undertake some experiments with civil 
institutions and their hygiene. He was well aware of the concern of civilians 
and professionals alike with the frequently severe sanitary and engineering 
problems in larger permanent hospitals. With this in mind, Billings in 
1872 prepared a plan for a permanent and “rather expensive’’ hospital to 
be erected by the Army as part of the United States Soldiers Home, in the 
northern outskirts of Washington. It was to be a four-story brick structure 
to accommodate fifty patients and was to incorporate a number of special 
features. Among these, he designed it to be a model of hospital building 
technology. It would include “all the most recent and improved appliances,” 
especially the machines and equipment required for effective ventilation 
2 Although no scholar has yet unearthed Billings’s actual report to Boutwell, 
several have provided challenging, if fragmentary and sometimes speculative, 
accounts of Billings’s survey and of his subsequent relations with the Marine 
Hospital Service. See, in particular, Chapman, Order out of Chaos, pp. 85-89, 
and 359-360; and Bess Furman, A Profile of the United States Public Health 
Service, 1798-1948 (Washington; G.P.O., 1.973), pp. 114-127. Billings himself 
left an untitled and undated (probably 1869) manuscript memorandum booklet 
of very short rough notes on his visits to about fifteen of these hospitals. JSB 
papers, NYPL. 
3 Some ramifications of this rivalry are touched on in Chapter 6. Army Models for the Johns Hopkins Medical Institutions 
59 
and heating. At the same time, it was “an attempt ... to solve some of the 
problems of hospital construction as presented in civil life,’’ notably to 
find a way to eliminate or at least diminish “hospitalism”, the frequently 
devastating spread of communicable diseases among the crowded populations 
of patients in urban hospitals.4 
Billings’s plan, including its research components, which were possibly 
unique at the time, at least in the United States, was quickly accepted 
since Barnes was also one of the Commissioners of the Soldiers Home. 
The Commissioners then selected Edward Clark, Architect of the Capitol, 
as their architect and designated Billings as their consultant to supervise 
construction. Work on the structure began in 1873 and, under the name 
Barnes Hospital, it was completed late in 1875.5 
During construction and for some time afterward, Billings had the 
services of several other Army Medical Department employees, especially for 
the research phases. Surgeon David L. Huntington joined the project on a 
full-time basis, while Surgeon Robert Fletcher and others, along with civilian 
consultants, did part-time tasks. With this help, Billings was enabled to carry 
on a continuing program of experiments upon the hospital as a building, with 
special attention to the hygienic aspects of its interior furnishings, equipment, 
and appliances. Some of the experiments were modelled on those of Pettenkofer 
and other European sanitarians, but many were original. Members of the 
Army team tested the effectiveness of the various shapes and sizes of flues, 
fireplaces, registers, and heating coils. They compared the power of different 
blowers, the efficacy of differen t sized furnaces, the efficiency of varieties of 
coal. They looked into the question of the retention or spread of infective 
agents by various kinds of wall coverings and floor materials. They made 
round-the-year observations of the performance of ventilation and heating 
4 Billings, Report on Hygiene, pp. liv-lv. The undertaking of this new hospital was 
almost certainly prompted, at least in part, by inquiries both to Barnes and 
Billings as early as 1871 from the trustees of the future Johns Hopkins Hospital 
in Baltimore, with Billings’s friend Alfred Whitehull acting as intermediary. 
Whitehull to JSB, 6/8/1871, JSB papers NLM. 
See manuscript minutes of the Board of Commissioners of the United States 
Soldiers’ Home, Washington, D.C.; Board meeting files of November 9, 1872 
(no. 19.Doc); April 12, 1873 (no. 19.Doc); October 22, 1873 (no. 20.Doc); 
September 15, 1875 (no. 22.Doc); at U.S. Soldiers’ Home, Washington, D.C., 
courtesy B. X. Smith. 60 
Army Models for the Johns Hopkins Medical Institutions 
systems under successive seasonal and weather conditions. And they brought 
in experts to do chemical analyses of gases found in the structure.6 
In 1875, before the completion of the Barnes Hospital, the trustees of 
the projected Johns Hopkins Hospital in Baltimore invited Billings and 
four other American physicians to submit plans for what was to be a large 
new hospital facility. The following year, with the Army’s concurrence, the 
trustees selected Billings to be their permanent consultant for the project. As 
an early task, he participated with them in evaluating and adopting the good 
features of all five of the submitted plans. Billings then made an inspection 
tour of selected European hospitals, after which he joined with the trustees 
and the architect, John R. Niernsee of Baltimore, in working out a final 
building plan. Construction work began in early 1877. Billings went on to 
provide expertise and oversight throughout the construction period, which, 
due to periodic financing difficulties, was spread out over the next twelve 
years.7 Throughout this period he handled most of the background analysis 
6 Billings left several short discussions of the Barnes Hospital: Billings, Report 
on Hygiene, pp. liv-lvi; Billings, “Hospital Construction and Organization,” in 
Johns Hopkins Hospital, Hospital Plans: Five Essays Relating to the Construction, 
Organization, and Management ofHospitals (New York: Wm. Wood, 1875), pp. 
1-46; and Billings, Report on Heating and Ventilation Prepared for the Trustees 
of the Johns Hopkins Hospital (Baltimore: Wm. K. Boyle, 1878), pp. 19-76. 
Carlo Biagini has examined similar contemporary Italian innovations 
in hospital design in the context of that country’s emerging field of hygiene, 
one “incorporating medical, statistical and technological” elements, as well as 
administrative. See his “Ospedali Vecchi E Nuovi: II Dibattito Tecnico-Culturale 
sul Rinnovamento delle Strutture Ospedaliere nell'Italia Post-Unitaria. II. 
Caso del Santa Maria Nuova a Firenze,” Nuncius, Vol. Ill, no. 1 (1998), pp. 
139-150. 
7 For the European history of hospitalism, as well as an account of the early 
Johns Hopkins Hospital, see Guenter Risse, Mending Bodies, Saving Souls: A 
History of Hospitals (New York: Oxford University Press, 1999), pp. 366-372, 
and 402-408. For other special studies, see Toby Gelfand, “11 January 
1887, the Day Medicine Changed: Joseph Granchers Defense of Pasteurs 
Treatment for Rabies,” Bull. Hist. Med., 2002, Vol. 76, pp. 698-718; Gert 
H. Brieger, “The Original Plans for the Johns Hopkins Hospital and their 
Historical Significance,” Bull. Plist. Med, Vol. 39 (1965), pp. 518-528; A. 
McGehee Harvey and Susan L. Abrams, “John Shawr Billings: Unsung Hero of Army Models for the Johns Hopkins Medical Institutions 
61 
and other intellectual work of the project from his desk in Washington. But 
during its active phases he took the train to Baltimore once or twice per week 
for on-site consultations with the trustees, the architect, and the builders. 
Billings’s selection for the Johns Hopkins Hospital project thus coincided 
closely with the development and testing of Barnes Hospital. As a result, 
at every stage of planning and construction, he was able to use the smaller 
hospital as the model for the larger one. He was careful to clarify to the 
Hopkins trustees in advance just what he contemplated for the Baltimore 
structure by going over with them details of the Barnes installation. Then, as 
construction proceeded on the larger hospital, the experimental findings that 
were being obtained at Barnes provided rational bases for his recommendations 
for solving numerous of the technical problems in Baltimore.8 
The ultimate plan for the Hopkins institution provided for a complex 
of buildings—structures for laboratories, nurses’ school and quarters, 
administrative offices, dispensary, kitchens, and so on—all in support of 
those containing the sick wards. Fully as much as at the Barnes Hospital, 
every unit was designed with the aim of utilizing modern building technology 
and materials in such a way as to ward off the incidence and spread of 
hospital infections. The experimental approach that he had been taking at 
Barnes was both expanded and refined for the new structure. For example, 
room materials as well as ventilation devices and systems were constantly 
being tested throughout the construction period, and those that ciid not 
work well were replaced by new and improved types. And such tests were 
intended to continue after the buildings were occupied. When the Baltimore 
institution finally opened in 1889, Billings stated his vision of that building 
complex as a continuing and flexible hospital model, as “a great laboratory 
for teaching the practical applications of the laws of hygiene to heating, 
ventilation, house drainage, and other sanitary matters.”9 
While the completed exterior facades of both the Hopkins and the 
Barnes hospitals were visually impressive, they actually had relatively little 
Medicine at Johns Hopkins,” Maryland Hist. Mag., vol. 84, no. 2 (1989), pp. 
119-134; Garrison, Billings, pp. 182-212; and Chapman, Order out of Chaos, 
pp.99-144. 
8 Billings, “Hospital Construction,” loc. cit., passim; Billings, Report on Heating 
and Ventilation, passim . 
9 Billings, “The Plans and Purposes of the Johns Hopkins Hospital,” Med. News, 
54 (1889), pp. 505-510. 62 
Army Models for the Johns Hopkins Medical Institutions 
distinction, in contrast to that of Billings’s frankly functional interior designs 
and construction. In fact, it was the latter elements, the solutions of practical 
interior problems in these two model hospitals, that were particularly 
welcomed in many circles and that greatly facilitated the spread of urban 
hospitals across late-nineteenth century United States. Information about 
them was disseminated first of all in the house publications of Billings and 
the Hopkins trustees and subsequently in the professional press. There was 
some complaint about the expense of such hospitals and some preference 
for systems or devices other than those selected by Billings, as, for instance, 
for steam heating rather than hot water. However, there seems to have been 
general agreement that the Billings model structures held one lesson above 
all others for American hospital sponsors and builders. They demonstrated 
that hospital design could no longer be a matter of guesswork. The process 
was now amply shown to be one that required exact mathematical and 
mechanical measurements for the planning of interior features and systems, 
together with special instruments for testing them. And equally essential was 
the active involvement in the process by technologically informed members 
of the medical profession, together with lay hospital officials.10 
Having shaped his model urban hospitals, Billings was pressed to 
produce other structures along the same line. In fact, throughout the period 
of building the Hopkins hospital, and for two decades and more after its 
completion, he was in frequent demand—from hospital building committees, 
architects, medical societies, and others around the country—to comment 
upon proposed hospital plans, to suggest architects, or to prepare his own 
additional designs. In Washington itself, during the 1880s, Billings designed 
the administrative building and first medical wing of the Children’s Hospital. 
In adddition, as one of the Incorporators, beginning in 1882, he played a 
considerable role in the organization of the capital’s new Garfield Memorial 
Hospital and went on to serve the institution in an active administrative 
capacity up to 1898.11 
10 J. R., “Art. XXVIII,” [i.e. review of Billings’s Report on Heating and Ventilation], 
Amer. J. Med, Sciences, n.s., Vol. 76 (1878), pp. 523-524. No attempt is made in 
this chapter to examine Billings’s comprehensive ideas about the management, 
staffing, or other non-technical matters pertaining to the Johns Hopkins 
Hospital. 
11 For Billings’s Childrens’ Hospital connection, see Miles, National Library, 
p. 110, note 69. For the Garfield Hospital, see Samuel C. Busey, Personal Army Models for the Johns Hopkins Medical Institutions 
63 
Outside of Washington, certain other consultancies that Billings accepted 
also involved substantial commitments of time on his part. Particularly 
significant were his plans for the Peter Bent Brigham Hospital in Boston, 
the Memphis City Hospital, the Army and Navy Hospital in Hot Springs, 
Arkansas, and the Presbyterian Hospital in New York City. While his 
contributions to those institutions did not match his input to the Johns 
Hopkins project, the design details for each seem to have displayed originality 
on his part that was in keeping with local needs.12 
Meanwhile, during the 1880s, Billings continued to play a role in 
updating hospital standards for the Army Medical Department. Although the 
opening of new Western posts had been tapering off, hospitals in America’s 
existing posts had to be refurbished periodically using the newer hygienic 
standards. Occasionally, moreover, officials in foreign countries asked for 
printed copies of the Department’s standards. In 1889, for instance, an 
official of the Mexican International Railroad, after a visit to the Army 
Post at San Antonio, wrote Billings for such a document, saying that the 
specifications for the Army’s standard small-size hospital would be an ideal 
model of a medical institution for the railroad’s employees.13 
In his designs of urban civilian hospitals as in the army hospital models, 
Billings was concerned above all else with solving public health problems. 
Early in his career, along with most other hospital designers of that day, he 
thought that most hospital structures were in themselves potentially dangerous 
environments for the sick patient. By the early 1870s he had become 
persuaded that this danger came about essentially because of the presence of 
germs, though exactly how was still far from clear either to him or anyone else. 
At any rate, he laid out the matter very positively to the Hopkins Hospital 
trustees: “Whatever may be the opinions held as to the nature of these diseased 
germs, and their mode of origin and propagation, they are what we have to 
fear and to provide against in the construction of a hospital.”14 
Reminiscences and Recollections of Forty-Six Years Membership in the Medical 
Society of the District of Columbia (Washington: The Author, 1895), pp. 
223-238. 
12 Plans or reports for several of these institutions may be found among the 
Billings papers in the New York Public Library, Box 68. 
13 Albert B. Hale to JSB, 1/22/1889; and Charles Greenleaf to jSB, 1/29/1889, 
both letters in the JSB papers, NLM, Box 19. 
14 Billings, “Hospital Construction,” loc. cit., p. 12. 64 
Army Models for the Johns Hopkins Medical Institutions 
By the time the Hopkins hospital was completed, the rapid expansion 
of bacteriological and hygienic research and discovery had greatly expanded 
man’s knowledge about these matters. But much knowledge about these 
relationships was still only partially worked out and remained hypothetical. 
Accordingly, as the expensive structure was readied for its opening in 1889, 
with its elaborate ventilation system touted as a bulwark against hospital 
infection, Billings for the moment was correct in asserting that no other 
better solution yet existed. At the same time, he knew as well as anyone 
in the United States that the continuing explosion of knowledge about 
germs and their behavior could render the system archaic over-night.1S 
In fact, for a dozen or so years, he had been planning and organizing 
another Hopkins unit, the University’s school of medicine, to have that 
very capability. 
From Army Science to a Science-Based Hopkins Medical School 
The Hopkins Hospital Trustees originally chose Billings as their 
consultant largely because of his consistently scientific approach to the 
planning and building of hospitals. And, in that same year of 1876, 
Daniel Coit Gilman, who had just accepted the presidency of the 
projected Johns Hopkins University, had much the same reason for 
selecting Billings as his consultant in building the University, especially 
the medical school. 
15 For changing views in this period concerning the relationships of germs to 
diseases, see Nancy J. domes, “American Attitudes toward the Germ Theory 
of Disease: Phyllis Allen Richmond Revisited,”/. Hist. Med. & Allied Sciences, 
52(1997), pp. 17-50; and James H. Cassedy, Charles V. Chapin and the Public 
Health Movement (Cambridge, Mass.: Harvard University Press, 1962), passim. 
Henry Hurd, looking back in 1913, summarized other shortcomings that, by 
the early eighteen-nineties, had been recognized in the just completed hospital, 
i.e., a lack of elevators, the smallness of service rooms, deficient laboratories, 
etc., but he felt that the building’s subsequent influence on other American 
hospitals nevertheless remained very strong. Cited in Garrison, Billings, pp. 
201-202. For Billings’s later ideas on some of these matters, see JSB, “The 
Relationship of Hospitals to Public Health,’’ in JSB and Henry M. Hurd, eds, 
Hospitals, Dispensaries and Nursing (Baltimore: Johns Hopkins Press, 1894), 
pp 1-7, and 122-212 passim. Army Models for the Johns Hopkins Medical Institutions 
65 
Gilman himself, who most recently had briefly headed the University 
of California, had earlier been an educational reformer at Yale’s Sheffield 
Scientific School. As such, he was well versed in the general development 
and potential of the sciences in the mid-nineteenth century, but not in 
American medicine, medical institutions, or physicians. By the time he had 
been in Baltimore a relatively short time, however, he had heard a good deal 
about Billings’s remarkable knowledge of medicine, his skills in microscopy, 
and especially about his relentless drive to bring scientific information and 
methods into every aspect of medicine, and medicine. 
During their initial exchanges, the two men presumably laid out their 
respective thoughts about medicine, science, and education, and gauged 
each other’s presumed areas of similarity and difference. From the beginning, 
Billings seems to have been in fundamental agreement with Gilman’s concept 
of the modern university, with its emphasis on instruction and research at 
the graduate level for the humanities as well as the sciences. And Gilman, in 
turn, liked what he heard about the other man as being essentially a medical 
scientist rather than a clinician.16 
Getting down to work, Gilman started out in 1876 by giving Billings 
academic status as a part-time lecturer, and then, in essence, turned him 
loose for a year or so to prepare his detailed recommendations for the medical 
school. He also involved the other man in some of the university’s earliest 
academic events. In the late spring, then, Billings, together with four other 
“learned professors’ from Washington’s scientific institutions—Cleveland 
Abbe, Simon Newcomb, Julius Hilgard, and Horace Hayden—could be 
seen at Gilman’s inauguration as President and the following reception in a 
Baltimore hotel. In September, he joined a similar distinguished Washington 
science contingent that went to participate in the formal opening of the 
16 The impact of the Hopkins phenomenon on American medicine has been 
penetratingly examined by Donald Fleming, William H. Welch and the Rise of 
Modern Medicine^Baltimore: Johns Hopkins University Press, 1954); and by 
Simon Flexner and James Thomas Flexner, William Henry Welch and the Heroic 
Age of American Medicine (New York: Viking, 1941). For Billings’ Hopkins 
connections, see A. McGehee Harvey and Susan L. Abrams, “John Shaw Billings: 
Unsung Hero of Medicine at Johns Hopkins, Maryland Historical Magazine, 
vol. 84, no. 2 (1989), pp. 119-134. See also Kenneth M. Ludmerer, Learning to 
Heal: The Development of American Medical Education (New York: Basic Books, 
1985), pp. 21-22, 51-61; and Chapman, Order out of Chaos, pp. 121-145. 66 
Army Models for the Johns Hopkins Medical Institutions 
university, an event highlighted by the address of Great Britain’s apostle of 
evolution, Thomas H. Huxley.17 
Late in 1877, after preliminary discussions with Gilman, Billings 
completed a tentative blueprint for the ultimate staffing, organization, scope, 
and courses of study of the university’s medical school. Originally, as desired 
by Gilman, he presented the material in the form of a course of twenty 
academic lectures to the university community over a period of months. And 
then, after completing the course, he edited and revised the most relevant 
and timely portions of the lectures and had them published. In that format, 
the lectures went on to provide the essential authoritative basis for several 
years of sometimes heated discussion of what was a highly innovative and 
radical proposal for a medical school. If some of its elements did not survive 
that process, a major portion of them did. Above all, it incorporated three 
of Billings’s most fundamental desires for the new institution: the medical 
school had to be closely integrated with the hospital; its academic program 
must be thoroughly grounded in the sciences relevant to medicine and in 
on-going laboratory research; and in other ways as well it should contribute to 
the American advancement of Europe’s science-driven medical revolution. 
By 1883, although neither the hospital nor the medical school facilities 
would be completed for another several years, Gilman, Billings, and the 
University Trustees agreed that it was time to begin assembling the medical 
school’s earliest faculty members. First to be selected were Ira Remsen and 
H. Newell Martin, respectively the professors of chemistry and physiology, 
together with Billings. While Gilman originally wished to give Billings the 
professorship of hygiene, such an appointment of a career army officer was 
vetoed by the Secretary of War. However, permission was granted for Billings 
to serve as a lecturer of hygiene, an arrangement that made it possible for 
him to expand his role as scientist as well as to continue his advisory role to 
the medical school until the institution could be completed. 
A few months after the first appointments, the Professor of Pathology 
and Dean William H. Welch arrived on the scene, followed shortly by 
William S. Halsted, William Osier, Howard A.Kelly, and others. While 
17 See clippings in JSB papers, NYPL; also on microfilm at NLM,MS film 25, 
Reel 56, Vol. 3. For Gilman, see Daniel Coit Gilman, The Launching of a 
University, and Other Papers (New York: Dodd, Mead & Company, 1906); 
and, in brief, Francesco Cordosco, “Daniel Coit Gilman,” American National 
Biography (New York: Oxford University Press, 1999), vol. 9, pp. 56-59. Army Models for the Johns Hopkins Medical Institutions 
67 
none of these should be considered “Billings’s men,” they all had to pass his 
scrutiny. And all had to be fully as strong believers in scientific medicine as 
he was. Inevitably, then, virtually all ol these first faculty members developed 
important professional ties with Billings over the next years. Moreover, most 
became more or less habitual users of the Surgeon General’s Library.18 
Billings and Welch got along well from the beginning. The two had 
met first in 1876 in Leipzig, where Welch was pursuing graduate studies 
and the other man was on a learning tour for various projects. Over their 
now legendary steins of beer at Auerbach’s Kellar, Welch told Billings about 
his hopes for an American career in medicine and scientific research, and 
Billings told the younger man about his plans for building a science-based 
American medical school with high admission standards, small classes, 
well-equipped laboratories, and other European features. The two seem to 
have been mutually impressed. And when Billings’s search started in earnest a 
few years later, he arranged for another meeting with Welch, by then in New 
York City, to confirm his highly favorable early assessment. Once Welch had 
taken over as Dean, the two were often in a position to support each other, 
not only in the growth of the medical school but in broader developments of 
public health, medicine, and science. And they could often be seen sharing 
their ideas and problems over dinner at the Maryland Flouse or some other 
Baltimore establishment. 
Billings also formed a special bond at Hopkins with the surgeon, Halsted, 
who operated several times on the former’s lesions of the lip, conditions 
that were associated with his excess cigar smoking. Pleased with the care 
he received, Billings subsequently recommended Halsted to several of his 
Washington associates, including the geologist and anthropologist, John 
Wesley Powell.19 
The clinician William Osier was one of several successful candidates 
for the Hopkins faculty who were already well known to Billings. In fact, 
the latter simultaneously became an active champion of Osier’s candidacy 
in Baltimore, while also going to great lengths to persuade him to move 
18 For the Billings blueprint, see JSB, “Suggestions on Medical Education,” Loc. 
Cit. See also Fleming, Welch, passim; and Ludmerer, Learning to Heal, pp. 
57-61. 
19 The setting of the Leipzig meeting is perceptively drawn in Fleming, Welch, p. 
55. For aspects of Billings’s health, see William Pepper to JSB, 8/3/1880 and 
8/19/1879, JSB papers NYPL. 68 
Army Models for the Johns Hopkins Medical Institutions 
from the University of Pennsylvania. Among other mutual avocations apart 
from business, both were avid bibliophiles, and both had more than casual 
interests in medical history. Actually, both thought of medical history as a 
part of the scientific knowledge that they wanted physicians to obtain. In 
fact, before Osier arrived in Baltimore, Billings had already started arguing 
that medical history should be made part of the curriculum of the new 
medical school. 
Medical History in Army and University 
By the early 1880s, Billings and Osier, who was still in Montreal, had 
begun corresponding in pursuit of their mutual bibliographical interests. 
And in 1881, the latter made a two day visit to the Surgeon Generals Library 
expressly to examine the older works in the Army collection. Beginning 
around that date, Billings gave Osier borrowing privileges in the library and 
began as well to send him copies of its publications, including the earliest 
issues of the Index Catalogue. In turn, Osier reciprocated handsomely, first 
by sending Billings duplicate copies of books from his own library as well 
as hard to find copies of past Canadian medical institutional reports and 
the like.20 
Like other physicians of their times, both men were essentially self-taught 
so far as medical history was concerned. Billings’s interest seems to have been 
kindled by occasional lectures on the subject by his professors at Cincinnati. 
But he rapidly made himself a true expert by his voracious reading in the 
growing collections of the Surgeon General’s Library. As such, he helped 
spread the Library’s good name by being able and willing to assist the 
patrons with their historical questions. However, he seems to have almost 
never used the collections for his own original historical researches. Until 
1876, apparently the closest he came to such a use was in the preparation 
of finding guides to portions of the older collections. 
20 Osier to Billings, 6/3/1881; 1/5/1883; 1/18/1883, among others in Billings 
Papers, NLM. See also quotation from Osier’s obituary of Fletcher, in Harvery 
Cushing, The Life of Sir William Osier, 2 vols. (Oxford: Clarendon Press, 
1925), Vol. 1, p. 198. For Billings’s relationships with Osier as well as other 
portions of this section, I have drawn considerably from my paper, “John Shaw 
Billings as a Historian,” (Columbia, South Carolina: American Osier Society 
and University of South Carolina, 2002). Army Models for the Johns Hopkins Medical Institutions 
69 
The first of these was a long journal article to mark the 100th anniversary 
of the country’s independence. The article was basically a bibliographical 
summary of relevant holdings, though Billings enhanced the interest of some 
of the entries with personal comments. In his introduction, he described the 
work simply as a collection of “statistics obtained from a nearly complete 
list of the medical books published in this country from 1776 to the present 
time,” together with data pertaining to medical societies, libraries, journals, 
and schools. As an annotated and classified historical directory, it served its 
purposes well. But it made no pretense to be a learned historical treatise.21 
Some years later Billings issued a finding guide to another segment of 
the library’s collections. Longer, but much like its predecessor in format, 
this work, the “History and Literature of Surgery,” was a factual listing of 
surgeons, operations, and surgical publications of the past rather than a 
reasoned historical interpretation of that particular medical branch over 
time.22 The historian Fielding H. Garrison, writing after Billings’s death, had 
mixed views about it as a contribution to history. Substantively, he considered 
it “the best work on the subject in English,” one that displayed a “genuinely 
critical spirit.” At the same time, however, he saw that potential readers must 
surely have often been turned off by its adherence to the government’s dull 
bibliographical format. Its long lists of obscure and unimportant names 
not only made for “a certain dryness” but were contrary to Billings’s “usual 
breezy spirit.”23 
Between his writing of the two governmental “histories,” Billings felt 
justified in accepting an invitation to undertake a very large and challenging 
writing project. He thus spent much of 1876 and 1877 in the intense task 
of researching and composing the twenty highly substantive academic 
lectures for President Gilman. It was an undertaking that he could not 
have even thought of without his intimate knowledge of and access to the 
Surgeon General’s Library. Billings could, of course, have saved himself 
much labor by confining himself to the two or three lectures necessary to 
21 John Shaw Billings, “A Century of American Medicine, 1776-1876: Literature 
and Institutions,’ American Journal of the Medical Sciences, 72 (1876), pp. 
439-480. 
22 John Shaw Billings, “The History and Literature of Surgery,” in Frederic S. 
Dennis, ed., System of Surgery, 4 vols (Philadelphia: Lea, 1895), vol. 1, pp. 
17-144. 
Garrison, Billings, pp. 181-212. 70 
Army Models for the Johns Hopkins Medical Institutions 
present his actual plan for the medical school. But he and Gilman agreed 
that considerable background information had to be presented as well if 
the project were to hope to gain the support of the university trustees and 
faculty as well as Baltimore’s physicians and the public. Concluding that 
such justification coulci best be found in the historical record, Billings thus 
devoted thirteen of his twenty lectures to a comprehensive review of the 
medical lessons of the past. Eleven of them covered western medicine and 
medical education from antiquity through the eighteenth century, while 
two others dealt with the early United States. He devoted four lectures 
to reviewing the existing medical schools, medical legislation, and related 
matters in mid-19th century Europe, and then concluded with the three 
lectures giving his specific recommendations as to “the Course to be pursued 
by the Hopkins University.”24 
The course was presented in a hall in downtown Baltimore as one 
of the earliest academic events of the new university. Contemporaries 
observed that in them, as in his other public appearances, Billings made an 
excellent impression as a speaker, that he was forceful, direct, and fluent 
in style. Contemporary opinion about the content of his specific medical 
recommendations seems to have been abundant and mixed, especially 
where it most mattered, among the trustees and in the encounters between 
Billings and Gilman. However, so far as I have discovered, there was next 
to no public reaction as to the content and quality of the thirteen historical 
lectures, even though when taken together they constituted one of the most 
comprehensive American reviews of the world’s history of medicine to be 
undertaken up to that time. 
In fact, it is remarkable that any of the lectures ever materialized. In 
1876, when he had only barely begun his writing, Billings began to doubt 
that he would be able to prociuce anything of much originality or intellectual 
merit in the short time available. He warned Gilman not to expect anything 
of very high caliber and noted that the historical lectures he was working 
up were commonplace in content, of interest mainly to medical men rather 
than scholars. Increasingly dissatisfied with himself, he pointed out that, 
24 Billings’s evolving ideas on the number and scope of the lectures in the course 
are indicated briefly in Sanford V. Larkey, “Two Letters by John Shaw Billings 
on the History of Medicine,” Bull. Inst. Hist. Med, VI (1938), pp. 394-398. 
See also Sanford V. Larkey, “John Shaw Billings and the History of Medicine,” 
Bull. Inst. Hist. Med,, VI (1938), pp. 360-376. Army Models for the Johns Hopkins Medical Institutions 
71 
to reach an audience of scholars, he would have to refocus his efforts in 
order to prepare lectures on the “philosophy of the history of medicine,” an 
approach which, by blending the history of medical knowledge with that 
of philosophy, government, science, and religion, for instance, would make 
for “a higher and better type of [historical] work.” Realistically, however, 
Billings had to face up to the fact that he could never find the time needed 
for writing such a work. “I could only do it by putting about a years reading 
and reflection into each lecture, since I must know much besides Medicine, 
to do it.”2" 
Gilman ultimately persuaded the other man to continue with his lectures 
as originally planned. However, when they were completed, Billings refused 
to consider publishing them. As he reminded Gilman, there was already an 
overabundance of writings on the subject, “mostly copied one from another, 
even as these lectures must be in the main.”26 
With his heavy load of scientific and medical undertakings, Billings 
seems to have been far too extended in the years after 1877 to think of 
continuing his medical-historical initiatives at Hopkins through other 
lengthy lecture series. Clearly, his main commitments with Hopkins were 
to get the hospital and medical school built. From time to time, however, 
he agreed to give one of his historical lectures to groups at the hospital. 
And in 1886 he dickered with Henry P. Bowditch about the possibility of 
his giving six historical lectures at the Harvard Medical School. When the 
two men failed to agree on dates, a series of eight lectures was arranged at 
Boston’s Lowell Institute. 
During this decade of the ‘eighties, before the Hopkins Medical School 
was ready to accept regular students, some of the faculty members were aware 
Larkey, “Two letters,” loc. sit., pp. 395-396. 
26 Ibid. Fielding H. Garrison, considering the lectures in 1915, after Billings’s 
death, had no such criticisms. Actually, he seems to have found a greatly 
improved writing style, with no sign of the arid bibliographical format that 
had marred Billings’s governmental histories. Garrison also noted that the 
lectures reflected the German historical medicine of the day. However, he did 
not specify any particular scholar who may have influenced Billings in this 
respect. He might have plausibly argued that historian Herbert Baxter Adams, 
whom Gilman had brought to Hopkins at the same time as Billings, could 
well have exerted such influence. But presumably the evidence wasn’t there. 
Garrison, Billings, pp. 202-203. 72 
Army Models for the Johns Hopkins Medical Institutions 
that Billings’s original recommendations for the school included provisions 
for some sort of graduate level academic program in the history of medicine, 
one that would incorporate and apply the research ideal and methods of the 
school’s other departments. His justification of that revolutionary proposal 
was still appropriate for an expected student body that was to be composed 
of individuals planning to teach, write, and/or carry on research. Courses in 
medical history would be essential for them, Billings thought, not only as 
“stimuli to thought” but in providing “means of culture.” And the absorption 
of bibliographical methods in the history of medicine department would 
be valuable not only to those training to practice medical history but also 
to those remaining in science positions.2 
Not surprisingly, Billings’s medical history proposal had little chance of 
going very far during the Hopkins Medical School’s organizational period. 
Billings himself never expressed interest in playing a permanent academic 
role in it. And, apart from him, there was probably no other commanding 
figure or scholar in the United States who could organize and take over such 
a program. There were also few anywhere else. Moreover, in 1892, when the 
Medical School finally opened, it had no visible means of financing such 
a program. Nevertheless, possibly in the hope that Billings would finally 
turn out to be available to help launch it, the school appointed Billings to a 
lectureship in the History and Literature of Medicine, one that he retained 
until 1905. Actually, however, during that period he never found time to 
present a full course of lectures in any one year and only rarely gave more 
than three annual lectures.28 
After 1905, the Hopkins school failed to find anyone to continue the 
history of medicine lectureship or other arrangement. However, Billings’s 
vision of a graduate level program or department for the subject, though 
quiescent, was somehow kept alive in the School, at least in the spacious 
mind of William H. Welch. And ultimately it came to fruition with the 
creation, funding, and buildup of the Institute of the History of Medicine 
in the 1920s and 1930s.29 
27 John Shaw Billings, “Suggestions on Medical Education, 1878,” reprinted in 
Alan M. Chesney, “Two Papers by John Shaw Billings on Medical Education,’ 
Bull.Inst. Hist. Med., VI (1938), p. 343. This work is an amalgamation of 
several of Billings’s non-historical lectures. 
28 Larkey, “Billings,” loc. cit., pp. 360-376. 
29 Donald Fleming, William II. Welch and the Rise of Modern Medicine. (Baltimore: Army Models for the Johns Hopkins Medical Institutions 
73 
Still during the Billings period, however, medical history in the larger 
Johns Hopkins community took an interesting new turn in 1889 with the 
opening of the hospital and the arrival of Osier. Billings, of course, was one 
of the members of the top-level Hopkins cabal that lured Osier away from 
the University'- of Pennsylvania. The plotters had also included President 
Gilman, Dean Welch, and Francis T. King, head of the hospital board. 
Officially, they wanted Osier for two positions, as Physician in Chief of 
the hospital and as Professor of the Theory and Practice of Medicine in the 
medical school. But it was never much of a secret that Hopkins was also 
getting an inspirational medical teacher along with a medical historian. 
And Billings, as he ended his tour as the hospital’s medical advisor, was well 
satisfied with this arrangement. 
With Osier on campus, the hospital and ultimately the medical school 
personnel began to get exposure to medical history and its methodology on an 
ongoing basis. In his clinical teaching, Osier not only introduced substantive 
historical illustrations into his presentations but involved his students in 
the process of searching for material in original medical-historical sources. 
At the same time, with Howard Kelly, Welch, and others, he organized the 
Johns Hopkins Hospital Historical Club, whose monthly meetings generated 
extraordinary interest among faculty and students alike.30 
Invited to become an honorary member of the Club, Billings went 
up from Washington for the meetings when he could, and sometimes he 
presented short papers or commentaries. On occasion, he wmild bring along 
one or more of the rare medical books that he had just acquired for his library. 
And with these impressive physical evidences of the past in hand, he would 
deliver short bibliographical descriptions of the tomes, summaries of the lives 
and times of the authors, and interpretations of the medical contents. Not 
a few members of the club, particularly those who were book collectors, are 
on record as having been influenced by these informal but knowledgeable 
presentations by Billings as much as they were by the more finished and 
literary historical profiles that Osier tried out on the club members. 
If Billings ever completely relaxed, it was at the meetings of the historical 
club. He was comfortable being with Welch, Osier, and other like-minded 
The Johns Hopkins University Press, 1987), pp. 194-199, 201. 
30 For Osiers early roles as a historian, see Charles G. Roland, “Sir William Osier,” 
ANB, vol. 16 (1999), pp. 804-807; and Michael Bliss William Osier: A ife in 
Medicine (Oxford: Oxford University Press, 1999), pp 164-260. 74 
Army Models for the Johns Hopkins Medical Institutions 
faculty members who participated. These were, of course, occasions when 
they all basked in the early fruits of the idealistic medical ambiance that 
they had been creating. Moreover, in their own ways, they took satisfaction 
in being surrounded by medical students at the point when the latter were 
beginning their attempts to illuminate the problems of current medicine 
through medical history. 
Billings’s contemporaries were probably not surprised that he and the 
Army Medical Department had furnished the principal models for the three 
medical segments of the new university. But some wondered that Billings, 
the career medical officer, remained satisfied with the low compensation he 
received in federal service. Others, to be sure, recognized the satisfaction that 
he had to be getting from these challenging medical and scientific activities. 
And most must have marveled that so many extraordinary opportunities 
should continue to come to him. Chapter 4 
Army Stimuli of Medical Knowledge and Change 
Through no fault of builders, staff, or consultants, both the Johns 
Hopkins Hospital and the Hopkins medical school were forced 
to remain in unfinished states for various lengthy stretches after Billings 
had worked out the first plans for them in 1876 and 77. While he was as 
frustrated as anyone by these interruptions, Billings may have particularly 
regretted every delay in opening the medical school because of the setback 
it represented to America’s struggle against medical ignorance. However, he 
could always use such lost time to good advantage for other Army projects 
that were intended to advance the same struggle. Among these was his 
participation in and encouragement of medical reform tendencies within the 
medical corps itself as well as in the Washington medical community. But 
by far the most important were his efforts to spread reform in the national 
medical community, to bring about a significant expansion of medical 
knowledge by means of an enlarged Surgeon General’s Library. 
Medical Reform and the Surgeon General’s Library 
When Billings joined the Surgeon General’s Office, he found that 
his fellow career medical officers were particularly preoccupied with two 
matters, the changes brought on their department by the war, and the 
goings on of the medical profession. Not surprisingly, for the most part, they 
thought of themselves as physicians before they were scientists, sanitarians, 
administrators, or anything else, and they took pride in their professional 
status as physicians. Most had considerable experience in caring for patients, 
and almost all had had to pass stringent examinations to gain entrance into 
the Army’s career medical corps. All were “allopaths”, or medical regulars, 
and a majority of them felt it important to make allopathic medicine work 
better than it had; it was currently badly in need of reform. 76 
Army Stimuli of Medical Knowledge and Change 
Billings himself, even after withdrawing from medical practice near the 
end of the Civil War, continued to find most of his friends from among 
the medical regulars, particularly that segment that was actively searching 
for improvements in the old approaches to medicine. As such, up to 1895 
anyway, he never ceased studying and learning the details of the medicine 
of his day, and he early gained standing as one of its authorities. He also 
acquired an early awareness of the information needs of the various segments 
of America’s medical and health-related professions.1 
When he went to work in Washington, apart from his work as an 
administrator, Billings went to considerable pains to keep up personally 
with new medical practices and knowledge about diseases and therapies. 
He hoped that he would be aided in this by making contacts in the local 
medical community. As it turned out, however, the post-war capital city 
had relatively few of the medical institutions or associated activities that he 
expected sizeable communities to have. Periodically he went across town 
from his office with an Army colleague to observe operations or other special 
cases at the recently built United States Soldiers’ Home. But non-federal 
community hospitals of Washington for some time remained few as well 
as typically crowded, poorly equipped, and not conducive to giving either 
clinical or scientific instruction. Billings made connections with some of 
the city’s prominent physicians, among them Joseph Toner and Christopher 
Cox, both of whom were active in national as well as local medical and 
public health activities, while Toner had an unusually large private medical 
library.2 Still, there was only a single medical school, one that thus far had 
few if any faculty members of sufficient reputation to attract good students. 
Moreover, there were no medical publishing houses, no medical journals 
of any standing, and little public sanitary activity except during epidemics. 
The quality of papers presented at sessions of both of the city’s two regular 
medical societies was apparently so pedestrian and generally lacking in 
scientific interest that Billings rarely attended such meetings. Nevertheless, by 
1875, along with Barnes, Crane, Woodward, and Otis, he had been elected 
1 For a short but insightful review of Billings’s contributions in the context of 
those professions, see Samuel Haber, The Quest for Authority and Honor in the 
American Professions, 1750-1900 (Chicago: The University of Chicago Press, 
1991), pp. 319-341. 
2 For Toner, see Whitfield J. Bell, jr., “Joseph M. Toner (1825-1896) as a Medical 
Historian,” Bull Hist. Med., 47 (1973), pp. 1-22. Army Stimuli of Medical Knowledge and Change 
77 
to honorary membership in one ol those groups, the Medical Society of the 
District of Columbia.3 Moreover, over the next two decades, he became 
active in several ol Washington’s emerging medical institutions, particularly 
as advisor lor the formation ol new hospitals. 
While Billings initially found little spirit ol improvement or innovation 
in Washington’s local medical community, there was generally an abundance 
of such sentiments in the Surgeon General’s Office in the late 1860s and 
early 70s. The surgeons who were brought into the office were, in fact, 
tapped specifically for their positions because, apart from their professional 
competence, they retained their Civil War energies and dedication to military 
medical betterment. Through their reading in the postwar medical press, 
the army surgeons also became at least generally aware of movements for 
medical reform that were under way in scattered parts of the United States 
in such problem areas as medical education, urban sanitation, medical 
licensure, industrial work conditions, and hospitals.4 It was clear, however, 
that thus far no effective federal voice or institution had emerged that might 
encourage or focus such movements. 
Meanwhile, however, the Surgeon General’s agenda to elevate Army 
medical learning was being vigorously pursued. Both the medical museum 
and the Civil War history projects were developing according to plan. Equally 
significant was the progress that Billings had already made with the newer 
project of upgrading the Surgeon General’s miscellaneous book collection 
into a true medical library. But, by the 1870s the magnitude of his project 
was becoming more and more evident, particularly to those who knew that, 
world-wide, the production of newmedical and scientific literature was piling 
up at an exponential rate of increase.5 
There is no comprehensive history of medicine in Washington. However, 
see Daniel S. Lamb, J. B. Nichols, et. ah, History of the Medical Society of the 
District of Columbia, 2 vols (Washington: The Society, 1909 and 1947); Betty 
L. Plummer, “A History ol Public Health in Washington, D.C., 1800-1890.” 
Ph.D. Diss., University ol Maryland, 1984; and Nancy B. Pauli, Capital 
Medicine, A Tradition of Excellence (Encino, Calif.: Jostens Publishing Group, 
1994). 
4 For a brief overview of American medicine during this period, see James H. 
Cassedy, Medicine in America: A Short History (Baltimore: Johns Hopkins 
University Press, 1991), pp.67-76. 
’ A trenchant inquiry into Billings’s and other claims about antebellum medical 78 
Army Stimuli of Medical Knowledge and Change 
Billings’s fledgling library had been given space in the former Ford’s 
Theatre building. There it was sandwiched in between several temporarily 
larger operations of the Surgeon General’s Office. Those activities had 
already begun giving the building some distinction as a post-Civil War 
center of military medical learning and related matters anci certainly as 
one of Washington’s more innovative medical facilities. On one floor of 
the former theater, volumes of the Medical and Surgical History of the war 
were beginning to be completed and distributed. On another floor, clerks 
were kept busy searching the wartime medical files for evidence to support 
the pension claims of America’s veterans or their relatives. And, up a few 
flights, in the medical museum, members of the public as well as medical 
students were able to examine the displays of wartime medical equipment 
and pathological specimens, while, out of sight, staff scientists prepared 
new materials for exhibit and conducted research in pathology, microscopy, 
chemistry, photography, anthropology, and other sciences.6 
Billings’s impressive buildup of the Library between 1867 and 1895, 
from its unpretentious beginnings in the Ford’s Theatre setting to its 
becoming a substantial and influential national institution there and later 
on the Mall, has been comprehensively examined by Wyndham Miles.7 
Here that growth can only be summarized briefly and then considered for 
its role in and impact on the medicine of the late nineteenth century. Miles 
notes the library’s early transformation from a facility that had been intended 
for the sole use of military medical personnel to one serving the medical 
library holdings, is John B. Blake, “Billings and Before: Nineteenth Century 
Medical Bibliography,” in John B. Blake, ed., Centenary of Index Medicus, 
1879-1979 (Bethesda, Md.: National Library of Medicine, 1980), pp. 31-52. 
For a dated but still challenging study of the historical growth patterns of 
scientific literature, see Derek DeSolla M. Price, Little Science, Big Science 
(New York: Columbia University Press, 1963). 
6 For a contemporary description of the layout of the building, see (Joseph 
J. Woodward), “The Army Medical Museum at Washington,” Lippincotts 
Magazine of Popular Literature and Science, March 1871, pp. 233 ff. See also 
Robert S. Henry, The Armed Forces Institute of Pathology: Its First Century, 
1862-1962 (Washington: Office of the Surgeon General, U.S. Army, 1964), 
pp. 51-71. 
Wyndham B. Miles, A History of the National Library of Medicine (Bethesda, 
Md.: National Library of Medicine, 1982), pp. 15-200. Army Stimuli of Medical Knowledge and Change 
79 
professions and citizenry as a whole. Fie then goes on to provide details of 
Billings’s resourceful and aggressive acquisition campaign, conducted first 
within the Medical Department and then among physicians and other 
health professionals everywhere as well as among librarians, editors, and 
agents. Billings’s objectives were not only to publicize the new resource 
among potential users but to ferret out and obtain as many medical works 
as possible for the collection from Americans, Europeans, and others. Miles 
subsequently covers such matters as Billings’s self-training in the skills of the 
librarian, his inspired recruitment of Robert Fletcher as his deputy, and his 
organization with Fletcher of the two enormous pioneering Finding guides 
to the library’s collections, the Index Catalogue and the Index Medicus. Both 
of those guides were launched in the late 1870s and with each successive 
volume gained further recognition as indispensable access tools for members 
of the medical and health-related communities, and hence as keys to the 
success of the library.8 
Equally crucial was Barnes’s willingness to retain Billings for duties in 
the Surgeon General’s office indefinitely instead of rotating him into field 
positions, which was the usual lot of the medical officers. By remaining in 
Washington, Billings ensured continuity of the Library’s growth into the 
largest medical library in the Western FJemisphere by the mid-1870s and 
into the largest in the world by 1895.9 As a repository of the world’s medical 
knowledge, moreover, it had begun, as much as anything else, to serve as a 
key marker of America’s newly respectable level of medical literacy. 
Among those who were essential in helping to build up the library and 
making it known were the individual American physians and other health 
professionals from whom Billings solicited exchanges or gifts of books. In the 
course of this process, he came to think of these individuals as participants 
and collaborators whose gifts gave them a stake in the library’s expansion. And 
many of them felt the same way. Over time he thus developed an informal 
personal network of contributors, exchangees, and medical influentials in all 
parts of the United States and elsewhere. It was a group that he rewarded by 
sending the individual members copies of publications of the library and of 
the Surgeon General’s office, generally in the hope that they would support 
future solicitations for the library or other projects. 
8 For Fletcher, see Estelle Brodman, “Memoir of Robert Fletcher,” Bull. Med. 
Libr. Assoc., vol. 40, no. 3 (July 1961), pp. 251-290. 
9 Miles, History ofNLM, pp. 85-86, 176-177. 80 
Army Stimuli of Medical Knowledge and Change 
The recipients, many of whom had had Civil War experience, and 
including former Confederates, welcomed these evidences of Billings’s 
library for various reasons. For some, they marked an early stirring of 
federal medical initiative, of a central medical authority that could help 
overcome the country’s deep-rooted medical provincialism. Others 
cheered the salutary and progressively larger intellectual influence that this 
Washington agency was exerting in the various communities. Access to 
its increasing collections of materials brought new rational viewpoints to 
bear upon the country’s divisive and fruitless arguments over conflicting 
medical theories and systems, along with illumination for the ongoing 
debates over the etiology of disease or about therapies old and new. It also 
stimulated the building of new local medical libraries or the rejuvenation 
of older institutions and in general sparked improvement among health 
professionals across the country. 
Billings’s assignment to the Surgeon General’s Library was clearly one 
of the most congenial and challenging opportunities that Barnes could 
have offered. It was one that allowed the younger man wide scope, not 
only for satisfying his thirsts for learning but for exercising his energies, 
organizational talents, and management skills. At the outset, it placed him 
at the head of what quickly proved to be one of the most concrete and 
effective initiatives of the post-Civil War period for elevating the quality 
of American medicine. Subsequently, it also opened up opportunities for 
him to participate in the planning and development of other projects of 
his generation that had similar aims. 
Throughout Billings’s Army career, people were frequently surprised to 
learn that Billings normally worked at the library only part-time. While he 
retained responsibility as the institution’s Director, he left large chunks of 
its routine operations to the Librarian and other subordinates. This made it 
possible for him to work on the successive special assignments of the Surgeon 
General or to carry on personal research. Billings’s personal preparation for 
these large assignments often required beefing up the library’s collections in 
the appropriate medical areas. This done, he became the library’s heaviest 
user, reading exhaustively first in existing holdings and eventually in the new 
acquisitions. Beginning in the late 1860s and continuing into the nineties, 
this repeated process helped Billings evolve into a many-sided expert, as 
authoritative in a variety of medical fields as anyone else in the Americas or 
elsewhere, not only in medical librarianship but in sanitation and hygiene, Army Stimuli of Medical Knowledge and Change 
81 
microbiology, hospital design, public health administration, vital statistics, 
and other specialties.10 
Normally, of course, the acquisition process, once set in motion, 
systematically brought large quantities of materials into the library on a 
regular basis. At an early date, Billings decided that, if the Library was 
worth creating, there should be lew if any restrictions—whether ideological, 
geographical, or chronological—on the types of materials to be added to 
its collections. He accordingly insisted on obtaining all he could find and 
afford of the literature of the entire medical tradition from antiquity onward . 
In this decision he had the grateful concurrence of the physician-historians 
and collectors of his generation, among them John Stockton Hough and 
S. Weir Mitchell. He was likewise applauded, late in the period, by his 
educator friends and scientific colleagues at Johns Hopkins. These included 
such increasingly influential medical educators as William H. Welch, 
William Osier, and Howard Kelly, scientists who often drew from the old 
medical volumes to help their students gain historical perspective on their 
laboratory-based studies in the rapidly changing medical world.11 However, 
Billings knew that the library had an even greater obligation to obtain the 
burgeoning medical publications and records of his own times. He thus 
pressed his suppliers, particularly in Europe, to search, not only for the latest 
monographs, but for the transactions of new medical and scientific societies, 
the mushrooming specialty journals, the reports of rapidly multiplying 
hospitals and public health agencies, the research findings of scientists at 
laboratories in academia and elsewhere. 
As he worked and studied in the mushrooming library collections, 
Billings became increasingly aware that the contents of these mainly recent 
European medical publications reflected a remarkable pattern of energies, 
methodological approaches, institutional resources, intellectual innovations, 
and technical and scientific applications that had been coming together in 
many areas of medicine, often with important or even spectacular results. 
In fact, with other American medical innovators of his generation, he 
saw that the totality of this phenomenon comprised a new or previously 
under-exploited way of approaching and thinking about medicine. And 
10 For extended elaborations of the results of this activity, see chapter 5. 
11 Miles, History of NLM, pp. 100-101, 231; and Garrison, Billings, pp. 209-210. 82 
Army Stimuli of Medical Knowledge and Change 
he grasped its significance as a comprehensive mid-nineteenth-century 
European medical revolution.12 
Billings was not one to suggest the importing of that revolution 
to the American scene uncritically or in its entirety, not even the 
much admired German blending of laboratory, clinical, academic, and 
governmental ingredients. He also recognized, for instance, the abundant 
influences of the British. However, he recognized that, as its holdings 
grew, his library wx>uld inevitably nourish most of the foreign-spawned 
ideas and supply whatever other facts would be needed to formulate 
and generate an American version of the revolution. By the mid-1870s, 
in fact, the library’s holdings incorporated a large proportion of the 
literature pertaining to the specifics of Europe’s revolution, details that 
were of particular interest to health professionals who did not have the 
opportunity of studying in Europe. 
East-Coast Collabomtors in America's Medical Revolution: 
The Surgeon General’s Library, of course, only gradually became the 
full-fledged gold mine of revolutionary medical knowledge that it promised 
to be for the prepared mind. Accordingly, Billings expended considerable 
energy in the effort to increase the number of prepared minds in the American 
medical community. At professional meetings, his papers frequently urged 
adoption of the scientific mode of thinking. For him, that basically meant 
replacing the easy reliance on hunches and guesswork in medical practice 
and health investigation by approaches that were critical, experimental, and 
systematic. But it also meant utilizing the entire armamentarium of effective 
approaches that were available for medical investigation and application, 
making the most, for instance, of technological skills and the observing 
and quantifying methods of the French clinicians as well as the laboratory 
12 One of Billings’s most detailed expositions of the medical revolutionary 
phenomenon is his 1878 “Suggestions on Medical Education,” reprinted in A. 
M. Chesney, ed. “Two Papers by John Shaw Billings on Medical Education,” 
Bulletin of the Institute of the History of Medicine, vol. 6, no. 4 (1938), pp. 
313-359. Among secondary discussions of the period’s medical change, see 
Lester S. King, Transformations in American Medicine (Baltimore: Johns 
Hopkins University Press, 1991), pp. 209-223; and Cassedy, Medicine in 
America, pp. 67-96. Army Stimuli of Medical Knowledge and Change 
83 
methods that were steadily spreading.13 Some of his papers thus described 
his own uses of varied modes of science. In other papers, he demonstrated 
the importance of business-like procedures in the planning, building, and 
management of medical institutions and enterprises. And equally often, 
he continued to advertise the basic values of his library as the increasingly 
authoritative American source of information about the other ingredients 
of medical change.14 
Through his network of friends and collaborators, Billings seems to 
have supported the reform projects of local medical communities fully as 
effectively as did those individuals who had just returned from medical and 
scientific studies in Europe. In fact, in those places, through the 1870s and 
’80s, key individuals began to be strongly infused with some of the Army 
mans enormous energies as well as to be impressed by the importance of his 
initiatives and the forcefulness of his organizing methods. 
As a result, in combination with the impetus of other reformers, the 
Billings influence contributed powerfully to the late nineteenth-century 
emergence of a new degree of confidence, sense of well-being, and desire 
to move ahead on the part of a significant segment of America’s regular 
medical profession, at least in the larger and more affluent communities. 
Such activists began or renewed campaigns to make their own medical 
society meetings more substantive and productive; to create laboratories and 
otherwise promote the sciences; to make the content of their professional 
journals more original and more critical; to establish or improve their health 
departments, and to give major support to the reform agitation in the medical 
schools.15 Moreover, strengthened or influenced by the Billings examples, 
they modeled some of their hospitals upon his plans for the Hopkins even 
13 John Harley Warner, Against the Spirit of System: The French Impulse in 
Nineteenth Century American Medicine (Princeton: Princeton University Press, 
1998. Warner effectively describes the considerable impact in mid-nineteenth 
century America of the French numerical mode of thinking scientifically about 
medicine, a generation before the German model emerged. 
14 JSB, A Report on the Hygiene of the United States Army. U. S. Surgeon General’s 
Office, Circular No. 8 (Washington: G.P.O., 1875); JSB, “On the Plans for 
the Johns Hopkins Hospital at Baltimore,” Medical Record (N.Y.), vol. 12 
(1877), pp. 129-133, 145-148; JSB, “Medical Bibliography,” Transactions of 
the Medical and Chirurgical Faculty of Maryland, 1883, pp. 58-60. 
15 See discussion in King, Transformations, pp. 209-223. 84 
Army Stimuli of Medical Knowledge and Change 
before that institution was completed, followed his reports on military 
sanitation in the interest of improving community hygiene, and began to 
shape the aims of their new local medical libraries after those of the Surgeon 
General’s Library, though retaining direct access to the latter through the 
expanding Index Catalogue and Index Medicus. As a result, in emulating 
the Billings innovations, they also provided testimony of the emergence 
of Washington as a newly significant center of national medical activity, 
influence, and change. 
While by no means excluding qualified individuals elsewhere, and certainly 
not Southerners,Billings over time developed particularly close and productive 
relationships with the reform-minded regular physicians and sanitarians of four 
other cities along the northeastern coast: Baltimore, Philadelphia, New York, 
and Boston. Some of those ties began with Billings’s part-time assignments 
or consultancies. Others grew out of his negotiations for contributions to 
his library and out of his labors on professional committees. But most of 
them resulted from his need to know, to see significant examples of existing 
American health facilities lor himself and to gather first-hand information 
about hospital design, ventilation, vital statistics, laboratories, and sanitary 
systems, for instance, for use in his own plans and works. Billings went on to 
maintain and enlarge his ties in these special cities through this period both 
because they were convenient and because he had legitimate professional 
reasons to travel to them in person, sometimes frequently. 
Development of these ties was greatly facilitated for Billings by 
Washington’s good rail service to the other cities. At the same time, the 
business functions of his trips were occasionally combined with events that 
were social or ceremonial in nature. There were sometimes lectures to be given, 
sometimes celebrations to participate in marking the completion of each 
others’ libraries, laboratories, new medical journals, boards of health, hospitals, 
or other reform projects. There were official events to attend and awards to 
be bestowed. And, from time to time there were splendid dinners in honor 
of long-lived luminaries of regular medicine, events marked by the excellent 
wines, by the numerous toasts, and by one or more original poems. Billings 
enjoyed such get-togethers of these accomplished representatives of regular 
medical reform and learning. While he seemed to have no gift for preparing 
original poems, he was often called upon to give or respond to toasts.16 
16 A number of programs and menus from these events are scattered through the 
scrapbooks and elsewhere in the Billings papers at NLM. Army Stimuli of Medical Knowledge and Change 
85 
Billings began reaching out to kindred spirits among the Boston reformist 
regulars at least by 1872. At the meetings of the AMA and the APH A of that 
period, he quickly came under the influence of Henry I. Bowditch, whose 
survey of public health was a major factor in turning the younger man into 
a vigorous advocate of preventive medicine.1 The two men continued to 
share and promote each other’s ideas and accomplishments, and occasionally 
to visit each other, until Bowditch retired from the Massachusetts State Board 
of Health, turning over his leadership in public health to a succession of 
capable successors, each of whom had his own ties with Billings.18 
During the same years, in Boston, Billings developed equally close 
professional and personal ties with the perpetually inquisitive and 
forward-looking poet-physician Oliver Wendell Holmes, as well as with 
James Read Chadwick, Librarian of the Boston Medical Library. Holmes 
could have become an even earlier role model for Billings than he actually 
was,because of his important studies of the microscope if nothing else, but 
he had also built up one of the very best libraries of an American physician, 
a collection that he went on to contribute to the Boston Medical Library. 
In the mid-1870s, Billings and Chadwick were engaged in energetic and 
highly profitable exchange activities to help build up the collections of both 
of their libraries, a process that went on at the same time that the former was 
also helping other officials of the Boston library with the planning of their 
new building. At the dedication ceremonies of the structure in December 
1878, Holmes as chairman credited Billings with furnishing numerous 
suggestions for heating, ventilation, lighting, and space arrangement. The 
latter, in response, appealed to the Boston library’s membership for help 
in gaining financial support from Congress for his own library. At the 
same event, Justin Winsor, the Harvard University Librarian, made certain 
everyone knew that Billings was the “greatest bibliographer of this or any 
other country.”19 
17 Henry I. Bowditch, Public Hygiene in America (Boston: Little, Brown & Co., 
1877). 
18 For a concise review of Bowditch’s career, see John Harley Warner, “Henry 
Ingersoll Bowditch,” American National Biography, vol. 3 (1999), pp. 
267-269. 
19 Unidentified clipping from a Boston newspaper covering the library’s dedication 
on December 3, 1878. Microfilm of Billings scrapbooks, vol. Ill, in JSB papers 
in NYPL (NLM holding is on MS Film-25, Reel 26). 86 
Army Stimuli of Medical Knowledge and Change 
Chadwick went on to help keep Billings involved in the Boston areas 
regular medical affairs through the rest of the century. He and others worked 
out plans for the latter to give the Lowell Institute lectures in 1888. And 
they made sure he was invited in 1896 to attend the fiftieth anniversary 
celebration of ether anesthesiology at Massachusetts General Hospital. In 
between, Billings did a certain amount of advising, including serving a stint 
on the Visiting Committee for Harvard University’s medical and dental 
schools.20 He also carried on preliminary discussions with university1' officials 
and prominent physicians pertaining to the need for a university hospital. 
Those consultations continued fitfully into the twentieth century, when such 
an institution, the Peter Bent Brigham Hospital, was finally realized using 
Billings’s plans, including his suggestions for merging existing facilities.21 
Billings’s ties with the regular medical community of Baltimore were at 
first few in number. This was largely because there was relatively little sign 
of medical innovation or awareness of the European model of reform in the 
city until the mid-1870s, when he himself began going to Baltimore to work 
on the Hopkins institutions.22 The content of his early public lectures at 
the University seems to have been moderately eye-opening in this respect 
for some of the local physicians who attended. At least, two years later, the 
Medical and Chirurgical Faculty of Maryland acknowledged as much by 
electing Billings to honorary membership. However, since no major local 
medical reform initiatives were immediately forthcoming, during the first 
few years that he was commuting to Baltimore his business remained mainly 
with Hopkins people. On the technical level it was with the hospital trustees, 
architects, and builders, while on the academic level his interchanges were 
with Gilman, Welch, and other members of the medical school faculty. 
Billings travelled to and from Baltimore one or more times almost every 
week while the hospital was under construction, and somewhat less often 
afterward through the early 1890s. He continued to keep a severe eye on 
the technical functioning of the buildings, and he gave periodic lectures. 
20 Frederick C. Shattuck to JSB, 1/29/91 and 3/3/91, jSB papers NYPL. 
21 JSB, correspondence and planning documents related to the Peter Bent Brigham 
Hospital, 1902-1908, JSB papers NYPL, Box 68 (Hospital Construction), 
Folder #8. See also Kenneth M. Ludmerer, Learning to Heal: The Development of 
American Medical Education (New York: Basic Books, 1985), pp. 221-222. 
22 Donald Fleming, William H. Welch and the Rise of Modern Medicine (Baltimore: 
Johns Hopkins University Press, 1954), pp. 70, 77-80. Army Stimuli of Medical Knowledge and Change 
87 
When the wards Filled with patients, he sometimes went on rounds with 
Henry Hurd, the able hospital director, or one of the professors. He also 
collaborated with Hurd in preparing several publications on hospital 
administration and helped him establish a hospital library. Not surprisingly, 
the two men maintained this active collaboration long after Billings had left 
Hopkins and the Army.23 
In Philadelphia, a similar but larger medically related web of friendships, 
professional collaborations, and administrative responsibilities existed, 
with Billings being drawn into it as early as the Civil War years. The web 
was spun over time by such prominent physicians as Joseph Leidy, S. Weir 
Mitchell, William Pepper, Horatio Wood, and William W. Keen, all of them 
early advocates of scientific medicine and other forms of medical reform 
in the city. The ties were equally welcomed and fostered by Billings, whose 
persuasive arguments turned these individuals into some of the most stalwart 
supporters of his library.24 
In turn, during the late 1870s and eighties, the Philadelphia physicians, 
like other American professionals, tapped the resources of the Surgeon 
General’s Library with increasing regularity; several of them got in the 
habit of going directly to Billings for help in expediting their book requests. 
Likewise, by the early eighties, Mitchell, a neurologist, and Pepper, the 
University of Pennsylvania’s provost, had both begun consulting him, 
sometimes separately and sometimes together, about hospital design, 
planning, and organization. The spring of 1881, for instance, found all three, 
together with Wood, involved in the processes of working up plans for a new 
wing at the University of Pennsylvania Hospital to accommodate chronic 
heart and lung sufferers. Billings’s roles in this included the examination of 
the preliminary plans in his Washington office, the preparation of proposals 
for ventilation and heating, and several trips to Philadelphia for working 
discussions and site visits with all concerned, including the architect and 
the building committee.21 
All in all, the consonance of Billings’s reformist inclinations and 
contributions with those of the Philadelphia regular reform elite was such 
23 The friendly correspondence between Billings and Hurd between 1891 and 
1.9.11 deals with many aspects of hospital operation. See JSB papers NYPL. 
24 Chapman, Order out of Chaos, pp. 257-274. 
21 S. Weir Mitchell to JSB, 1/28/1875 and 1/7/1875; and William Pepper to 
JSB, 3/4/1881, 4/6/1881, and 3/31/1881; all in JSB papers NYPL. 88 
Army Stimuli of Medical Knowledge and Change 
that their ties continued to expand by mutual agreement. During the eighties, 
Pepper in particular, acknowledging the other man’s growing value to him, 
to the University of Pennsylvania, and to medical reformers in Philadelphia, 
continued to propose new things for Billings to do or ways to keep him 
in their circle. In early 1884, for instance, he named Billings to be the 
University’s representative at the 300th anniversary of the establishment 
of the University of Edinburgh. Late that same year, he invited Billings 
to dinner “to meet Osier and some good fellows,” and to stay overnight 
afterward.26 
Through the rest of the decade, Billings and Pepper had many more 
meetings, often including other individuals. Prominently, their discussions 
dealt with the question of what the University of Pennsylvania needed 
to do to match health reforms that were being introduced elsewhere in 
academia. Pepper was well aware of the comprehensive innovations in 
medical education, hospital design and care, health-related research, and 
other areas that Billings had formulated and helped introduce at Johns 
Hopkins and that Charles Eliot had begun at Harvard.27 By 1889, Pepper 
had worked out a partial plan for change in which Billings was to be the 
central figure and which the latter, after obtaining the necessary permission 
from the Surgeon General, was happy to accept. This provided for Billings to 
become Director of a new Department or Institute of Hygiene as well as to 
design and build its laboratory building, to serve as Professor of Hygiene in 
the medical school, and to be Director of the university hospital. As agreed, 
his work in these posts remained on a part-time basis until 1895, when he 
resigned from the Army, disengaged himself from most of his obligations to 
other institutions, and took up residence in Philadelphia.28 
Later that year, members of the Philadelphia medical community, 
jubilant from their success in luring Billings to their city, organized a lavish 
26 Pepper to JSB, 3/29/1884, and 11/4/1884, JSB papers NYPL. Osier had 
been borrowing from Billings’s library before he moved to Philadelphia from 
Canada. 
2 As early as 1878 Billings sent Pepper a published version of his Hopkins lectures 
on medical education. Thanking him, the latter replied: “Your plan [is] just 
what our country needs and with least chance of getting elsewhere.” Pepper 
to JSB, 6/21/1878, JSB papers NYPL. 
2S Further details of Billings’s hygiene activities at the University are discussed in 
chapter 5. Army Stimuli of Medical Knowledge and Change 
89 
testimonial dinner for him, one which included presenting him with a 
huge purse. The speakers—including Osier, Chadwick, Abraham Jacobi, 
and Mitchell—predictably came from medicine’s improving nucleii in the 
large northeastern cities and vied with each other to praise his stimuli to 
American medical reform, particularly those growing out of the Surgeon 
General’s Library and the Index Catalogue.29 
As early as 1879, the regular medical profession of New York City also 
had organized a number of extraordinarily enthusiastic demonstrations of its 
collective belief in the importance of Billings’s innovations of the previous 
decade. Late that year, the New York Medical Society elected him to honorary 
membership and made him the main speaker for their December meeting. 
The Medical Society of the County of New York also made him an honorary 
member. In supporting that nomination, the pediatrician Abraham Jacobi 
cited four of the main Billings accomplishments to date: the development of 
the Surgeon General’s Library; his investigations of hygiene and sanitation; 
his designs of the Johns Hopkins Hospital; and, most recently, his success 
in gaining Congressional approval of America’s First federal public health 
body.30 Jacobi then urged other American physicians to give Billings the 
recognition he deserved before the Europeans beat them to it. 
Tributes in much the same vein continued in October at the dedication 
of the new library hall at the New York Academy of Medicine. The Academy’s 
President, Benjamin Fordyce Barker, an obstetrician and pediatrician, 
addressed the members at some length. To him, Billings’s achievements were 
fundamental contributions to the advancement of American medicine, and 
he marvelled that this one unusual man of “ability and genius”, though still 
barely 40, should already have accomplished “so much, stimulating, swaying, 
and educating the whole medical mind of the country.” Going on, Barker 
hoped that the Billings examples would serve as stimuli to comparable 
initiatives by members of the Academy and other New York physicians.31 
29 For an account of the dinner and of Billings’s departure from Philadelphia 
soon afterward, see Garrison, Billings, pp. 282-287. See also chapter 9 of this 
book. 
30 Medical Society of the County of New York, Minutes, September 22, 1879, 
in scrapbook, vol III, JSB papers NYPL (NLM copy is on MS Film-25, Reel 
56). I examine the National Board of Health in chapter six. 
31 New York Academy of Medicine, Transactions, 1879; in JSB Clippings 
scrapbook, Vol. Ill, JSB papers NYPL (NLM copy, MS Film-25, reel 56). 90 
Army Stimuli of Medical Knowledge and Change 
During this period, Billings developed close ties with several individual 
members of the New York medical profession. He and George F. Shrady, 
editor of the Medical Record, swapped favors throughout most of the 
seventies and beyond. Billings supplied the other man with news of the 
Washington scene, while Shrady went out of his way to write editorials in 
support of the Index Catalogue and other Billings projects32 With Barker, 
by contrast, Billings developed a much more personal friendship, one that 
nearly matched his connections with Mitchell, Holmes, and Henry I. 
Bowditch in warmth. In the early eighties, the two men supported each 
other as travelling companions to two international medical events in Great 
Britain. Barker also invited the other man to stay with him and his family 
when Billings came to New York on business, rather than leaving him to 
go to a hotel or club. To be sure, other New Yorkers (as well as physicians 
elsewhere) were similarly hospitable, including the clinician and pathologist, 
Austin Flint, Sr. On one such visit with Flint in 1884, Billings’s business 
took him to the Bellevue Hospital Medical School, where he talked with 
the young pathologist William H. Welch in his laboratory and sat in on one 
of his lectures. That evening, back at Flint’s house, Billings asked his host 
for his opinion of Welch, but he never revealed to Flint that he and Daniel 
Coit Gilman currently had Welch under consideration for an appointment 
to the Johns Hopkins University Medical School.33 
In many ways the most valuable of Billings’s medical colleagues in New 
York was Abraham Jacobi. Jacobi was a strong if sometimes selective advocate 
of modern scientific medicine. He was also a personal friend who saw eye 
to eye with the other on many medical issues, and was a man of action who 
provided support for Billings’s innovations. The latter also looked both to 
Jacobi and his wife, Mary Putnam Jacobi, for critical comments on new 
ideas and projects. 
Not least in importance, Jacobi used his influence to help keep Billings 
prominently in the collective eye of the New York regular medical profession. 
One way that he did this was literally to place the latter at or near appropriate 
podia. In the spring of 1883, for instance, Billings was one of the out-of-town 
notables chosen to grace the head table at the legendary dinner for Oliver 
Wendell Holmes that the profession put on at Delmonico’s Restaurant. 
Two years later, he was placed on the platform of the New York Academy 
32 See Billings’s correspondence with Shrady, JSB papers NYPL. 
33 Quoted in the Flexners’ Welch, pp. 127-128. Army Stimuli of Medical Knowledge and Change 
91 
of Medicine meeting at which Barker turned over the presidential gavel to 
Jacobi, and he appeared there again at the Academy’s 1887 “Anniversary 
meeting”. Subsequently, with Mitchell of Philadelphia and Reginald Fitz 
of Boston, Billings gave one of the invited addresses at the formal opening 
of the Academy’s new building. 
In 1881, partly on the recommendation of several of the New York 
regulars as well as of others around the country, Billings was invited to 
present one of the keynote addresses at the London meetings of the Seventh 
International Medical Congress. The invitation was rightly seen as a sign of 
the new status of American medicine, and Billings was appropriately the first 
American to be recognized by such a body. With him on the program were 
five of Europe’s most eminent physicians and medical scientists: Richard von 
Volkmann of Halle, Louis Pasteur and Maurice Raynaud of Paris, Rudolf 
Virchow of Berlin, and Thomas H. Huxley of London. 
Carleton Chapman has provided details of the extensive social and 
ceremonial phases of this event, of Billings’s enthusiastically received ninety 
minute address, and of his European travels before and after it.31 The address 
was in essence a commentary on the medical significance of the literature 
collection that Billings had accumulated during the past dozen or so years 
for the Surgeon General’s Library. It acknowledged his intellectual debt to 
numerous medical authors, particularly European, for things he had learned 
from their writings. And, as he spoke, he noted that many of the authors 
of those books and articles were in his audience. The address was thus, on 
the one hand, a testimony to the breadth and depth of Europe’s medical 
revolution, while on the other hand, it touched on some of the ways in 
which the Americans were beginning to adopt portions of the revolution 
for themselves.'’5 
Billings’s extraordinary reception in London solidified his position near 
or at the top of his profession as one of America’s foremost spokesmen for 
and interpreter of scientific medicine as well as one of its most persistent and 
effective workers for the elevation of American medicine. Back in the United 
States, the cumulation of prestige gave him added influence in dealing with 
book dealers and persuading national medical organizations to hold meetings 
at the library and museum. It also proved invaluable every second year in his 
34 Chapman, Order out of Chaos, pp. 198-214. 
35 JSB, “Our Medical Literature,” in 7th International Medical Congress, 
Transactions (London: The Congress, 1881), vol. I, pp. 54-70. 92 
Army Stimuli of Medical Knowledge and Change 
attempts to get the medical profession and other health professionals to push 
for Congressional support of the library’s operating budgets, especially for its 
publications. And it was still more timely for Billings’s strenuous campaign 
during the early eighties to get the professionals to lobby Congress for a new 
library and museum building. The favorable outcome of this campaign, and 
the building’s excellent ultimate location in the heart of Washington, was thus 
a major success for organized medicine as well as for the Surgeon General’s 
Office, the Library, and Billings himself.36 Moreover, on the practical side, 
it also afforded Billings with the occasion to effect a substantial updating 
of the programs and displays of the Museum. 
Revitalizing the Army Medical Museum 
At the end of 1883, a new Army Surgeon General, Robert Murray, as 
one of his first official acts, consolidated the Surgeon General’s Library and 
the Army Medical Museum into a single administrative unit to be known 
as the Museum and Library Division of the Surgeon Generals Office. To 
head the division, he selected Billings, naming him Curator of the Museum 
as well as Librarian. This action gave the latter control over the Medical 
Department’s principal scientific unit and as such enhanced his position in 
the top echelon of the Department’s professional pecking order.37 Billings’s 
new duties, however, did not include any responsibility for the completion of 
the Medical and Surgical History project. That task remained in the hands 
of Surgeon Charles Smart, who saw it to its publication in 1888. 
Murray’s changes were key steps in an attempt to protect and strengthen 
the scientific programs of the Surgeon General’s Office at a highly critical 
and even threatening stage in their history to date. Two developments 
had led to a gradually intensifying sense of urgency in the office between 
1880 and 1883. One of these was the rapidly deteriorating condition of 
36 See Miles, National Library of Medicine, pp. 141-174. For the highly negative 
sequel to these developments, see chapter nine of the present volume. 
' Billings’s biographers in the main have virtually ignored his twelve year 
stint with the Museum. Historians of the Museum, however, have provided 
important accounts of that era. A particularly well-informed treatment that 
focuses extensively on Billings is Adrianne Noe and George S. M. Cowan, 
“Microscopy and the Army Medical Museum,” Caducaeus, Vol. 2 (summer 
1986), pp. 1-36. See also Henry, Armed Forces Institute, pp. 73-89. Army Stimuli of Medical Knowledge and Change 
93 
Ford’s Theatre, the building that housed both the museum and the library 
as well as several other units of the office. By that time, the structure had 
become grossly over-loaded with heavy equipment, displays, books, files, 
and personnel, while its walls were developing large cracks and otherwise 
showing unsettling signs of decay and possible collapse. Besides, there was 
no space left for expansion, especially of the Library. 
By 1880 Billings, working with others, had gained Barnes’s approval of 
a new building. Over the next two years, the two men planned the specifics 
of such a structure and began searching for firm support from the Secretary 
ofWar, concerned congressmen, and influential professionals. At that point, 
however, a second development, the loss of three of the principal long-time 
staff members of the Surgeon General’s Office, began to seriously disrupt 
this search as well as to threaten the continuities of the Office’s scientific 
programs. George Otis, one of the museum’s co-curators as well as an editor 
of the Medical and Surgical History, died in 1881. Barnes himself had to 
retire for age that same year, while by 1882 Woodward’s health had failed to 
an extent that incapacitated him for performing further duties or research 
prior to his death in 1884.38 
Billings’s designation as head of the new Division was a natural in several 
respects. First of all, he had a relatively light work load at that particular time 
and was known for his willingness to take on new tasks. Moreover, with his 
long service in the Surgeon General’s Office, he had considerable familiarity 
already with its scientific activities, while in most other respects he was as 
well as or better qualified than any other possible candidate in the Medical 
Department. He also by then enjoyed extensive professional standing both 
in and outside of the Department. 
The position had certain clear-cut duties and responsibilities. Billings 
was, of course, expected to continue his activities with the Library as usual. 
Moreover, he was formally named also to continue as coordinator of the 
planning, construction, and moving phases of the new building. These came 
to a climax in the fall and winter of 1887 when the museum and library 
reopened to the public at their new site near the Smithsonian Institution 
on the Mall. 
With respect to the Museum, Murray may have initially anticipated 
that Billings would only have time enough left to cope with the routine 
administrative tasks and curatorial functions that were already in place. 
38 For details, see Henry, Armed Forces Institute, pp. 68-81 94 
Army Stimuli of Medical Knowledge and Change 
However, from the start, the latter determined to exercise full control over 
the agency and had no hesitancy about introducing major ideas of his own. 
These translated into a series of innovations that substantially changed the 
emphasis of the institution’s work as well as its image, chiefly by introducing 
exhibits and programs that focused on the innovations and sometimes the 
excitements of contemporary science and explained their workings. Billings 
made no secret, for instance, of his intention to balance and supplement 
the original displays of Civil War-related specimens by adding up-to-date 
exhibitions that would have greater immediate value and interest for a new 
generation of physicians and scientists. 
Even before Congress appropriated money for the new building, Billings 
began thinking about possible staffing changes that might expedite his plans 
for the museum. While a nucleus of the current professionals such as the 
pathologist Daniel S. Lamb could be kept on, his mind leaped ahead to 
the possibility of having one of the “younger men of our Corps” assigned 
to the museum every year for six or more months as a sort of interne “in 
order that they may see what is going on and be prepared to give intelligent 
assistance in the work.”39 Meanwhile, he also began talking with Washington 
Matthews, S. G. Cowdrey, and other relatively senior medical officers with 
scientific interests who he hoped might consider applying for positions in 
the museum. 
This lead to the problem of what to do about Billings's friend, the 
microbiologist George Sternberg, who, with Woodward out of the picture, 
was far and away the Army’s most capable and accomplished laboratory 
research scientist. Exiled at remote southern and western forts most of the 
time that Billings was in Washington, Sternberg had been perenially frustrated 
by the limited facilities that such forts afforded for research. By the 1880s, 
understandably, he was particularly yearning tor an assignment back East. 
When he first heard about Woodward’s disability, Sternberg wrote 
immediately, appealing particularly to Billings as one who “appreciate(s) 
the value of etiological studies and of the experimental method” to support 
his candidacy if or when a replacement was to be named.40 A good many 
months later, after Billings himself was named to succeed Woodward as 
curator, he brought Sternberg up to date with a partly apologetic letter that 
could not have left the latter happy. First of all, he explained that he was not 
39 jSB to Washington Matthews, 2/5/1884, JSB papers NLM. 
40 Sternberg to JSB, 5/29/1882, Sternberg papers NLM. Army Stimuli of Medical Knowledge and Change 
95 
planning to recruit for a research position such as Woodward had enjoyed 
and Sternberg evidently wanted. In fact, he did not even intend to use the 
museum facilities very heavily to support his own research: “I shall make 
it my object to stimulate and give opportunities for other men to work in 
connection with the Museum rather than try to work or write on details 
myself.” “I am sorry,” he concluded, “that it has not been possible to meet 
your wishes by placing you in charge of this department [i.e. microscopy], 
but I hope I shall be able to help you to a part at least of what you want, 
after a little.”41 
While Sternberg never obtained a post in the Museum, he and Billings 
managed to remain on friendly terms and to keep each other abreast of their 
career developments. The Surgeon General did bring Sternberg back East 
later in 1884, assigning him to a post near Baltimore. That location permitted 
the latter to utilize research facilities at Johns Hopkins, to participate in 
several international yellow fever investigations, and to strengthen his name 
as Americas foremost bacteriologist before being named Surgeon General 
in 1893. While considering the establishment of an Army Medical School 
that year as one of his first acts in that post, Sternberg knew that he had the 
full concurrence of Billings in the project and went ahead to include the 
latter on the schools first faculty.42 
The nearly four year period between Billingss appointment as Museum 
Curator and the completion of the new building allowed substantial 
time, both for implementing the various changes and for firming up the 
professional staff, both the carryovers and a few new ones. Accordingly, the 
museum that opened to the public in the new building in the spring of 1888 
was itself new in important ways. Above all, its exhibits now presented a 
wealth of tangible demonstrations, verifying and enlarging on the literary 
evidence in the adjoining medical library that formed the core of the new 
knowledge constituting scientific medicine. The new displays were, of 
course, central parts of an expanded teaching function aimed at explaining 
key segments of that knowledge. Much attention was given to the display 
of specimens that illustrated recent findings everywhere in human anatomy 
and pathology, while another section of the museum was devoted to the 
presentation of specimens of diseases and injuries that were drawn from 
the Army’s experience, some to be sure from the Civil War but others from 
41 JSB to Sternberg, 1/15/1884, Sternberg papers NLM. 
42 See the short account of the school in Chapter 5. Army Stimuli of Medical Knowledge and Change 
more recent years. Related presentations included samples of the medical 
instruments and equipment, the hospitals, the modes of transporting the 
sick, and other objects developed lor the Army.43 
Billings also gave considerable attention to the museum’s large stores of 
material related to human osteology, particularly craniology. His plan was 
to use those specimens to illustrate both the ethnological differences and the 
similarities of the various “native races of America.” Thus, anthropometry, 
or study of the “real or supposed structural differences in man according 
to race,” was arranged to be studied and displayed in the medical museum, 
“while specimens illustrating manners and customs, implements, weapons, 
clothing, pottery, etc” were left to the nearby National Museum.44 
Billings obtained Surgeon Washington Matthews, one of America’s most 
knowledgeable specialists, to supervise the craniological arrangements and 
studies during the planning period, but he could not persuade him to remain 
with the museum permanently.45 
Billings regarded it as imperative for all sections of the museum to display 
and use “the latest methods, the newest apparatus, etc.,” both to show visitors 
how modern science was being done as well as to eventually allow staff 
members and other scientists to do some experimentation. By 1888, a separate 
room had been provided for anthropological equipment that was intended 
to provide the nucleus of a complete laboratory, mainly for educational 
purposes. Billings, among other things, also looked forward to the day when 
that facility might emulate Francis Gabon’s London laboratory in offering 
to make standard anthropometric tests and measurements on visitors.46 
43 Soon after its reopening, Billings discussed the new features of the museum in 
detail in his presidential address before the Congress of American Physicians 
and Surgeons: JSB, “Medical Museums, w'ith special reference to the Army 
Medical Museum at Washington,” MedicalNeivs, Vol. 53 (1888), pp. 309-316, 
or reprint, pp. 1-43. See also a reporter’s earlier review in Medical News, Vol. 
49 (1886), pp. 330 ff; and the discussion in Henry, Armed Forces Institute, pp. 
73-88. 
44 JSB, “Medical Museums,” loc. cit., reprint, pp. 22-23. 
45 JSB to Matthews, 3/12/1884 and 5/5/1884, both in JSB papers NLM. For a 
recent study of Matthews’ scientific career, see Katherine S. Halpern and Susan 
B. McGreevy, ed., Washington Matthews: Studies of Navajo Culture, 1880-1894 
(Albuquerque: University of New Mexico Press, 1997). 
46 JSB, “Medical Museums,” loc. cit., reprint, p. 23. Army Stimuli of Medical Knowledge and Change 
97 
Meanwhile, Billings was able to purchase a variety of instruments, 
including one for psychophysical research.47 Among these, in 1888 he 
arranged with the young psychologist James McKeen Cattell, who was 
then working with Wilhelm Wundt in Leipzig, to order a German electric 
chronoscope. Cattell volunteered to set the apparatus up in Washington 
after he returned to the United States the following summer.48 
Some ol Billings’s most conspicuous innovations in the museum were 
in the microscopy section. Soon after becoming curator, he arranged with 
a London agent, John Mayall, to start purchasing microscopes for the 
museum’s tiny historical collection, one which he hoped would eventually 
include “an example of every different form” of the instrument ever built. 
By the year the museum opened, over one hundred anci forty instruments 
shipped by Mayall had been put on display.49 
Also prominent in the displays of the microscopy section were over 11,000 
specimens, together with photomicrographs, that had been collected during 
the previous twenty years from the various fields of microscopic research. 
Thinking apparently of an interest of his former colleague, Woodward, 
Billings attempted to enhance those holdings by purchasing one of Friedrich 
A. Nobert’s most advanced test plates, a ruling device for assessing the 
performance of the highest-powered objective lenses. However, the asking 
price proved to be more than the museum’s budget could afford.50 
In any case, he was already spending fairly liberally on instruments and 
other laboratory equipment to illustrate the applied aspects of microscopic 
research, including the processes. He was especially concerned with 
demonstrating their recent uses in bacteriology to identify the causative 
47 Daniel S. Lamb recorded the accessioning of many of them, in his “A History 
of the United States Army Medical Museum 1863 to 1917,” typed manuscript 
at NLM. 
48 Cattell to JSB, 1/3/1883, 3/13/1885, and 7/3/1885, all in JSB papers 
NLM. 
49 JSB, “Medical Museums," loc. cit., reprint, p. 20; and John Mayall, Jr. to the 
Surgeon General, U.S. Army, 3/25/1884, in JSB papers NLM. See also the rich 
account in Noe and Cowan, “Microscopy and the Army Medical Museum,” 
loc. cit., pp. 1 -36; together with Henry, Armed Forces Institute, p. 85; and James 
L. Hansen, et. al., The Billings Microscope Collection, 2d. Ed. (Washington: 
Armed Forces Institute of Pathology, 1974), passim. 
50 John Mayall, Jr. to JSB, 12/27/1884, JSB papers NLM. 98 
Army Stimuli of Medical Knowledge and Change 
organisms of particular infectious diseases as well as to develop means to 
cure, inhibit or prevent such diseases. Early in 1884, for instance, Billings 
had requested scientific acquaintances in the United States and Europe to 
furnish the museum with specimens of those disease-related microorganisms 
that were already known, together with proved preventatives, sera or vaccines 
that had been developed. Moreover, soon after Koch’s research methods 
became known in the United States, the museum obtained a full set of the 
German scientist’s famous “culture apparatus” as well as related research 
instruments that he had been using.51 
In the process ol obtaining such materials and instruments, Billings 
took on an occasional service function for the Museum’s correspondents 
in the research community. Fie used his contacts, for instance, to obtain 
specimens of trichinous pork for research purposes and to verify a case of 
lead poisoning caused by canned corn, while he assigned staff members to 
make chemical tests of water, disinfectants, or rags, and when possible he 
filled requests for microbes or sera from the Museum’s own supplies. Late 
in 1890, with the arrival of news about Koch’s introduction of tuberculin 
as an alleged cure for tuberculosis, Billings immediately sought to obtain 
some of the “lymph” from Germany. When Koch himself sent off a supply, 
Billings in turn forwarded portions to his close acquaintances, first of all 
to Welch at Hopkins, who in turn passed it on to Osier and Halsted for 
actual clinical testing. Later, when the museum’s supply of the lymph ran 
low, he advised investigators, such as Saranac Lake’s Edward Trudeau, to 
apply directly to Koch’s aides for what was needed, while he quickly placed 
another order for the museum.52 
Several months later, as criticisms of tuberculin mounted in the scientific 
periodicals, Billings wrote Koch that the army museum had distributed the 
lymph “widely to hospitals and to medical officers of our army,” for testing. 
He also reported having made the tests on a few patients himself. Though 
the American results, including his own, had so far been mixed, Billings told 
Koch that he himself remained “as fully convinced of the importance and 
value of your work on the tuberculin as ever.” He assured him, moreover, 
11 JSB, “Medical Museums,” loc. cit., p. 24; JSB to F. H. Formad, 2/25/1884 and 
A. Pearce Gould to JSB, 6/3/1884, both in JSB papers, NLM. 
,2 William Osier, “Preliminary Report on Koch’s Lymph,” Medical Neivs 
(Phila), Vol. 57(1890), p. 644; E. L. Trudeau to JSB, 12/14/1890, JSB papers 
NLM. Army Stimuli of Medical Knowledge and Change 
99 
that American scientists generally understood that Koch had been persuaded 
to make his First optimistic announcements about tuberculin ubefore you 
were ready and much against your will.” The Washington man closed by 
reiterating his personal friendship, urging Koch to pay a visit to the United 
States, and informing him that “I have a room in my house always ready 
for you.”53 
Through this period Billings remained a persistant advocate of the 
creation and spread of research laboratories in the United States, particularly 
those devoted to hygiene and microbiology. His lectures continued to 
emphasize the essential central roles that they, together with registration 
systems, played in public health work, i.e. for ferreting out and accumulating 
accurate knowledge of the causes of death and distribution of diseases. 
Accordingly, if America was to catch up with Europe in contributing to the 
bacteriological age, he urged, it was important that its large communities 
should give every encouragement to the building of such laboratories.54 
Meanwhile, from the museum and library, Billings provided his 
readers and correspondents with background literature and reports about 
laboratories. In the early years, he had suggested that American physicians 
prepare themselves as health scientists by taking study visits to the pioneer 
European research institutions. By the mid-1880s he was also directing 
the development of small model laboratories for the educational programs 
of several units of the museum. However, he resisted any suggestion of 
developing a substantial medical research facility in connection with the 
museum. At the same time, Billings continued to nurture a vision of 
organizing such a facility somewhere, perhaps along the lines that he and 
Curtis had projected in 1869. Writing to a potential contributor in 1884, 
he touched on some aspects of the vision: “I do take a very great interest 
in researches into the etiology of disease, and if 1 could lay hands on half a 
million of dollars to build and endow a laboratory such as I wish I believe it 
would be the best investment that ever was made. It would not do, however, 
to have it a government laboratory.’”'5 
53 JSB to Koch, 6/30/1891, JSB papers NYPL. 
54 For a late statement of this belief, see JSB, Public Health and Municipal 
Government (Philadelphia: American Academy of Political and Social Science, 
1891), (Supplement to the Academy’s Annals for 1891, offprint, pp. 20-23). 
55 JSB, draft of letter to Mrs. Thomas P. Plunkett, 1/3/1884, JSB papers NLM. 
His opposition to government financing of such establishments was likely 100 
Army Stimuli of Medical Knowledge and Change 
It was thus no accident that, at almost the same time, Billings was 
beginning the discussions with his Philadelphia associates that eventually 
pinned down the necessary resources for building a non-governmental 
laboratory in that city. In fact, even as he promoted laboratories, he continued 
to welcome the abundent opportunities to design and build other kinds 
of urban buildings, along with the challenge to make them hygienically 
liveable. 
largely prompted by the extreme difficulties he already experienced on a regular 
basis in obtaining adequate legislative appropriations tor the continuance of 
the Index Catalogue and of Index Medicus as well as for the Surgeon General’s 
Library itself. Chapter 5 
Ventilation Technology, Sanitary Politics, 
and Professi o nalism 
While Billings became particularly associated in some circles with 
the spread of laboratory science and new medical knowledge 
generally and science-related health measures, he never got away permanently 
from his interest in some of the older public health problems and activities. 
In fact, the name he gained from his applications of science to hospitals 
was sufficient in itself not only to bring him further hospital commissions 
but numerous requests to plan other kinds of buildings. Through them his 
expertise in ventilation helped give him ever larger authority in the public 
health world. 
The Surgeon General himself from time to time continued to loan 
Billings out to apply his expertise in ventilation to practical health problems 
of other government agencies or branches. At the same time, the latter 
involved himself increasingly in programs of the national public health 
professional groups. In such meetings and discussions, he began to carve 
out an expansive role as planner for the field, specifically as formulator of 
late 19th century public health priorities. Pursuing one of these priorities 
with particular vigor, he emerged as a pioneer academic instructor in the 
field, albeit as one who spread his energies all too thinly. 
Habitually relying on the informational riches of the Surgeon-General’s 
library to buttress such undertakings, Billings welcomed the occasional 
opportunities to resume his activity in practical sanitation while he also at 
times acted as a public health pundit or philosopher. In fact, by continuing 
to do both, he enlarged his understanding of the currents of change in 
nineteenth century medicine, science, and technology as they impacted on 
sanitation and public health. With that understanding, he went on to become 
one of America’s key interpreters of those changes, a valued guide for public 102 
Ventilation Technology, Sanitary Politics, and Professionalism 
health officials through the thickets of postwar debate over disease theories, 
sanitary measures, and scientific methods, old and new. And, in this role as 
guide, undertaken during lulls in his administrative duties, Billings made it 
his business to periodically reevaluate and restate the definitions of hygiene, 
sanitation, and public health. 
Cleansing the United States Capitol—Expert Boards and 
the Congress 
In the spring of 1876, Representative Casey Young, on behalf of the 
House of Representatives’ Sub-Committee on Public Buildings and Grounds, 
wrote Surgeon-General Barnes for advice in dealing with chronic ventilation 
problems in the cavernous hall of the House. Ever since its design and 
construction some twenty years earlier under the direction of the Army 
engineer Montgomery Meigs, this new area of the Capitol building had 
been repeatedly criticized lor serious inadequacies in its ventilation.1 
But successive attempts to improve the facilities had met with little if any 
success over the years. Learning, presumably through the Capitol architect, 
of Billings’s innovative ventilation for the Barnes Hospital, Young and his 
committee hoped that the latter’s expertise could be enlisted to help end 
the House’s long frustration by showing the way to more effective corrective 
measures. Barnes promptly made him available. 
Billings’s first contribution to the Sub-Committee was to prepare 
an outline of his preliminary view of the problems and how they might 
be approached. With that guidance, the sub-committee then created an 
ad hoc board of “United States Officers” to assess the situation fully and 
undertake the necessary improvements. Named the Capitol Ventilation 
Board, it became one of several early ad hoc bodies of experts established 
by Congress to deal with limited sanitary problems without creating any 
kind of permanent federal health agency. 
The Board brought together a prominent segment of Washington’s 
architectural and scientific talent. Included were the Smithsonian Institution’s 
patriarch, Joseph Henry, who was named as its President, and four others: 
the architect of the Capitol, Edward Clark; Lt. Col. Thomas Casey of the 
1 Meigs is known to have given much personal attention to the Capitols 
ventilation. See Charles Dudley Rhodes, “Montgomery Cunningham Meigs,” 
Dictionary of American Biography, Vol. VI, Part 2 (1964), pp. 507-508. Ventilation Technology, Sanitary Politics, and Professionalism 
103 
Corps of Engineers; Franz Schumann, supervisory architect of the Treasury; 
and Billings. The latter, who was the only physician in the group and, with 
Schumann, one of two members with special competence in ventilation, 
was named Secretary of the Board and was tacitly accepted by the others as 
the effective manager of the investigation.2 
In April 1876, this body began considering the interior state of the 
Capitol building even as Frederick Law Olmsted and his landscapers were 
working at beautifying the exterior grounds. After a few weeks of inspections, 
the Board issued two preliminary reports that summarized the existing 
problems, suggested several temporary measures for relieving them, and 
asked for a modest appropriation to carry them out. 
The Washington newspapers, obtaining the reports, quickly published 
details of what seemed to be the matter, sometimes using them for 
political purposes. One of the Republican-leaning organs, the Washington 
Chronicle, accurately reported that for years there had been complaints 
of uncomfortable drafts circulating unchecked throughout the hall. 
More vaguely, it observed that there had been much sickness among the 
congressmen, caused allegedly by “deadly gases descending to the floor of 
the House from the kitchen restaurant, the subterranean vaults, and dingy 
passages of the basement.” The account maintained that, because of those 
conditions, in the current session of Congress “more than ten percent of 
the members were confined to their rooms with colds and pneumonia,” 
while other lawmakers suffered different complaints. The Chronicle’s writer 
went on to accuse Clark, the Architect of the Capitol, who was a Democrat, 
of having wasted large sums of money between 1870 and 1874 on poorly 
conceived attempts to improve the ventilation. And he hoped that the 
new board would be more successful, particularly because James G. Blaine 
was among the ill representatives. Blaine, it reminded its readers, “is the 
Henry Clay of the Republican party today, and it [the party] cannot well 
afford to lose his valuable services at this particular time through the gross 
stupidity of the Architect of the Capitol.” ' 
“Ventilation of the Hall of the House,” U. S. House of Representatives, Select 
Committee on Ventilation, Report, Feb. 4, 1878, (45th Congress, 2d Session, 
Report No. 119); “Ventilation of the Hall of the House of Representatives,” 
U. S. House of Representatives, Select Committee on Ventilation, Report, Feb. 
21, 1879, (45th Congress, 3d Session, Report No. 116). 
3 Washington Chronicle, June 24, 1876. 104 
Ventilation Technology, Sanitary Politics, and Professionalism 
Galvanized by the newspapers and by their own colleagues, the members 
of the congressional subcommittee had little doubt about how to proceed. 
In keeping with a popular pre-bacteriological-age concept, it seemed evident 
that the Capitol was a classic case of a sick building. Accordingly, little seemed 
needed other than to have their expert board get started on repairing the 
assumed ills of the ventilation system. 
As an expert who believed in the probable truth of the germ theory of 
disease, Billings knew that a good deal more investigation was needed before 
the board could take any other action. He noted that the alleged health 
problems of the Capitol building remained vague and unsubstantiated. 
Certainly the problems were not of the same kind or magnitude as the 
deadly infections that sometimes ran rampant through the large urban 
hospitals of the day. Moreover, no congressional deaths were suspected to 
have occurred as a result of odors or other noxious emanations from the fabric 
of the building. Nevertheless, acting as an ad hoc health officer, Billings saw 
that the situation had to be regarded seriously, at least for political reasons. 
He thus made it part of his business to educate the congressmen to some 
extent, not by flaunting his own beliefs in the germ causation of disease but 
by maki ng an exhaustive series of tests, which were really demonstrations, 
of the various elements blamed by anti-contagionists as likely causes, tests 
that concluded by effectively rejecting those hypotheses. Besides, the panel 
had a good deal of technical modification and chemical analysis to do just 
to make the building comfortable for working in. 
In the fall of 1876, to determine the effectiveness of various ventilation 
and heating systems, members of the Board of Experts made first-hand 
inspections of selected large buildings elsewhere. Several visited American 
structures, while Billings covered western Europe. This trip, Billings’s first to 
Europe, was already planned as a fact-finding expedition in connection with 
his project to design the Johns Hopkins Hospital, but he easily rearranged 
the schedule to allow for inspections of some of the great non-medical 
structures of the continent as well as of its hospitals and medical schools. 
The two-month trip included, in fact, visits to an assortment of buildings, 
interviews with building engineers, searches for epidemiological histories of 
the structures, and the collection of architectural plans and specifications. 
Billings also fitted a considerable amount of other business into his trip 
between the inspections: appointments with booksellers on behalf of the 
Surgeon-General’s library and with instrument makers for his Army medical 
colleagues; visits to libraries as well as health and registry offices; dinners 
with physicians and scientists whom he had met earlier, among them Huxley Ventilation Technology, Sanitary Politics, and Professionalism 
105 
and Lister in England; and stops at a few laboratories. He apparently did 
not get to Munich’s Institute of Hygiene even though he had a letter of 
introduction to Pettenkofer.4 
When Billings returned to Washington, he turned numerous building 
plans and systems specifications over to the rest of the board, along with 
his analyses of them. In his mind, the buildings with the most satisfactory 
ventilation and heating arrangements were the English houses of Parliament 
and the Vienna grand opera house, though there were useful features in 
others also. 
Following this phase of fact-finding, the board resumed its frequent 
meetings and extensive tests, continuing them through the remainder of the 
term of the 45th Congress, to the end of 1877. A large proportion of these 
meetings were held at the Army Medical Museum in downtown Washington, 
where Billings and his army colleagues could provide laboratory, clerical, and 
other facilities. At the Museum sessions, the board went over the numerous 
reports, examined equipment specifications, prepared calculations of space 
and airflow, placed orders for anemometers and other measuremen t devices, 
and studied the results of experiments made for them by outside specialists, 
among them the New York architect Carl Pfeiffer. Much of their scrutiny 
focused on the chemical composition of the air in the Capitol and the 
mechanical performance of blowers and other equipment. 
Fairly early in 1877 the board came to the conclusion that no major 
changes would be needed, particularly no replacement of the buildings 
existing ventilation system. For the rest of that congressional term, then, 
and much of the following term, the members’ time was mainly spent in 
supervising a host of lesser changes, analyses, and adjustments; installing 
screens in front of ventilation openings; modifying the direction and rates of 
air circulation; changing the location and size of ducts; improving temperature 
controls; and so on.5 Occasionally compromises had to be worked out. In 
4 On this trip, Billings was accompanied by Dr. Ezra M. Hunt, the New Jersey 
sanitarian, who was then President of the AMA’s section of public hygiene. 
The two visited some nineteen cities in seven different countries. Billings’s 
detailed report of January 16, 1877 on his inspections of hospitals and medical 
schools was published in Johns Hopkins Hospital, Reports and Papers relating 
to Construction and Organization, No. 3 (Baltimore: The Hospital, 1877). 
5 House reports of Feb. 4, 1878 and Feb. 21, 1879 on “Ventilation of the 
House.’’(See note 2). See also JSB manuscript, “Minutes of the Board of 106 
Ventilation Technology, Sanitary Politics, and Professionalism 
one case, Frederick Law Olmsted and his landscaping associates objected 
that the location of a large air intake duct that was proposed for the exterior 
of the building would spoil the aesthetic appearance of that portion of the 
Capitol’s grounds. Billings, though not particularly happy with the request, 
agreed to find another location.6 
At the end of 1879, Billings and his fellow experts assembled a 
voluminous final report to the House Subcommittee. It essentially confirmed 
that the House chamber in itself was basically healthy, with no “deadly 
gases” circulating in or near it. And it provided abundant details of the 
technological changes that had been made to reduce drafts and raise the 
chamber’s comfort level. The House and its ventilation committee were 
clearly well pleased with these results, as were the ailing congressmen, the 
press, and other Washington individuals. In turn, throughout the project, 
Billings and the other Board members were happy with the respect that 
Congress had displayed for their professional authority as individuals as well 
as for the Board’s consistent use of scientific methods. 
The same respect for science, however, was not demonstrated by a 
subsequent Congressional committee that Billings advised. Between 1878 
and 1884 the ventilation board’s report had been widely circulated among 
America’s architects, builders, and manufacturers of ventilating and heating 
equipment. As the record of a major late nineteenth century investigation of 
ventilation, the document provided valuable information to such individuals. 
Even tually, however, certain of these individuals, out of self-interest, re-raised 
with their congressmen some of the old alarms about the alleged poor 
ventilation and unhealthiness of the Capitol. A number of the congressmen, 
some of whom were apparently trying to advance the agenda of the newly 
influential Marine Hospital Service, welcomed these alarms, seeing them as 
potential ways to discredit the Army Medical Department and to undermine 
the standing of the Department’s expert, Billings, and his report. In 
the 1884 session of Congress, then, a House Committee on Ventilation 
U. S. Officers, 1876-1877,” J$B Papers, NYPL, Box 69 (Ventilation and 
Heating). 
6 Billings statement, in U. S. House of Representatives, Committee on Ventilation 
and Acoustics, Report, June 24, 1884, “Method of Heating, Lighting, and 
Ventilating the Hall of the House of Representatives” (48th Congress, 1st 
session, Report No. 1970), p. 71. 
7 See Kohler, “Sanitarians and Engineers,” loc. cit, pp 197-207. Ventilation Technology, Sanitary Politics, and Professionalism 
107 
and Acoustics seems to have been created expressly to accomplish this. A 
majority of this committee first agreed to invite a Chicago firm, the Exhaust 
Ventilator Company, to submit an evaluation of and proposal for changes 
in the ventilation of the Hall of the House. Between February and June the 
committee held a succession of hearings to consider that plan. 
Briefly summarized, the Chicago company proposed a drastic and 
expensive modification of the House’s current ventilation system or 
preferably its total replacement by a different system. In so doing it directly 
challenged the unanimously adopted findings and changes of the 1876-77 
House board of experts, specifically certain central features worked out 
by Billings. Chief among those had been his reliance on “a system of 
direct upward ventilation”, which largely emulated systems of the Vienna 
opera house and the British houses of Parliament. The Chicago company 
proposed to install the opposite, or “downward system,” one which not 
only Billings but most other knowledgeable experts were then rejecting as 
being ineffective. 
At the hearings, the arguments of the Exhaust Ventilator Company 
were supported in detail by the statements of their own experts, particularly 
J. L. Smithmeyer, a Washington architect. Documents that he and the 
company submitted were then referred for evaluation or comment to a newly 
constituted federal advisory board composed of Joseph Henry’s successor 
at the Smithsonian, Spencer E Baird, as the new Chairman, along with 
three reappointees from the 1876-77 board, Lt. Col. Casey, Edward Clark, 
and Billings. Since this board had not been constituted for the purpose of 
conducting another full survey of the ventilation of the House, it obtained 
its own expert. Surgeon J. H. Kidder of the U. S. Navy. Kidder went on to 
make an investigation that strongly supported the findings and positions 
of the earlier board. 
Billings, as the chief shaper of the 1876-77 study and report, was 
inevitably chosen to take on much of the new panel’s questioning of the 
company’s presentation. Initially he had no difficulty in refuting most of it 
or in criticizing the reliance of the company experts on what he considered 
to be the questionable authority in ventilation matters of “exhorters” 
or popularizers. However, that changed when the company’s principal 
supporters on the Congressional committee abruptly abandoned all pretense 
of conducting the proceedings impartially and objectively. In short, they 
turned the proceedings into a veritable kangaroo court—aiming antagonistic 
questions against Billings and their other experts, irrationally belittling 
the latters’ scientific arguments and data, and ultimately impugning the 108 
Ventilation Technology, Sanitary Politics, and Professionalism 
competence of all of them. Their evident objective was to ram the company’s 
plan through the committee by discrediting both the improvements made 
by the earlier ventilation board and the authority of the new experts.8 
Faced by this overtly hostile segment of the House committee, Baird, 
Billings, and the other experts defended themselves as best they could and 
refused throughout to compromise the integrity of their views as scientists. 
Eventually the hearings broke up in total pandimonium and acrimony. The 
advisory panel left hurriedly, but not before they had voted unanimously 
to reject what they viewed as the company’s ill-advised and poorly based 
proposal. Subsequently the full House sided with that rejection, making a 
timely expression of confidence in the panel’s work and in the functioning 
of science.9 
Billings, as Secretary of the Board, kept extensive minutes, both of 
the routine testimony at the hearings and of the vituperative outbreaks 
that marred them. These were not published, nor did they include his 
personal comments on the possible reasons behind the behavior of the 
congressmen. However, the historian, considering the minutes along with 
other contemporary fragments of evidence, is left with the strong possibility 
of there having been some kind or other of corruption, perhaps involving 
company officials, perhaps congressmen, or even some of the experts. 
Nevertheless, the Board as a whole seemed scrupulously clean to those who 
knew them. Moreover, while Gilded Age sanitary enterprises often showed 
themselves to be vulnerable to political corruption, 1 have found no evidence 
that Billings himself was ever implicated adversely in this or any other such 
affair. On the contrary, both his integrity and his competence as a public 
health expert were enhanced rather than tarnished in Washington circles 
by this particular episode. 
While never regularly involved with the work of Washington’s health 
department, Billings was well aware of health conditions in the post-Civil 
8 U. S. House of Representatives, Committee on Ventilation and Acoustics, 
“Report on Methods of Heating, Lighting and Ventilating the Hall,” (48th 
Congress, lsr Session, No. 1970, June 24, 1884), p. 71. 
9 Ibid., p. 10. See also, “Ventilating the Hall of the House of Representatives,” 
U. S. House of Representatives, Committee on Ventilation and Acoustics, 
Report, July 2, 1884 (48th Congress, 1st Session, Report No. 2026). Includes 
a minority report of the committee. In addition, see JSB, “Minutes of the 
Board,” loc. cit. Ventilation Technology, Sanitary Politics, and Professionalism 
109 
War District of Columbia besides those of the Capitol building. He discussed 
some of these in professional sanitary journals,while the local press often 
aired his opinions about smoky chimneys, public baths, and other public 
health matters. Moreover, Congress continued to seek his advice and 
services, sometimes on the Districts problems. In 1882, testifying before 
a Senate committee on the sanitary condition of the city’s riverfront, 
Billings urged the Filling in of the Potomac mudflats as a measure to reduce 
the incidence of malarial fevers.10 At about the same time, the House of 
Representatives appointed him, together with architect Edward Clark and 
U.S. Commissioner ofEducation John Eaton, to look into the condition 
of public school buildings in the District. Their report emphasized the need 
for improvements in heating and ventilation.11 
Although the main focus of Billings’s activities as a practicing sanitarian 
was ventilation and heating, he familiarized himself also with the work of 
practitioners in other areas of sanitation, especially those who were effective 
in promoting and running large projects in and for communities of various 
sizes. Outstanding among such individuals was the sanitary engineer George 
E. Waring, who came to his notice in the 1870s as builder of drainage and 
sewer systems in the northeastern areas of the United States and who proved 
his value to Billings with his important sewer design and construction 
for Memphis. While Waring, in his popular writings, had long held and 
disseminated a traditional non-contagionist view of disease as the rationale 
of sanitary work, he proved willing to learn better about such matters from 
Billings and ultimately to modify his rhetoric. In any case, the two were 
drawn together by such things as their mutual devotion to the National 
Board of Health, as well as by the fact that they were both men of action with 
common interests in applying technology to sanitary ends. Socially, Waring 
became one of those who was always welcome at the Billings home on Gay 
10 The EveningStar (Washington), May 10,1882. For additional local background, 
see Betty L. Hummer, “A History of Public Health in Washington, D. C., 
1800-1890,” Ph.D. Diss., Univ. Of Maryland, 1984. 
11 “Resolution,” U. S. House of Representatives, Feb. 20, 1882 (47th Congress, 
1st Session); JSB to Commissioners of the District of Columbia, Feb. 23, 
1882, JSB Papers, NLM; JSB, “The Information Necessary to Determine the 
Merits of the Heating and Ventilation of a School Building,” in U. S. Bureau 
ofEducation, Circular of Information, No. 2 (Washington: The Bureau, 1882), 
pp. 11-19. 110 
Ventilation Technology, Sanitary Politics, and Professionalism 
Street, while for his part he kept trying to lure the frequently overworked 
Billings up to his home in Newport for a rest.12 
Professionally, Waring made no secret of his high opinion of the 
other man: he wrote President Arthur to support Billings’s candidacy 
for the Surgeon-Generalship, and he dedicated his 1889 book, Sewerage 
and Land Drainage, to him. In the meantime, Billings continued to be a 
ready and willing sponsor of Warings occasional sanitary assignments in 
Washington, some of them for the federal government. In early 1880, on 
Billings’ recommendation, the Smithsonian Institution invited Waring to 
lecture on the sanitary drainage of Washington. And about the same time, 
possibly on a similar recommendation, he was appointed special agent in 
charge of compiling social statistics for the tenth United States census. 
However, Billings was out of the country during the summer and fall of 
1881, a traumatic period for the national capital,when Waring was engaged 
to inspect the sanitary condition of the White House to determine whether 
some miasmatic condition was hindering the recovery of the wounded 
President, James A. Garfield.1'’ 
In 1892 Billings was called, this time by a Senate committee, to 
supervise the making of still another examination of the sanitary condition 
of the Capitol. For this survey, Billings persuaded Waring to work with 
12 James H. Cassedy, “The Flamboyant Colonel Waring: An Anti-Contagionist 
Holds the American Stage in the Age of Pasteur and Koch,” Bull. Hist.Med., 
Vol. 36, No. 2 (1962), pp. 163-176. For further background on environmental 
sanitation and the expansion of sanitary engineering during this period, see 
Stanley K. Schultz and Clay McShane, “To Engineer the Metropolis: Sewers, 
Sanitation, and City Planning in Late-Nineteenth Century America,” Jour of 
Amer. Hist, Vol. LXV, No. 2 (Sept. 1978), pp. 384-411; and James H. Cassedy, 
Charles V Chapin and the Public Health Movement (Cambridge, Mass.: Harvard 
University Press, 1962), pp. 36-125. 
13 The President died in September, before Warings recommended plumbing 
renovations had been made. This episode has been reconstructed and commented 
on in Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in 
American Life (Cambridge, Mass.: Harvard University Press, 1998), pp. 68-75, 
287-290. See also communication from George E. Waring to John Shaw Billings, 7 
Dec. 1881, entitled, “Report on the Sanitary Condition of the Executive Mansion,” 
in Garfield Scrapbooks, NLM. Billings does not seem to have made a public or 
professional statement on the Garfield death or on the Waring report. Ventilation Technology, Sanitary Politics, and Professionalism 
111 
him in investigating the building’s interior ventilation, exterior drainage, 
and the state of the kitchens. He also obtained A. C. Abbott, a University 
of Pennsylvania colleague and bacteriologist, to examine the chemical 
composition of the air in the Senate wing, along with F. W. Farquhar, a 
sanitarian, to survey the plumbing and the sewage system. As anticipated, 
their combined reports indicated serious problems in each ol these areas, 
with potential estimated repair costs of nearly $100,000.14 However, as 
usual, Congress seems to have done little or nothing to follow through 
on these findings. As a result, a new panel of sanitary experts had to be 
engaged in 1896—Dr. Joseph J. Kinyoun oi the Marine Hospital Service 
and engineer Henry Adams of the Treasury Department. In their report, 
these men took notice of Congress’s continuing pattern of neglect of the 
sanitary recommendations made by successive postwar expert panels, and 
they suggested two reasons for it. For one, the tasks were indeed large and 
complex. But above all, at least in the House, congressmen’s short terms in 
office made for a frequent lack ol continuity of knowledgeable members. 
In consequence, newly constituted committees almost always had to start 
the inquiry process all over again.15 
While Billings and his fellow federal experts were undoubtedly frustrated 
by the paucity of action following their sanitary recommendations, as career 
government officials they understood the reasons. Moreover, they had little 
choice but to undertake new surveys for Congress whenever called upon to do 
so. At the same time, those like Billings who were attempting to help elevate 
and professionalize civilian public health work encountered frustration there 
as well. In fact, almost every facet of activity in the emergi ng profession 
required both infinite patience and frequent repetition of expert advice by 
leaders who hoped to bring about change. 
The Design and Ventilation of Urban Buildings 
By the 1880s, Billings could easily produce plans for a laboratory 
structure, hospital, barracks, or almost any other kind of building, even 
14 “The Sanitary Condition of the Capitol,” Senate of the United States, 
Committee on Public Buildings and Grounds, Report, July 5, 1892 (52nd 
Congress, 1st session, Report No. 880). 
15 See summary of their 1896 report in Senator W. S. Linton, Senate document 
no. 1825 (54th Congress, 1st Session), copy in JSB Papers at NYPL, Box 69. 112 
Ventilation Technology, Sanitary Politics, and Professionalism 
though he had no formal credentials as an architect and never pretended to 
have all of the architect’s skills. His approach to this type of work obviously 
differed fundamentally from the fine arts approach of most of the reputable 
architects of the day. In essence, his earlier experience of surveying army 
environments and needs had equipped him with a strongly empirical 
basis for the process of designing and erecting buildings. The impact of 
frontier conditions and tight budgets in themselves combined eventually 
by 1870 to help produce in him a philosophy of architectural simplicity, 
utility, and functionalism, while the shifting current ideas about disease 
transmission contributed to his embracing a somewhat jeffersonesque 
concept of limiting some military buildings, especially hospitals, to life 
spans of around fifteen years. 
For Billings, this philosophy was strongly reinforced by the injunctions 
that were delivered by Thomas Huxley in 1876 at the opening of Johns 
Hopkins University. Particularly resonant was the latter’s advice to the 
university launchers not to rely on the conventional formulae of trained 
architects for the new academic buildings; rather, they should turn to “honest 
bricklayers” if truly serviceable laboratories or other structures were desired.16 
In his subsequent career as designer and builder, accordingly, so far as he 
had the choice, Billings firmly rejected the employment of the monumental 
or other fashionable architectural styles in either his exterior facades or his 
interiors. In so doing, he became one of the leading Gilded Age exponents 
of the utilitarian and functional in American building. And as such he came 
to be thought of by many as being an architect, though he himself continued 
to point out that there were distinct professional differences between his 
work and that of most architectural taste-setters. 
Implementation of Billings’s plans for a scientifically up-to-date 
medical museum and library in Washington in the mid-1880s was certainly 
facilitated by the fact that he himself was principal designer of the building. 
He certainly had well-developed ideas of what he did not want, originating 
16 John Bure hard and Albert Bush-Brown, The Architecture of America: A Social 
and Cultural History (Boston: Little, Brown, 1961), pp. 102-104, 178-184. 
Presenting Billings as their leading exemplar of utilitarianism and functionalism 
in scientific and medical buildings during that period, the authors tie his ideas 
by inference not only to the influence of Huxley s oration but to a gathering 
critique and rejection by some Americans of the formalism exhibited by much 
of the established fraternity of architects. Ventilation Technology, Sanitary Politics, and Professionalism 
113 
from his having had to work in the makeshift facilities that Fords Theatre 
had afforded. However, he also learned much from his readings about 
and visits to libraries in Europe and the United States as well as from his 
experience as consultant for new medical libraries in Boston, New York, 
and other locations. Ideas for the museum portion, in turn, seem to have 
been drawn from similar sources, including Washingtons National Museum 
as well as from plans borrowed from other institutions and studied in his 
own offices. 
Billings’s wishes for the new building, as refined and drawn up by 
the architect, Adolph Cluss, were subject to severe modifications before 
the structure was completed. Because of a barebones appropriation from 
Congress, there was little money for innovation or experimentation in the 
design, let alone for decoration. As a result, the interior when finished 
strongly reflected the utilitarian furnishings of its different sections: the 
long iron bookstacks in the library; the rows of showcases in the museum; 
the purposeful apparatus of laboratories and work rooms; and the plain 
shelves and desks of numerous clerks. At the same time, the spaces allowed 
for toilets and washrooms were cramped, while provisions for other basic 
amenities and comforts were similarly cut back.1 Meanwhile, the exterior of 
the building was completed just as Billings had wanted it to be, “exceedingly 
plain, without ornamentation.”18 His general idea seemed to be, and it was 
reinforced in some of his other buildings, that individuals who were truly 
committed to the pursuit of the medical and scientific revolution should 
be willing both to settle for a minimum of architectural splendor in any 
military medical structure and to put up with a certain lack of amenities 
and comforts. 
Nevertheless, in the next few years, the buildings features attracted serious 
interest from various segments of the library and museum communities. 
For instance, W. H. Bradley, a trustee of Chicago’s Newberry Library, went 
to see the new building in Washington and to consult Billings on “library 
construction, arrangement and management,” while Columbia Teachers 
College invited the latter to present his concepts of library and hospital 
construction in lectures to the students and faculty. Officers of the New 
York Academy of Medicine, considering the purchase of new book stacks 
for its library, decided to adopt the type that Billings had designed for the 
1 Miles, National Library of Medicine, pp. 165-167. 
18 Henry, Armed Forces Institute, p. 82. 114 
Ventilation Technology, Sanitary Politics, and Professionalism 
Army. And F. W. Peabody, curator of Harvard’s Peabody Museum, wrote 
for technical information, in his case for details about certain features that 
might well be adopted in a new wing of the Cambridge museum. He wanted 
a “sketch showing the arrangement of the floors,” information about the 
iron girders as well as about the hollow bricks used in the arches, and, where 
were the bricks made? Not least, he was “so much pleased with the floors 
that you are to have that I wish to have them in our building.”19 
Demand for Billings’s skills as designer and planner also spread, during 
the 1880s and ’90s, beyond the library, museum, and hospital communities 
to groups requiring planning acivice for other types of structures ranging 
from office buildings to city halls. But it was the nation’s public schools 
that generated the most urgent and most numerous inquiries. School board 
members and health officers in particular wrote Billings for advice or plans 
for school construction, ventilation, and heating. Most were concerned with 
these and other sanitary problems of two-story urban schools. However, 
Henry B. Holton of the Vermont State Board of Health needed suggestions 
for the state’s one-room rural schools. Later he asked Billings to review the 
board’s proposed regulations for the construction and ventilation of schools 
and to suggest amendments.20 
In the early 1880s Billings served as examiner for the National Academy 
of Design’s competition to select the best plans for schoolhouses, as well 
as on the House’s committee on school buildings.21 Billings also discussed 
these subjects before such groups as the National Educational Association, 
but he declined G. Stanley Hall’s invitation to speak at Clark University on 
“The Ideal Public School Building & Grounds.” His reason for declining was 
that the University would not reimburse his expenses and by that omission 
failed to recognize his professional status. Quite simply, he reasoned that his 
19 D. B. Delavan to JSB, 9/27/1889, in JSB papers NYPL; Isabel Hampton Robb 
to JSB, 12/11/1899; Egbert H. Grandin to JSB, 2/15/1894; F. W. Peabody to 
JSB, 2/18/1888; the last three in JSB papers NLM. 
20 Henry B. Holton to JSB, 2/21/1897 and 3/22/1897, in JSB papers NYPL. 
21 U. S. House of Representatives, “Resolution” of the House, Feb. 20, 1882 (47th 
Congress, 1st session); JSB to Commissioners of the District of Columbia, 
2/23/1882, JSB papers NLM; JSB, “The Information Necessary to Determine 
the Merits of the Heating and Ventilation of a School Building,” in U. S. Bureau 
of Education, Circular of Information, No. 2 (Washington: The Bureau, 1882), 
pp. 11-19. Ventilation Technology, Sanitary Politics, and Professionalism 
115 
expertise “in the planning and arrangement of a school or hospital should 
be counted in and provided for in the estimates of its cost quite as much 
as . . . are the bricks or the work of the architect.”22 
The undoubted apex of Billings’s professional career as a planner and 
arranger of public health and medical structures occurred in May 1889 
with the long-awaited completion of the Johns Hopkins Hospital complex 
and the event of its ceremonial opening. Of probable equal interest to him, 
however, was the announcement in Philadelphia, only four months later, 
of the University of Pennsylvania’s decision to build a research institute 
or laboratory of hygiene with himself named as planner and supervisor of 
construction as well as director and professor. 
The designing of the Penn institute was obviously a congenial undertaking 
for Billings; he was well aware of its pace-setting significance even if not 
actually “the first structure of its kind erected in the United States.” As such, 
he planned it consciously as a model, providing, among other features, an 
original and sophisticated air circulation system and equipping the rooms 
with up-to-date research facilities and apparatus. Much as in his Hopkins 
design, he provided for installation of a variety of different sizes and styles 
of radiators, vents, blowers, and other heating and ventilation apparatus in 
the different rooms with the intention that the building interior itself would 
be part of an ongoing experimental design. 
During the planning and construction phases, he came to enjoy a close 
and productive relationship with the university’s architects, Collins and 
Autenrieth. As a key element of this, they worked out together a plain and 
mutually satisfying functional solution for the building. Billings noted that 
solution in his address at the opening exercises of the institution in February 
1892. “As regards the external appearance of the building,” he noted, 
“opinions will, of course, differ. I will only say that it has been planned from 
within outward, which is the reason why it looks like a laboratory and not 
like a castle or a cathedral.”23 
22 G. Stanley Hall to JSB, 6/20/1891; and JSB to Hall, undated draft ol 1891; 
both in JSB papers NYPL. For his designs of governmental buildings, Billings 
did not receive fees. 
23 JSB, “Address of John S. Billings, M.D.,” The Opening Exercises of the Institute 
of Hygiene of the University of Pennsylvania, Philadelphia, February 22, 1892, 
(Philadelphia: The University, 1892), passim but especially pp. 17 and 27. 
For additional rich details, historical and architectural, see Susan Glassman 116 
Ventilation Technology, Sanitary Politics, and Professionalism 
Two years later, the University officials asked Billings to draw up plans 
for yet another laboratory structure, this one to be attached to the University 
Hospital. Working this time with the architectural firm of Cope and 
Stewardson, he planned and completed the William Pepper Laboratory of 
Clinical Meciicine within two years. Considered to be the earliest American 
institution specifically devoted to clinical research, the four-story laboratory 
was dedicated in December 1895. However, Billings did not take over its 
immediate direction and seems never to have taken as much interest in its 
purposes and internal features as in those of the Hygiene Laboratory.24 
As his various buildings rose across urban America, Billings also began 
playing an adjunct role as explicator, and to some extent popularizer, of the 
technological principles and practices involved in this emerging specialty 
of building design and planning. To be sure, he was covering much of this 
material in his hygiene courses at Hopkins, Columbia, and Pennsylvania. But 
it had become evident that there was a broader demand for such information 
or learning than those courses could supply. 
The post-Civil War period brought an increase in the number of 
American journals in the general fields of engineering, architecture, and 
tech nology as well as of such health or science-related periodicals as The 
Sanitarian, The Popular Science Monthly, and The Hospital. Billings’s writings 
and projects in these fields were published in several of these, but in none as 
systematically as in The Plumber and its successor, The Sanitary Engineer. 
In 1879, taking advantage of Billings’s consultancy at the Johns Hopkins 
Hospital, the editor of The Plumber invited him to prepare a series of papers 
about that experience. These were intended principally to deal in some detail 
with the kinds of interior technical problems that Billings was encountering 
as the hospital progressed. Using the general title of “Letters to a Young 
Architect on Ventilation and Heating,” he ran the series regularly in The 
Plumber until 1880, at which point The Sanitary Engineer took over the 
feature, continuing it to early 1883. The “letters” were originally prepared 
as replies to random questions sent the editor from sanitary engineers, 
and Julie Johnson, “Institute of Hygiene, University of Pennsylvania,” in U. 
S. National Park Service, National Register of Historic Places: Registration Form, 
(Philadelphia: Wagner Free Institute of Science, 1993), various paginations. 
See also Garrison, Billings, pp. 278-282; and Chapman, Order Out of Chaos, 
pp. 265-271. 
24 Ibid,, pp. 271 -272; and Public Ledger, Philadelphia, 12/5/1895. Ventilation Technology, Sanitary Politics, and Professionalism 
117 
physicians, relatively new architects, and others. They were intended 
to “provide practical directions . . . which can be easily understood by 
an intelligent builder” rather than forming a systematic and technically 
advanced manual for skilled architects or engineers.25 
After completing his series, and upon the suggestion of Henry C. 
Meyer, editor of The Sanitary Engineer, Billings rearranged and partially 
rewrote the papers, added some new illustrations and other material, and 
published them in book form in 1884 as The Principles of Ventilation and 
Heating and their Practical Application. For its material, the book now drew 
substantially from Billings’s other early building designs and projects, not 
only those for the Hopkins hospital but for the Barnes Hospital and the hall 
of the House of Representatives. However, another large part was devoted 
to his analyses and descriptions of the interior features of other structures 
that he had inspected and of the plans of still others that were supplied to 
him by builders or architects. While including features that had impressed 
him about a few European buildings he had personally studied, including 
some in Vienna, London, and St. Petersburg, for the most part the book 
was a review and technological critique of the liveability of selected large 
public buildings of gilded age America. A sizeable number were New York 
City landmarks, among them the Metropolitan Opera House, Madison 
Square Theatre, the Union League Cluib, and the Fifth Avenue Presbyterian 
Church, together with some residences of the well-to-do. But there were 
also a few scattered illustrations of buildings located elsewhere, including 
a high school in Bridgeport, Connecticut, the Cook County Hospital in 
Chicago, and the Academy of Music in Baltimore.26 
In response to continuing demand, the publisher reprinted the work 
within a few years. Meanwhile, Billings began preparing a virtually new and 
greatly expanded volume on the same subject, as usual doing most of his 
research and writing in his Washington office. In this latter opus, Ventilation 
and Heating, which appeared in 1893, he discussed the technical features of 
many more buildings than he had covered in the earlier volume, including 
several of his own later buildings. Fie also introduced illustrations from 
25 JSB, The Principles of Ventilation and Pleating and their Practical Application 
(New York: The Sanitary Engineer, 1884), preface, and pp. 13-14. Billings also 
wrote occasional articles for this journal on other technical aspects of sanitation 
and public health, including a shorter series on vital statistics. 
26 Ibid., passim. 118 
Ventilation Technology, Sanitary Politics, and Professionalism 
substantially more American communities outside of New York City and 
the East than he had used earlier, and he added a history and bibliography of 
ventilation. Most striking, however, was his consideration of the ventilation 
of an important cross-section of Americas industrial, commercial, and service 
structures, including mines, ships, tunnels, railway cars, prisons, sewers, 
stables, and shops.27 
As much as his analyses of urban mortality statistics, Billings’s large tomes 
on ventilation and heating were impressive attempts to improve basic health 
and living conditions in the Gilded Age. On the technical side alone, they 
led to the marked elevation of his stature in a number of related building 
and engineering professions. They also eventually brought him, not that he 
needed or sought it, at least partial admission into the fraternity of architects. 
In 1892, the Washington Chapter of the American Insti tute of Architects 
elected him their first honorary member, while two years later the national 
body followed suit. And in 1894 the American Society of Heating and 
Ventilating Engineers honored him as one of its charter members. 
As he prepared his 1893 tome, Billings reflected on the changes in 
ventilation and heating provisions that had occurred since 1870. He 
particularly noted the modifications that he had made in his own ventilation 
planning practices in response to the changing knowledge about the nature 
and behavior of germs. Along with other up-to-date sanitarians, he had found 
less and less evidence over the years that germs, fungi, or other causes of 
infectious diseases were spread promiscuously around buildings on drafts or 
vague miasmas that needed to be warded off by ventilation systems. Instead, 
he acted increasingly on the assumption that the greatest benefits from 
ventilation and heating controls lay in their capacity to promote people’s 
general physical well-being and comfort. Public health circles of the early 
1890s, however, remained of two minds about this, with many apparently 
still believing that the central purpose of ventilation “was to prevent people 
from being poisoned by their own exhalations,” i.e. by carbon dioxide.28 
Billings had his own guess about this matter but agreed that it was 
not yet supported by a preponderance of reliable scientific evidence. Soon 
■ JSB, Ventilation and Heating (New York: The Engineering Record, 1893), 
passim. 
28 George T. Palmer, “What Fifty Years Have Done for Ventilation,” Mazyck P. 
Ravenel, ed., A Half Century of Public Health (New York: American Public 
Health Association, 1921), (Reprint Edition 1970 by Arno Press), p. 338. Ventilation Technology, Sanitary Politics, and Professionalism 
119 
after the opening of his Laboratory of Hygiene in Philadelphia he took up 
the matter with S. Weir Mitchell, and the two men decided to organize 
a laboratory research project of their own to look for fuller answers. In 
May, 1893, the Smithsonian Institution awarded them a grant for the 
specific purpose of investigating “the nature of the peculiar substances of 
organic origin contained in the air expired by human beings, with special 
reference to the practical application of the results obtained to problems of 
ventilation for inhabited rooms.” Under the grant, the actual experiments, 
including replications of the work of earlier investigators, were carried out 
at the laboratory over the next two years or so by a young physician, David 
H. Bergey, with technical support from A. C. Abbott and others. Billings 
and Mitchell reviewed the experiments closely at every stage, suggesting 
“modifications or new experiments as the work progressed.”29 
For the final report that came out late in 1895, the technical appendices 
were prepared by Bergey and the narrative sections seemingly by Billings. 
The conclusions must have been highly satisfying for the latter to spell out, 
providing, as they did, highly explicit confirmation of his early hunches 
and understanding of the relationship of ventilation to health. The results 
of the experiments were such, they asserted, as to “make it very improbable 
that the minute quantity of organic matter contained in the air expired 
from human lungs has any deleterious influence upon men who inhale it 
in ordinary rooms, and, hence, it is probably unnecessary to take this factor 
into account in providing for the ventilation of such rooms.” Moreover, they 
concluded, “The discomfort produced by crowded, ill-ventilated rooms in 
persons not accustomed to them is not due to the excess of carbonic acid, 
nor to bacteria, nor, in most cases, to dusts of any kind. The two great causes 
of such discomfort, though not the only ones, are excessive temperatures 
and unpleasant odors.”>0 
Looking back in 1921 to some of the early days of his profession, George 
T. Palmer, a later ventilation expert, concluded that in the decades since 
1870, the period of Billings’s heaviest involvement in the specialty, “the 
29 J. S. Billings, S. Weir Mitchell, and D. H. Bergey, The Composition of Expired 
Air and its Effects upon Animal Life (Washington: Smithsonian Institution, 
1895), pp. iii and 341. The Smithsonian grant was vetted for merit by an 
outside expert committee composed of Horatio C. Wood, William H. Welch, 
and Charles S. Minot. 
30 Ibid., pp. 24 and 26. 120 
Ventilation Technology, Sanitary Politics, and Professionalism 
most outstanding change in ventilation . . . has been the substitution of 
experimentation for guesswork.” Moreover, he thought that the findings of 
Billings, Mitchell, and Bergey had been particularly noteworthy among the 
researches of that period. Their 1895 contribution, he believed, had been 
a bold, definitive, and “astonishingly clear” statement in its flat assertion 
“that chemical impurities were insignificant as causes of discomfort in 
occupied rooms, and that bad ventilation was in reality due to excessive 
temperature and moisture.” Palmer saw those researches and conclusions as 
marking “the dawn of a new conception of ventilation,” and he marvelled 
at their lasting power, at their having been “so closely in agreement with 
our understanding of the situation today after twenty-five years of further 
experi mentatio n. ! 
Drawing up Agendas for Sanitation and Public Health: 
Even as Billings immersed himself in the practical sanitary challenges 
of buildings large and small, he also productively involved himself in the 
intellectual processes of helping define priorities, tasks, and limits for post 
Civil War Americas emergent public health profession. Early agenda-shaping 
was obviously necessitated and stimulated, particularly during the 1870s, 
by his concurrent involvements and responsibilities in the American Public 
Health Association and the A.M.A.’s Section on State Medicine and Public 
Health. And later on, in the give and take of those organizations as well 
as of working sanitary departments or health agencies, he found abundant 
occasion to defend and test the merits of his various agenda components. 
As early as 1875, Billings published an initial outline of tasks and 
challenges that among other things suggested ways of redefining and 
modernizing the profession of sanitation and public health. From that 
presentation, he went on to issue a series of analyses, critiques and 
exhortations intended to provide various audiences with details of how 
to organize and improve the health of Gilded Age America in ways that 
were both professional and scientific. Tailoring his messages as appropriate 
respectively for physicians, scientists, sanitarians, and other kinds of public 
health practitioners, Billlings presented his own gradually changing views 
to the appropriate professional organizations, in national publications, and 
in academia. Though Henry I. Bowditch, Ezra Hunt, Stephen Smith, and 
31 Palmer, loc. cit., pp. 335-344. The quotations are from pp. 335 and 341. Ventilation Technology, Sanitary Politics, and Professionalism 
121 
others also offered schemas of the scope and future of public hygiene, none 
argued as persistently, comprehensively, or rationally as Billings. As a result, 
through these multiple presentations, by the 1880s his personal views rapidly 
became substantially accepted as the unofficial though authoritative agenda, 
both for the profession as a whole and for its segments. 
Addressing the APHA in Boston in 1876, Billings stressed the fact 
that modern public health work required a much larger degree of expertise 
than many old line sanitarians had realized or been accustomed to. And to 
illustrate this, he re-emphasized such current shortcomings as the typical 
health officers lack of precise knowledge about the causes of disease; the 
absence of statistics suitable lor testing the value of their public health 
measures; and the lack of facilities lor training public health officials.32 
Four years later, in his Presidential address to the Association in New 
Orleans, Billings noted other kinds of obstacles, among them the absence of 
adequate salaries and full-time employment for public health professionals, 
as well as the continuing lack of uniformity in disease terminology. But, on 
that occasion, he particularly stressed the urgent need for the Association’s 
members to turn substantially to laboratory research in the various sanitary 
sciences, a step that many of their European counterparts had already taken. 
“It is probable,” he observed, “that if we knew the whole life history of half 
a dozen minute organisms ... we should know the causes of some of our 
most destructive diseases and could proceed with their prevention upon 
truly scientific principles.”13 
In his 1879 report as Chairman of the A.M.A.’s Section on State 
Medicine and Public Health, Billings found but little recent “progress” in the 
section’s areas of concern. To be sure, he noted, “the number of new patent 
ventilators, sewer gas traps, sanitary soaps, etc., has been above the average, 
[but] it must be admitted that in our knowledge of the causes of disease, 
or of the means of avoiding or destroying those causes, little or no positive 
advance has been made during the year.” At the same time, the medical 
literature of the previous year included as usual a considerable array of claims 
of discoveries in these latter areas—and Billings cited a few, including the 
presumed discovery of the bacillus of diphtheria by Ewart and Simpson. 
But all of those that he found in the literature were premature and still in 
32 JSB, “Rights, Duties and Privileges,” loc. cit., 48-52. 
33 JSB, “The President’s Address,” Public Health: Papers and Reports, Vol. 6 (1880), 
pp. 1-11. The quotation is on p. 2. 122 
Ventilation Technology, Sanitary Politics, and Professionalism 
need of satisfactory proof and confirmation. Accordingly, he concluded, “as 
yet we must suspend judgment as to the correctness of the conclusions.” 
Citing similar tentative conclusions in much of the other scientific literature, 
Billings then devoted the remainder of his address mainly to a recapitulation 
of other public health needs.34 
At this same time Billings was working on what became his fullest 
elaboration of a public health agenda. In 1878, the New York otologist 
Albert H. Buck invited him to prepare a substantial introduction to a new 
text on the practice of hygiene and public health in the United States. He 
also solicited Billings’s opinion on the tentative outline of the work and 
sought suggestions for additional chapters and authors. 
Billings divided his own contribution into three sections. The first 
included a detailed review of the scope, values, and dominant rationale of 
nineteenth century public health down to the mid-l870s. France, Germany, 
and England all continued to offer instructive models for the field’s 
development in the United States, but he warned against attempting to adopt 
any of them in toto in this country. “The results will probably disappoint 
us.” The main reasons, he thought, were that most parts of the United 
States still lacked the basic sanitary legislation, administrative bodies, and 
mechanisms, did not have the necessary experts to run them, and in other 
respects were not yet ready to profit from organized public health. Moreover, 
he maintained, even those communities that had been installing the various 
sanitary measures could not claim that their public health programs were 
either scientific or truly socially useful until they established disease registers 
and other tools for evaluating the measures. “The absence of the information 
which such registers would give is one of the greatest obstacles to hygienic 
progress, for it is due to this that our legislators and political economists 
do not take the hygiene of the people into consideration, except in a few 
special cases.”35 
In his second section, Billings summarized and assessed the concepts 
of the 1870s pertaining to the causes of disease. Discussing the lingering 
filth theory of disease, principally through the recent critique by the British 
sanitarian John Simon, he was skeptical of it being able to furnish helpful 
34 JSB, “Address in State Medicine and Public Hygiene,” Transactions of the 
XXX (1879), pp. 279-291. Quotations are on p.279. 
35 JSB, “Introduction,” in Albert H. Buck, ed., A Treatise on Hygiene and Public 
Health, 2 vols. (New York: William Wood, 1879), I, p. 10. Ventilation Technology, Sanitary Politics, and Professionalism 
123 
answers to the scientific questions of the day. At least, he cautioned, “it is 
necessary not to overestimate it, and to beware of the popular notion that filth 
is almost the only thing which requires the attention of the sanitarian.” 
Accordingly, Billings once more pointed his readers in more constructive 
directions: “Our hope of substantial progress in knowledge of the causes 
of disease rest mainly on two methods as yet little used, namely, on the 
registration of disease and on comparative experimental pathology.” He 
illustrated the former by reference to William Farr’s statistical analyses in 
England of the nature and behavior of epidemics, but saw little likelihood 
of there being much research at that level from American data in the near 
future. In contrast, he reported that some limited American laboratory 
investigation, particularly in microbiology, had begun, though he stressed 
that it needed much stimulation before it could be expected to play any 
considerable part in the improvement of public health in this country. 
Billings went on to review at some length the latest classifications and 
definitions of microscopic organisms or “germs” and to summarize current 
etiological knowledge about numerous diseases. He emphasized the value 
of Pasteur’s contributions to “scientific precision” in his fermentation 
research as well as Koch’s innovative laboratory methods for isolating and 
cultivating bacteria. And he urged that some of the new methods be applied 
to other diseases, such as the economically damaging and frustrating Texas 
Cattle Fever, a disease which he himself and Edward Curtis had fruitlessly 
investigated a decade earlier.5t1 
The final section of Billings’s contribution to the Buck text dealt with 
an equally important topic for sanitarians, the “Jurisprudence of Hygiene.” 
36 Quotations in this paragraph are, in succession, from Ibid., pp. 29, 34, 23, 15, 
19, 20. For Billings’s research on Texas cattle fever, see chapter 3 of this book. 
Billings continued to refine his definitions of the terms sanitation, 
hygiene, and public health, depending on his audiences. In 1895 he offered a 
comprehensive definition of ‘sanitary science.’ “By sanitary science, vve mean, 
not a definite branch of accurate investigation by means of peculiar instruments 
and methods, such as astronomy or chemistry, but the sum of all the means of 
accurate in vestigation used in, and the conclusions of all branches of science 
which give increase of knowledge with regard to the nature and importance of 
the causes of disease and death in man and the means of avoiding, doing away 
with, or preventing the action of these causes.” JSB, “The World’s Debt to 
Modern Sanitary Science,” The Chautauquan, Vol. 21, no. 1 (April 1895), p. 18. 124 
Ventilation Technology, Sanitary Politics, and Professionalism 
In it he reviewed and commented on the legal bases of sanitation in Europe 
and America, on types of legislation, and on desirable provisions to include 
in such laws. And, as a guide to lawmakers and sanitarians alike, he provided 
bibliographical lists of authoritative works dealing with public health 
legislation, of general treatises and official reports on public health, and of 
journals and transactions of professional societies. 
Published in 1879, Buck’s two volume Treatise on Hygiene and Public 
Health before long at least partially succeeded the British work of E. A. Parkes 
as the standard text in its field in late nineteenth century America. It included 
twenty-five chapters by American specialists in the various branches of state 
medicine and sanitation. Several of the authors in addition to Billings enjoyed 
national reputations; among them, the New York pediatrician Abraham 
Jacobi, the President of the Philadelphia Board of Health, William H. Ford, 
and the sanitary engineer William R. Nichols of the Massachusetts Institute 
of Technology. For the historian, the work now appears as a definitive profile 
of the field at a brief but interesting transition period of American medical 
and sanitary thought. However, despite its momentary authority, within 
hardly a decade, if that, much of its material was made obsolete by new 
certainties and knowledge of the bacteriological age. Of its chapters, only 
Billings’s introduction had really embraced and given directions to the public 
health community for reaching out to that new scientific world. 
Hygiene and Public Health in Academia: 
Central to Billings’s expositions of his agenda was his conviction of 
the need to enlist more members of the medical profession in the new, for 
the United States, fields of state medicine and public health. But equally 
necessary for the future of the field was the expeditious establishment of 
special academic facilities and programs for the training of its professionals, 
facilities which were almost totally lacking at the time. By the mid-1870s 
Billings had begun cultivating interest along this line among friends both 
in medical schools and in other departments of America’s colleges and 
universities. And over the next two decades he succeeded to the point of not 
only gaining the support of several institutional heads for such programs 
but in obtaining appointments to launch them himself and to do some of 
the instruction, though necessarily as part-time arrangements. 
A natural place for Billings to attempt a start was the Johns Hopkins 
University. As part of his prospectus of 1877 for the intended Hopkins 
medical school, he had indeed included a remarkably comprehensive Ventilation Technology, Sanitary Politics, and Professionalism 
125 
program of studies in state medicine and related topics.37 State medicine, 
Billings granted, was as yet “not a familiar [term] in this country, owing to 
the almost total absence of the thing itself.” But he went on to define it in all 
its breadth, as one of the dynamic central features, along with the university 
systems and the cultures of science, for instance, that made mid-nineteenth 
European medicine so worth emulating in the United States. 
To propose that the embryo university consider developing a curriculum 
in state medicine was a large order, using it as he did as an umbrella term which 
included such subjects or concepts as preventive medicine, the registration of 
vital statistics, sanitation, hygiene, public health administration, and forensic 
medicine. In other words, he issued a challenge to Hopkins to do thoroughly 
what no other American educational institution had yet attempted to do 
at all, to train experts to cope with the crucial health problems and tasks 
of the Gilded Age. Among the most pressing of these latter, he cited “the 
steadily increasing pollution of our Water supplies, the Hygiene of Schools, 
the construction and management of Municipal Hospitals, the regulation of 
Prostitution, the prevention of the sale of improper or adulterated articles 
of food, [and the amelioration] of dangerous and unhealthful trades and 
occupations.”38 
In sum, thinking of Pettenkofer’s noted Institute of Hygiene in Munich 
and other European institutions, Billings proposed that the anticipated 
Hopkins medical school, in addition to its other innovations, should design 
for the United States a rather similar and truly revolutionary curriculum 
for hygiene and state medicine. Its students should have thorough training 
in microscopy and analytical chemistry, with special attention to bacteria 
and other lower forms of life. They should gain practical skills in analyzing 
air, water, food, and drink. Courses should be included on the principles 
of engineering and building construction, particularly in relation to the 
health aspects of ventilation, plumbing, drainage, sewerage, and other 
sanitary mechanisms. Before graduating, the student “should be able to 
make a topographical sketch of a given district, and should have a sufficient 
knowledge of Geology to understand the position of Strata and their 
37 JSB, Medical Education, pp. 347-348, 352. For other American initiatives 
of this period, see Judith Leavitt, “Public Health and Preventive Medicine,” 
in Ronald L. Numbers, ed., The Education of American Physicians (Berkeley: 
University of California Press, 1980), pp. 250-256. 
38 JSB, Medical Education, pp. 347-353. 126 
Ventilation Technology, Sanitary Politics, and Professionalism 
influence on Sanitation.” And, far from least important, he should become 
proficient in mathematics, vital statistics, and epidemiological methods, 
as well as familiar with the processes of legislation and the sanitary laws of 
various countries, states, and local communities.39 
Billings’s comprehensive plan for public health at Hopkins was obviously 
very dear to his heart, but few other Americans were yet ready for it. It was 
far ahead even of the innovative Johns Hopkins University’s capacity to 
implement during his lifetime. His hygiene lectures at the medical school 
did enable him for some time to pass on portions of his dreams for public 
health to faculty and students alike. But he essentially phased them out after 
1893, while the University put off creation of a comprehensive School of 
Hygiene and Public Health until 1918.40 
During the same post Civil War period, Billings took some rather 
similar steps to initiate public health instructure at Columbia College (later 
University) in New York. One of his associates in the American Public Health 
Association was the President of the college, Frederick A. P. Barnard. In 
1873, recently returned from visits to universities and scientific laboratories 
abroad, Barnard delivered a paper to the Association that reported on 
current European developments relating to the germ theory of disease and 
its relations to hygiene. During the following decade he seems to have 
periodically considered the possible creation at Columbia of a laboratory of 
hygiene to be modelled on the Pettenkofer Institute in Munich. In 1883 he 
persuaded Billings to lay some of the groundwork for such an institution, to 
be based in the college’s School of Mines.41 As a starter, Billings instituted 
a course of lectures on hygiene, a series that included large amounts of 
instruction on drainage, ventilation, water and sewerage systems, and other 
aspects of sanitary engineering. In addition, he helped the Department of 
Biology and Microscopy to organize its laboratory, specifically by drawing 
up lists of essential research instruments as well as of such desirable teaching 
devices as “a model of a house to illustrate various modes of ventilation.” 
At another level, Billings urged the Columbia administration, not only 
to appoint a full-time professor of biology, but to take steps to elevate the 
status of sanitary engineering as a field of university studies. "It should . . . 
be definitely understood that a sanitary engineer should be much more than 
39 Ibid., p. 353. 
40 Chapman, Order Out of Chaos, pp. 136-144. 
41 JSB to Barnard, 12/4/83 and 5/28/86, JSB Papers at NLM. Ventilation Technology, Sanitary Politics, and Professionalism 
127 
an inspector of house plumbing or of nuisances.’’ Such persons should thus 
be given the complex skills necessary, for instance, to design public water 
and sewage works as well as ventilating and heating systems.42 
Due to his other commitments, Billings never pushed for a comprehensive 
hygiene institute at Columbia. However, he profited professionally from his 
connections with several of the other faculty members, particularly with 
the Professor of Engineering, William P. Trowbridge, whose own researches 
on heating and ventilation helped undergird the former’s writings on 
those topics. Moreover, even after Barnard’s death, Billings continued his 
association with the School of Mines into the early 1890s. Every year, he set 
aside the necessary time to travel to New York to present either one or two 
series of ten lectures as requested. And while there he remained a productive 
participant in the meetings of the school’s student-faculty engineering 
society.43 
Despite his academic allegiances and satisfactions at Johns Hopkins and 
Columbia, Billings apparently made no real attempt, late in this period, to 
refuse requests from the leaders of two other institutions to participate in 
their pioneering academic programs. One of these was George Sternberg, 
who, in one of his first acts as Surgeon General, initiated and organized the 
long-hoped-for Army Medical School. The school opened in Washington in 
November 1893, in the same building as the Army’s medical museum and 
medical library. Along with courses on surgery, law, and military procedures, 
it offered several courses of public health relevance. Billings was named 
professor of military hygiene, covering such topics as the sanitary aspects 
of air, water, food, and clothing, while his recently arrived associate at the 
museum, Walter Reed, became professor of clinical and sanitary microscopy 
as well as director of the pathological laboratory. In addition, special lectures 
were given by Sternberg on bacteriology and by Charles Warded Stiles, then 
at the Department of Agriculture, on parasites of man. 
The end of the school’s first session was celebrated properly with 
appropriate speeches and ceremonies for the five graduates. The organizers 
bowed to history by including former Surgeon General William A. 
Hammond, one of the original proponents of the school as well as the 
42 JSB to C. R. Agnew, 12/11/84, JSB Papers, NLM. 
43 Charles D. Searle to JSB, 1/10/93, JSB Papers, NLM. For some of Billings’s 
debts to Trowbridge, see JSB, Ventilation and Heating (New' York: The 
Engineering Record, 1893), pp. 144, 148-134. 128 
Ventilation Technology, Sanitary Politics, and Professionalism 
“father” of modern American military hygiene, among the distinguished 
guests. Billings himself continued on the school’s faculty only one more 
year. Shortly after the 1894-95 session ended he resigned from the school 
as well as from the Army.44 
Billings’s army resignations were among his final steps in fulfilling the 
several-sided commitment that he had entered into several years earlier with 
the University of Pennsylvania. The central feature of that commitment was 
his designation as Professor of Hygiene and Director of the new Institute 
or Laboratory of Hygiene.45 Of course, Mitchell, Pepper, and his other 
sponsors at Penn had been long aware of Billings’s scientific contributions 
and reputation in hygiene, sanitation and public health. As early as 1881, 
Pepper invited the other man to prepare a chapter on hygiene for a text he 
was preparing, A System of Practical Medicine. As he acknowledged, “You 
are identified with [those topics] as we have developed them in America.”46 
Later in that decade, Billings may also have privately expressed to one or 
more of his Philadelphia friends some degree of impatience with the slow 
and limited implementation at Johns Hopkins and Columbia of his full 
scheme of instruction in these subjects, that is with the failure of either 
institution to commit itself to an institute of hygiene that might combine 
the approaches of Pettenkofer’s and Koch’s institutes. After reaching his 1889 
agreement with Pepper for such an institute, Billings immediately began 
planning and supervising its construction. He also began giving periodic 
lectures on hygiene, while the following summer he travelled to Europe to 
examine existing European hygiene institutes. 
44 For comments on the founding of the army medical school, see Robert S. 
Henry, The Armed Forces Institute of Pathology: Its First Century 1862-1962 
(Washington: Office of the Surgeon-General of the Army, 1964), pp. 90-95; 
Gillett, Army Medical Department, 1865-1917’, pp. 97-99. 
4:> See discusion in chapter 4. 
46 William Pepper to JSB, undated but probably late 1881, JSB Papers, NYPL. 
Billings accepted the invitation. His chapter, on “Hygiene," appeared in 
Volume I of Pepper’s A! System of Practical Medicine (Philadelphia: Lea Brothers, 
1885). Intended to educate general practitioners and medical students, the 
chapter was another part of his continuing effort to explain and advance the 
modern fields of hygiene and public health. Another of Pepper’s works, his 
1893 Textbook of the Theory and Practice of Medicine, included a comparable 
chapter by Billings. Ventilation Technology, Sanitary Politics, and Professionalism 
129 
Pennsylvania’s Institute of Hygiene opened with appropriate fanfare 
in February 1892 as the first teaching institution of its kind in the United 
States. Billings envisioned it as eventually providing research services to 
virtually all areas of the discipline, either in its own building or elsewhere 
and potentially in collaboration with other academic departments. He 
also looked forward to working to some extent with state and local health 
departments and actually did some consulting with both during his short 
tenure/17 However, at this stage, his attention was largely divided between 
fitting out the laboratories and completing the other physical facilities of 
the building along with conducting the Institute’s modest initial academic 
program. This latter consisted mainly of two basic courses. Billings himself 
taught the course in practical hygiene, which included lectures as well as 
laboratory work on topics very similar in scope to his lectures elsewhere. 
Alexander C. Abbott, who was brought on from Johns Hopkins University 
to be Billings’s principal assistant in the Institute, taught an elementary 
course in bacteriology.48 
From the available evidence, it is clear that the Institute of Hygiene did 
not achieve great success during these years, and scholars have concluded 
that Billings himself must have been responsible in some way or another for 
the steady decline in student enrollments after their 1892 high of eleven. 
However, few conclusive reasons have been offered as to why it occurred or 
even whether these graduate enrollments were actually small in numbers 
when considered by the expectations of Billings and his contemporaries. In 
his search for answers, George Corner speculated that Billings tried to cover 
too much ground in his course and that he had a prosaic teaching style that 
turned students off. Fie felt that Billings was also delinquent in such things 
as developing networks of support for the Institute within the University, 
in advertising it, and in actively seeking out and developing students, or 
4 Jonathan M. Liebenau, “Public Health and the Production and Use of 
Diphtheria Antitoxin in Philadelphia,” Bull. Hist. Med., Vol. 61 (1987), 
pp. 219-220. This article notes but provides no specific details on Billings’s 
activities. 
48 Addresses by Billings and other speakers on this occasion, together with outlines 
of the initial courses, are included in The Opening Exercises of the Institute 
of Hygiene of the University of Pennsylvania (Philadelphia: The University, 
1892). 130 
Ventilation Technology, Sanitary Politics, and Professionalism 
in short, that he failed to exercise effective management of the unit on any 
continuing basis.49 
Whatever truth there may be in these suggestions, it appears to me that 
any such delinquencies can have been only partial reasons for the decline. 
Another reason may have been the possibility that Billings never had the 
amount of time needed, either to teach or to administer the Institute 
properly. Through most of his 1889-1895 affiliation with the University of 
Pennsylvania, he was on a part-time arrangement which usually brought him 
to the campus only one day per week. However, in 1895, when he became 
full-time, he stated that he had had ample time to accomplish everything 
he had agreed to do at the Institute. 
This and other clues suggest that by 1895, when he resigned from the 
university, Billings may simply have become bored with his situation at the 
University of Pennsylvania. At least, he seems to have concluded that the 
package of responsibilities arranged for him at the University were no longer 
adequate. Specifically, he may well have concluded that there was no way they 
could continue to provide him with public health and medical challenges 
of the same magnitude as those that he had been grappling with during 
the previous thirty years, in or made possible by the federal government. 
Certainly this would have been true of the enormous tasks that he had faced 
during his rocky assignment with Americas first federal health body, the 
National Board of Health. 
49 George W. Corner, Two Centuries of Medicine: A History of the School of 
Medicine, University of Pennsylvania (Philadelphia: Lippincott, 1965), pp. 
180-183. Arthur J. Viseltear, in his review ol early public health education 
initiatives, reviewed the formation of the Pennsylvania Institute and Billings’s 
roles in it, but he did not acknowledge Billings’s other teaching stints. Arthur 
J. Viseltear, “The Emergence of Pioneering Public Health Education Programs 
in the United States,” Yale J. of Biol, and Med., vol. 61 (1988), pp. 539-542. 
Viseltear’s article is reprinted in Elizabeth Fee and Roy M. Acheson, ed., A 
History of Education in Public Health: Health that Mocks the Doctors Rules 
(Oxford: Oxford University Press, 1991), pp. 114-154. Chapter 6 
The National Board of Health: A Painful Experiment 
With Billings’s work and that of his Army colleagues, the Surgeon 
General’s Office by the 1870s increasingly took on the character 
of a large health department. Its officers were called upon to carry out 
epidemiological studies and prepare other scientific reports. Its museum 
had facilities for chemical analyses and other laboratory investigations. Staff 
experts were made available to serve as health consultants to other government 
and private agencies. Field surgeons acting as registrars carried out regular 
duties for the army’s nationwide vital statistics system. They also conducted 
vaccinations as needed and were beginning to perform sanitary inspections. 
Moreover, the Surgeon General’s Library was already partly organized, both 
for the expeditious dissemination of sanitary and public health literature and 
for its use in health decision-making at all levels of government. 
While these activities were first and foremost organized and conducted 
for the benefit of Army personnel, reports pertaining to several of them were 
circulated to broader audiences, particularly to local officials, physicians, and 
civilian health professionals. As such, these programs of the Surgeon-General’s 
Office, and after 1869 those of the Massachusetts State Board of Flealth, provided 
important native models for further post-Civil War American public health 
development elsewhere. They became stimuli, not only for the organization 
and expansion of city and town sanitary services around the United States but 
especially for the creation of additional state boards. They also served in some 
respects as examples for the scattered individuals who had begun to argue for 
some form of federal health bureau or agency. Previously almost unthinkable 
in the United States, this last concept was still a radical and debatable proposal 
for a nation whose health orientation up to that time had been almost entirely 
state and local. But some felt it could no longer be put off since there were by 
then so many pressing national health concerns that were outside the scope 
and competence of local and state authority to deal with. 132 
The National Board of Health: A Painful Experiment 
Several of the Army medical officers, including some Surgeons-General, 
endorsed these ideas, at least in general. But it was Billings who, with his 
numerous professional links in civilian public health circles, proved to 
be especially positioned and qualified to help advance the public health 
movement at the national level. And for over a quarter of a century, he 
remained as a key player—some thought him indispensable—in the 
initiating, energizing and implementation of new national health bodies 
and enterprises. In leading those causes, Billings the military man may not 
have fitted the usual mold of the reformer. Yet, he served them with force 
and conviction. This was true even though, by his time, the motives behind 
public health activity were less composed of humanitarian or other social 
reform forces than they had been a generation earlier, and more so by other 
ingredients, in his case mainly by scientific, medical, and technological 
imperatives, but rarely by political factors. 
Shaping a Federal Agency: The Profession and the Congress 
When the American Public Health Association (APHA) was launched in 
1872, practicing hygienists saw the body as a much needed continuation and 
focal point for Americas approximately forty-year-old but poorly coordinated 
sanitary movement. In order to bring new energies to the movement, the 
organizers, at one of their first meetings, invited some sixty additional 
professionals and others, including Billings, to join them as members.1 
Billings accepted partly because of the opportunity it offered to publicize 
the Surgeon-General’s Library among the members as well as to expand his 
personal network of Library collaborators and contributors. However, like 
many others, he also joined the Association in order to exchange professional 
ideas and information with his peers. 
At the Association’s initial meetings, Billings established what proved to 
be progressively useful relationships with Edward Jarvis, Edwin M. Snow, 
and several other senior sanitarians who had participated in the National 
Quarantine and Sanitary Conventions of 1857-1861 as well as with some 
of the participants in the wartime programs of the United States Sanitary 
1 For general histories of the movement, see John Duffy, The Sanitarians: A 
History of American Public Health (Urbana: University of Illinois Press,1990), 
espec. pp. 93-192; Wilson G. Smillie, Public Health: Its Promise for the Future 
(1955), pp. 235-268. The National Board of Health: A Painful Experiment 
133 
Commission. From the beginning he also had much in common with 
Stephen Smith and Elisha Harris, in large part because of their leadership 
of New York City’s celebrated sanitary reforms of the 1860s. And, as others 
joined the Association, he went out of his way to cultivate ties with the 
chemist Charles Chandler, with the sanitary engineers George E. Waring 
and Rudolph Hering, and with other kinds of health professionals. In fact, 
one of the conspicuous needs of the new society, he thought, was to attract 
still more engineers, lawyers, architects, and scientific specialists to balance 
its initial preponderance of physicians.2 
1 he early membership of the Association included a small but growing 
nucleus of active local health officers and a larger number of other city officials, 
including members of boards of health. By the mid-1870s, ten or a dozen 
representatives of newly created state boards of health had also begun attending 
the meetings. Equally noticeable was the appearance and participation of a 
few representatives from federal government agencies, a particularly welcome 
development since no such officials had shown up at the antebellum national 
quarantine and sanitary conventions. The head of the newly formed Marine 
Hospital Service, Supervising Surgeon General John M. Woodworth, came 
to meetings and served on committees from the beginning, while officers of 
the Navy’s medical department became members shortly afterward. From 
the Army, both Billings and Joseph J. Woodward contributed actively to the 
Association during these first few years, including the performing of extensive 
service on the Executive Committee and other committees. However, while 
the latter’s participation waned some time after 1876, Billings’s roles and 
responsibilities in the organization continued to expand; he was elected First 
Vice-President in 1878 and became President in November 1879.3 
2 The New York reforms are reviewed briefly in Duffy, The Sanitarians, pp. 
118-121, but for a vivid view by one of the participants, see Stephen Smith, The 
City that Was (New York: F. Allaben, 1911). For a short recent review of Smith’s 
career, see Gert Brieger, “Stephen Smith,” American National Biography, Vol. 
20 (1999), pp. 290-291. See also J.S.B., “The Rights, Duties, and Privileges 
of the Community in Relation to those of the Individual in Regard to Public 
Health,” American Public Health Association, Public Health: Papers and Reports, 
Vol. 3 (1875-1876), p. 52. 
3 These leadership and membership details of the Association are to be found 
in the minutes of its successive meetings. See the respective volumes of the 
Association’s Public Health: Papers and Reports. 134 
The National Board of Health: A Painful Experiment 
From the First, Billings proved to be versatile in his usefulness to the 
association. To be sure, he had no civilian experience as a local health 
officer or sanitary inspector. But, he brought to the discussions a degree 
of experience and expertise in initiating and organizing large-scale public 
health projects or operations that few other Americans of that period had 
had. Moreover, from his knowledge of the holdings of the Surgeon General’s 
Library, he could speak decisively about the latest and most important 
developments in every aspect of hygiene, in Europe as well as America. 
Billings was additionally already known as a man of action, a “doer” who 
was persuasive in argument and undaunted by difficulties. His friends and 
allies in the Association seem to have been particularly impressed by his 
normally calm demeanor, supreme self-confidence, and rational approach 
to problems. But those who opposed his positions would have more often 
found him stubborn, belligerent, or unyielding. 
When Billings joined the APHA, he became a participant in a vigorous 
world-wide discussion and debate over the causation and spread of crowd 
diseases or infections. Along with the other members of the Association, 
Billings hoped that the interchanges of shared experiences would add to 
their understanding of all of the communicable diseases. And with this 
new knowledge they looked forward to eventual improvements in the 
quarantines, vaccinations, environmental sanitary measures, and other 
disease control modes that were available to American communities, or to 
adjustments in their use. Divided among anti-contagionists, contagionists, 
and the undecided, the bulk of the membership was united only in their 
admitted ignorance of these matters. In fact, their vast helplessness before 
the crowd diseases made them feel an obligation to the public to continue 
trying almost every available preventive measure for as long as it seemed 
to hold any possibility of reducing disease and death, or as long as public 
opinion insisted. As a result, through this period of shifting scientific 
knowledge, neither Billings nor his APHA associates had much choice but 
to recommend sweeping very broadly in their public health measures, which 
meant, to some extent, the continued pursuit of environmental sanitation 
even if, like him, they were believers in the germ theory.4 
4 For Chadwick, see Benjamin W. Richardson, The Health of Nations: A Review 
of the Works of Edwin Chadwick, 2 vols (London: Longmans, Green & Co., 
1887); and Edwin Chadwick, Report on the Sanitary Condition of the Labouring 
Population of Great Britain, 1842, edited by Michael W. Flinn (Edinburgh: The National Board of Health: A Painful Experiment 
135 
The early APHA members varied somewhat in what they expected 
of their Association. Allies of Woodworth, for instance, wanted it to 
focus almost exclusively upon improving quarantine laws and practices. 
However, a larger segment of members agreed that, whatever else they 
did as an Association, they should devote themselves to the pursuit of two 
large interlocking objectives. The one was to design, organize, and carry 
out a comprehensive fact-finding survey of the nation’s health and what 
was being done to protect and improve it. And the other was to work for 
the creation of some form of national health bureau or commission. By 
all accounts, from an early day a sizeable number of the members began 
deferring to Billings’s expertise in these matters, and apparently with little 
or no discussion they went on to give him major roles in the Association’s 
pursuit of both objectives. In turn, Billings, in or through the Association, 
by and large sought national health solutions that would be compatible with 
the interests of the Army Medical Department. 
The case for a federal health organization and the one for national health 
fact-finding both gained significant new impetus, beginning in 1873, when 
a new cholera epidemic exploded across the United States. As usual, most of 
the responses to the epidemic, such as they were, were worked out by each 
individual community almost in isolation; few of the new state boards of health 
were yet in a position to provide much assistance.5 As expected, moreover, the 
only substantial and coordinated response that involved the crossing of state 
lines was that of the Army Medical Department. Throughout the 1860s the 
Surgeon-General’s Office had monitored the successive threats of epidemics 
Edinburgh University Press, 1965); and Cassedy, American Medicine, pp. 
208-215. An important new study is Christopher Hamlin, Public Health and 
SocialJustice in the Age ofChadwick: Britain, 1800-1854 (Cambridge University 
Press, 1998). 
1 xMarcus examined several aspects of the spreading late nineteenth-century 
national outlook in public health. However, he failed to take into account 
the large roles played in this development by the Army Medical Department, 
the American Public Health Association, the National Board of Health, or 
to a lesser extent, by the Marine Hospital Service. Alan I. Marcus, “Disease 
Prevention in America: From a Local to aNational Outlook, 1880-1910,” Bull. 
Hist. Med., (53), 1979, pp. 184-203. For a thorough study of the impact of 
cholera on nineteenth century America, see Charles Rosenberg, The Cholera 
Years (Chicago: University of Chicago Press, 1962), passim. 136 
The National Board of Health: A Painful Experiment 
at the various army posts and as necessary had bolstered the resources of the 
latter for preventing or treating the diseases. Subsequently, Barnes detailed 
Woodward to compile and publish a statistical report on the Army’s experience 
with epidemic cholera in 1866 and a similar report on both the cholera and 
yellow fever outbreaks of 1867.6 Even before the 1873 epidemic reached 
American shores, Barnes ordered still more extensive sanitary and therapeutic 
measures as well as improved reporting procedures at all of the field posts. 
And at an early stage he appointed Surgeon Ely McClellan to compile a 
comprehensive report on the course of the disease in the United States, not 
only in the Army posts but in the civilian communities. 
Following this most recent epidemic, Billings prepared and published 
a bibliography of the world-wide literature on cholera. He worked on 
this between 1873 and 1875 with his associates in the Surgeon-General’s 
Library and in the latter year completed a document of over three hundred 
pages.8 With its publication, the public health and medical communities 
were afforded expanded insights into this one destructive malady. Moreover, 
with it, the mechanisms for similarly illuminating other epidemic diseases 
in the near future and circulating other public health information were now 
virtually all in place. Billings had already begun planning the publication of 
the huge subject index of the contents of the Surgeon-General’s Library, a 
resource which eventually would provide health administrators and workers 
with exhaustive bibliographical information on every disease and every health 
and medical topic.9 Meanwhile, the cholera bibliography acted both as a 
stimulus and an adjunct to the APHAs anticipated health survey. 
6 Joseph J. Woodward, Report on Epidemic Cholera in the Army of the United States 
during the Year 1866, Surgeon General’s Office, Circular No. 5 (Washington: 
G.P.O., 1867); Joseph J. Woodward, Report on Epidemic Cholera and Yellow 
Fever in the Army of the United States during the Year 1867, Surgeon General’s 
Office, Circular No. 1 (Washington: G.P.O., 1868). See also Mary C. Gillett, 
The Army Medical Department, 1865-1917 (Washington: Center of Military 
History, U.S. Army, 1995), pp. 25-43. 
Ely McClellan, “History ol the Cholera Epidemic ol 1873 in the United States,” 
In Cholera Epidemic of1873 in the United States, House of Representatives, 42d 
Congress, 2d Session, Ex. Doc No. 95 (Washington: G.P.O., 1875), pp. 1-705. 
tH J.S.B., “Bibliography of Cholera,” in Ibid, pp. 705-1025. 
9 Wyndham B. Miles, A History of the National Library of Medicine (Bethesda, 
Md: National Library of Medicine, 1982), pp. 117-124. The National Board of Health: A Painful Experiment 
137 
Long before the American Public Health Association was founded, 
scattered physicians and government administrators across the western world 
agreed that the pursuit of public health required the amassing of much special 
information. Specifically, it became an article of public health faith that both 
the need for and the focus of sanitary action could only be determined by 
exhaustive surveying, classifying, and quantifying of environmental and 
other factors, both natural and man-made, especially those that appeared 
to contribute to excesses of ill health in any given community. In the 
antebellum United States, sanitary reformers and “statists” were particularly 
impressed by the unrelentingly systematic fact-finding processes that had 
evolved in England. In particular, beginning in the 1840s, they studied 
both the methods and the results that were detailed in Edwin Chadwicks 
famous Report on the Sanitary Condition of the Labouring Population of Great 
Britain, and they were equally avid to obtain similar publications of surveys 
by Chadwick’s contemporaries.10 Some few of the Americans—Lemuel 
Shattuck, John Griscom, Erastus D. Fenner, and others—went on to draft 
or even conduct such surveys in their local communities. But substantial 
support for a coordinated national sanitary fact-finding enterprise failed to 
materialize until after the Civil War.11 
At its Philadelphia meetings in November 1874, the APEIA created a 
committee to design such a survey. The Association chose Billings to be its 
chairman and selected twenty-three additional senior sanitarians to work 
with him as members. Over the next year Billings directed the committee’s 
work from his desk in Washington, a process that chiefly entailed deciding 
upon the main subject areas to be covered, assigning committee members to 
draft specific questions, and then editing a final draft. Surprisingly he made 
no attempt to impose his own opinions but instead let the report reflect the 
belief and practices of the entire committee. 
It was such a report that was submitted to the Association at its fall 1875 
meeting in Baltimore. The report emerged as a model questionnaire to be 
made available to communities that wanted to survey themselves. Exhaustive 
in scope, its nineteen main topical headings or survey schedules included 
over five hundred questions designed to elicit definitive information as to 
“the present condition of Public Health” and the extent of measures for its 
regulation in America. The members intended that for the time being the 
10 Cassedy, American Medicine, pp. 208-215. 
11 Ibid., pp. 208-219. 138 
The National Board of Health: A Painful Experiment 
survey would be confined to towns and cities with populations of over 5,000 
inhabitants; they identified some 325 such communities.12 
The report’s topics and questions strongly reflected the membership’s 
dominantly anticontagionist beliefs with respect to the spread of disease, 
their concerns with climatic and topographic influences on health, and their 
preoccupations with urban wastes and their disposal: i.e., with drainage 
and ventilation of houses and public buildings, with sewers and water 
supplies, with the elimination of odors, and with other sanitary activities 
related to the environment. In deference to holders of contagionist beliefs, 
however, questions were also included about the organized use of quarantine, 
vaccination, and other measures. The committee members then differed over 
the question of what use the Association should make of the potential data 
collections and ultimately ended up making no clear recommendations. 
They did agree that individual communities could find much of value 
in the scheme, if only as a basis for discussing future plans. Moreover, it 
seemed evident to the committee that “until some such sanitary survey is 
accomplished, State Medicine in this country cannot take rank as a science, 
but must rest mainly upon individual opinion and hypotheses, as it now 
does.”13 
After considerable discussion, those in attendance at the Baltimore 
meeting endorsed the plan drawn up by the committee and then created 
a new special committee to organize and begin the work of the survey. To 
staff the group, they carried over many members of the original committee, 
including Billings, but they turned the chairmanship over to Elisha Harris. 
The official minutes of the meeting do not specify any reasons for that 
change, but it seems to have been initiated by Billings himself. 
To begin its work, the APHA committee under Harris explored the 
possible use of maps in its future reports, attempted to test the so-calledBillings 
committee’s questions and schedules in a few sample communities, and made 
tentative plans to launch the full-scale survey in 1880 in collaboration with 
officials of the United States Census. However, between 1875 and 1878 
12 JSB, “Report of Committee on the Plan for a Systematic Sanitary Survey of 
the United States,” Public Health Papers and Reports, II, 1876, pp 41-54. The 
only scholarly review of this project is the short paper by George Rosen, “John 
Shaw Billings and the Plan for a Sanitary Survey of the United States,” Amer. 
J. Of Public Health, Vol. 66, No. 5 (May 1976), pp. 492-495. 
13 JSB, “Sanitary Survey,” loc. cit., p. 44. The National Board of Health: A Painful Experiment 
139 
tangible progress of any kind was badly stymied by a nationwide economic 
recession. In 1877, Harris thus had to confess that the survey project was 
still marking time pending realization of three desiderata: the creation of a 
federal public health office or bureau that might coordinate the survey; the 
creation of boards of health in every state to actually conduct local segments 
of the survey; and the obtaining of fiscal support.14 
Billings, meanwhile, had come to the decision that he had to repudiate 
much of the plan that his own survey committee had drawn up. At some 
point in the process, he realized that he had come to look at the purposes 
and contents of sanitary surveys in a totally different way than most of his 
committee members did. He did agree with them that America’s cities and 
states would unquestionably benefit to some extent from the standard sanitary 
surveys of the day just as much as English and European communities had 
benefitted in previous decades. Yet, even as the committee completed its 
deliberations in 1875, he was thinking of ways to move beyond what was 
a highly traditional and limited type of survey. Accordingly, he turned his 
presentation of the committee’s plan at the Baltimore meeting into a strong 
proposal for modifications and additional ingredients that he thought were 
essential for future surveys. 
Arguing from history, Billings noted that his committee’s survey 
plan actually promised only marginally greater usefulness, if any, than 
previous American plans of this character had achieved. A major reason, he 
maintained, was that, even though all but one of his committee members 
were physicians, the plan included little that would be of interest to the bulk 
of the medical profession. As such, it was an incomplete, one-sided inquiry. 
Despite the immense store of facts about America’s sanitary topography 
that it was intended to pull together, he concluded, “the medical part has 
been left out.’’ Moreover, the likelihood seemed strong that, unless actual 
survey teams raised their sights, replies to the 1875 survey questions might 
well, as in past surveys, end up dealing with “only one form of disease, the 
malarial,” and that only in “vague and general” terms.15 
“The one great object of medical topography” or of sanitary surveys, 
Billings asserted, should be the investigation of the causes of disease. 
However, up to that time, as he reminded his peers in the APHA, in the 
14 See minutes of annual meetings for 1875-1878, Public Health Papers & Reports, 
volumes II-1V. 
|S JSB, “Sanitary Survey,” loc. cit., p. 51. 140 
The National Board of Health: A Painful Experiment 
United States only the Army Medical Department had done much of 
significance along that line. The Department had been unique in collecting 
factual information about disease as well as about mortality, and its long 
continued attempts to correlate those data with meteorological information 
at the various posts were, despite their inconclusiveness, the most valuable 
American contributions yet made to the study of disease etiology. Thus, any 
future sanitary survey should similarly include searching questions about 
diseases as the core of its inquiries. Moreover, in order for them to have teeth, 
future inquiries into the nation’s health had to seriously enlist the methods 
and findings of the sciences so that ‘Vague generalities and opinions [can] 
be replaced by specific information.” As another crucial part of the process, 
the medical profession had to be enlisted and intimately involved far more 
than it had yet been. Finally, to become at all complete and effective, the 
entire survey operation seemed to require the involvement of some form of 
federal health agency or bureau.16 
While the early members of the American Public Fiealth Association had 
some enthusiasm about the project for a national sanitary survey, they were 
initially less interested in working for some vaguely distant federal health 
agency. After all, most of them were first and foremost heavily committed 
to getting their city and state health departments off the ground. Fiowever, 
many became more favorably inclined toward the idea of a national agency 
during the 1870s, partly after hearing the persuasive arguments of a handful 
of their colleagues but particularly following the outbreak of a devastating 
new epidemic of yello w fever. 
Billings’s views on the matter were expressed in various ways and to 
different audiences. As early as 1866 he confessed to having had a daydream 
in which he “got very enthusiastic all by myself over the Utopian idea of 
making the Surgeon-General head centre of the medical profession” of the 
United States, and he may well have ultimately thought of himself as an 
equally suitable person for such a job.1 Fiowever, within a few years he 
was asserting in public his conviction of the imminent need for a federal 
health body. In 1869 he and Barnes maintained before Congress that the 
“large medical library” they were creating would be an essential element in 
forming and carrying on the work of such a body. By the mid-1870s Billings 
16 Ibid., 50, 51, 53. For further references to the Army statistics, see chapters 2 
and 5. 
17 Quoted in Garrison, Billings, p. 146. The National Board of Health: A Painful Experiment 
141 
was letting it be known that the Surgeon-Generals Library’s collection of 
sanitary reports and other public health documents had already become 
fully adequate to support the needs of a national health organization. And 
in his 1870 reports to the Secretary of the Treasury he had discussed his 
ideas about the likely relations of the proposed Marine Hospital Service to 
a broader national health agency.18 
During the 1870s Billings gained increased opportunities to exchange 
views on these matters, not only at the APHA but in the American Medical 
Association’s newly founded Section on State Medicine and Public Hygiene. 
A broad range of opinions and proposals emerged in these circles despite 
the well-known limits that the United States Constitution placed on federal 
activity in health-related matters. In the AMA, several prominent hygienists, 
particularly A. N. Bell and Henry I. Bowditch, came up with comprehensive 
and influential schemes. But in the final analysis they concluded, as did 
Billings, that, for the time being any such bureau would be premature. This 
position rested chiefly on the fact that state boards of health, which would 
have to lead the sentiment for a national body, were still few and limited in 
powers. Moreover, the public, whose concurrence would be essential, was 
still uninformed about the issues.19 
At the APHA, some agreed with Bowditch, while another group 
continued to follow the ideas of John M. Woodworth, who had been 
effective in lobbying Congress for the buildup of federal quarantine functions 
in his Marine Hospital Service and was hopeful of expanding in other 
directions. However, a larger proportion of the members, especially the 
active sanitarians, remained skeptical of the value of quarantine, except as a 
last resort, and a good many seriously questioned Woodworth’s exclusively 
contagionist premises. These members responded more favorably to other 
advocates of national health legislation, among them Christopher Cox, 
Stephen Smith, Dorman Eaton, and Billings, though there were still other 
18 John Shaw Billings, “The National Board of Health and National Quarantine,” 
in American Medical Association, Transactions, Vol. 31 (1880), pp. 
435-455. 
|l> See discussion in Smillie, Public Health, pp. 306-310. Billings seems to have 
been especially influenced by Bowditch’s extensive survey of the individual 
states and by the latter’s effective organization and direction of the first fully 
operative American state health department, in Massachusetts. Henry I. 
Bowditch, Public Hygiene in America (Boston: Little, Brown, 1877). 142 
The National Board of Health: A Painful Experiment 
areas of disagreement.20 Some wanted a strong federal office with permanent 
professional staff that could perform an extensive range of preventive 
activities, including quarantine if appropriate. Others, however, including 
Billings, preferred a mainly advisory body of experts, at least to begin with. 
This segment agreed that some such office was needed on a continuing basis, 
as much between epidemics as during them. They did not urge copying 
any of the various types of central public health agencies that had been 
developed in Europe. But they did want a body with enough authority and 
expertise for carrying out an effective national sanitary survey and for shaping 
statistical and health information systems. Equally desirable was the conduct 
or stimulation of studies of the causation of disease and the development 
of other health-related research. likewise, most expected such an office to 
promote the creation of public health boards in every state and to support 
the extension of local environmental sanitation programs.21 
During the same period Congress extended its own parallel consideration 
of national health measures and institutions, though with often different 
priorities. The prime interest of the lawmakers in the early and mid-1870s 
was in working out a national quarantine system, though the sanitary and 
medical societies i ncreasingly urged them to consider some broader form of 
sanitary bureau or agency. In the summer of 1878, a new epidemic of yellow 
fever that struck much of the South and the Mississippi basin brought a 
powerful new sense of urgency to these discussions. It also accelerated the 
emergence of political and other divisions in the debates over new health 
legislation. 
Polarization of the public health community was especially evident 
from the mid-1870s on, when Billings and Woodworth began staking out 
increasingly conflicting positions with respect to such legislation. And it 
solidified as each of these strong personalities began to perceive the other 
as a formidable rival and obstacle, someone standing in the way, not just to 
obtaining a particular kind of legislation but to dominating any national 
agency that might be created. One episode illustrates the adversarial 
relationship that had developed. Late in 1878 Woodworth was the intended 
beneficiary of a national health bill introduced in the Senate by Senator 
20 See Ibid., pp. 301-306; Duffy, The Sanitarians, pp. 163-167. 
21 Billings outlined his preferences to other APHA officers at several points, but 
see his letter of mid-December 1878 to Dr. C. B. White of New Orleans, in 
JSB Papers, NLM. The National Board of Health: A Painful Experiment 
143 
Lucius Q.C. Lamar of Mississippi. Comprehensive in scope, the bill proposed 
a federal health department that would not only administer a national 
quarantine system and perform standard sanitary and epidemiological 
activities but also incorporate the current Marine Hospital Service operations 
and personnel. Focussing on this latter provision, Billings and his supporters 
immediately identified the bill as a dangerous attempt to place Woodworth, 
whom they had come to regard as unacceptably power-hungry, in control of 
Lamar’s entire projected scheme, and they managed to get it pigeon-holed. 
As it happened, many Senators, still uneasy about any broadening of federal 
health activity, were all too willing to quash the bill anyway, just as they did 
many of the period’s other health proposals.22 
For one illustration of Billings’s strong feelings toward Woodworth, see JSB 
to Elisha Harris, 12/14/1878, JSB papers, NLM, box 10. 
Historians have given considerable attention to these political, professional, 
and personal conflicts. Among the most useful works are Wyndham D. 
Miles, “A History of the National Board of Health, 1879-1893,” 2 vols., an 
unpublished manuscript dated 1970 in the National Library of Medicine, 
chapter I (pp. 1-36); Peter W. Bruton, “The National Board of Health,” 
Ph.D. Diss., University of Maryland, 1974, pp. 30-165; Bess Furman, A 
Profile of the United States Public Health Service, 1798-1948 (Bethesda, Md.: 
National Library of Medicine, 1973), pp. 121-149; Margaret Humphreys, 
Yellow Fever and the South (New Brunswick: Rutgers University Press, 1992), 
pp. 55-110, passim.; John H. Ellis, Yellow Fever and Public Health in the New 
South (Lexington: University Press of Kentucky, 1992), pp. 60-82; Robert 
H. Kohler, “Sanitarians, Engineers, and Public Science in the Gilded Age,” 
Minerva, Vol. XXXI, No. 2 (Summer 1993), pp. 184-210, passim. 
Of these works, the Miles study, though never quite finished or published, 
remains the most thorough and useful examination to date of the National 
Board, not only of its specific program activities but of its highly contentious 
legislative history. The Bruton work provides a fuller background of public 
health history. Furman, in turn, interprets the political developments and 
personal conflicts from the point of view of Woodworth, who died in 1879, and 
the interests of the Marine Hospital Service. While her treatment is interesting 
and useful, there remains a need for a much fuller and less disputatious account 
of the Woodworth-Billings relations as well as of Woodworth’s larger role in 
American history. The Humphreys and Ellis volumes illuminate the National 
Board rivalries and issues in the context of the 19th century yellow fever 144 
The National Board of Health: A Painful Experiment 
Following this incident Woodworth lost much of his influence in 
the American Public Health Association, leaving Billings as the principal 
spokesperson of the body’s efforts to obtain national health legislation. 
Already, during the mid- 1870s, the latter had worked toward that goal 
from his seats on the Association’s Executive Committee, the Sanitary 
Survey Committee, and other committees. Now, at the Richmond meeting 
in November 1978, Billings gained additional leverage as the Association’s 
vice-president. He also earned a seat on the body’s newly created Advisory 
Council on National Sanitary Legislation. The Council in turn empowered 
a three-man executive committee to pursue the cause of national legislation 
with the utmost urgency during the period before the next APHA meeting. 
With Billings on this committee were the Washington physician arid former 
APHA President Joseph M. Toner and the New York attorney Dorman 
Eaton, highly respected for his contributions in shaping New York City’s 
path-breaking sanitary legislation of the 1860s. During the next six or 
more months, these three individuals virtually lived in the U. S. Capitol 
building, lobbying for the cause of a national health bureau and working 
with individual congressmen in the attempt to obtain a compromise bill 
that both the lawmakers and the sanitarians could accept.23 
epidemics. Both works are particularly valuable in detailing the activities of 
southern congressmen and physicians who became backers of Woodworth. 
Finally, Kohler’s article, while flawed in some respects, is a highly original 
and stimulating examination of the National Board’s scientific setting and its 
political struggles, and it deals penetratingly with the causes of the Board’s 
demise. However, it needs qualifiication, I believe, in its portrait of Billings as a 
loose cannon or power-hungry bureaucrat in the federal government. Actually, 
through his long military career, Billings remained scrupulous about doing 
things through channels, observing red tape as necessary, keeping the Surgeon 
General informed of his plans, and working with existing organizational 
hierarchies, committees, and chains of command. For another view of the 
federal government and its components during this period, a surprising number 
of which touched on Billings's career, see the classic study by Morton Keller, 
Affairs of State: Public Life in Late Nineteenth Century America (Cambridge, 
Massachusetts: Belknap Press of Harvard University Press, 1977), passim. 
23 Drawn from various Association reports in Public Health Reports and Papers, 
Vols. II-IV, 1874-1878. Billings’s preferences for a particular form of national 
health organization during these years were undoubtedly shaped in part by The National Board of Health: A Painful Experiment 
145 
The legislation that finally emerged in several installments in the spring 
of 1879 from these hectic joint efforts of Congress and the public health 
association was far from ideal for anyone. Some saw it as a blatant abdication 
of congressional responsibility for health, but others recognized it as the best 
that could be expected from a succession of dif ficult compromises. In lieu of 
the comprehensive and permanent federal department of health that some 
had wanted, Congress settled on a part-time council called the National 
Board of Health and effectively limited it to a life span of four years. The 
initial legislation was Fairly close to creating the limited agency favored by 
Billings and other sanitarians, one empowered to perform extensive advisory 
and information gathering functions, public health research, and a few other 
activities. However, within a short time, supplemental legislation heavily 
burdened the new Board with a cumbersome and controversial quarantine 
support system that most members originally had little enthusiasm for. 
Equally damaging, while the new laws made the Board responsible for 
reducing the country’s burden of disease and epidemics, they allowed it little 
authority as well as scant fiscal resources for attempting anything except 
quarantine. Moreover, they made no provision for an executive office and 
manager. Nevertheless, it represented a start, and as such most of the public 
health community seemed anxious to make the most of it.24 
Federal Health Officer by Default: Billings Runs the Board 
To no ones surprise, President Rutherford B. Hayes’s list of eleven selectees 
for the Board included Billings in the slot assigned to the Department of 
the Army. At their first meeting the members selected James L. Cabell, the 
current President of the American Public Health Association, as President 
of the Board, Billings as Vice-President, and Thomas J. Turner, Medical 
Inspector of the Navy, as Secretary. Named with these officers to the executive 
committee were Stephen Smith of New York and Preston H. Bailhaiche, a 
surgeon with the Marine Hospital Service. The remaining members included 
the prominent physician-sanitarians Henry I. Bowditch of Boston and 
Samuel M. Bemiss of New Orleans, three lesser known sanitarians—Hosmer 
his service on a series of other Congressional boards of sanitary experts. See 
discussion in Chapter 5. 
24 For details, see Duffy, The Sanitarians, pp. 166-168; Miles, “National Board,” 
pp.32-66; Bruton, “National Board,” pp. 152-164. 146 
The National Board of Health: A Painful Experiment 
A. Johnson of Chicago, Robert W. Mitchell of Memphis, and Tulio S. Verdi 
of Washington, D.C.—; and a Justice Department attorney, Samuel F. 
Phillips. Most of these individuals remained throughout the contentious, 
often hand-to-mouth, and sometimes productive first three years or so of the 
Boards existence. And it was Billings who, by default as much as through 
ability, dominated the Boards work in those years just as he had dominated 
its formative period in the APHA. 
Of these original members, the two who came with the best professional 
credentials proved to be of only limited or brief value to Billings and the 
work of the Board. The capable and widely respected New York sanitarian, 
Stephen Smith, found himself unable to attend very many of the meetings 
of the Boards executive or other committees. Actually, the historian has to 
wonder if Smith in reality was unwilling to attend. By that point in time, 
though there is no factual support for the supposition, it would have been 
surprising if he had not built up considerable resentment over a series of 
Billings’s public health successes that came, at least partly, at his (Smith’s) 
expense. Billings had prevailed over Smith in the design competition for 
the Johns Hopkins Hospital. He had effectively pushed Smith, the founder 
of the A.P.H.A., aside in the Association during the intense political and 
professional debates of the mid-1870s. Moreover, in 1879, when the 
Billings-led sanitarians had prevailed over Woodworth’s forces in obtaining 
a board with only limited powers from Congress, it was equally a defeat for 
Smith, who had wanted and still wanted a strong national health agency 
immediately. Subsequently, it cannot have been pleasant for him, as an 
avowed friend and supporter of Hamilton, Woodworth’s successor at the 
Marine Hospital Service, to sit at Board meetings that were so thoroughly 
dominated by Billings. 
By contrast, Henry Ingersoll Bowditch came to the Board as Billings’s 
closest and much admired professional role model in public health. 
Billings valued the other man’s important research in hygiene. In the 
context of the Board, however, he especially appreciated the latter’s unique 
accomplishments and authority, among Board members and public alike, 
as Chairman of America’s first effective state board of health. The two men 
shared similar objectives and timetables for public health, and with their 
wives they sought out each other socially as often as possible. Bowditch’s 
resignation after less than a year, apparently due to illness, was thus a heavy 
blow for Billings. Writing his regrets, the latter hoped that the President 
would consult Bowditch about possible successors so the Board would 
obtain someone of comparable sanitary competence as well as strength of The National Board of Health: A Painful Experiment 
147 
character. In fact, he added, “The Board is much in need of two or three 
men who really study and know something of sanitary science instead of 
devoting themselves to legal and states rights and other similar questions, 
and being guided by MCs [Members of Congress] as to what they ought to 
do, instead oi stating what ought to be done and leaving MCs to take the 
responsibility of doing it or not.”2'’ 
Unlike some of his contemporaries, Billings pragmatically accepted 
many of the built-in imperfections of the Board with relatively little protest. 
He welcomed the challenge of getting the new agency started, and he was 
ready to work for changes as they became necessary. Well prepared by the 
assignments he had had in the Army Medical Department, he was confident 
in his abilities to solve problems and get things done, as long as he had 
adequate support. At the same time, his part-time status with the Board 
appeared to suit him just fine, particularly in making possible his continuing 
commitments to the Surgeon-General’s Library, the Johns Hopkins Hospital 
and Medical School, the APHA, and other institutions. Ever the consummate 
juggler with his time, he seems to have kept everyone happy by somehow 
managing to avoid short-changing the interests of any. 
The Board as a whole held its first meeting in April 1879. At that time it 
organized and announced itself to the public, set up its office in Washington, 
established committees, and got started on priority matters. From the first, 
the members reportedly took their responsibilities seriously, and most of 
them proved to be both able and hard-working at their regular meetings, 
each of which lasted as much as a week or more. However, these were all 
individuals with full-time medical practices or other occupations that tended 
to cut their attendance down. Moreover, the full Board was required to meet 
only twice a year regularly or on special occasions, leaving the executive 
committee to manage most matters in the interim. In turn, the executive 
committee itself was often depleted, with the President, Cabell, being only 
sporadically willing or able to interrupt his medical teaching and practice in 
Charlottesville, Virginia, to make the trips to Washington. In his frequent 
absences, Billings as Vice-President presided over the meetings.26 
From the beginning, accordingly, with not just the tacit concurrence but 
the urgent insistence of most of the rest of the Board, Billings steadily built up 
an even larger informal role for himself, one that had not been provided for in 
25 JSB to Bowditch, 1/18/1880, JSB papers NLM, box 11. 
26 Miles, “National Board,” pp. 37-49. 148 
The National Board op Health: A Painful Experiment 
any legislation. This was as de facto chief executive officer of the agency. With 
his broad professional and institutional connections as well as his permanent 
geographical base in Washington, he was in a position to do many things 
for the Board that other Board members could not feasibly perform, even if 
they wanted to. In taking them on, he thus emerged variously as a forceful 
goad, facilitator, and trouble shooter; as a person who tied things together 
and generally ensured the continuity of the Board programs and operations. 
Contrary to some other historical opinion, it seems to me that Billings, in 
playing out this necessarily assertive role, was fundamentally attempting to 
strengthen the Board as a whole rather than to aggrandize himself. Besides, 
there were too many other strong-minded individuals in the organization 
to allow the latter; and even the most persuasive Billings opinions were by 
no means always seconded by the majority.27 
Working primarily from his desk in Washington, then, and in many 
matters in close tandem with Thomas Turner, the organizations secretary, 
Billings provided an essential administrative focus for the National Board 
of Health’s country-wide effort during the period up through August 1882. 
During that time he applied his energies to three large areas or phases of the 
Board’s affairs. First of these was the continuing management of legislative 
relations. In Cabell’s absences but bolstered by whatever other members 
were available, Billings almost invariably led the sessions of defending 
and explaining Board activities, needs, and budgets to Senate or House 
committees as well as to individual congressmen. He was the member 
who drafted most of the new bills for congressional consideration and 
who did much of the lobbying for increased statutory authority and other 
supplemental health legislation. And through 1879, pursuant to the March 
3 law, he assumed much of the task of working with outside sanitarians, 
physicians, and the National Academy of Sciences on a plan for a permanent 
federal public health agency. Echoing his views after the Board’s first few 
months in existence, all of these groups ended by recommending that the 
Board format be continued indefinitely. 
In a second area of Board activity, Billings took on several essential tasks 
of communications and public relations. He went to considerable lengths, 
2 I base these observations as well as those on the following pages heavily upon 
my readings in the Billings papers at the National Library, particularly his 
National Board of Health correspondence between 1878-1882. See NLM, 
MS, Film 4. See also, Furman, op. cit.; and Kohler, loc. cit. The National Board of Health: A Painful Experiment 
149 
first of all, to help create and maintain a mutuality of understanding with 
his colleagues on the Board with respect to their joint tasks. Accomplishing 
this involved such things as preparing agendas and briefings, reinforcing the 
members in their controversies with antagonistic officials or other persons, 
exhorting those whose spirits were flagging, and sometimes taking one or 
more of them to the Gay Street home for evenings with his wife and family. 
He made a special point of writing frequent detailed letters to Cabell, the 
often absent President, to keep the latter informed of Board developments. 
But that was hardly exceptional, for between meetings Billings was constantly 
writing letters or sending telegrams to all of the Board’s members and agents 
as well as to its many actual and would-be collaborators around the states. 
Highly focussed on the particular business at hand and with a minimum 
of small talk, he used his letters effectively for coordinating, consulting, 
sending instructions, or otherwise maintaining the ties essential in keeping 
the enterprise going. Added to his already extensive communication networks 
with military, medical and public health contacts, this continuing barrage of 
correspondence in both directions became one of the ma jor ingredients, the 
glue, in keeping alive a strong commitment of sanitarians and local officials 
around the country to the aims and programs of the Board between 1879 
and 1882.28 
Billings was equally careful to maintain communication channels with 
his professional organizations and to keep the sanitary and medical press 
informed as to the Board’s plans and programs. Critical articles or editorials 
sometimes had to be responded to. And, far from least important, he had to 
keep an eye on the movements, pronouncements, and intentions of John B. 
Hamilton, who, in March 1879, succeeded Woodworth as Surgeon-General 
of the Marine Hospital Service. Fully as much as Woodworth, Hamilton 
came to resent Billings’s successes in obtaining creation of the National Board 
of Health, and he made little secret of his hopes of undermining the Board 
and getting Congress to assign its functions to his own agency.29 
28 See Billings papers, NLM. 
29 For the Marine Hospital Service and the National Board of Health during 
the Hamilton years, see Furman, op. cit., pp. 1 51-198. But compare Bruton, 
“National Board,”; and Miles, “National Board,” passim. For Woodworth,see 
Margaret Humphreys, “John Maynard Woodworth,” American National 
Biography, Vol. 23, pp. 836-837. For Hamilton, see Shari Rudavskt, “John 
Brown Hamilton,” American National' Biography, Vol. 9, pp. 923-925. 150 
The National Board of Health: A Painful Experiment 
The third area of Billings’s concern was the coordination or management 
of the Board’s actual programs and activities. As an officer and member of 
the executive committee he was above all, from the beginning, continually 
involved in planning, shaping, and overseeing the Board’s central 
responsibility, its large maritime quarantine support activity with the states, 
along with related infectious disease assistance. This was work that had to 
be launched almost immediately in the summer of 1879, only a few weeks 
after the Board’s formation, when the yellow fever returned to America. 
With his colleagues, Billings thus organized and put a network of inspectors 
in place along the Atlantic and Gulf coasts and the Mississippi River, and 
then monitored the latters’ work. They expanded their links with local and 
state health officials and began distributing funds to aid such activities as 
identifying cases of yellow fever and attempting to limit their spread. He 
was one of those who worked out details with the State Department for 
distributing disease inspection forms to consular offices abroad and made 
arrangements with the Treasury Department for distributing funds to 
eligible recipients. In turn, more often than not, he became involved in 
such matters as advising local and state officials how to apply for such funds, 
in working with them to settle political or jurisdictional health disputes, 
and in obtaining regular vital statistics reports from them. Moreover,with 
his colleagues on the Board, he was in increasing demand from legislators, 
educators, health professionals, and others for information about hygiene, 
sanitation, and public health. 
While the lion’s share of Congress’s appropriation for the National Board 
of Health went expressly to reinforce state and local quarantine efforts, small 
but important amounts were also available for certain other purposes. These 
mainly had to do with the advancement of public health through scientific 
research and the gathering of quantitative information, both of them strong 
professional and scholarly interests of Billings. Accordingly, throughout his 
service on the Board, he expended a great deal of energy, both in trying to 
protect and enlarge whatever funds had been allocated for such projects and 
in the processes of planning and carrying them out. 
Billings got the Board started particularly quickly on a small program of 
support for scientific investigation, and the other members seconded him 
strongly in this. He was instrumental in enlisting his Johns Hopkins associate, 
the chemistry professor, Ira Remsen, to undertake several investigations, 
among them an analysis of organic particles in the air. The Board also 
made grants to George E. Waring for investigations of household plumbing 
devices; to Horatio C. Wood for a study of diphtheria; to William EWhitney The National Board of Health: A Painful Experiment 
151 
for malaria research; to Rudolf Hering for a survey of European sewage 
systems; and to an assortment of other individuals. None of the projects 
produced major scientific breakthroughs, but several made useful additions 
to knowledge, while the program as a whole served to advertise Billings’s 
conviction of the pressing need for a far greater expansion of research in 
American public health.30 
On a level by itself was an 1879 proposal of the English scientist John 
Gamgee. Gamgee requested congressional support to build an experimental 
refrigerating ship as a possible alternative to the disinfection of ships during 
yellow fever epidemics. Evaluating this request in a time of public alarm 
stirred by the disease, Billings and his Board colleagues found the proposal 
neither ridiculous nor technologically unsound. Since even a failure could 
substantially add to man’s knowledge about the sources and behavior of 
yellow fever, they recommended “that the experiment should be tried,” 
However, Congress ultimately failed to provide the necessary financial 
support.31 
Of far more immediate interest to the Board was the organization 
and work of its HavanaYellow Fever Commission. The idea for such a 
commission, broached late in 1878 by a congressional board of experts, 
had been examined that same year by a special APHA committee chaired 
by Billings and expanded by the latter to include a comprehensive scientific 
investigation of the circumstances and causes of the disease. Now, on the 
National Board’s executive committee, Billings took an active part in drawing 
up guidelines for the commission, in staffing it, and in guiding its work 
throughout its duration. 
With the New Orleans physician Stanford Chaille as Chair, the 
commission carried on its investigations in Havana through the summer 
of 1879 and then returned to the United States. Although the commission 
also included another physician, Juan Guiteras, along with a civil engineer, 
a photographer, and others, its key member, at least so far as Billings was 
concerned, was the Army surgeon, George M. Sternberg. A fellow career 
medical officer of Billings, Sternberg had gained an intimate knowledge of 
yellow fever during service at various small army posts, had begun to be 
recognized as an expert through his writings on the disease, and in 1879 
stood out as one of the tiny coterie of American medical individuals who 
30 See review in Ibid., pp. 352-421. 
31 Ibid., pp. 487-502. The quotation is on p. 492. 152 
The National Board of Health: A Painful Experiment 
were beginning to explore the possibilities of bacteriology. Billings personally 
invited Sternberg to join the operation, persuaded Surgeon-General Barnes 
to detail him to the Board on extended service, and then monitored while 
strongly supporting the project.32 
In Havana, though given the title of Secretary of the Commission, 
Sternberg was actually principal microscopist and laboratory chief, aided 
by Guiteras. In his early letters from that city to Billings, he wrote about 
his relations with the other commission members and described problems 
encountered in setting up his laboratory. Later he gave details of his 
experiments, sometimes on animals, and his uses of micro-photography. In 
August, 1879, Sternberg sent Billings a bundle of cigars and acknowledged 
the late arrival from Washington of a shipment of Spencer lenses and other 
microscopy equipment. Several times he mentioned his high esteem for 
Turner and expressed thanks for the home office’s help to the commission. 
In mid-September, tired out, he wrote that the commission was about ready 
to leave Havana. He confessed that his searches for the causative organism 
of yellow fever had been essentially negative, concluding that whatever he 
had accomplished to date would be “principally in paving the way for future 
investigations.”33 
Back in the United States, Sternberg remained on detail to the Board 
for almost two more years, dividing his time up to August 1881 mainly 
between Washington, Baltimore, and New Orleans on a group of ongoing 
laboratory studies, several of them of major importance. Under Billings’s 
and the Board’s direction, he studied and made photomicrographs of 
the blood of yellow fever patients; searched for disease-related organisms 
in the dust of cities; tested the efficacy of disinfectants; performed 
microbiological analyses of water; and tested and disproved claims of Klebs 
and Tommasi-Crudeli of having isolated the causative bacillus of malaria. 
During his time in New Orleans, he complained to Billings about the 
irregularity of mail service and the generally filthy condition of the city. 
But he also kept Billings fully apprized of every step in his investigations, 
32 A full modern biography of Sternberg is much needed. However, see Martha 
L. Sternberg, George Miller Sternberg: a Biography (Chicago: American Medical 
Association, 1920). 
33 Sternberg to Billings, five letters written between 4/10/1879 and 91X2179, in 
JSB Papers, NYPL. Quote is from letter of 9/12/79. See also Miles, “National 
Board,” pp. 359-363, 369-374. The National Board of Health: A Painful Experiment 
153 
asked him for copies of European articles on malaria, and pressed him 
for more and better research instruments, which the latter almost always 
managed to produce. In April 1880 Sternberg informed Billings of several 
lectures he was preparing for New Orleans medical groups; in reply, the 
latter cautioned Sternberg against divulging too much of his malaria reseach 
on those occasions, and urged him to save the bulk of his findings for the 
official publications of the Board. 
Likewise in the spring of 1880, Sternberg wrote Billings about his 
increasingly close relationships with Bemiss, then the Boards chief 
representative in New Orleans, and about the latter’s often frustrated efforts 
to work out cooperative quarantine measures with the city and state officials. 
He also noted Bemisss fears of the likely selection of Joseph Jones as the next 
President of the New Orleans Board of Health, adding his own conviction 
that the move would be highly unfortunate and disruptive from the National 
Board’s view. By fall, with Jones well entrenched as President, Sternberg’s 
letters were documenting the full effect of the other man’s hostility to the 
Board and its operation in New Orleans. In turn, the press had swung 
around to almost total opposition to the Board, while Bemiss had been 
personally villified to a point where he had lost much of his effectiveness.34 
And Sternberg himself had come under violent attack from officials and 
press alike for reporting new cases of yellow fever nearby. In a September 
letter to Billings he reported that he felt virtually under siege but that he was 
strong enough to weather the situation; “It requires a considerable amount 
of enthusiasm for the advancement of science to bear the abuse of the 
newspapers, to work with the microscope all day, and to fight mosquitoes 
all the evening.” This was the sort of response that Billings, himself with a 
pronounced combative streak, liked to hear from his associates. ° However, 
it led to Sternberg being transferred to San Francisco, where he was unhappy 
with the poor research facilities. 
Fully as pressing as the Board’s laboratory research activities, and almost 
as extensive, were its projects for collecting quantitative public health 
information of various kinds. Such data were sought to justify and give 
direction to the other activities. Billings thus attached central importance 
to Turner’s labors of amassing and publishing such information, both local 
34 Sternberg to JSB, 2/14/80; 3/17/80; 4/4/80; 4/8/80; 9/11/80; 9/23/80; 
10/18/80; all in JSB Papers, NYPL. 
35 Sternberg to JSB, 9/23/80, JSB Papers, NYPL. 154 
The National Board of Health: A Painful Experiment 
and foreign, for the Boards weekly Bulletin, and he pushed steadily to help 
improve its coverage. '6 
Billings and his colleagues carried a final health information enterprise 
over to the Board directly from its beginnings within the American Public 
Health Association. Almost everyone concerned thought that, with the 
establishment of the Board, the national sanitary survey would gain a 
new lease on life. In one of their early meetings the Board members thus 
designated some funds to be used to stimulate local interest in and adoption 
of the survey. With Billings’s intercession, the Board then gained the use 
of the APHA’s elaborate survey questionnaire, printed portions of it, and 
distributed copies widely around the United States. Despite this effort, the 
sanitary survey remained more admired than implemented. Some sanitarians 
undoubtedly felt that, with the results available of Henry I. Bowditch’s fir less 
detailed personal survey, conducted by mail in 1876, the Board’s definitive 
type of project was no longer as pressing as it had been. Moreover, it was 
complicated, time-consuming, and costly as a public health tool; reportedly, 
only 1 5 or 20 towns went to the expense of conducting the official plan 
on their own. Moreover, due to the Board’s limited budget, even fewer 
communities could be awarded subsidies for sanitary surveys. Among that 
handful, Baltimore and New Jersey health officials each received small 
grants, while Memphis, which in the fill of 1879 was trying to recover 
from another devastating yellow fever epidemic, was awarded a substantial 
showcase grant of $5,000.37 
In the case of Memphis the Board designated a special survey committee 
composed of Billings as Chairman, H. A. Johnson, and Robert W. Mitchell. 
Beginning in August, 1879, the three began working together to obtain the 
necessary collaboration of local officials and to plan the work to be done. 
Mitchell, an attractive and energetic Memphis physician with whom Billings 
had much in common, organized and directed the actual house-to-house 
inspections, data compilations, and followups that were carried out in the 
fall and early winter by local officials and physicians. Billings took on himself 
the task of enlisting outside experts to advise and assist the committee with 
technical matters, and with the tacit understanding that the experts might feel 
36 I examine the Board’s large role in improving and energizing American vital 
statistics in chapter 7. 
3 Bowditch’s survey is given in detail in Bowditch, Public Hygiene. However, for 
the limited success of the Board, see Miles, “National Board,’ pp. 422-438. The National Board of Health: A Painful Experiment 
155 
free to go beyond the fact-finding mission of the committee by helping with 
the planning and even participating in designing and installing some elements 
of a modern sanitary infrastructure for the city of Memphis. The individuals 
whom he brought in included the sanitary engineer George E. Waring of 
Newport and New York; Charles F. Folsom, Secretary of the Massachusetts 
Board of Health; Major W.H.H. Banyuard of the Army Corps of Engineers; 
and the Army medical officer Charles Smart, a leading water chemist.38 
Billings and his Committee visited Memphis several times during those 
months. In addition to overseeing the survey details, they watched over and 
as necessary prodded the local processes of sanitary reform. The planning and 
beginning of a sewer system, construction of which was contracted out by 
the city to Waring and begun in 1880, was naturally of central importance. 
But it would be some time before that large project could show much in 
the way of results. It was thus of particular importance when some of the 
other sanitary activities begun by the local community during this time—the 
improvements in housing and street cleaning, publication of water analyses, 
removal of garbage and outhouse wastes, and so on—began to take effect 
enough to silence local critics of the surveys methods. Their implementation 
also began to raise the morale of the people of Memphis and dissipate the fears 
that had run rampant during the epidemic. Ultimately, as the improvements 
took form, those concerned in the process, though especially the outsiders, 
came to have status almost as heroes in some residents’ eyes. As early as 
November of 1879, the city’s legislators, businessmen, and other prominent 
citizens organized a dinner of thanks for the National Board’s committee 
and its experts. And in January, after another Billings visit, a Memphis 
newspaper editorial suggested that he was the person most responsible for 
“the present reassuring prospect for the sanitary regeneration of Memphis,” 
at least for providing something of “a moral tonic, which has invigorated and 
strengthened every one engaged in the work of rehabilitating the Bluff City.”39 
38 John S. Billings, “Report of the Committee Charged with Making a Sanitary 
Survey of Memphis, Tenn. In Annual Report of the National Board of Health, 
1879, (Washington: GPO, 1880), pp. 416-441; JSB, “Report on Sanitary 
Survey of Memphis, Tenn.,” Annual Report of the National Board of Health, 
1880 (Washington: GPO, 1881), pp. 602-617. 
39 Memphis Appeal, 1/18/1880; Daily Memphis Avalanche, 11 /29/79. Copies of 
both clippings are in the National Library of Medicine manuscript collection, 
MS Film 25, Reel 56, Vol. 111. 156 
The National Board of Health: A Painful Experiment 
Congressional Abdication of Health Responsibility and its Sequel 
The Memphis operation was clearly a matter of satisfaction for Billings 
and the rest of the Board. But they had no reason or opportunity to rest 
on its laurels, real or imagined. This locale was only one among many that 
needed similar help after the epidemic, and the Board’s limited resources 
remained only a fraction of what it could have used nationwide. What 
resources it would have in the future could not be predicted. 
In June 1880, Billings touched on this question and related matters in an 
address at the New York meeting of the American Medical Association. He 
reminded his listeners ol the limited powers of the Board and its vulnerability 
to political whim, and he alluded to the constant uncertainty hanging over 
its deliberations and work. He recalled that the Board had been created 
prematurely and in a crisis situation, i.e. “forced into existence” by the tears 
stirred up by yellow fever. And he wondered whether, now that the epidemic 
had subsided, “it would find itself without the support of an educated public 
opinion,” which was essential to all such government organizations. He was 
as aware as anyone that, while the Board at that particular moment seemed 
“healthy and lively, ... it would be rash to make any prophecies as to its 
immediate future, since this depends so largely upon the contingencies of 
the next few months.”40 
Events of the next few months indeed produced ever more serious 
questions about the Board’s health and left further hard-to-ignore clues that 
there would be no long-term future for the Board. Specifically, a combination 
of factors during the early 1880s set in motion a steady decline in the Board’s 
fortunes that proved to be very largely beyond the capacity of anyone to 
halt. The most influential factor was the apparent end of yellow fever in 
the years after 1880 as an immediate public health threat and with it, as 
Billings well understood, a sharp dropoff of popular support for federal 
disease containment efforts. At the same time, the hostility of Jones and his 
allies in New Orleans completely crippled the Board’s efforts to organize 
a cooperative quarantine in the lower Mississippi and Gulf region. In the 
process, the formers’ vitriolic and uncompromising opposition began to 
spread outside New Orleans to newspapers and politicians in other parts of 
the lower South and elsewhere. 
40 JSB, “National Board and National Quarantine,” loc. cit., pp. 19-21. The National Board of Health: A Painful Experiment 
157 
Influenced by these and other factors, including a still-intransigent 
states-right’s sentiment among many lawmakers and the remarkably 
effective lobbying of Hamilton and the Marine Hospital Service, Congress 
in 1880 began reducing its already slim appropriations for the Board despite 
numerous letters of support from health boards around the country and 
renewed petitions from medical and public health organizations. With each 
new reduction of funds the Board had to cut back some part of its operation, 
painful developments that most members accepted in frustration and anger 
over what they regarded as a congressional abdication, chiefly in the House, 
of its own previous commitment to national health. Starting in 1881 Billings 
was occasionally heard wondering about or threatening resignation, and 
most of his friends tried to talk him out of such a step. George Sternberg, 
however, after affirming that the others resignation would “be a serious 
loss to the Board and to the country,” stated the hope that Billings, if or 
when he ever resigned, would use his influence to have himself, Sternberg, 
appointed in his place. 
Billings did resign in August 1882 after a particularly deep congressional 
cut left the Board with barely enough funds to keep the Washington office 
open. Surgeon Charles Smart rather than Sternberg was chosen to replace 
him as the Army representative on the Board. Congress ended most of the 
Boards statutory powers the following year but continued to finance a few 
small-scale services for a short time. Even those were terminated in 1886, 
though the Board itself retained a nominal existence until 1893.41 
Even as the Board’s powers petered out, more than a few individuals, 
not only in Congress but among health professionals and segments of the 
American public began expressing their anger and regret over the abolishment 
of what they regarded as a basically useful and needed agency. To many, the 
Board’s only substantial fault had been that it had been premature. Despite 
its statutory limitations, they saw the record of its initiatives as evidence 
of what could be accomplished for large scale public health in the United 
States when guided by competent experts and managers. Moreover, they 
saw that its very existence had given a major stimulus to the revived public 
health movement at all levels of government, especially to the creation of 
additional state and local boards of health and to the refinement of their 
technical and scientific programs. 
41 The decline of the Board is thoroughly chronicled in Miles, “National Board,” 
pp. 80-241; and in Bruton, “National Board,” pp. 330-428. 158 
The National Board of Health: A Painful Experiment 
Throughout the decade or more after the last moneys were appropriated 
for the Board, individual congressmen periodically introduced bills to 
revive the Board in whole or in part, though none got very far despite 
support from Billings and other sanitarians for some of them. Meanwhile, 
the vacuum in national public health coverage that was left by the demise 
of the Board was at least partially filled through the rest of the century 
by programs or expedients begun in other federal agencies, some of them 
stimulated by earlier initiatives or trials of the Board. The Marine Hospital 
Service, of course, benefitted much from Congress’s acts by being assigned 
to take over certain Board activities, notably the quarantine and disease 
inspection functions but also the weekly health bulletin and other matters. 
The federal census, taking advantage of its connections with Billings, began 
a major expansion of its vital statistics operation. In turn, the Department 
of Agriculture began taking action in several areas of public health concern 
that the Board, lacking the funds, had explored but not seriously pursued, 
among them, animal diseases, nutrition and diet, and drug regulation. 
Not least, the Army Surgeon-General’s Office itself remained a prominent 
public health contributor. And Billings himself, even after retiring from the 
Army, continued to encourage movements for national health organization 
well into the twentieth century, when he participated briefly in some of the 
Committee of One Hundred for National Health’s discussions.42 
Billings’s career, meanwhile, went on almost as if he and his allies had not 
been roundly outmanoeuvered and decisively beaten in their extended brawl 
with Hamilton and his congressional supporters for national public health 
power. To be sure, that struggle kept Billings’s relationships with the Marine 
Hospital Service’s leaders antagonistic for years to come. He particularly 
continued in his conviction that Hamilton had been unprincipled and 
unfair in his methods, a sentiment that the latter was known to reciprocate 
in full measure. However, Billings took satisfaction in knowing that most 
42 Billings played only a limited role in the Committee of 100’s work. While named 
to several of its committees, he had little time to participate in their activities. 
His main contributions were to evaluate the various proposals for a new 
national health agency and to lend his name to the Committee’s publications 
and dealings with Congress. There are three folders of his correspondence with 
Irving Fisher and other material pertaining to the Committee between 1906 
and 1911 in the JSB Papers, NYPL. For details of the Census connections, see 
chapter 7. The National Board of Health: A Painful Experiment 
159 
of the other Board members had felt as he did. Turner, who was particularly 
outspoken, became “as mad as the devil” when he had to deal with 
Hamilton and his “hounds.” And even the reserved Bowditch had joined 
in the disapproval during the earliest months of the Boarci: “ What apes the 
opponents of the [Board] are,” he ventured!43 
Above all, these men, together with a large proportion of the other leaders 
of the public health and medical communities, agreed that the Board had 
been very poorly used by Congress. They also concluded that Billings had run 
the Board in an outstanding fashion under extremely difficult circumstances. 
Fo them, the ending of the Board was in no way a failure on his part, but a 
gross dereliction by Congress. George Sternberg had assured Billings as early 
as 1881 that if the latter were to resign it would not be damaging to him or 
his career in any way, since he had a well “established reputation which in 
no way depends upon your connection with the Nat.[sic] Board.”44 This 
opinion was borne out in impressive fashion the following spring. At the 
very moment that the Board was losing favor in Congress, a remarkable 
collection of America’s most distinguished physicians, scientists, sanitarians, 
and university heads petitioned President Chester Arthur to elevate Billings 
to the newly vacant post of Surgeon-General of the Army, though he was 
ultimately passed over for lack of sufficient seniority.45 
When Billings ultimately withdrew from the Board, he did so at least 
partly to prevent Congress’s animus against that body from prejudicing its 
continued support of the Surgeon-General’s Library.46 He thus spent much 
of his new free time after 1882 working up the plans for the new Library/ 
Museum building and then organizing a campaign within the medical and 
public health communities to lobby Congress for the necessary building 
funds. His new official position, beginning in 1883, as overall Director of 
the combined museum and library operation of the Surgeon-General’s office, 
did not, perhaps, on the face of it, have much to do with public health. 
But actually, it provided a means and a focus within the Army Medical 
Department for Billings, again partly officially and partly in collaboration 
43 Turner to JSB, n.d. but ca. July 1881; Bowditch to JSB, 8/11/1879. Both 
letters are in the JSB Papers, NYPL. 
44 Sternberg to JSB, 2/23/81, JSB Papers, NLM. 
45 While this post became vacant four additional times during the next decade, 
Billings was passed over each time for the same reason,. 
46 Miles, National Library of Medicine, pp. 149-150. 160 
The National Board of Health: A Painful Experiment 
with other institutions, to continue and expand some of the laboratory 
and sanitary experiments, and other pursuits that he had supervised on the 
Board. It likewise facilitated the expansion of his public health information 
function within the Surgeon-General’s Office. In addition, and far from 
least, it gave Billings expanded time, facilities, and reason for continuing 
his professional correspondence. That included not only his American 
peers but Lister, Edwin Chadwick, Koch, Buchanan, and other prominent 
European leaders in hygiene and public health, along with the numerous 
lesser names and comers in these fields who had been users of his Library, his 
hospitals, and his Board, or had otherwise benefited from his expertise. It 
also provided him with a base and with the authority necessary for moving 
further into the professional organizations, into academia, and also into the 
public arena in the course of developing and disseminating his concepts of 
hygiene, sanitation, and public health. But, most of all perhaps, it afforded 
time and opportunity for Billings to expand his long-term involvements in 
the field of vital statistics. Chapter 7 
The Transformation of Vital Statistics 
Far from least of the concerns of the American Public Health 
Association in 1872 was the status of Americas vital statistics, the 
ongoing arrangements for recording the nation’s births, deaths, and other 
personal events and for studying their quantitative meanings. This was not 
surprising, since the more intellectual early members of the Association often 
already participated in the general interest in quantification and statistics 
that had been spreading through much of the previous century into many 
aspects of the country’s material life. The medical world itself, in fact, had 
long since begun to utilize several varieties of statistics: the numerical method 
and other forms of clinical statistics; the calculations of the actuaries; the 
quantification of diseases and sanitary measures; political arithmetic and 
other analyses of demographers and sociologists. 
The more avid of America’s public health reformers were thus as 
convinced of the importance of vital statistics collection and study for the 
long range pursuit of their profession as they were of the desirability of 
creating a national health bureau. Like the previous generations of American 
public health professionals, they particularly admired British vital statistics 
and sought to emulate them. They considered it a truism that collections of 
vital data were essential for justifying their other activities in public health 
and assessing their results. They also followed the antebellum generation in 
looking up to such scholarly statists as the British registrar William Farr, to 
the professionals who, with their systematic analyses of these data, became 
authoritative guides to the condition of society, government, and health 
programs.1 
1 New York's Franklin Tuthill had characterized the statists as the “calm, cool 
heads [who] take the observations, make the calculations, issue the orders, 162 
The Transformation of Vital Statistics 
Shortcomings of Early American Vital Data 
Whether compared with the British or some other system, it was 
painfully obvious that early America’s vital statistics had serious problems. 
A central problem was that the governmental gathering and processing of 
vital data, when it was done at all, was still strictly a state or local matter, 
with no federal coordination or other involvement. Where systems did 
exist, they were often faulty in design and incomplete, their data marred by 
imperfections. In some states, the very idea of legislating such systems was 
rejected by taxpayers and lawmakers alike, while some cities continued to 
draw their vital data from parish registers or bills of mortality from various 
sources. 
Up to 1872, only Massachusetts led by Edward Jarvis and Lemuel 
Shattuck, Providence under Edwin M. Snow, and a handful of other 
American states and cities had succeeded in establishing official vital statistics 
systems that actually functioned at all well, while even those successes 
were mostly confined to the registration and analysis of deaths.2 Birth 
and marriage registration attempts everywhere were largely ineffective and 
remained so until the twentieth century. At the same time, the existing 
registration systems differed in the disease terminologies that the registrars 
used and in the data that their report forms displayed. As a result, the vital 
information that was produced in one state or city jurisdiction could not 
be easily compared with the data of another, while such data collections 
did little if anything to suggest accurate patterns of life and death for the 
United States as a whole. 
During the 1850s and 60s, the American Medical Association as well as 
the several National Quarantine and Sanitary Conventions had urged their 
and guide our destinies,” as “ciphering closet-men” who worked in solitude to 
separate the age’s theories from fact. Franklin Tuthill, “Registration of Births, 
Deaths, and Marriages,” Transactions of the Medical Society of the State of New 
York (Albany: C. Van Benthuysen, 1853), pp. 12-13. See also Cassedy, American 
Medicine, pp. 198-200. 
2 Ibid., pp. 196-197, 203-206; Vital Statistics of the United States, Vol. I 
(Washington: U. S. Department of Health, Education, and Welfare, 1950), 
pp. 6-7; Cressy L. Wilbur, “The Outlook for a General System of Registration 
of Vital Statistics in the United States,” Journal, American Public Health 
Association, Vol. XXI (July 1896), p. 237. The Transformation of Vital Statistics 
163 
members and delegates to work for vital statistics registration legislation and 
systems similar to the English pattern for their local communities. Originally 
it was rather innocently agreed or assumed that each state or local jurisdiction 
could be left to work out its own laws and procedures.3 However, given the 
disruptions of the Civil War along with a lack of trained local leadership, 
little or nothing of importance seems to have been accomplished until new 
professional groups began to organize. 
The APHA, proceeding systematically, created a committee on vital 
statistics registration at its first meeting and agreed on a few basic lines of 
action. It urged its members to work for registration legislation wherever it 
was lacking, and it directed the committee to prepare standard forms for the 
weekly and monthly statistical reports of every community. The meeting also 
urged the adoption of a common nomenclature and classification of diseases 
by American institutions, including censuses. Specifically, it recommended 
the nomenclature developed by the Royal College of Physicians of London 
and hoped to participate with the College in future revisions.4 
APHA members agreed that the technical aspects of vital statistics 
reform could be appropriately left to the hoped-for national sanitary 
agency and its professional staff. However, committees of the association 
did get down promptly to the crucial task of stimulating local registration 
legislation. In fact, they achieved impressive results, with the number of 
new state registration systems more than doubling by 1880. In addition, 
the Association s debates over vital statistics matters proved to be important 
steps toward building a consensus among the members about what needed 
to be done. 
Though not a registrar, John Shaw Billings began participating actively 
in these debates as soon as he joined the Association. As a young man, 
3 Edward Jarvis, “Report on Registration of Births, Marriages, and Deaths,” 
Transactions, American Medical Association, Vol. XI (1858), pp. 527, 534-535. 
Throughout much of the period, William Farr’s analyses and publications at 
England’s General Register Office set among the highest standards for the 
American efforts. For a thorough study, see John M. Eyler, Victorian Social 
Medicine: The Ideas and Methods of William Farr (Baltimore: Johns Hopkins 
University Press, 1979). 
4 “Abstract of Minutes, April 18, 1872 to November 12, 1875,” Public Health, 
Reports and Papers of the American Public Health Association (New York: Hurd 
& Houghton, 1876), pp. 537ff. 164 
The Transformation of Vital Statistics 
Billings had absorbed arithmetic and algebra easily and seems to have become 
mathematically literate before starting medical school.5 Later on, when he 
came to prepare his medical dissertation, he was entirely convinced of the 
importance of simple statistics in evaluating the various surgical operations 
used for epilepsy. And, subsequently, through his career in the Army Medical 
Departmen t, he actively sought the spread of vital and medical statistics in 
all levels of government as well as among individual physicians and health 
professionals. Dedicated to better statistics then, as much as he was to the 
pursuit of science, it became a personal career aim for Billings to keep the 
faith with his forebears in that field, with the Farrs in England and Europe, 
and with Shattuck and the other pioneers in the United States. 
There is no indication that Billings ever harbored thoughts of pursuing 
a formal career in statistics, mathematics, actuarial science, or some other 
branch of numeration. At the same time, when he went to APHA meetings, 
he was as knowledgeable as all but a handful of Americans about those 
sciences as well as about vital statistical collection, registration, and related 
processes or skills. And, continuing the learning process over the next two 
decades or so, he ultimately became the unquestioned prototype of the statist 
for late nineteen century America’s vital statistics community.6 
At his first APHA meetings, Billings solicited donations and exchanges 
of registration and census reports for the Surgeon-General’s Library. And, 
beyond that, he went out of his way to inform himself, not only about 
European and British vital statistics practices and systems, but about the 
problems that had been encountered by the handful of America’s pioneering 
early statists who were in attendance. One of the most important of these 
was Edward Jarvis, who was almost at the end of a long career, one spent 
both in helping shape Massachusetts’ vital statistics and in federal census 
work. Another individual to learn from was Elisha Harris, who in the decade 
up to 1876 was active in running both the sanitary administration and 
the vital statistics system of New York City and who went on in the early 
1880s to similar appointments in New York State’s new Board of Health. 
5 Chapman, Order Out of Chaos, pp. 30-31. 
6 James H. Cassedy, American Medicine and Statistical Thinking, 1800-1860 
(Cambridge, Mass.: Harvard University Press, 1984), passim. York: Hurd & 
Houghton, 1876), pp. 537ff. 
For Jarvis, see Gerald N. Grob, Edward Jarvis, passim. For Harris, see E. W. 
K. [Kopf], “Elisha Harris,” DAB, Vol. IV, Part 2 (1964), pp. 307-308; and The Transformation of Vital Statistics 
165 
As a perennial officer and committee member in the association during this 
period, Harris, through frequent papers and reports, did much to build 
up a consensus of knowledge among the membership about vital statistics 
legislation, data collection systems, and other basic matters. 
At the same time, Billings sought out some of the newer faces in 
American public health and vital statistics—such members as John H. 
Rauch, Henry B. Baker, and others who brought fresh outlooks, ideas, 
and energies to the Association. However, it was probably another veteran, 
Snow, to whom Billings turned the most often, both in the APHA and 
elsewhere during the decade or so after 1872, for technical illumination and 
advice pertaining to vital statistics. Since 1856 Snow had been Registrar 
of Vital Statistics as well as Superintendent of Health in Providence. 
Moreover, his 1860 “Report on Registration” was still a standard guide to 
the subject for America’s local officials and sanitarians. For his part, Snow 
found in Billings a no-nonsense kindred spirit who already understood 
the needs and values of vital statistics, if not yet all of its processes. By 
1878 he was expressing to the latter his “earnest desire to do anything” 
within reason to advance the younger man’s ideas for the development of 
that field.8 
The National Board and a Conference of Registrars 
As it turned out, during the hectic months of pushing the National 
Board of Health through, Billings had no time to take immediate advantage 
of Snow’s offer, or of the skills of others in the vital statistics community. 
Moreover, when he did find time, given the lack of an administrative staff and 
office facilities, he had to improvise drastically in order to take on any vital 
statistics programs. This meant getting extra volunteer services from willing 
fellow Board members and outsiders as well as doing far more himself than 
he should have had to. But at least Congress had not actually banned such 
John Duffy, The Sanitarians: A History of American Public Health (Urbana: 
University of Illinois Press, 1990), pp. 118-121, 130-131, 148. 
8 Edwin M. Snow to JSB, 10/17/78, JSB Papers, NYPL. For Snow, see Seebert 
J. Goldowsky, “Edwin Miller Snow,” ANB> 20 (1999), pp. 340-341; and James 
H. Cassedy, “Edwin Miller Snow: An Important American Public Health 
Pioneer,” Bull. Hist. Med., XXXV, no. 2 (1961), pp. 156-162. 166 
The Transformation of Vital Statistics 
activities; it covered them by authorizing the collection and dissemination 
of public health information.9 
Despite such difficulties, the Board at its organizational meeting made 
the matter of vital statistics one of its leading concerns and created a standing 
committee of three to deal with it. Stephen Smith of New York was chosen 
to be the committee’s first chairman, with Robert Mitchell ofTennessee and 
Hosmer Johnson of Illinois as members. Billings, as Vice President, from 
the start also began the habit of attending the committee’s meetings and 
participating fully in its deliberations and decision-making, mainly because 
Smith was not able to attend all of the meetings. After the first year he 
succeeded Smith as chairman. Meanwhile, at one of the earliest meetings, the 
committee assigned priorities to their list of vital statistics matters needing 
attention, a list that elaborated upon the APHA’s list and which included 
a specific proposal for the “eventual establishment within the Board of a 
national center, or ‘Bureau of Vital Statistics.”’10 
In another early action, the committee took over from the Marine 
Hospital Service the responsibility for publishing weekly public health 
reports. Begun in June 1879 and edited by Turner, the Board’s Bulletin 
went on to publish general public health news as well as to encourage and 
assist the spread of vital statistics laws and systems in the states and cities. 
It particularly featured regular summaries of mortality statistics, sometimes 
in tabular form and usually arranged by diseases and other causes of death. 
As in the Marine Hospital Service’s earlier publication, these data included 
abstracts of sanitary and mortality statistical reports for selected European 
and British cities that by law had been compiled by American consular 
officials abroad. To obtain comparable information for the United States, 
the committee sought the cooperation of America’s local health officers, 
registrars, physicians, and others. In particular, in cities where regular 
registration systems or bills of mortality arrangements were in existence, 
the officials were cajoled into supplying regular weekly or other mortality 
reports for the Bulletin. From the beginning, and as long as the Board had 
the funds to publish it, this organ was a welcome and regular source of health 
information, particularly quantitative, across the United States as well as 
abroad. A Scottish correspondent wrote his opinion about it to Billings, 
9 Wyndham D. Miles, “A History of the National Board of Health, 1879-1893,” 
2 vols., MS, National Library of Medicine, pp. 477-486. 
10 Ibid., p. 474. The Transformation of Vital Statistics 
167 
“Nothing so comprehensive and so thorough in administrative details has ... 
emanated from any other government.”" 
From this period on, Billings carried on a correspondence with local 
American health officials, not just to get better data from them for the Bulletin 
but to stimulate the creation and improvement of local registration systems. 
To drive his message home, he drew upon a fertile supply of analogies and 
metaphors. Writing, for instance, to C. N. Brackett of the New Jersey State 
Board of Health, he explained that “Without [vital] statistics, collected and 
properly classified by some central state authority, a state is like a merchant 
doing business without keeping any account of stock.” Similarly, in an 
address to a State Sanitary Conference in Maryland, he suggested that such 
registration “is, as it were, the eyes of the State Board of Health, and without 
it the Board is like a blind man trying to put out a prairie fire.”12 
Even as he lectured others, Billings realized that, since neither he nor 
the other Board members were registrars or statistical specialists, they had 
to look to qualified outsiders for technical advice as well as for ideas about 
what other vital statistics programs the Board should undertake. From the 
outset, he personally counted on Snow and Harris for substantial help. 
He thought that Snow could be of special value in helping organize and 
run the Bulletin, but the latter had to beg off from that or any major vital 
statistics role with the Board since he could only rarely get away from his 
routine Providence duties. Snow did continue responding to Billings’s letters 
promptly and helpfully as well as performing occasional smaller jobs for the 
committee.13 
Harris, in turn, undertook various contract work for the Board during 
the late ‘seventies. Initially, he left the impression with Billings that he was 
11 William T. Gairdner to JSB, 1/14/1880, JSB Papers, NLM; see also iVliles, 
National Board of Health, pp. 479-481. However, in England, William Farr 
for years had issued a weekly publication that had some similarities, though he 
focussed more on the data itself. It was a summary of some of the vital statistics 
that were to be included in the annual reports of the Registrar General. 
12 JSB to C[yrus] F. Brackett, 2/23/88, JSB papers, NLM, box 11; JSB, “Why a 
State Should Have a Proper System of Vital Statistics,” Seventh Biennial Report 
of the State Board of Health of Maryland (Annapolis: James Young, 1888), p. 
513. 
13 Edwin M. Snow to JSB, 7/7/1879; 9/18/1879; 12/10/1879; 12/29/1879, all 
in JSB Papers, NYPL. 168 
The Transformation of Vital Statistics 
ready and willing to assist significantly with vital statistics matters, such as 
helping the committee sort out its options and preparing detailed plans. 
Early in May 1879, seemingly acting on his own initiative, Harris proposed 
to Snow that the two of them meet informally with Henry Baker to devise 
a comprehensive vital statistics scheme for the Board. Snow, however, 
considering such a meeting premature, persuaded Harris and Billings to defer 
it until such time as the Board would have “more definite objects in view.”14 
Two months later, still uneasy, Snow advised Billings that Harris had 
increasingly “large plans” in mind, and the Providence man wondered where 
they fitted in the Board’s thinking. Answering immediately, Billings replied 
that, in fact, they did not fit. In fact, Harris had recently been “entirely 
relieved from all duty connected with the subject of vital statistics” and had 
been summarily transferred to new duties as one of the Board’s quarantine 
inspectors along the Atlantic coast. The reason proved to be that Billings 
had found the latter’s suggestions to be “too vague and general to be of 
any practical use, at least to me. I must say that I failed to get any definite 
information from him as to what was or what was not the best course to 
pursue in any particular case.”15 
Following Harris’s departure, Billings and the vital statistics committee 
recognized that they needed still more outside guidance. They particularly 
required help with some of the basics, on the problem of effectively ordering 
their priorities as a public agency, but also in working out how they could 
“secure greater uniformity in the methods of obtaining, recording, and 
publishing vital statistics.” The committee finally decided to bring as many 
as possible of the Americans who were working closely with vital statistics 
to a Washington gathering in the new year.16 The event was to become 
the first national conference devoted to problems of registration and vital 
statistics. A cautious Snow reminded Billings that “a convention is no good 
place to settle on a plan” unless things were carefully thought through ahead 
of time.1 But, as things worked out, he needn’t have worried. 
The Conference on Vital Statistics took place in Washington on May 6th 
and 7th, 1880, in connection with the regularly scheduled spring meeting of 
14 Snow to JSB, 5/2/1879, JSB Papers, NYPL. 
13 JSB to Snow, 7/9/1879, JSB Papers, NLM. 
16 JSB, “The Registration ofVital Statistics in the United States,” National Board 
of Health Bulletin, Vol. 3, no. 33 (Feb. 11, 1882), p. 296. 
17 Snow to JSB, 12/29/1879, JSB Papers, NYPL. The Transformation of Vital Statistics 
169 
the National Board. Cabell, as Board President, presided over the event, while 
Turner, Stephen Smith, Billings, and the other members of the committee 
on vital statistics handled the local arrangements. 
The bulk of the twenty-five outside participants came, of course, from 
America’s northeast, partly reflecting the reality that those persons could 
best afford the travel costs, but also because many of the functioning vital 
statistics registration systems were in that region. Two participants came 
from the upper South, while others were from Chicago, Pensacola, and New 
Orleans. Twenty-three of the twenty-five were physicians. 
All who came seemed to consider the conference as a unique learning 
experience, and almost all brought problems or questions from their own 
professional experiences for discussion with the group. By far the most 
numerous among the participants were the health officers, men who had 
had at least some experience in the supervision of registration systems and 
personnel and who recognized the scientific importance of accurate vital 
data in public health administration. Of the six who represented state 
boards of health, Illinois’John Rauch and New Jersey’s Ezra M. Hunt played 
particularly active roles in the proceedings, while Edward G. Janeway of New 
York, R. A. Cleemann of Philadelphia, and Samuel H. Durgin of Boston 
were similarly productive discussants among the dozen or so municipal 
health officers.18 
Of the outside participants, only Harris and Snow had status at that 
time as recognized experts in vital statistics work. Despite his differences 
with Billings, Harris brought valued experience, perspective, and continuity 
to the deliberations. However, it was generally agreed that it was Snow 
who spoke to the conference both with the greater technical authority and 
with a keen sense of the politically possible. Billings, in fact, midway in the 
conference, reminded the participants that Snow, in his landmark “Report 
on Registration” of 1860, had long since laid out with specificity and clarity 
many of the matters that the conference was now puzzling over. Rejecting 
the conventional practice of invoking the Englishman William Farr as the 
examplar of vital statistics expertise, he implied that this American conference 
might well look to the home-grown Providence registrar, with his practical 
wisdom, as its authoritative model.19 
18 “Proceedings of Conference on Vital Statistics,” NBH Bull., Vol. 2 (1881), 
Suppl. 5, pp. 1-14. 
19 Ibid., p. 9. 170 
The Transformation of Vital Statistics 
The agenda for the meeting was the result of much preliminary debate in 
the Board s committee on vital statistics. While it was presented as a collective 
product, it was more accurately a strong reflection of Billings’s desires for a limited 
program aimed at getting “some very simple general principles established.” He 
had personally rejected several proposals because they were too general, and 
ultimately managed to narrow the program to four fairly specific tasks or areas 
for discussion.20 Of these, the groups evaluation of the various modes of data 
collection and registration gave them little difficulty; their consideration of 
statistical reporting techniques revealed little agreement and had to be referred 
to the National Board for further examination;21 the discussion of desirable 
makeups of certificates of death, birth, and marriage also originally brought 
deep differences of opinion, but after postponing any decision about birth and 
marriage certificates the meeting easily adopted a model death certificate;22 and 
finally, the meeting endorsed and adopted the Royal College of Physicians’ 
nomenclature of causes of death with no opposition, along with proposals for 
American collaboration in the works subsequent revisions.23 
20 JSB to Elisha Harris, May 1880, JSB Papers, NLM, Box 11. See also Miles, 
“National Board of Health,” pp. 481-483; and “Proceedings of Conference 
on Vital Statistics,” loc. cit., pp. 1-14. 
21 This and other uncompleted conference matters were dealt with over the next 
few months by one of the conferences committees. JSB, et. al., “Report of 
Committee on the Nomenclature of Diseases and on Vital Statistics,” Annual 
Report of the National Board of Health, 1880 (Washington: GPO, 1881), 
Appendix O, pp. 537-540; and “Proceedings of Conference on Vital Statistics,” 
loc.cit., p. 12. 
22 Ibid, pp. 2-14. 
23 Some months later, Harris, aggrieved at not having been included on the 
committee to deal with the College, and assuming that Billings had chosen 
the members himself, wrote an accusatory letter that the other man, though 
claiming himself to have been blameless, had considerable difficulty in 
answering. JSB to Harris, 11/22/1880, JSB Papers, NLM. See also JSB et.ai, 
“Report on Nomenclature,” loc.cit., pp. 537-540; “Proceedings of Conference 
on Vital Statistics,” loc. cit., pp. 1 -3, and passim; Royal College of Physicians of 
London, The Nomenclature of Diseases..., 2d. ed. (London: RCPL, 1884), pp. 
xvi, xxiii; A. H. T. Robb-Smith, “A History of the College’s Nomenclature of 
Diseases: its Reception,” /. Royal Coll. Physs.London, Vol. 4, no. 1 (Oct. 1969), 
PP. 5-15. The Transformation of Vital Statistics 
171 
If the Conference on Vital Statistics accomplished most of what Billings 
had hoped for, it was because he had involved himself fully in every aspect of 
the affair. He cajoled the other leading lights of the profession to attend, and he 
got most of them to participate. He acted as floor manager of the sessions for 
the Board: introducing and interpreting the respective agenda items, keeping 
the discussion on track, responding to questions, formulating many of the 
motions, and keeping the other participants involved. And he took a central 
role in every phase of the substantive discussions, dealing with the legislative 
and administrative ramifications of the topics as well as the scientific.24 
Following the conference, Billings did not undertake any new major 
projects with his Committee on Registration and Vital Statistics, largely 
because of the increasing uncertainty surrounding the Board’s funding and 
future prospects. Flowever, he did carry out a good deal of follow-up activity 
aimed at maintaining the momentum that the conference had generated. 
He considered it particularly important to spread word about the 
imminent publication of the revised disease nomenclature in London and to 
emphasize its importance for American public health and medical personnel 
and their institutions. When the British Registrar General’s office in 1882 
announced that it was adopting the new version, Billings made sure that the 
U.S. Army Medical Department followed suit. He also urged Harris and 
other registrars and health officers to do the same and to resist all thoughts 
of preparing their own local nomenclatures. “The importance of uniformity 
is so great,” he emphasized to Harris, “that it should overcome all minor 
objections.—By all means do not change the order of the diseases in your 
published list. If you do, everything will be in confusion in this country for 
another ten years—your tables will not be comparable with the English nor 
with those of other States.—I discussed this matter fully with Dr. Woodward 
and the Surgeon General, and we all agreed that while we do not fully 
approve all the details of the new lists of the College and Registrar General, 
yet it was our duty to accept them for the present.”2S 
24 I draw these conclusions from my examination of the official report of the 
meetings. “Proceedings of Conference on Vital Statistics,” loc. cit., pp. 1-22. 
See also Miles, National Board of Health, p. 484. 
25 JSB to Harris, 10/9/1883, JSB Papers, NLM. Following the demise of 
the National Board of Health, the American push for a uniform disease 
nomenclature lagged until around 1900, when the APHA introduced the 
Bertillon system into this country. For discussion, see James H. Cassedy, 172 
The Transformation of Vital Statistics 
In the middle of these discussions, the National Board of Health lost 
the capacity to play further major roles in American vital statistics reform 
as well as in public health generally. In June 1882, faced with the steady 
diminution of congressional funding, the Board was forced to discontinue 
its much-valued Bulletin, while in August Billings resigned, taking with 
him several other Board members. As he left the Board, he perceived that 
the achievement of an effective national vital statistics registration system 
remained one of the country’s most urgent public health needs.26 He already 
had a firm idea of what steps were required to bring this about. And he 
enthusiastically recommended the United States Census as a highly suitable 
and probably receptive agency to carry on this work since he was assured of 
being invited to play a large role in it.2 
The Census and the Federalizing of Vital Statistics 
Billings’s 1882 mention of the Census as a possible substitute seat for 
national vital statistics reform projects and energies was by no means a 
new or passing thought. It was a fully considered possibility or option that 
had been taking shape in his mind through the previous decade while he 
served that agency as a consultant. To be sure, the federal Census was a 
government operation that had almost as many uncertainties as the National 
Board of Health. But at that point in time, it constituted the most logical 
place in the government for the continuation and extension of the Board’s 
Charles V. Chapin and the Public Health Movement (Cambridge, Mass.: Harvard 
University Press, 1962), pp. 143-145. See also Royal College of Physicians, 
The Nomenclature of Diseases . . . 2d. Ed. (London: The College, 1884) 
26 The breadth of this consensual support was spelled out in much detail in an 
official APHA document of late 1881, following the Boards conference on 
Registration. “Report of the Committee on Vital Statistics and a Uniform 
System of Registration,” Public Health Reports and Papers, VIII (1882), pp. 
339-342. 
27 The quotation is from a much abbreviated version of the report, JSB, 
“Registration of Vital Statistics in the United States,” loc. cit., pp. 295-296. 
The full report is JSB, “The Registration of Vital Statistics,” Annual Report of 
the National Board of Health, 1882, Appendix E (Washington: GPO, 1883), 
pp. 355-461. A third version is JSB, “The Registration of Vital Statistics,” 
Amer. J. Med. Scis, n.s., Vol. 85 (1883), pp. 33-39. The Transformation of Vital Statistics 
173 
vital statistics activities. Moreover, census work already constituted a large 
and highly congenial area of personal career activity for him even though 
part-time, one that was intellectual in nature as much as administrative and 
eventually technical. 
The United States census had figured in sanitarians’ plans for 
obtaining vital statistics well before the establishment of the National 
Board of Health or even of the American Public Health Association. At 
least as far back as the 1840s, Edward Jarvis and other reformers had 
suggested using the census mechanisms as an alternative to waiting for 
state registration systems to supply death data. And in 1850 new federal 
legislation provided for such data to be obtained through regular census 
enumerations. When carried out, however, the mortality enumerations 
of the censuses of 1850 and 1860 proved discouragingly inadequate, 
with little more than sixty percent completeness in either of them.28 
Moreover, in 1870, in the absence of new legislation, there could be little 
realistic hope for much improvement in the data that was expected to be 
obtained from the ninth census. 
Billings became personally aware of the scope and nature of these 
continuing deficiencies soon after the enumerations were made in 1870. 
Early that year, Francis A. Walker, recently chosen Superintendent of the 
Ninth Census, requested Surgeon-General Barnes to direct the correction of 
the statistics of mortality that were produced by that operation. Committing 
his office to the task, Barnes in turn first designated Woodward to carry it out 
and then added Billings to the project when its magnitude became apparent. 
Laboring at the task between 1870 and 1872, the latter two of course 
could not do anything about the large continuing incompleteness of the 
mortality count. However, they did advise Walker on several substantive 
matters. For one, they urged adoption of the Royal College of Physicians’ 
28 Grob, EdwardJarvis, pp. 137-154, 185-200. For the general history of American 
censuses, see Margo J. Anderson, The American Census: A Social History (New 
Haven: Yale University Press, 1988); and Carroll D. Wright, The History and 
Growth of the United States Census (Washington: G.P.O., 1900 and reprinted 
by Johnson Reprint Corp, 1966). Wright briefly summarizes the legislative and 
organizational history of each of the large general areas of inquiry, including that 
of mortality, as they became incorporated in the census operation. Anderson, 
however, has deliberately focused her study on the population segment of the 
censuses and mentions the other areas, including that of mortality, only in passing. 174 
The Transformation of Vital Statistics 
disease nomenclature and classification.29They also collaborated in Walkers 
plans to include maps in the various census publications; specifically, they 
identified and arranged data on disease distribution that went into four 
maps.30 For the most part, however, in an experience similar to that of 
Edward Jarvis, their labors turned out to be the tedious repairing of the 
most conspicuous discrepencies, contradictions and errors that they found 
in the enumerations.31 
While those modifications did little if anything to improve the 1870 
mortality report, Walker attempted to put a good face on the results for public 
consumption, maintaining that the report provided as much information about 
the nations mortality experience as most people would want. However, when 
he spoke about it to the APHA in 1873, he readily conceded, as others already 
had, that the 1870 census, like its two predecessors, had been structurally 
unable to produce mortality statistics that were at all reliable or adequate. The 
sanitarians who heard him concurred with his conclusion that new legislation 
and administrative procedures were clearly needed in coming years to bring 
about any improvement. Modifications were also necessary to make possible 
such socially and politically interesting comparisons as that of the mortality 
of the various racial segments of the American population.32 
29 An important aspect of that work had been its modernizing of the long-standard 
disease classification of William Farr. Reflecting the views of Woodward and 
Billings, Walker commended the new classification’s compilers for having 
replaced such disease designations as “Zymotici, Miasmatici, [and] Diathetici’, 
along with other “offensive” terms that had “burdened” Farr’s work. See 
Woodward’s report and Walker’s comments in The Vital Statistics of the United 
States, Volume II of Ninth Census of the United States, 1870 (Washington: 
G.P.O., 1872), pp. v-vi. 
30 The maps, which appeared in Volume II of Ninth Census, 1870, depicted the 
distribution and prevalence of four groups of diseases: consumption; malarial 
diseases; enteric, cerebrospinal, and typhoid fevers; and intestinal diseases. For a 
valuable study of the cartographic background of this census, see Fulmer Mood, 
“The Rise of Official Statistical Cartography in Austria, Prussia, and the United 
States, 1855-1872,” Agricultural History, Vol. 20 (1946), pp. 218-222. 
31 For some idea of the herculean manual labors involved, see Grob, Edward 
Jarvis, pp. 141-150, 185-194. 
32 Francis A. Walker, “The Relations of Race and Nationality to Mortality in 
the United States,” Public Health Reports and Papers, Vol. I (1873), pp. 18-35. The Transformation of Vital Statistics 
175 
It was obvious to many in the 1870s that the federal census’s problems 
with death enumeration needed as much attention as did the state and city 
problems with death registration. In fact, the search for solutions led to a 
continuing if sporadic dialog between Billings and Walker throughout the 
rest of the decade and beyond.” Both men kept the matter under discussion 
at the APHA and worked out some accommodations concerning it between 
that organization, the Medical Department, and the Census. Walker, in 
1875, apparently with some hope of keeping the other man’s interest in 
censuses active from one census to the next, sent Billings a copy of his newly 
issued Statistical Atlas of the United States™ Phis gesture was probably not 
necessary, for Billings not only was already highly challenged by the census 
problems but welcomed his dialog with a man of Walker’s caliber. At an 
early point in their relationship he had come to appreciate the charismatic 
Walker not only as an “agreeable” professional associate but as a man of 
wide knowledge and a real gentleman. Moreover, he found him to be “a 
born leader—bold, frank, sincere, and entirely devoted to his work.” He 
identified closely with Walker’s innovative and action-oriented approach, 
with his utilization of non-political experts and administrators, and with his 
search for technical improvements in census methods.35 And he found the 
Probably on Billings’s and Woodward’s suggestion,Walker also obtained a 
corroborative opinion from the actuary, Ezekiel B. Elliott. See the latter’s 
“Remarks Upon the Statistics of Mortality,” The Vital Statistics of the United 
States; Ninth Census of the United States, 1870, Vol. 2 (Washington, D.C.: 
G.P.O., 1872), pp. ix-xvi. 
33 Between his appointments with the Census of 1870 and that of 1880, Walker 
held other positions both in the government and outside, but to maintain 
some continuity of census organization and planning, the Secretary of Interior 
named him to a non-salaried census post during this period. See discussion in 
Wright, History of the Census, pp. 56-57. A far more extended and analytical 
commentary on Walker’s census career and contribution, is Anderson, American 
Census, pp. 78-106. 
34 Walker to JSB, 3/25/1875, JSB papers, NLM, Box 7. 
35 JSB, “Biographical Memoir of Francis Amasa Walker 1840-1897,” in National 
Academy of Sciences, Biographical Memoirs, Vol. V (Washington: The Academy, 
1905), pp. 209-218. For a more recent short summary of Walker’s life, see A. 
W. Coats and Patrick Williams, “Francis Amasa Walker,” American National 
Biography, Vol. 22 (1999), pp. 491-493. See also Bernard Newton, The 176 
The Transformation of Vital Statistics 
latter helpful in his suggestions for the APHA’s sanitary survey and other 
public health activities.36 
When Walker, in the late 1870s under his new appointment as 
Superintendent, began full-time planning for the Census of 1880, he seems 
to have already selected Billings both to design the data collection portion of 
the mortality operation and to take charge of its later phases.3 He obviously 
valued the fact that the latter, on his own, had continued studying the 
problem of how to improve the census death statistics. Billings now made 
it clear to Walker that there were still no easy solutions, but he felt that the 
recent close collaboration between the APHA, the National Board, and the 
census officials, if continued, would facilitate progress in that direction. Most 
important, he was ready with two proposals for supplementing or replacing 
certain of the vital statistics normally obtained through enumeration. Walker 
agreed to both provided Billings would organize them. 
One expedient was to enlist physicians in the reporting process. To 
prepare for this, Billings had the National Board of Health review the 
suitability of the death return forms that were to be used in the census. 
He also made it known, through the NBH Bulletin and other professional 
periodicals, that the Census office would supply copies of the forms to 
interested physicians.38 Above all, he used his concurrent positions as an 
officer of the American Medical Association and also of the APHA to urge 
the participation of physicians in this urgent public health fact-finding 
effort. 39 
The other supplement to the enumeration, even more promising, 
was the experimental use of the death records that were being collected 
by existing state and municipal vital statistics registration systems. Most 
of those systems were managed by knowledgeable health officers and 
Economics of Francis Amasa Walker: American Economics in Transition (New 
York: Augustus M. Kelly, 1967). 
36 For discussion, see Chapter 6, passim. 
37 I have found no official papers pertaining to this appointment, but there is 
no reason to doubt that Barnes concurred in the arrangement, as he had in 
1870. 
38 Miles, National Board of Health, p. 484. 
39 JSB, “Address in State Medicine and Public Hygiene,” Trans, of AMA, Vol. 30 
(1879), pp. 279-291; JSB, “The President’s Address,” Public Health Papers and 
Reports, Vol. VI (1880), pp. 7-8, 436. The Transformation of Vital Statistics 
177 
registrars who had attended the Conference on Registration. However, 
new systems and new registrars were steadily appearing, providing tangible 
testimony to the 1870s efforts of the APHA. As the various systems became 
operational, sample death records were supplied to the NBH Bulletin and 
other professional organs or bociies where they began to demonstrate 
how a close state and federal statistical collaboration could be made to 
work out. In addition, such groups began the process of evaluating the 
completeness and quality of the mortality data gathered by those systems. 
And, by 1880, from what evidence they already had, Billings and his 
supporters were confident that, when tried with the new census, the data 
from the registration systems would already demonstrate their immense 
superiority over the crude data of the enumerators and would emerge as 
benchmarks of excellence for the future. 
Billings also hoped that the Census of 1880 could take a first step toward 
realizing a long-held dream of sanitarians, that of obtaining records of the 
data of disease. And he made strenuous efforts in that direction. In 1878 
he drew up a plan for sickness enumeration that he discussed at length 
with Walker, Barnes, several congressmen, and a number of public health 
colleagues. The responses seem to have been overwhelmingly favorable. 
However, Edwin Snow, despite agreeing with the proposal in principle, kept 
finding problems: i.e., the plan included too many questions; the questions 
were too complicated; they would be of little use statistically; and the 
introduction of the plan at that particular time seemed premature. Snow’s 
extended arguments finally proved persuasive with Billings, who eliminated 
most of his original slate of questions. That left only a single question about 
sickness for inclusion in the final schedule.40 
40 JSB to Surgeon-General Barnes, 9/28/1878, in JSB, Collected Papers, II, 
1871-1882, NLM. For a review of related 19th century British public health 
statistical problems, see Graham Mooney, “Professionalization in Public Health 
and the Measurement ol Sanitary Progress in Nineteenth-Century England 
and Wales," Soc. Hist, of Med., Vol. 10 (1997), pp. 53-78. See also Edwin 
M. Snow, “Report on Registration,” Proceedings and Debates of the Fourth 
National Quarantine and Sanitary Convention (Boston: Rand & Avery, 1860), 
reprint, pp. 17-18; JSB, “Remarks on Medical Topography,” in “Report of 
the Committee on the Plan for a Systematic Sanitary Survey of the United 
States,” Public Health Papers & Reports, II (1874 and 1875), pp. 50-52. JSB to 
Barnes, 9/28/1878, loc. cit. Barnes to Hon. S. S. Cox, 10/15/1878, attached 178 
The Transformation of Vital Statistics 
Sometime prior to the actual taking of the tenth census, in June 1880, 
Walker obtained Billings’s agreement to remain as head of its vital statistics 
operation up to its conclusion. Accordingly, although Walker resigned at 
the end of 1881 to become President of the Massachusetts Institute of 
Technology, Billings continued for another three years and more with a 
large measure of autonomy, working at the tasks of organizing the mortality 
data that had been collected and preparing them for publication. In so 
doing he gained the admiration of James H. Warded, Walker’s successor 
as Superintendent, who was responsible for overseeing the final processing 
of the Census as a whole. Warded was impressed with how much Billings 
had accomplished for the Census during those years, somehow squeezed 
in among his non-census activities: “He has projected the entire scheme of 
compilation for the Mortuary Statistics of the Census, has supervised the 
work in ad stages of its progress, and has subjected the results of these vast 
tabulations to a discriminating analysis and discussion.”41 
The three-volume report on the vital statistics of the 1880 census came 
out in 1885 and 1886. In this document and elsewhere, Billings reported 
mixed success for his various census innovations and experiments. He 
expressed satisfaction that several of these features, specifically his division’s 
selection of mortality tables and its use of the Royal College’s revised 
nomenclature of diseases, would be widely emulated in state censuses and 
health department reports. On the other hand, he had to report that “the 
results of the attempt to record the number sick on the day of the census 
[were] not very satisfactory.”12 
Billings went on to explain that mortality data collection under the 1880 
census regrettably still had had to be conducted under a crippling legislative 
mandate. The federal enumeration had had to be employed again since it was 
still the only means of obtaining any idea, however rough, of deaths and death 
to Ibid. JSB to Snow, 9/7/1878, JSB papers, NLM; Snow to JSB, 10/17/1878, 
4/25/1879, and 5/14/1879, all in JSB papers, NYPL. See also C. D. Wright, 
History of the Census, pp. 62-63, 167, 167. 
41 James H. Wardle, quoted in JSB, Report on the Mortality and Vital Statistics of 
the United States, Vols. XI and XII of U. S. Census Office, Tenth Census of the 
United States, 1880 (Washington: GPO, 1885, 1886), Vol. XI, p. 3. 
42 Ibid., Vol. XI, p. xxvii; and JSB, “Mortality Statistics of the Tenth Census,” 
[Abstract], Bulletin of the Philosophical Society ofWashington, Vol. 4(1880-1881), 
pp. 164-165. The Transformation of Vital Statistics 
179 
rates for by far the largest portion of the United States. Moreover, as foreseen, 
it had proved as impossible to compile accurate vital statistics by that method 
as it had been in the three preceding censuses, and the completeness was 
still less than 70%. To be sure, a certain amount of supplementary data 
was obtained from cooperating physicians. But Billings ended up being less 
than enthusiastic about the quality of these data. A considerable number of 
responses, it turned out, were not from “competent medical men, but from 
all those who chose to call themselves physicians.”43 
By contrast, Billings’s experiment with using death registration records 
as a second type of supplemental data was a conspicuous success. It was a 
positive step, one that introduced a welcome element of quality and reliability 
into the enterprise. Under this arrangement, data were obtained from all 
local jurisdictions with registration systems producing death statistics that 
were at once acceptably accurate and complete; ninety percent became the 
standard. Billings identified twenty-two jurisdictions that met or approached 
this standard in 1880—two states, nineteen cities, and the District of 
Columbia—and denominated them collectively the death “registration area.” 
As he had insisted, this cooperative state-city-federal enterprise had been 
scrupulously conducted on business principles; the various contributing 
localities were all paid appropriately for the use of their data.44 
Rapidly recognized as a benchmark of excellence in vital statistics, the 
concept of the death registration area was continued in subsequent federal 
censuses. Billings naturally adopted it to bolster the mortality figures of the 
1890 enumeration. By then six additional states had become eligible for 
inclusion in the death registration area, while in 1900 three further states 
gained admission. In 1903, the newly created permanent Census Bureau 
totally abandoned enumeration as a means of collecting death statistics 
and began efforts to establish a birth registration area. From then on, the 
Bureau staff relied completely on its cooperative arrangements with state 
and urban registration offices to ensure regular supplies of reliable data. At 
43 JSB, Vital Statistics of Tenth Census, Vol. XI, p. xi. 
44 The political entities included in the original death registration area were 
Massachusetts, New Jersey, the District of Columbia, Baltimore, Brooklyn, 
Charleston (S.C.), Chicago, Cincinnati, Cleveland, Indianapolis, Louisville, 
Milwaukee, Nashville, New Orleans, New York, Philadelphia, Pittsburgh, 
Providence, Richmond, San Francisco, St. Louis, and Wilmington. See Ibid., 
passim. 180 
The Transformation of Vital Statistics 
that same time, the Bureau expanded the criteria for future admissions to 
the area by requiring states to enact acceptable registration laws and to use 
standard death certificates.45 
Technological Revolution in the Census: 
Tabidating Mortality Data 
As the outside expert brought in on an ad hoc basis to head the tenth 
census’s mortality operation, Billings was essentially insulated from the 
political headaches that constantly beset Walker as well as from many of 
the financial and other administrative problems. Left largely to focus on 
and manage the intellectual and technological elements pertinent to the 
gathering, processing, and analysis of mortality data, for instance, he was 
not called on to join other census statists in working out new formulas for 
legislative apportionment. Moreover, for obvious reasons, his compilations 
of mortality figures were rarely sought after by Gilded Age publicists seeking 
data to illustrate the American nation’s spectacular growth. At the same time, 
Billings was as knowledgeable as almost any of his census associates about 
the general ramifications of that growth, including its profound implications 
for the census enterprise itself. In fact, with his ongoing studies of the 
relentless pressures of the growing population alone, he was well prepared 
to predict and plan for the continuing expansion, not only of the Vital 
Statistics Division, but of other segments of the census enterprise. He was 
able, for instance, to anticipate the likely magnitudes in the multiplication 
of clerks and specialists in the Washington office; the proliferation of subject 
schedules and inquiries; the increase in the number and size of publications; 
the needs for improved methods and apparatus. 
Quite apart from these problems and pressures of growth, the ephemeral 
nature of each successive census made for a cyclical operation typified by 
45 Admission dates of states to the death registration area up to the middle of the 
twentieth century may be found in “History and Organization of the Vital 
Statistics System,” Vital Statistics of the United States, Vol. I (Washington: 
National Office ofVital Statistics, 1950), pp. 12-13. For the larger significance 
of this development, i.e. the historical progress of registration as a measure of 
state and national civilization, see James H. Cassedy, “The Registration Area 
and American Vital Statistics: Development ol a Health Research Resource, 
1885-1915,” Bull. Hist. Med., 39, No. 3 (1965), pp. 221-231. The Transformation of Vital Statistics 
181 
much hectic activity and uncertainty if not actual crisis. This atmosphere 
could be noticed at the beginning of each decennial effort, and it was 
intensified throughout by the fits and starts of congressional debate on 
the scope of the census, by chronic inadequacies in budgeting, by the 
requirements of rigid timetables, by the demands of assembling a large and 
diverse workforce almost from scratch in a very short time span and then 
dismissing much of it abuptly following completion of its spasmodic labors. 
The reengagement of Billings and other experienced experts from one census 
operation to the next was certainly desirable as a means of minimizing the 
confusion. 
Speaking further about the difficulties of the 1870s and 80s, as Anderson 
has written, “those familiar with the internal workings of the Census 
Office . . . knew that the real crisis facing the Census Office [lay in the 
process of] tallying or cross-tabulating the population data.” Beginning 
chiefly in the Walker period, demands spread in all sections of the census 
operation for the technical staffs to produce and tally increasingly detailed 
breakdowns of the basic data and otherwise to expand their statistical analyses 
and presentations. These operations made the processing of the material 
increasingly unwieldy. The situation was also exacerbated by the continued 
carrying out of the tabulating and some other operations by hand, thus 
perpetuating a frustrating bottleneck that produced ever growing delays 
in completing the various segments of the census.46 During this period, 
several census officials introduced mechanical devices in the hope of relieving 
these difficulties, but none proved more than minimally successful.47 On 
the contrary, the deeper that Billings got into census operations, the more 
urgent, he saw, was the need for more effective solutions to such operational 
and technical problems, not only in the mortality work but in all of the 
other census segments, particularly in the population segment. 
When the two enormous tomes of the tenth census’s vital statistics report 
were ready for the printer in 1885, each one over 1,000 pages, Billings paused 
to insert two acknowledgments in his introduction. He especially noted the 
essential contribution of his principal statistician, William A. King, who had 
supervised the central processing labors, the complex and time-consuming 
46 For a general history of the census after 1860, see Anderson, American Census-, 
the quotation is on p. 102. See also Wright, History of Census, pp. 52-69. 
47 Leon Truesdell, The Development of Punch Card Tabulation in the Bureau of 
the Census 1890-1940 (Washington: Bureau of the Census, 1965), pp. 1-25- 182 
The Transformation of Vital Statistics 
work of compiling and translating the rough mortality data into tabular or 
other formats desired by Billings. 
In addition to his mention of King, Billings also acknowledged the 
assistance of Herman Hollerith, a recent engineering graduate of Columbia 
Colleges School of Mines. At intervals between 1879 and 1882, though he 
was employed in another division of the census, the precocious and already 
inventive Hollerith seems to have sought diversion by doing odd jobs in 
Billings’s division. His contribution there was originally to help with the 
compiling of life tables according to the formulae and methods of William 
Farr and preparing diagrams to illustrate them. Billings, delighted to have 
an additional mathematically competent individual available, had Hollerith 
prepare life tables for certain of the individual states, but deferred any 
attempt at creating a national life table until more accurate and complete 
data became available.48 
The two men did not enter into any kind of formal mentor-student 
relationship; Billings at first simply showed Hollerith around the vital 
statistics division and explained what the latter was expected to do. However, 
those contacts quickly lead to an extended series of informal brainstorming 
sessions between two mentally agile and probing individuals with differing 
intellectual backgrounds. This mainly took the form of impromptu 
discussions between the two that focussed on the current census problems, 
sessions that typically sprang up as they walked around the large and often 
noisy census processing rooms and were sometimes continued during or after 
dinner at the Billings home. At some point in time and place that neither 
participant ever precisely identified, Billings the census administrator stated 
very directly to Hollerith the young engineer his perception of the census’s 
desperate need for some kind of mechanical apparatus that could perform 
the routine tabulating of the basic population data, perhaps “something 
on the principle of the Jacquard loom, whereby holes in a card regulate the 
pattern to be woven.”49 
48 JSB, Vital Statistics of Tenth Census (1880), Vol. 11, p. ix; Ibid., Vol. 12, p. cxlii; 
and JSB, “Mortality Statistics of the Tenth Census,” Bull. Philos. Soc. Wash., 
Vol. 4 (1880-1881), p. 165. 
49 Quoted in Truesdell, Punch Card Tabulation, pp. 30-31. Truesdell reviews 
recollections of Billings, Hollerith, and other individuals apropos these matters, 
Ibid., pp. 30-33. The Transformation of Vital Statistics 
183 
Hollerith evidently took this statement much as Billings had intended, 
not quite as an invitation or request but rather as a personal challenge and 
opportunity. Reflecting on it in that sense over the next several months, he 
continued his brainstorming with Billings, spent time in the population 
division to make himself familiar with the tabulating operation, and 
generally studied the problem from every side. Ultimately, probably by 
mid or late 1880, he informed Billings not only that he thought he could 
build a machine to do the job but that he had decided to form a company 
to develop and sell the machines commercially. At this same time Hollerith 
asked Billings to join him in the enterprise, but the latter declined, expressing 
no interest in that aspect of the ventured0 
From that point on, Hollerith’s career as inventor, designer, and industrial 
entrepreneur took off. While using some of his time to work on other 
promising investigations and ventures, he nonetheless committed himself 
more and more deeply through the decade of the 80s to the project for the 
census. Refining and testing his ideas first on crude models, he changed his 
approach several times as he went along. However, by 1884 he had settled on 
a tabulation system that had grown out of some of Billings’s original ideas, 
one based on the use of punched cards and in which electricity was applied 
to the principle of the Jacquard loom. Once he had a firm idea of what his 
system was to be, Hollerith began the processes of raising money, devising 
auxiliary devices, applying for patents, organizing his business office, and 
ultimately demonstrating advanced models to would-be buyers. Well before 
the end of the decade, with all or most of the essential preliminaries taken 
care of, he considered his system ready for use in the census of 189071 
50 Ibid., pp. 30-31. See also Virginia Hollerith, “Biographical Sketch of Herman 
Hollerith,” ISIS, Vol. 62, Part I, No. 211 (Spring 1971), p. 70. Billings had little 
money to invest in such a project. Moreover, he had been financially burned by 
one or more failed commercial ventures earlier in his career. He also may well 
have sensed that there was not room enough in this proposed venture for two 
such dominating personalities. However, his governing reason for declining 
was probably a desire not to be drawn so far away from his intellectually rich 
and many-sided professional life. 
51 For details, see the account by Geoffrey D. Austrian, Herman Hollerith, 
Forgotten Giant of Information Processing (Ne w York: Colu mbia University 
Press, 1982), pp. 1-37. 184 
The Transformation of Vital Statistics 
Billings, for his part, while declining any commercial or other business 
involvement in Holleriths system, retained an intense interest in possible 
applications of the apparatus and was highly confident of its ultimate success. 
He remained Hollerith’s good friend as well as one of his most consistent and 
active supporters. Looking forward especially to fulfillment of the invention’s 
potential for radically improving the processing of mortality data, he became 
a champion of the system at every stage and went out of his way to expedite 
its adoption, both in the census operations and elsewhere. 
From the beginning, Billings also remained essential to Hollerith as 
one of the system’s principal technical critics. One of the Billings daughters 
recalled the evenings sometime in 1882 or 83 when Hollerith went to the 
Billings home carrying the “first little wooden model” of his invention. The 
two men placed the model on a table in the library where they could observe 
its movements and sort out the pros and cons.52 Subsequently, Billings 
went to other sites for tests and demonstrations of later models, though at 
some of them he appeared not only as the critic but as the promoter and 
expediter of the machine. 
Billings apparently became persuaded of the essential workability of 
the system about as soon as Hollerith himself did, by late 1884. Almost 
immediately, he began to alert the public health profession and other 
specialists to the developments that were in the offing. Taking the news to 
the American Public Health Association in the following year, he linked the 
announcement to a lengthy discussion of a statistical dilemma that health 
officers of states and large cities were encountering at this time, a dilemma 
that had been discussed briefly at the National Board’s recent conference on 
vital statistics. On the one hand, these professionals were under increasing 
pressure to publish health bulletins or reports at regular intervals, both for 
the public and for professional use, and to fill them not only with the basic 
facts of diseases and deaths but with numerous statistical charts, tables, 
and analyses that took into account their relations to certain sanitary and 
demographic variables or combinations of other circumstances. On the other 
hand, preparation of such statistics was costly and required the expenditure 
of an immense amount of time and labor by skilled individuals. 
Billings’s paper analyzed the different kinds of publications and tables, 
suggested means of simplifying them without reducing their usefulness, 
and, almost in passing, mentioned that one means of reducing statisticians’ 
52 Reported in Trues dell, Punch Card Tabulation, p. 31. The Transformation of Vital Statistics 
185 
errors had just become available, while another was about ready. The first was 
his own contribution to the census operation of a simple substitute for the 
“large and clumsy" tally sheets that statisticians had long used for arranging 
and compiling death data. To take their place in processing the 1880 census 
figures, he had first recorded the data manually on post-card sized cards, one 
for each death, though since that time he had come to realize that it would 
be far preferable if such recordings were done by punching holes or slots. 
Billings stressed to the sanitarians the fact that this changeover to 
recording on cards was of added importance because it was expected to be 
an integral feature of the second innovation, Holleriths soon to be available 
tabulating machine. “It would be quite possible," he explained in 1885, 
“to have the punching of these cards done by machinery, by simply playing 
upon keys like those of a piano or a writing-machine, and after the cards had 
been punched, to have them distributed in various ways, and counted by 
machinery or by electricity. In lact, a method for doing this last has already 
been devised, and seems to work very well.”53 
Although Billings’s announcements to the APHA were understated as 
usual, they were the words of a thoroughly happy official. They conveyed 
the satisfaction of a statist who, as much as any of his hearers, stood to 
gain almost incalculably from the imminently available Hollerith machine. 
However, as before, unlike so many ambitious individuals of his generation, 
Billings was not diverted by the lure of a possible bonanza of financial gain. 
Rather, he looked forward to the huge bonus of efficiency and speed that 
the Hollerith machine would surely bring to his own statistical operations 
and those of his professional colleagues. 
Billings does not seem to have spent much time reflecting on the relief that 
the machine might bring to statistical professionals from the crushing load of 
routine mental calculations and pencilled entries that had characterized and 
encumbered middle and late-nineteenth century vital statistics tabulation. In 
fact, as a workaholic, he appeared to regard such matters as being unworthy 
for health professionals to entertain very seriously, particularly in the face of 
undiminishing statistical work expectations, standards, and timetables. He 
was quite explicit about this in an 1887 paper to the APHA. Dealing again 
with the new data processing methods, he exhorted health officers to include 
13 JSB, “Methods ofTabulating and Publishing Records of Death,’’ Public Health, 
Papers and Reports, 1885, Vol. XI (1886), pp. 51-65; the quotation is on p. 55. 
See also, JSB, Vital Statistics of Tenth Census, Vol. 12, p. clviii. 186 
The Transformation of Vital Statistics 
as much mortality data as possible on the cards they punched as well as to be 
unstinting in preparing additional tables for their reports, thereby paving the 
way toward improving the next census even if it meant additional statistical 
labors. The fact that these latter “will involve a considerable amount of labor 
in computation of ratios is true; but by the use of Thatchers slide rule this 
labor may be much lessened. Such computations are essential to bring the 
data into such shape that they can be compared.”54 
As Hollerith, during the mid- and late 1880s, perfected the tabulators, 
punches, sorters, and other components that were needed to be linked 
together in his system, Billings was helping make arrangements for Field 
tests of the system in American health departments and registration offices. 
Tests began at the Baltimore Department of Health in 1887, at the New 
Jersey state registrars offices a few month’s later, and in the New York City 
health department in 1889. The Surgeon-General’s Office of the Army 
installed one of the machines in 1888 for testing, while the Navy Medical 
Department deferred their decision in the matter until the Army’s tests were 
completed.55 
Billings kept the public health community informed of the various 
early tests and generally alerted health officers to the features and capacities 
of the new machines. For some time, however, at least as long as those 
machines remained expensive and in short supply, he also kept reminding 
professionals that the punched cards, which were simple, inexpensive, and 
readily available, continued to be decidedly valuable even if used alone. In 
1887, he argued “that the existence of such a machine [as Hollerith’s] is a 
strong additional reason for the use of the card system of record for statistical 
54 JSB, “On Some Forms of Tables of Vital Statistics, with Special Reference to 
the Needs of the Health Department of a City,” Public Health, Papers and 
Reprts, 1887, Vol. 13 (1887), reprint, p. 4. 
For further details of the trials, see Austrian, Hollerith, pp. 39-57; also Truesdell, 
Punch Card Tabulation, pp. 32-47. For the introduction of the device in the 
Army, see Albert G. Love, Eugene L. Hamilton, and Ida L. Heilman, Tabulating 
Equipment and Army Medical Statistics, (Washington: Office of the Surgeon 
General, Department of the Army, 1958), pp. 30-51. The later adoption of 
such technology in British censuses and vital statistics is examined by Edward 
Higgs, “The Statistical Big Bang of 1911: Ideology, Technical Innovation and 
the Production of Medical Statistics,” Soc. Hist of Med., vol. 9 (1996), pp. 
409-426. The Transformation of Vital Statistics 
187 
computations. The punched cards cannot, of course, take the place of the 
written registration records which are required for judicial purposes,—they 
are an addition, and not a substitution,—but the facilities which they give 
for statistical work are so great that I advise their use in all cases, no matter 
whether they are to be counted by machinery or not.”56 
Throughout the 1880s, neither Billings nor Hollerith faltered in their 
shared conviction that the latter would have a successful tabulating machine 
system ready for installation in time for full use in the 1890 federal census. By 
1889, the machine had convincingly passed the tests conducted in Baltimore, 
New Jersey, New York, and the Surgeon-General’s Office, while potential 
customers had begun clamoring for it on both sides of the Atlantic. The 
selection of Robert P. Porter to be the new Superintendent of the Census, 
greatly simplified its final adoption in that agency. 
A personal friend of Hollerith, Porter was already advocating the 
invention’s early acceptance.'’7 He was also well aware ot the unique role 
that Billings had been playing as Hollerith’s supportive but critical alter 
ego in the government during the period between censuses. And he saw 
that his census administration stood to benefit from a continuation of the 
relationship while the machines were being placed into service. 
As one of his key appointments, therefore, Porter was all too happy to 
select Billings to return as head of the Vital Statistics Division. He had been 
personally familiar with the latter during the 1880 census and was well aware 
of his excellent record. Moreover, the two men shared a common interest 
in carrying over many of Walker’s methods and innovations from 1880 to 
the new census enterprise?8 
There seems to have been little if any disagreement among the other 
upper echelon census officials who came together with Porter and Billings 
about the urgent need for improved data processing methods. But there were 
some initial differences over which of several systems should be adopted. To 
resolve them, Porter and the Secretary of the Interior appointed a committee 
composed of Billings as chairman and two other census experts to make an 
investigation and evaluation. In the fall of 1889 the committee organized 
and conducted a competition that pitted Hollerith’s electric tabulating system 
56 JSB, “Some Forms of Tables,” loc. cit., p. 5. 
' Reviewed in Austrian, Hollerith, pp. 39-49. 
58 Robert P. Porter to the Honorable Secretary of rhe Interior, May 3, 1889, 
photocopy, in JSB Papers, NLM. 188 
The Transformation of Vital Statistics 
against two essentially manual systems, one devised by the census statistician 
William C. Hunt, the other by Charles F. Pidgin, a Boston inventor. For 
the test, Billings and his committee had the competing devices process 
actual population data that had been gathered from selected districts of St 
Louis in the previous census. The systems were then evaluated according 
to the time they took, first to transcribe the data from the original census 
schedules to the punch cards, slips, or chips of the respective systems, and 
then to tabulate the data.59 
The competition took place in September and October, but the 
outcome became evident long before all steps had been completed, with 
the Hollerith system far surpassing the other two in virtually all aspects of 
its performance. Weeks prior to completing his committee’s final report, in 
fact, Billings recommended to Porter that the Hollerith system be adopted 
for the forthcoming census, and that an immediate order be placed for the 
first six machines needed to start the data processing in the vital statistics 
division. Porter accepted both proposals and lost little time having contracts 
with Hollerith prepared.60 
Around this point in time, Billings’s relationship to the Hollerith 
invention and system necessarily began to change. To be sure, he kept an 
enthusiastic and observant eye upon the machines as they arrived from 
the factory and were physically installed in the census building. He readily 
gave his views on the training of staff in running them. And he remained 
available to Porter and his staffs to answer questions about the system’s 
use in the census operation. Likewise, when the American Association 
for the Advancement of Science met in Washington in 1891, Billings 
arranged a tour and demonstration for the members on the machines 
that the census was starting to use.61 Otherwise, however, by then he 
was referring many of the questions to Hollerith, who had an office on 
the premises. He also steadily phased out his role as critic and promoter 
of the machines as Hollerith took on more of such functions himself. 
59 See Austrian, Hollerith, pp. 50-51; and Truesdell, Punch Card Tabulation, pp. 
40-43. 
60 See Austrian, Hollerith, pp. 50-52. 
61 JSB, “Mechanical Methods used in Compiling Data of the 11th United 
States Census; with an Exhibition of a Machine,” (Abstract), Proceedings of the 
American Association for the Advancement of Science, 40 (1891), pp. 407-409. The Transformation of Vital Statistics 
189 
Instead, with the systems’ integration into the new census operation, 
Billings’s interests inevitably shifted to the actual use of the machines, 
to the statistical processing of the large new quantities of data that they 
generated and processed. Fully as much, moreover, his attention moved 
on to a host of other scientific and managerial challenges connected with 
the vital statistics of the nation’s 11th Census. Chapter 8 
National Vital Statistics and the Great Census of 1890 
News of the successful testing of the Hollerith machines and of their 
planned adoption for the Eleventh Census of the United States 
stirred up widespread interest during the 1880s. In fact, as 1890, the year 
of the actual census event, approached, considerable excitement and sense 
of anticipation was built up, not only among the involved government 
professionals, statisticians, and other specialists but among academics and 
intellectuals generally. And, when the results began to be published by the 
respective census divisions, the various users and fans seem to have been 
widely satisfied. This was at least true of Billings’s Vital Statistics Division 
and the two other divisions for which he was responsible. 
Billings’s personal involvement in the development and testing of the 
Hollerith tabulating system during the 1880s helped ensure a virtually 
seamless transition for him from the work of the tenth census to that of 
the eleventh. He was as aware as anyone of the revolutionary effects that 
the Hollerith system would have on many aspects of the eleventh census. 
However, his primary interest remained the use of the system for processing 
the ever increasing quantity of mortality statistics nationwide. As a technical 
innovation, the system was intended to allow a new large-scale exploitation 
of data, of those from the death enumerations and those from the death 
registration area alike. Moreover, it brought to his Vital Statistics Division 
the capacity to greatly expand and refine the processing of the factors bearing 
on mortality that Billings was interested in examining. 
Statists in the Land: Census Experts and Administrators 
By the fall of 1889, the organization of the eleventh census had 
been substantially completed under the new superintendent, Porter, and 
preliminary tasks were under way. Porter, apparently desirous of gaining National Vital Statistics and the Great Census of 1890 
191 
public support for his sizeable enterprise, persuaded several editors to prepare 
and run special articles in their periodicals about the plans for the upcoming 
operation. In October, one of these, Frank Leslie’s Illustrated Newspaper, 
carried an account that included summaries of the missions of the principal 
divisions, photographs of Porter, Billings, and the other chiefs, a few data on 
numbers ol employees, field procedures, and publications, and sketches of the 
two large buildings where the Washington operation was housed. Impressed 
by the statistical significance of the impending census, the writer reminded 
his readers that, preparatory to carrying it out, “the omnipresent statist will 
soon be abroad in the land .... Already the murmuring of the mustering 
statistical hosts may be heard from Washington, in the appointment of 
special agents, statistical experts, and ‘sharps’, as they are termed. The next 
two years will be the statistical harvest-time, and the merry reaper, whether 
expert, sharp, special agent, or enumerator, will take his position in the broad 
field of information known as our national domain.”1 
A large proportion of this statistical “host” that was being mustered 
for the census was made up, as usual, of the temporary field enumerators 
and supervisors that were spreading through the respective states. Another 
sizeable number was composed of professional registrars or statists in 
academia, industry, or local government who were being asked to serve, 
mostly from a distance, as consultants or suppliers of special kinds of data. 
However, the core of the contributors was made up of the administrators, 
planners, technicians, and analysts who were being brought to Washington 
for varied functions over the seven or eight years of the preporation and 
processing of the census. Many of those were coming to fill jobs in the lower 
echelons of the census’s central office operations, while Porter was selecting 
seven or eight of the most prominent individuals along with Billings for 
his immediate staff.2 
This upper echelon of experts, most of whom were division heads, 
did not include any mathematical statisticians. However, it had a strong 
1 Frank Leslie’s Illustrated Newspaper, October 12, 1889. Other articles appeared 
in The Philadelphia Press, Nov. 3, 1889; and Scientific American, Aug. 30, 1890. 
The cover of the latter periodical featured illustrations of the work processes and 
mechanical devices of the Hollerith system, which gave the census enterprise 
a truly new look. 
2 For brief general summaries of this census, see Anderson, American Census, 
pp. 104-110; and Wright, United States Census, pp. 69-76. 192 
National Vital Statistics and the Great Census of 1890 
complement of experienced applied statisticians. Five of the eight, including 
Billings and Porter, had worked with Walker on the 1880 census, while four 
in addition to Billings were on loan from positions as statisticians in federal 
bureaus in Washington.3 The members of this group went on to serve 
together through long portions of the eleventh census’s existance. However, 
relatively little professional cohesion seems to have developed between most 
of them, either as administrators or statisticians, with the conspicuous 
exception of each individual’s relationships with the Superintendent. 
A political appointee and non-professional, Superintendent Porter, 
in sharp contrast to his preciecessor, Walker, had relatively little standing 
among American statisticians. However, he generally deferred to the expert 
statisticians on his staff and seemed to have their support. With respect to 
Billings, he was impressed not only by the latter’s statistical accomplishments 
and technological bent but by his organizational abilities, businesslike 
approach, and reputation for reliability. From the beginning of their 
relationship, Porter wisely left him largely free to run his own show without 
interference. He accepted Billings’s objectives for the census almost without 
question. And he seems to have readily supported the other’s requests for 
funds and other resources, including the detailing of a male stenographer 
to the Army medical museum and library to accommodate Billings’s work 
habits.4 
In turn, the Army man acted the part of the consummate civil servant. 
Above all, he made sure that the Superintendent was kept fully informed 
about what was going on. He accomplished that through a constant flow of 
letters and reports to Porter, communications in which he laid out his ideas 
and objectives in detail, kept the other apprised of progress being made, and 
let him know of any needs to modify plans or obtain more funds.5 
Billings’s ties with the other members of Porter’s immediate staff varied 
considerably. He apparently had no work relations at all with the chiefs 
of the census’s divisions of manufactures, transportation, or mines and 
3 Truesdell, Punch Card Tabulation, pp. 217-219. 
4 U. S. Census Office, “Memorandum of property in the Army Medical Museum 
Building belonging to the Census Office,” 4/26/1893, Ms in JSB Papers, 
NLM. 
1 This paragraph is based on my examination of the contents of a sizeable 
collection of Billings’s correspondence with Porter between 1889 and 1893, 
in JSB Papers, NLM, especially letterpress books #132 and 153. National Vital Statistics and the Great Census of 1890 
193 
mining.6 He did maintain crucial links with the capable Chief of the 
Population Division, William C. Hunt, particularly to ensure the smooth 
flow of certain kinds of data from that Division that were essential for some of 
the calculations and publications of the Vital Statistics Division. Billings also 
came to rely heavily on the Geographer of the Census, Henry Gannett, for the 
preparation and supply of maps, diagrams, and other kinds of illustrations for 
his intended publications. The two had collaborated at least once before, in 
ways that had greatly enhanced the value of Billings’s vital statistics reports of 
the tenth census. H. G. Funkhouser has pointed out that those publications 
included, among other forms of illustration, not only “many age pyramid” 
graphs but also polar diagrams, a type of graph not previously used in 
censuses. Now, planning his various publications for the eleventh census, 
including a portion of its Statistical Atlas, Billings sent Gannett several large 
shopping lists: for such items as maps in color, others in black and white, 
diagrams, and cartograms, some of the latter in six shades of color.8 
Billings also came to have substantial dealings with certain professionals 
who had permanent positions in the Interior Department. One of these 
was the statistician James H. Wardle, who managed unfinished census 
affairs during the interim between the tenth and eleventh censuses and 
then served as the census’s chief clerk (administrative director) during the 
early 1890s. A more widely known figure was the Commissioner of Labor, 
Carroll D.Wright, who as an additional duty, succeeded Porter as census 
superintendent in 1893 on the expiration of the latter’s appointment. 
Although Billings had no special involvement in the statistics of labor 
reform, he was well aware of Wright’s important work in that field, first in 
Massachusetts and since 1885 in Washington at the Interior Department. 
The two also knew each other as members of the American Statistical 
Association; during the late 1880s both were office-holders in that body. 
6 These individuals were Frank R. Williams for manufactures, Henry C. Adams 
for transportation, and David T. Day for mines and mining. 
H. Gray Funkhouser, “Historical Development of the Graphical Representation 
of Statistical Data,” Osiris, Vol. 3 (1938), pp. 341-342. Funkhouser viewed 
the 11th Census’s Statistical Atlas, to which Billings also contributed, as being 
one of the high points of American graphics. See also Wright, United States 
Census, p. 68. 
8 JSB to Porter, 9/9/1890, JSB Papers, NLM, letterpress book #133; and B. to 
Gannett, 6/18/1894, B papers NLM, letterpress book “from May 14, 1889.” 194 
National Vital Statistics and the Great Census of 1890 
As a result, with much in common both as statisticians and as government 
administrators, the two became mutually supportive as colleagues in the 
later phases of the 11th Census. They sometimes found occasion to work in 
tandem in order to advance the quality of statistical methods in government. 
They also shared strong views about the need for a permanent census office 
and labored together during the ’90s, both in the government and in some 
of the professional organizations, to advance that objective.9 
Like most of the other senior members of the 1890 census hierarchy, 
Billings was engaged as an advisory division director who would carry out varied 
part-time responsibilities under the generic title of expert special agent. As in 
1880, he was first and foremost the effective head of the Vital Statistics Division. 
However, for the new census he also took on the general supervision of two of 
the other divisions as well: Social Statistics of Cities, and Special Classes. Each 
of the three divisions had its own full-time operating chief, an expert in his own 
right who managed the day-to-day administrative details as well as the routine 
statistical and technical labors of the staff. These were the individuals through 
whom Billings channeled his plans for the census operation. W. H. Olcott 
performed this role in the Special Classes Division, while Harry Tiffany and 
John D. Leland filled it successively in the Social Statistics of Cities Division. 
By far the most important for Billings, however, was the competent and loyal 
managing head of the Vital Statistics Division, William A. King. 
Persons outside the census enterprise sometimes gained the impression 
that Billings himself was the full-time executive manager of each of these 
units, a belief that he occasionally attempted to correct. “My position,” he 
wrote, “is that of an advisor of the Superintendent as to the data which should 
be collected in the Divisions ofVital Statistics, Social Statistics of Cities, and 
Statistics of Special Classes, and as to the forms on which these should be 
tabulated and the illustrations required. I have very little to do with the details 
of carrying out of the work which is managed by the Chiefs of Divisions, 
and absolutely nothing to do with appointments . . .”10 The historian may 
wonder how many people actually took Billings strictly at his word on this 
matter, for his long record as a “hands-on” director or administrator was 
9 James Leiby, Carroll Wright and Labor Reform: The Origin of Labor Statistics 
(Cambridge: Harvard University Press, I960), p. 127. The Wright items in NLM’s 
Billings papers deal mostly with routine administrative matters of the census. 
10 B. To W. Godwin Moody, 9/12/1890, B. Papers NLM, Box 25, letterpress 
book #153. National Vital Statistics and the Great Census of 1890 
195 
well known. There is much evidence that he frequently went far beyond 
the mere giving of advice to the three division chiefs. Moreover, from the 
beginning he was expected by all to take full active charge of the analytic, 
writing, and publication activities of the divisions. 
Billings’s three divisions differed in scope, complexity, and extent, as well 
as in the kinds of outside experts and collectors they used. Understandably, 
by far the largest portions of Billings’s time, energies and concerns in the 
11th census went into his work with the Vital Statistics Division. Reflecting 
that unit’s obvious importance, one of his most urgent steps upon being 
reappointed to the division was to try to obtain King, his valued associate 
in the tenth census, once again as its operating head. Porter concurred in 
this selection in May, 1889, and Billings apparently needed to do but little 
arm-twisting to gain King’s acceptance. The latter seems to have welcomed 
the idea of the imminent resumption of their close work relationship as much 
as the former did, though he needed over two months to wind up his affairs 
in Pueblo, Colorado before he could resettle in Washington. 
In their correspondence over the next several weeks, the two men sorted 
out the responsibilities and terms of King’s upcoming position, including 
a salary of $2,000 plus possible extras; Billings promised to get him all the 
compensation that the law would permit. Billings also brought King up to 
date on pertinent developments since completion of the tenth census and, 
most important, his plans for the new census, in most of which King was to 
be intimately involved. Selections for some of the other staff appointments in 
the Vital Statistics Division, he noted in May, were well advanced, including 
that of a prospective Assistant Chief, but there was likely to be much 
competition from the various other census divisions for available skilled 
clerks. Billings added that he had already planned for the work of copying 
death registers from the registration area to start in January and to be mostly 
done by the following June. He also mentioned his new connections with 
the other divisions, though King would not normally have responsibilities 
in them except to furnish ratios of mortality. In the Vital Statistics Division, 
King at the start was to be in charge of processing only the same kinds of 
statistics that he had directed in the 10th census, but Billings hoped that, 
as the work progressed, the other man would have time to organize the 
processing of certain other kinds of data as well.11 
11 B to King, 5/24/1889, unnumbered letterpress book, “From May 14, 1889/' 
B papers NLM, Box 25. 196 
National Vital Statistics and the Great Census of 1890 
Soon after King came aboard, in fact, Billings committed the division to 
fitting in an investigation of vital statistics among a cross-section of the Jewish 
population of the United States. Since adequate data for such a study were 
not available from registration records, Billings arranged to have a special 
agent in Washington, A. S. Solomons, distribute copies ol a special inquiry 
to about 15,000 heads of Jewish families around the country. Responses 
for some 60,000 individuals ultimately came back to the division. These 
included basic birth, marriage, and death data which were then arranged by 
sex, age, locality, occupation, birthplace of mothers, and other factors, and 
were also compared with Jewish experience in Europe.12 
In another early letter, Billings brought King in on the planning for use 
of the Hollerith system. The final decision for its adoption came just before 
King arrived back in Washington.12 With this decision settled, Billings 
began to outline substantially more ambitious goals for King and the rest 
of the Vital Statistics Division, including himself. This included specifying 
quantitatively higher levels of production that reflected the anticipated 
capacity and speed of the machines. He thought there would be around a 
million deaths to take into consideration and said that he planned to have the 
data for each one transcribed for use with the machines. Generally speaking, 
his intent was to “have much more copied from registration records than 
was done in the last census.” Going on, he also specified “rather elaborate” 
new tables of deaths that he wanted, arranged by color, occupations, and 
marital condition, while “the distinctions as to localities will be finer than 
they were in the last census. I shall, also, add about six diseases and groups 
of diseases to Table XIII.” Turning to other matters, Billings alerted King to 
additions that had been made to the registration area as well as to the fact 
that physicians were again being asked to send in their registers of deaths. 
“I expect,” he wrote, “to use the physicians’ registers in the same way as was 
done the last time . . .”14 
Once King was back at work, Billings could devote more of his time 
to the task of reactivating and extending the Division’s ties with statistical 
experts around the United States, specifically his network of heal th officers 
12 JSB, “Vital Statistics of the Jews in the United States,” Census Bulletin, No. 19 
(1890), pp. 3-23. 
13 B to King, 5/24/1889 and 6/7/1889, B papers NLM, Box 25, letterpress book, 
“From May 14, 1889. 
14 Ibid (i.e. B to King, both letters). National Vital Statistics and the Great Census of 1890 
197 
and registrars from registration states and cities. These, of course, were the 
individuals who were needed to authorize and arrange for the copying of and 
supplying the Division with certified mortality data, a process that remained 
the core element in the census’s continuing contribution to vital statistics 
reform. When the division resumed operations, King and his assistants as 
before monitored details of this inflow of data as well as doing the subsequent 
processing. Usually the supply phases of the operation were fairly easily 
carried out, particularly where local officials had previously collaborated in 
such work for the 1880 census. However, some transactions were complicated 
and time consuming. In Pittsburgh, special copyists became needed when 
clerks of the local Registrar’s Office declined to perform any copying at the 
rate of compensation that was offered.1" And at some other locations, King 
had to send some of his own clerks to assist in finishing the copying.16 For 
everyone in the division, the finding of solutions for the glitches in making 
copies was a matter of urgency, a matter that had to be worked out before the 
division could get down to the heavy load of machine punching, tabulation, 
and other processing that Billings had laid out. 
The Special Classes Division did not require anything approaching 
the amount of attention that Billings gave to the Vital Statistics Division. 
However, its work of enumerating and handling of information on the insane, 
the feeble-minded, the deaf and dumb, and the blind was of interest to him, 
particularly since the Hollerith machines were to be used in processing the 
data. At the same time, like earlier analysts of such data, Billings contributed 
to that division’s efforts to supplement the census figures with statistics from 
state and local censuses as well as from records of hospitals, special schools, and 
other institutions and interest groups.'7 In his efforts to augment the data on 
the deaf, for instance, he took advantage of one of the special interests of his 
near-neighbor and friend in Georgetown, Alexander Graham Bell. Among 
other ideas, the latter suggested canvassing schools for the deaf for lists or 
figures of all former as well as current students. Late in 1889, on Billings’s 
request, Bell also reviewed the division’s plans to add several new inquiries to 
15 B to Porter, 2/6/1890, B papers NLM, Box 25, letterpress book 152. 
16 B to King, 11/19/1890, B papers NLM, Box 25, letterpress book 153. 
1 JSB, Report on the Insane, Feeble-Minded, Deaf and Dumb, and Blind of the 
United States at the Eleventh Census: / <990 (Washington, D.C.: G.P.O., 1895). 
Billings and Olcott also published extracts Irom this report as brief special 
bulletins of the census. 198 
National Vital Statistics and the Great Census of 1890 
enumeration schedules pertaining to all of the special classes, not just the deaf. 
In turn, during the ’90s, Billings collaborated modestly with Bell on a project 
of the latter’s Volta Bureau to develop mortality tables for the deaf.18 
Measuring Urban Population Ills: The Census and Public Health 
Billings intervened to a greater extent in the work of the Division of Social 
Statistics of Cities than he did in that of Special Classes. In fact, he was able 
to link portions of that work closely with his ongoing personal interests in 
public health and vital statistics. As in the 1880 census, this division initially 
relied almost exclusively on numerous local experts, agents or contractors 
for its supply of statistics. Those individuals furnished a wide variety of data 
pertaining to the individual cities of the United States: from modes of transport 
to places of amusement, from boards of health to the dog population, from 
churches and other public institutions to saloons and cemeteries. However, in 
1890 Billings asked them to focus their fact-finding more narrowly, to reduce 
the amounts of descriptive, historical, topographical, and other background 
material that had been prominent in previous reports. This change led to a 
final census document that was shorter than its predecessor and that placed 
greater emphasis upon the statistics per sc, together with their analysis and 
their illustration by graphs, maps, and special tables.19 
At the same time, Billings canvassed officials and agents in the country’s 
larger cities for special information pertaining to streets, waterworks, sewers, 
fire and police departments, and other elements of urban administration 
and the infrastructure. When these data came into the division, he had them 
sorted, arranged and compared with respect both to individual municipalities 
and to groupings according to population size, physical space, geographical 
region, costs, and other factors.20 Of interest for many persons, it turned 
out, were data reflecting the early impact of the age of electricity on the 
cities. Hardly a dozen years after commercial arc-lighting was installed on 
Philadelphia’s streets, the census showed that electric street lamps were already 
rapidly replacing gas lamps in American municipalities.21 
18 Bell to JSB, 12/21/1889; John Hartz to B, 12/3/1892, JSB papers NLM. 
19 JSB, Report on the Social Statistics of Cities of the United States at the Eleventh 
Census: 1890 (Washington, D.C.: G.P.O., 1895). 
20 JSB, “Social Statistics ol Cities,” Census Bulletin, No. 100 (1891), pp. 3-27. 
21 Ibid., p. 8. National Vital Statistics and the Great Census of 1890 
199 
Few of the statistics were more striking, however, than those that 
highlighted the population increases of American cities during the intercensal 
decade of the 1880s. Studying them even before the census processing was 
completed, Billings was able to sketch and make public some of the outlines 
ol the phenomenon. Not least in significance, the number of cities with 
10,000 or more inhabitants had grown from 219 in 1880 to 345 in 1890, an 
increase of 58% representing over six and a half million individuals. While 
the older states of the Northeast still led in the numbers of cities in this size 
range, he was impressed that the North Central region had had a gain of 
50 such cities during the same period, while even the Western states had 
increased by a total of thirteen such cities. In Kansas, Minnesota, Nebraska, 
Colorado, and Oregon, moreover, the populations living in cities of over 
10,000 increased by 194 percent or more.22 
These statistics of a rampant urbanism in the West high-lighted the 
obverse of some of the Population Division’s statistical maps of that region, 
conspicuously those that traced the inexorable shrinking of the areas of free 
land under the pressure of increases in population densities. Billings had 
abundant opportunities to examine drafts of those maps and the statistics 
on which they were based as he prepared his analyses for the Social Statistics 
of Cities Division. However, he had little time during this period to linger 
over the population trends of the western frontier. Rather, his attention, 
by and large, was concentrated on the mortality and sanitary statistics of 
Americas most densely populated urban areas of settlement, mainly east of 
the Mississippi. 
As soon as Billings began his work with the Eleventh Census, he had 
proposed and launched a large special inquiry into these matters, but one 
that would draw on the expertise, energies, and data of the Division of 
Vital Statistics more than those of the Division of Social Statistics of Cities. 
Briefing Porter in 1889, he outlined a plan to greatly expand the census’s 
statistical scrutiny of mortality in America’s largest metropolises, specifically 
the cities of over 100,000.22 It was to be a cooperative pilot project, a 
demonstration of the new capabilities of modern census offices and local 
22 Ibid., p. 3. 
23 JSB to Robert R Porter, May 14, 1889, JSB letterpress book, “From May 14, 
1889,’ [SB papers NLM. Billings was well aware of the uses of census data by 
British sanitarians, medical officers ol health, and others in their medical and 
public health investigations. 200 
National Vital Statistics and the Great Census of 1890 
health departments working together. It was also to be a demonstration of 
the use of statistical methods in combination with the Hollerith technology, 
ol the analysis of newly reliable mortality data along with other local health 
and social statistics in order to better understand the circumstances of urban 
sickness, death, and health. 
The ideas for such a project had come together and gained support 
through the 1880s as Billings got deeper into census work. And he 
early realized that any such undertaking would be feasible only with the 
continuance of his fruitful ties with Americas local health officers and 
registrars. The original links were with officials who participated in the 
successful death registration area arrangements; he worked especially closely 
with individuals in the large cities since they furnished large proportions 
of the census’s certified mortality data. Beginning around 1885, additional 
links formed between Billings and the public health community as the 
implications of punched card records and the emerging Hollerith machines 
for vital statistics processing and inquiry began to be discussed. Writing in a 
number of professional papers, Billings took on himself the task of explaining 
the new methodologies and how to apply them to the statistical work of local 
health offices. In the process, his ideas gained acceptance as indicating the 
right way to do such things as organizing routine vital statistics functions, 
conducting health investigations, and preparing health department statistical 
reports. Whether intended or not, the papers also helped materially to pave 
the way for further collaborative projects with Billings and the census in 
the future.24 
Billings and the city health officers now also attempted to resolve some 
older questions abou t investigations and reports. Of particular importance, 
by 1885 they had begun to reach agreement as to which of the circumstances 
that bore significantly on every death should be factored both into the 
census inquiries and into the cities’ regular health reports. The majority 
agreed with Billings that around ten such factors, each with sub-factors, 
were all that could be feasibly handled—among them: sex, age, color, cause 
24 See JSB, “Methods of Tabulating and Publishing Records of Death,” Public 
Health Papers and Reports, American Public Health Association, Vol. 11,(1885), 
pp. 51-65; and JSB, “On Some Forms of Tables of Vital Statistics, with Special 
Reference to the Needs of the Health Department of a City,” Public Health 
Papers and Reports, American Public Health Association, Vol. 13 (1887), pp. 
203-223. National Vital Statistics and the Great Census of 1890 
201 
of death, occupation, and race—and even then only in the federal census 
and in those states and large ci ties that could afford the costs of intensive 
statistical processing.^ 
Another basic element in planning almost any mortality or health related 
inquiry was (and is) the factor of locality, the geographical focus of the 
investigation. In many cases at that time this focus was the city. However, 
in the larger nineteenth century cities, American as well as European, 
health officials were tending to divide the area of investigation into smaller 
locality units that were more feasible administratively and more useful 
epidemiologically. In the United States, it was originally the ward that was 
most frequently selected to serve as such a unit. 
During the 1880s, Billings considered it imperative that the urban 
health officer, in analyzing mortality and other statistics to determine where 
sanitary work was most needed, “have the information from individual 
localities ... as well as for the whole city.” He urged that such information 
“must as a rule, be in the form of percentages or ratios, in order to permit 
of comparisons” between the various localities. Still, he protested that the 
ward was not always the appropriate locality unit for such investigations. 
The problem was that some cities delineated their ward boundaries “for 
purely political purposes,” as Baltimore had at that time. In such cases, he 
pointed out, “the ward divisions are absolutely useless for the purpose of 
the sanitarian and statistician, and should be abandoned.” 
In their place, Billings advised urban health officers to make their own 
rational choices as to locality units. While the ward could still be selected 
when appropriate, in a large proportion of cities the desirable solution was to 
divide large existing wards into one or more variously sized subdivisions, or 
“sanitary districts.” Instead of political considerations, the basis for forming 
such districts, he argued, must be “in accordance with the topography and 
the character of the population,” with topography being considered in its 
broadest senses. In other words, the mortality investigation of each district 
would gain immensely in both social and medical significance by factoring 
in a selection of the social as well as environmental features that were peculiar 
to the district—the patterns of housing; predominant occupations, elevations 
of terrain, meteorological peculiarities, waste removal facilities, wealth or 
poverty of the inhabitants, and other factors as appropriate.26 
25 JSB, “Methods of Tabulating and Publishing,” loc. cit., pp. 51-52. 
26 Ibid., pp. 51, 56. 202 
National Vital Statistics and the Great Census of 1890 
Thanks to his linkages and highly practical decade-long interchanges with 
individuals in the public health community, Billings had already assembled 
a comprehensive set of ideas for an urban mortality inquiry well before the 
organizational phases of the 11th census began in mid-1889. Moreover, he 
and the large city health officers were largely in agreement as to matters of its 
content, methodology, and organization. There was thus little if any surprise, 
for instance, when he made the sanitary district concept a central feature 
of his plan for the study. There was likewise only limited suspense over his 
choices ol individual cities for the project: six east-coast communities were 
ultimately selected: Baltimore, Boston, Brooklyn, New York, Philadelphia, 
and Washington. Billings had originally suggested giving special attention to 
eight cities and even considered as many as seventeen for a time. Those that he 
finally picked were required to have effective death registration systems, while 
their officials had to be willing and able to finance and organize the special 
mechanisms that were called for, such as surveying and setting boundaries for 
their sanitary districts and enumerating their respective hygienic attributes. 
It was also imperative that those operations be completed in timely fashion, 
some of them well before the actual census en umerations of June 1890. 
This early planning, assembling of resources, and firming up of work 
assignments for his three divisions characterized the first of the two especially 
busy and demanding periods for Billings during the eleventh census. Once 
those first matters were taken care of, there was a period of relative lull for him 
while King’s technicians carried out their mainly routine tasks of collecting 
and copying data, entering them on punch cards, tabulating, and performing 
preliminary analyses. Occasional reprieves, of course, were necessary to allow 
him to fulfill his commitments in the medical library, in other segments of 
the Surgeon-General’s Office, in academia, and elsewhere. But he also used 
portions of such time for occasional census trouble-shooting, for seeing that 
deadlines were met, for periodic consultations on the design or content of 
maps and other illustrations, and for preparing monthly status reports. 
The second major phase of Billings’s labors as census expert, one that 
took large portions of the period 1892-1896, had to do with the intellectual 
analysis, arrangement, writing, and hoped-for publication of the results of the 
census. In fact, by late 1890, as soon as substantial amounts of data arrived 
in Washington, he and his staff were preparing a number of preliminary 
bulletins or special reports on particular topics. Each of his three divisions 
ultimately issued one or more such documents. By 1896, however, in many 
cases, their contents had been expanded and merged with much other related 
data to make up the huge final reports. National Vital Statistics and the Great Census of 1890 
203 
Billings characteristically gave close attention to all aspects of the 
preparation of these reports. However, when they were actually published, 
he undoubtedly took special satisfaction with the tome of some 1100 pages 
that dealt with the health and mortality of American cities of over 100,000 
population. Actually, all but a small part of that volume pertained to the six 
cities of Billings’s special study and had been issued earlier as three separate 
monographs: the one for the District of Columbia and Baltimore in 1893; 
for New York and Brooklyn in 1894; and for Boston and Philadelphia in 
1895. These were detailed technical treatments for the health officers and 
registrars, the epidemiologists, the census statisticians and demographers, 
the city planners and other professionals. While by no means perfect in 
every detail, these were works which, in the aggregate, constituted America’s 
most ambitious pre-1900 sanitary survey as well as one that brought a 
distinctive new level of statistical sophistication to the genre. They also 
included a far larger intellectual contribution on the part of Billings than 
most of his other reports did and, as such, were probably most influential in 
extending his standing among professionals as statistician, epidemiologist, 
and demographer. His special contribution was to provide extended analyses 
and interpretations of the numerous tables and charts in each volume, 
presentations that were strictly factual and lacking in theory or speculation. 
He analyzed the paired cities both separately and together and compared 
their mortality rates as they related to the various factors. Maps in color 
showed the distribution of ma jor causes of disease.2 
During the same period, Billings also prepared several short articles that 
summarized portions of these census findings for The Forum and its audience 
of mainly non-technical readers. The result was a series of up-to-date public 
health profiles of the six American metropolises at the juncture of old and 
new. These provided glimpses of sanitary districts in which traditional 
2 JSB, Vital Statistics: Cities of 100,000 Population and Upivard (Washington: 
GPO, 1896), in JSB, Report on Vital and Social Statistics in the United States 
at the Eleventh Census, 1890 (Washington: GPO, 1894-1896), Part II; JSB, 
Vital Statistics of the District of Columbia and Baltimore Covering a period of six 
years ending May 31, 1890 (Washington: GPO, 1893); JSB, Vital Statistics of 
New York City and Brooklyn, covering a period of Six Years ending May 31, 1890 
(Washington: GPO, 1894); JSB, Vital Statistics of Boston and Philadelphia, 
covering a Period of Six Years ending May 31, 1890 (Washington: GPO, 
1895). 204 
National Vital Statistics and the Great Census of 1890 
sanitary services and modern bacteriologically based facilities, together 
with their respective philosophies, of necessity often coexisted at that 
particular moment in history. On the one side, he thus was able to review 
the status of municipal sewer, water, and street cleaning systems, along with 
environmental cleansing activity generally, and to consider any possible 
relationships, however remote, that they might have to the incidence of 
damaging crowd diseases. On the other hand, he examined the impact of 
such factors as the presence of infectious disease hospitals and the provision 
of quarantine, disinfection, vaccination and other services in the health 
departments, while noting the special urban circumstances that affected 
death rates of tuberculosis, diphtheria, scarlet fever and other diseases known 
by then to be caused by microorganisms.28 
Although most of the technical matter of the original reports was 
stripped off, Billings designed these Forum articles to focus above all else 
on the findings of the mortality statistics. In each article, he drew attention 
to contrasts that the survey showed in the death rates of various racial 
and ethnic populations in the several cities and their respective sanitary 
districts. In Washington and Baltimore, differences between the white and 
black populations stood out; in New York and Brooklyn, those between 
various large ethnic populations of the tenements were noteworthy; while 
for Boston, the high rates among the concentrations of Irish living in 
tenements contrasted forcefully with the lower death rates of virtually all of 
Philadelphia’s population segments, most of whom then lived in single-family 
houses. For all of the cities, he also drew attenti on to the high infant mortality 
among many of the population groups. 
In these articles, Billings occasionally made public one or another of his 
statistical frustrations. Among those was his impatience over the continued 
lack of sickness statistics, while even the most refined mortality statistics 
that he had been able to obtain during the eighteen nineties seemed to be 
marred by insuperable limitations. Even his main 1890 census study had 
not been able to take into consideration many of the large general influences 
on urban mortality, including the economic, cultural, sociological, and 
28 JSB, “Municipal Sanitation Defects in American Cities,’’ Forum, Vol. 15(1893), 
pp. 304-310; JSB, “Municipal Sanitation in Washington and Baltimore,” 
Forum, Vol. 15 (1893);JSB, “Municipal Sanitation in New York and Brooklyn,” 
Forum, Vol. 16 (1893-1894); JSB, “The Health of Boston and Philadelphia,” 
Forum, Vol. 17 (1894). National Vital Statistics and the Great Census of 1890 
205 
other factors. In fact, there were so many unknowns in those areas that he 
could not see how any fully satisfactory larger study of death rates could 
currently “be effected by the purely statistical method of research, because 
the obtainable data are imperfect, and more or less inaccurate, and because 
temporary and local conditions cannot be sufficiently taken into account by 
it.” For the foreseeable future, he warned, some of the statistics from such 
studies would probably remain so incomplete that they would have to be 
used cautiously and selectively.29 
Nevertheless, Billings had no difficulty in identifying, from the 11th 
census statistics, exactly what he considered to be the most serious urban 
American public health problem of that period. This was the tragically 
high death-rate among blacks, especially as highlighted by the experience 
of Washington and Baltimore. It particularly demanded attention, he 
thought, because there was “not much reason to think any marked lowering 
of this death-rate can be effected by municipal engineering methods, or 
by legislation which can be practically enforced at present.” Moreover, the 
causes seemed to lie in the murky and apparently unending cycle of “poverty, 
ignorance, and uncleanliness,” and related conditions in the lives of the 
blacks, as in those of other slum dwellers. “One of the grave questions of 
the day,” Billings went on, speaking for philanthropists, politicians, and 
social thinkers, as well as for his generation of statists and health officers, 
was whether or not it was possible to reduce excessive death rates that were 
rooted in such conditions. But, equally important was the question, “‘To 
what extent and in what manner is it expedient to attempt to bring about 
such reduction by municipal regulations and authorities, and at public 
expense.’?” He noted that any attempt at the strict enforcement of such laws 
in Baltimore and Washington “would make it impossible for the poorer class 
of colored people to live in those cities at their own cost. To force them to 
go elsewhere, and thus increase the burdens of some other locality, is not a 
solution of the problem; to provide for them in institutions at public expense 
and allow their family life to be maintained, is impracticable.” Billings saw 
little current chance of solving this dilemma in any city in the United States 
except possibly Washington. And even there, if some such attempt were to 
be decided upon, “it will be necessary to change slowly, for great evils may 
be easily produced by such interference.”30 
29 B, “Sanitation in Washington and Baltimore,'’ loc. cit, pp. 730-731. 
30 Ibid., pp. 736-737. 206 
National Vital Statistics and the Great Census of 1890 
This venture into some of the late-nineteenth century’s core “problems 
of social pathology and pauperism” was neither very extended nor at all 
characteristic of Billings. However, his restraint in discussing them was highly 
typical. As a career Army medical officer, he had habitually suppressed his 
personal opinions on social issues as well as on politics. Moreover, while 
he shared some of the prevailing social prejudices and fears of his white 
Anglo-Saxon Protestant middle-class neighbors in Washington, he was 
constitutionally opposed to using his writings to stir up public alarms in 
connection with them. The same could not be said, in the early 1890s, 
about Billings’s former census colleague, Francis Walker. In fact, no longer 
inhibited by government restraints, Walker began drawing from some of 
the new census population data to support a highly conservative social and 
political agenda which he broadcast in alarmist articles in The Forum and 
other organs. Central in these were his pessimistic views of what he thought 
was a suddenly decreasing fertility rate of the white American racial stocks 
and their alleged steady degradation under the influence of the massive 
numbers of poverty-stricken and presumedly inferior immigrants.31 
Billings seems to have neither endorsed or criticized Walker’s most 
extreme printed positions. Still, without mentioning names, he did touch 
upon some few of the other’s basic ideas briefly, almost in passing. In 
1892, for instance, in a review of demographic trends, he posed what he 
considered to be three “really interesting questions” about the world’s 
population, each of which was well known to be a worrisome matter 
for Walker. The three were “namely, at what rates are the different 
groups increasing, how are they migrating and mixing, and what are 
the probabilities as to their future development?” When he dealt further 
with American immigration in this article, Billings proved to be close, 
not only to Walker but to many other analysts, in concluding that “the 
present migration to the United States will probably injure rather than 
benefit the great mass of the people of this country.” However, the tone 
of his presentation distanced him from the way Walker wrote about 
immigration. He was rational rather than polemic, promoting constructive 
31 For a detailed analysis of and commentary on Walker’s position, as well as 
a review of the extensive historical literature about it, see Dennis Hodgson, 
“Ideological Currents and the Interpretation of Demographic Trends: The Case 
of Francis Amasa Walker," journal of the History of the Behavioral Sciences, Vol. 
28 (1992), pp. 28-44. National Vital Statistics and the Great Census of 1890 
207 
discussion rather than appealing to prejudice or exhorting to restrictive 
social or political action. Co nceding the central importance of the issue for 
Americans, he called for an intellectual rather than an emotional approach 
to its solution: “Do we want the tide of immigration to continue at its 
present rate and of its present character? and—if it be agreed that we do 
not, is there any way in which it can be checked without running the risk 
of doing more harm than good?”"2 
The following year, still studiously avoiding mention ofWalker, Billings 
confronted Walker’s bug-a-boo of a calamitously declining white American 
birthrate in a very direct but matter-of-fact and statistically informed 
manner. Systematically sifting through the abundant American census data 
for 1880 and 1890 and comparing them with European data, he arrived 
at a set of factual conclusions about the birthrate, none of which seemed 
to have surprised him. Among the most important, the data confirmed his 
belief that the decline was not something new in the 1890s but had been 
evident among American groups of all sections for well over a decade. The 
phenomenon had also been widespread over much of Europe, but there 
was no evidence that the American decline was related to any kind of white 
response to the massive immigration from Europe. 
Actually, Billings concluded, the fall of the birth rate was not a 
demographic calamity at all, though he advised statisticians, demographers, 
and politicians to keep the phenomenon under observation. On the 
contrary, he rather guardedly suggested that it was a positive good. It seemed 
probable that “the most important factor in the change is the deliberate and 
voluntary avoidance or prevention of child-bearing on the part of a steadily 
increasing number of married people, who not only prefer to have but few 
children, but who know how to obtain their wish.” Several factors seemed 
to him to have brought this state of opinion about: the accelerated spread 
of sexual information during the previous several decades; the lessening 
of the religious imperative for couples to have children; a rising standard 
of living; and changes in women’s roles in society. Contrary to Walker’s 
alarms, Billings concluded, “it does not appear to me that this lessening of 
the birth-rate is in itself an evil, or that it will be worth while to attempt 
to increase the birth-rate merely for the sake of maintaining a constant 
32 JSB, “The Population of the Earth,” Chatauquan, Vol. 16 (1892-93), pp. 
527-530. For one of Walker’s statements on this topic, see his “Immigration 
and Degradation,” Forum, Vol. 11 (1891), pp. 634-644. 208 
National Vital Statistics and the Gre:at Census of 1890 
increase in population, because to neither this nor the next generation will 
such increase be specially beneficial.”33 
In the mid-1890s, at the end of the census cycle, after Billings completed 
his analyses of the census’s ciata, it must have been tempting for him and 
many others to judge the census’s accomplishments or successes largely in 
terms of the proven workability of the Hollerith system, the great numbers 
of data issued jointly by the new technology and the multi-tiered statistical 
echelons. However, the intellectual substance and meaning of the materials 
processed in the Division also remained of central interest for him and 
for large numbers of late 19th century America’s public health specialists, 
physicians, and demographers, as well as for legislators, sociologists, and 
even historians. Moreover, they went far to confirm several of Billings’s 
assumptions about late nineteenth-century America’s demographic and 
epidemiologic configuration and changes. 
Statistics Beyond the Census 
Along with his debate with Walker, Billings had a particularly heavy 
correspondence during this time with a mix of individuals in the statistical 
and public health communities. Some individuals offered last-minute 
suggestions for changes in the census, others had requests for clarification 
of the data. Jacob Riis, author of Flow the Other Half Lives, wrote with a 
plea for pre-publication statistics on the numbers of school-age working 
children in New York, for use in a new book.34 In turn, Juan Guiteras, the 
Philadelphia pathologist, asked where data on mortality differences between 
“higher and lower classes” could be found in the the census reports.34 
Meanwhile, the actuary Levi Meech attempted unsuccessfully to persuade 
Billings to include comprehensive life tables in his report. The latter had to 
reply that, as in 1880, the lack of adequate mortality records in many areas 
still made it impracticable to compile a life table for the entire United States. 
33 JSB, “The Diminishing Birth-Rate in the United States," Forum, Vol. 15 
(1893), pp. 467-477. See also discussion in Hodgson, “Ideological Currents,” 
loc. cit., pp. 34-35. 
34 Jacob I. Riis to JSB, 6/2/1892, in JSB papers NLM, Box 21. 
3’ B. to Juan Guiteras, 12/4/1893, JSB, Letterpress book #153, JSB papers NLM, 
Box 25. National Vital Statistics and the Great Census of 1890 
209 
Thus the best that could be done was “to give a number of approximate life 
tables relating to three or four states and several cities.”36 
Some of the communications that flowed onto Billings’s desk were 
from able newcomers to the ranks of America’s registrars and public health 
statisticians, all of them avid users of the census findings. Some of these men 
aspired to scientific leadership in the country’s professional vital statistics 
work; they were well aware of the gaps that had been opened by the deaths, 
in the eighties, of such large figures as Jarvis, Snow and Harris. Among the 
potential aspirants were such health officers as Boston’s Samuel W. Abbott, 
Providence’s Charles V. Chapin, and Michigan’s Cressy L. Wilbur, along with 
the actuary Frederick L. Hoffman and the Cornell demographer Walter F. 
Willcox. By the nineties, all of them had begun to borrow materials from 
Billings’s library and sometimes to ask his opinion of their work. Most were 
supporters and sometimes constructive critics of his work. And all were 
influenced in some way or another by him. 
Willcox, like other scholars who wanted to obtain the census’s newly 
published vital statistics reports, initially wrote Billings for copies. However, 
since the latter’s office had no role in the sale of census publications, Billings 
suggested that Willcox write directly to officials at the top who controlled 
such distributions, to the Superintendent of the Census or even the Secretary 
of the Interior. “In that way,” he advised, “you are not only sure to obtain 
what you want, but will give to these gentlemen the idea that there is 
someone in the United States who wishes these reports and will use them. 
They receive very few requests for reports on vital statistics in comparison 
with those which they receive for reports upon other branches of statistical 
science, and I think it is a good thing that they should occasionally be 
reminded that there are students in this department also.”37 
Through the eighties and early nineties, Billings periodically took time 
from his census activities to continue his academic lectures at Hopkins, 
Columbia, the Army Medical School, and Penn. In them, he normally 
covered the basics of vital statistics registration and health statistics, 
particularly to his classes of embryo health professionals. In the process, 
he interested some of them in the further study of statistical methods in 
preparation for eventually doing public health analyses and research. 
36 B. to Walter F. Willcox, 2/21/1894, JSB papers NLM, Box 25, letterpress book 
#153. 
37 Ibid. 210 
National Vital Statistics and the Great Census of 1890 
In another direction, Billings likewise persevered, at least sporadically, 
as part of the campaign to make public health a central part of medicine, in 
his efforts to keep physicians informed about the values and methods both 
of vital statistics and medical statistics. His most ambitious effort along this 
line was his presentation in 1889 of the Cartwright series of four lectures 
at the College of Physicians of New York. Rather than aiming them at the 
trained statistician, Billings intended these lectures to provide moderately 
well-educated members of the medical profession with an introduction to 
the uses of statistics in “scientific and practical medicine and sanitation.” 
Noting that both he and the College officials had had “considerable doubt 
and hesitation” about presenting a topic that was inherently “dry and 
uninteresting,” he nevertheless agreed to go ahead because “the subject is not 
one which lies within the ordinary range of medical studies, [and because] the 
data are widely scattered in literature.” Moreover, he reminded his readers, 
they could be useful to anyone. “Statistics are somewhat like old medical 
journals, or like revolvers in newly opened mining districts. Most men rarely 
use them, and find it troublesome to preserve them so as to have them easy 
of access; but when they do want them, they want them badly.”38 
A few years later, Billings returned to his discussion of medical statistics 
with a chapter in a general medical text by Thomas Allbu tt. His presentation 
there was at a rather more advanced level than that of the Cartwright lectures. 
He also gave it added importance by providing a summary and assessment 
of disease statistics from a handful of censuses, military forces, European 
varieties of ‘friendly societies,’ and others. However, he noted the continuing 
paucity of such statistics and warned that “it is not probable that anything 
like complete returns of sickness will be obtained in the near future for any 
large body of the general population.”39 
Billings’s census work as well as his varied other writings on vital and 
medical statistics brought him into considerable contact with European 
professionals during the eighties and nineties. He exchanged reports and ideas 
with such prominent statisticians as Luigi Bod io of Italy, Jacques Bertillon of 
France, Josef Korosi of Hungary, and Arthur Newsholme of England. And he 
came to know these individuals personally to some extent at the occasional 
38 JSB, “On Vital and Medical Statistics,” (The Cartwright Lectures), Medical 
Record, Vol. 36 (1889), pp. 589ff, 6l7ff, 645ff. 
39 JSB, “Medical Statistics,” in Thomas C. Allbut, ed., A System of Medicine (New 
York: Macmillan, 1896), pp. 3-20. National Vital Statistics and the Great Census of 1890 
211 
meetings he attended of the various international societies. In 1893 Billings 
was elected to membership in the International Statistical Institute, one of 
twelve American members, though he was rarely able to participate.40 He was 
somewhat more active, during the early nineties, as member of the permanent 
committee of the International Congress of Hygiene and Demography. His 
main contribution there seems to have been the distribution of information 
to the other members about American medical and science journals, state 
and local boards of health, and prominent physicians. In 1891 he alerted 
one of the British committeemen to the pressure the latter was likely to 
receive from Americans who were hoping to be named honorary president 
of one or another of the Congress’s sections. “It is well to remember that 
those who ask are least likely to deserve . .. There are really very few men in 
this country [The United States] who have actually done much to promote 
sanitation, but there are many who can talk about it indefinitely.”41 
Billings made special efforts to attend the triennial meetings of the 
International Congress of Medicine, and he spoke at or otherwise participated 
in several. At Berlin in 1890, addressing the Tenth Congress’s section on 
military medicine, he proposed creation of a committee to recommend a 
uniform system of sanitary statistics for all armies. Following this, after three 
years of discussion, the governments of ten countries accepted the proposal, 
and in 1894 all of them sent delegates to Budpest to the first formal meeting 
of the permanent Commission on Uniform Military Health Statistics. The 
meeting agreed, among other things, that statisticians of all participating 
armies should publish annual statistical summaries of their sanitary condition 
and should exchange these publications with each other. The delegates then 
chose Billings to be the Commission’s President, with Paul Myrdacz of the 
Austro-Hungarian empire as Secretary.42 
40 Among other American members at that time were Francis Walker, Carroll 
Wright, Davis Dewey, Richard Ely, Edward Atkinson, and Worthington Ford. 
41 B. to W. S. Corfield, 1/7/1991, JSB papers NYPL. 
42 JSB, “Can the Reports of the Sick and the Sanitary Statements of the Different 
Armies be arranged According to a Scheme essentially Uniform for the purpose 
of gaining statistics of scientific worth for Comparison of Diseases, Wounds, 
and Deaths in Times of Peace and War,” Verhandlungen des XInternationalen 
Medizinischen Congresses, Berlin, 4-9 August 1890 (Berlin, 1891), Band 5, 18 
Abtheilung, pp. 107-134. For details of the Commission’s founding, see Paul 
Myrdacz to JSB and others, 3/25/1895, unpaginated memorandum in French, 212 
National Vital Statistics and the Great Census of 1890 
On the face of it, the creation of the Commission, particularly since it 
was to be under the guidance of a statist of Billings’s stature, seemed for its 
members to have been a hopeful development, at least to stimulate if not fully 
standardize vital data collection within the European community of military 
sanitary statisticians. However, there were no means of enforcing statistical 
improvement on members, all of whom represented fully autonomous 
nations. Likewise, armies by nature often tended to be suspicious or hesitant 
about sharing any of their internal data with personnel in other armies that 
might become adversaries at any time. Moreover, for Billings, his separation 
from the rest of his commission by 3,000 or so miles of ocean was a serious 
obstacle to effective management of the body. 
Still, there were some constructive early activities. In his First year, 
Billings made certain that the Commission invite other European countries 
to become members and thereby enlarge the interchange of data and 
publications. To bypass local bureaucratic printing delays in some of the 
countries, he also made arrangements for copies of their various tabular 
summaries to be published regularly in the American Army Medical 
Department’s statistical reports. During the Commission’s first few years, 
moreover, he carried on a lively correspondence with the other members, 
especially Secretary Myrdacz. 
At the same time, however, since Billings received no money from die Army 
Medical Department for further trips to Europe, he was unable to prevent 
some waning of the Commission’s early enthusiasm and initiatives. In 1893, 
this decline became more pronounced with Billings’s resignation from the 
United States Army, a step that required him to turn some of his Commission 
responsibilities over to others, particularly to the Secretary. But Myrdacz 
lacked both the authority and the professional standing to do anything about 
reversing the decline. He continued to send Billings news, but little if any of 
it from that point on showed the organization in a positive light. Myrdacz 
faithfully attended the body’s second triennial meeting in Moscow in 1898, 
but he wrote that it had been a waste of time. Looking for reasons, he came 
to the conclusion that, without having Billings available to play an active role, 
the Commission was no longer in a position to do much of importance.43 
in JSB papers NYPL, see folder for International Commission on Uniform 
Military Health Statistics. 
43 P. Myrdacz to JSB, 9/18/1898, JSB papers NYPL, folder for International 
Commission on Uniform Military Health Statistics. For an account of National Vital Statistics and the Great Census of 1890 
213 
Actually, as the century ended, Billings became less concerned with 
European sanitary statistics than with winding down his activities with 
the American census. Specifically, at this point, it meant completion of the 
process of proofreading the huge vital statistics tomes of the 11th census, a 
task that he shared with King. This was a labor that had by no means ended 
when he became Director of the New York Public Library in 1896. In fact, the 
work dragged on for months, but Billings seems never to have even thought 
of sloughing his share of the duty off onto the ever-reliable King.44 
Meanwhile, Billings encountered difficulties in carrying out his 
proof-reading tasks, and these elicited an uncharacteristic complaint about 
the clerical and other support he was receiving from the Census Office. 
Writing to Willcox in 1896, he confessed that “the whole of my work in 
the Census has been done in the face of great obstacles owing to repeated 
changes of clerks for political reasons, and I am tired of struggling with 
the most unpropitious circumstances which have surrounded the work.”45 
Nevertheless, despite his dissatisfactions, he and King persevered in the 
reading of proofs until the last of them could be sent to the printer. 
When the vital statistics reports for the 11th census finally appeared in 
print, little seemed to remain for Billings to do in this area of activity except 
to have King named to succeed him in directing the census’s future vital 
statistics operations. This was accomplished in two stages. In 1897 he gained 
King a temporary appointment as census clerk for the inter-censal period. 
And, less than two years later, he was instrumental in having his protege 
named director or “chief statistician” for vital statistics for the twelfth census. 
This was a post that the latter held until his death in 1906.46 
Billings’s work on the Commission, see Walter F. Willcox, "The Development 
of Military Sanitary Statistics,” American Statistical Association, Publications, 
Vol. 16 (1918), pp. 917-920. Willcox, writing during World War I, thought 
that the Commission’s initiatives had been praiseworthy, particularly since 
the difficulties it had laced were “almost insuperable.” He blamed its failure, 
inappropriately, 1 believe, largely on the lack of any international “driving force 
of public opinion and indignation” such as Florence Nightingale and Sidney 
Herbert had benefitted from earlier in England. 
44 William A. King to JSB, 6/17/1897, JSB papers NYPL. 
45 Quoted in W. F. Willcox to JSB, 5/30/1897, JSB papers NYPL. 
46 King to JSB, 6/21/1897 and 3/12/1899, JSB papers NYPL. For an appreciation 
of King’s tenure as Chief Statistician for Vital Statistics, see George H. Van 214 
National Vital Statistics and the Great Census of 1890 
During the late 1890s, except for occasional correspondence, Billings 
normally followed the developments of the King era of official vital statistics 
principally from a distance. Soon after 1900, however, King and the 12th 
Census’s Director, William R. Merriam, sought him out for help in coping 
with a full-blown crisis. The congressional enabling act for the 12th Census 
had required that all of the agency’s reports be published before July 1,1902. 
However, it was quickly evident to the census officials that a large proportion 
of the vital statistics data that were collected could not possibly be ready by 
that date. In fact, the essential analysis and interpretation of those data would 
barely be started by that time, since they depended totally on the receipt in 
King’s division of related data from the agency’s population division. 
Billings initially protested that he had been away from the census too 
long to be able to do anything useful except with great difficulty. Eventually, 
however, he agreed to prepare a short description and analysis of key portions 
of the material that had had to be omitted . The result was a limited followup 
of his earlier report on the 1890 census, one that focussed particularly on 
comparative urban death rates and on selected state life tables.47 
Before Billings completed this work, the United States government’s 
census operation finally gained new and much-needed status as a permanent 
federal bureau. When the news reached him, in March 1902, he sent his 
congratulations to Merriam.48 He was also entitled to much personal 
satisfaction; this was, after all, a development that he himself had sought 
for over a quarter of a century. 
Billings and many of the other late nineteenth century medical advocates 
of vital statistical improvement were, of course, members of the active wing 
of the medical regulars. As such, a considerable number of them had become 
Buren, “William Alexander King and the Federal Registration System, 
1900-1906” Journal of the American Statistical Association, n.s., Vol. 21, No. 
155, (Sept. 1926), pp. 267-272. 
4 JSB, A Discussion of the Vital Statistics of the Twelfth Census (Washington: GPO, 
1904) (U. S. Bureau of the Census, Bulletin 15. See particularly North’s “Letter 
of Transmittal,” p. 5. 
48 W. R. Merriam to JSB, 3/10/1902, in JSB papers NYPL. See also Wright, United 
States Census, pp. 79-84; and Anderson, American Census, pp. 78-106. National Vital Statistics and the Great Census of 1890 
215 
involved in a broad spectrum of other science-related health reforms.49 In 
fact, they had finally begun stirring up the anti-science regulars to an extent 
that few of the reformers seem to have foreseen.’0 
49 Cressy Wilbur, a few years later, vividly paraphrased a popular impression 
of vital statistics “as the Cinderella of modern public hygiene, sitting in the 
chimney corner sifting the ashes of dusty figures while the proud sisters, 
Bacteriology and Preventive Medicine, go to the ball, and talk about the 
wonderful things they have done.” Quoted by William H. Guilfoy, “Vital 
Statistics in the Promotion of Public Health,” /. Am. Pub. Health Assoc., Vol. 
1 (1911), p. 20. 
50 See discussion in James H. Cassedy, “Registration Area . . .1885-1915,” loc. 
cit., pp. 221-231. Chapter 9 
Billings in Organized Medicine and Science 
The founding of the American Medical Association in 1848 was 
initially at least a moderately welcome event for most regular 
physicians. And, during its early decades, the membership displayed 
enough unity to organize their reforming struggles against irregulars, while 
attempting also to improve medical education, stimulate better quality 
medical journals, and encourage individual medical investigation. By the 
postwar period, however, the membership was beginning to divide over the 
nature and desirability of the European medical-scientific elements that had 
begun to be discussed at their meetings. On one side were the followers of 
those ideas, the relatively small number of well educated and mostly urban 
physicians who were influenced by leaders such as Billings or who had stuciied 
scientific medicine abroad. On the other side, however, a majority of the 
AMA members were typically less educated, knew little science, and were 
becoming suspicious of those who promoted science. In fact, they came to 
believe that the advocates of scientific medicine among them were fully as 
threatening to their traditional medical practices as the sectarians were. 
Physicians in Conflict: The A.M.A. and the Threat of Science 
It is unlikely that Billings or many other enthusiasts of scientific medicine 
before 1880 felt very strongly one way or another about the American 
Medical Association as a professional body. They certainly never thought of 
themselves as medical revolutionaries. Moreover, Billings had become one of 
Americas best-known medical men by working with the establishment when 
appropriate. He went to its meetings fairly often, though, with his friends, 
he tended to find the Association cumbersome, ineffectively organized, or 
sometimes simply irrelevant. In the late 1870s he also became a member and 
then Chair of the A.M.A.’s Section on State Medicine and Public Hygiene, Billings in Organized Medicine and Science 
217 
though he seems to have found the American Public Health Association and 
its activities more useful for himself than the other body was. At the same 
time, he recognized the political clout that the A.M.A. could wield, and he 
took advantage of that influence when it could be marshalled on behalf of 
the Surgeon General’s Library. 
Meanwhile, the efforts of Billings and other reformers to bring scientific 
medicine to the post-Civil War United States initially went forward with little 
or no reference to the American Medical Association. According to some, this 
came about because, among other reasons, while AMA meeting programs 
included some scientific papers, the Association had no official journal that 
could give the members some guidance to the European medical and scientific 
literature. While other physicians did not think that this was a good idea at 
all, the Association did vote for such a journal and set about to organize it. 
By the early 1880s, however, the heightened use of foreign medical 
sources by the reform physicians increasingly appeared as a hostile gesture 
to many A.M.A. members, particularly those from rural areas of the South 
and Midwest. Scientific medicine, especially, took on a threatening aspect 
simply because its ideas and practices differed so much from America’s 
traditional medicine. Accordingly, when the A.M.A. had an opportunity to 
endorse and encourage science at this time, these conservative segments not 
only rejected that chance but did so in a way that stirred up an acrimonious 
dispute, one that badly divided the Association’s membership for most of 
the remainder of the nineteenth century. 
In 1883, certain physicians, seemingly seeking to appease both parties, 
attempted to interest Billings in becoming the first editor of the A.M.A.S 
new official journal. Theophilus Parvin of Indianapolis, writing in a midwest 
journal in an attempt to influence the choice, described Billings as being 
“peculiarly fitted for this important and responsible position,” a respected 
leader who was “loyal to the American Medical Association, one of its most 
constant attendants, and one of its best workers,” and apparently also a 
proven mediator. Subsequently, the conservative physician Nathan S. Davis 
sent an offer under which the other man could have the job virtually on 
his own terms. However, Billings could not see his way clear to accepting it 
and instead urged Davis himself to take the editorship.1 
1 Parvin to the editors, Louisville Medical News, (1883), p. 27. Clipping is in 
JSB scrapbooks (microfilm copy is with JSB papers NLM). Also, JSB to N. S. 
Davis, 1/25/1883, JSB papers NLM, Box 13. 218 
Billings in Organized Medicine and Science 
In 1884, seemingly almost unaware of the sentiments and strength of 
the anti-science bloc, the current president of the A.M.A., Austin Flint of 
New York, together with Billings and other pro-science leaders, initiated 
action that ultimately led to a violent response. They had unilaterally 
committed the Association to invite the International Medical Congress 
to hold its 1887 meetings in Washington, D.C. The invitation specified 
that a committee to be chosen by Billings largely from among well-known 
scientific professionals in the eastern states would organize and make initial 
arrangements for the meetings. For these individuals, the meetings offered 
a unique opportunity to show off the recent advances of medicine in the 
United States. They thus proceeded to work up what they considered to be 
an attractive, heavily scientific program. And for it they recruited a panel 
of outstanding physicians as section heads and speakers, individuals whom 
Billings regarded as being among Americas most productive investigators 
and contributors to scientific medicine.2 
In April 1885, Billings’s committee took its plans for the Congress to 
the A.M.A., then in session in New Orleans. There, with no advance notice, 
it received a thoroughly hostile reception. Traditionalists, on hearing about 
the plans of Billings’s pro-science group, packed the meeting in protest. And 
above all, they made it known that the committee members themselves, 
together with most of the proposed participants were unsuitable. The public 
reason they gave for this was that many of the latter individuals were members 
of the State Medical Society of New York, a body that in 1882 had broken 
with the A.M.A. by adopting a new code of medical ethics, thus making all 
its members heretics in the eyes of the Association. Their crime consisted in 
the fact that the new code was deliberately contrary to the A.M.A.’s old code 
in permitting participating physicians to consult with any legally qualified 
practitioner, even homeopaths, as was allowed in New York.3 
2 Studies of the AMA include Morris Fishbein, et. al., A History of the American 
Medical Association, 1847 to 1947 (Philadelphia: Saunders, 1947); and James 
J. Burrow, AMA: Voice of American Medicine (Baltimore: Johns Hopkins 
University Press, 1963). 
5 Short accounts of the formation and history of the International Medical 
Congress of 1887 are A. McGeehee Harvey, The Association of American 
Physicians, 1886-1986 (Baltimore: Waverly Press, 1986), pp. 13-19; Toby A. 
Appel, “Biological and Medical Societies and the Founding of the American 
Physiological Society,” in Gerald L. Geison, Physiology in the American Context, Billings in Organized Medicine and Science 
219 
Armed with this and other fabricated justifications, sympathetic local 
A.M.A. officials at New Orleans dissolved the Billings committee and 
appointed a new committee that went ahead to select a sanitized list of 
participants for the Congress. In turn, Billings and all of the other original 
founders and committee members except Flint promptly resigned, touching 
off a nationwide wave of sympathy by their supporters. Within the next few 
months, not only the rejected participants but representatives of Americas 
new medical specialty associations and other scientifically minded physicians, 
distanced themselves from a Congress that was now to be organized and run 
by the anti-science majority of the A.M.A.4 Typical of the more temperate 
responses was that of George Sternberg, who declined the invitation of the 
new organization committee to be vice-president of the Congress’s pathology 
section: “I was very well pleased to be a member of this Section under the 
first organization [that of Billings], but under present circumstances think 
it more creditable to be outside of the ring.”’’ 
Facing the likelihood of the Congress’s total failure, some A.M.A. 
moderates searched for means of restoring its appeal and integrity. Among 
other steps, they attempted to have Billings named to the new committee 
on arrangements or some other post, perhaps even the Presidency of the 
Congress. However, Billings, still offended by the way he had been treated, 
was unwilling to make any such accommodations. He swore that he “could 
not accept an official position of honor while some of my friends were 
disgraced by being turned out.” Moreover, as the time for the Congress came 
closer, it appeared to him that “the great majority of the leading physicians of 
America will have nothing to do with it. There has not been the least attempt 
towards a compromise—in fact, the trouble is one that does not admit of 
any compromise. The Congress is under the control of a set of demagogues 
1850-1940 (Bethesda, Md: American Physiological Society, 1987), pp. 
158-163; and LesterS. King, Transformations in American Medicine (Baltimore: 
Johns Hopkins University Press, 1991), pp. 212-214. 
4 For a pertinent examination of this period’s medical ethics issues and conflicts, 
see John Harley Warner, “Ideals of Science and their Discontents in Late 
Nineteenth-Century American Medicine,” Isis, Vol. 82, No. 313 (1991). See 
also Robert B. Baker, et. ah, ed., The American Medical Ethics Revolution: How 
the A.M.A. s code of Ethics has Transformed Physicians Relationships to Patients, 
Professionals, and Society (Baltimore: Johns Hopkins University Press, 1999). 
5 Sternberg to JSB, 6/3/1886, JSB papers NYPL. 220 
Billings in Organized Medicine and Science 
and medical politicians who have no scientific standing, and the best men 
in Europe will refuse to endorse them by attending the Congress.”6 
At this same point in time, in 1886, Billings himself contributed to the 
general rancor and polarization with an address that he presented in Brighton, 
England. His largely statistical address was possibly intended simply to inform 
the British physicians of the different levels of medical and public health 
practice then existing in the respective geographic regions of the United States. 
And if that was all Billings had in mind, he was less politically-minded than 
he was usually considered to be. In any case, he could have hardly done more 
to stir things up than to emphasize, as he did, the high disease incidence 
and undeveloped medical status of western and southern small towns and 
rural areas, in contrast to the relatively favorable health and medical status 
of the northeast and other more populated areas. Whatever Billings had in 
mind, the address may well have lessened some of the European interest 
in the Congress, while, when the text reached the United States, it further 
inflamed some of the southern and western traditionalists. 
Eventually, Billings came to realize that he had to be careful to avoid any 
appearance of acti vely working for the failure of the Congress. To friends, he 
confided his fear that his opponents, if given the slightest of pretexts, might 
well retaliate by attempting to weaken or destroy the Army medical museum 
and library. “My position as a government official in this matter is a delicate 
and difficult one, for I do not wish to injure the interests of the scientific 
work of our Bureau.”'9 His solution was thus to avoid publicity and keep 
as low a profile as possible. Yet, though he had relinquished his leadership 
roles, he declared that he remained available to work with the new organizers 
for the success of the Congress, stating that now “I am simply a high private 
and mean to stay so, but in that capacity I will do what I can.”0 
The Ninth International Medical Congress did meet in Washington 
between September 5 and 10, 1887, under the presidency of Nathan S. 
6 JSB to Jerome Cochran, 4/21/1886, JSB papers NLM. 
JSB to W. H. Doree, 12/6/1886, JSB papers NLM. For Billings’s Brighton 
address, see John Shaw Billings, “Medicine in the United States, and its Relation 
to Cooperative Investigation,” British Med. J., Vol. 2 (1886), pp. 299-306. See 
also comments in Garrison, Billings, pp. 252-262. 
9 Ibid. 
9 JSB to A. B. Palmer, 5/29/1886, JSB papers NLM. See also JSB to Jerome 
Cochran, 4/21/1886, JSB pa pers NLM; and Garrison, Billings, pp. 260-262. Billings in Organized Medicine and Science 
221 
Davis, by then the editor of the A.M.A.’s journal, and with Billings’s rival, 
John B. Hamilton, as Secretary-General. The new A.M.A. committees had 
rounded up over 2,500 attendees, but Billings write his out-of-town friends 
that there were almost no big names or distinguished scientists and only a 
handful of foreign delegates. Meanwhile, the scientific level of the papers 
presented at the sessions was reported in the probably partial medical press 
to have been mediocre if not abysmally low.10 Afterwards, one of Billings’s 
friends expressed a certain wry pleasure, apparently common to many 
other individuals, that he had not had to attend or participate in what he 
considered to have been an embarrassingly poor quality event, “A Congress 
chiefly remarkable by the absence of the leading men of the country in 
which it is held was unique to say the least—not only unique but eunuch, 
i.e. emasculated.”11 
For the historian, the episode of the Congress reveals Billings at his most 
complex and human, and sometimes his least attractive. On the one hand 
he was often demanding and dictatorial. At the same time, convinced of his 
rightness, he refused to compromise when his medical beliefs and those of his 
elitist faction were at stake. Sometimes he proved to be a poor loser. Above 
all, perhaps, he was bitterly frustrated to have been bested, professionally 
and politically, for a second-time in a decade by his Marine Hospital Service 
rival, Hamilton, and to be forced for a time into a position where he was not 
in control of his own destiny. Nevertheless, after a surprisingly short period 
as a loser, he emerged once again as a winner. In fact, before the Congress 
was even completed, he was leading America’s pro-science movement in a 
new direction and with new organizational structures, this time outside the 
AMA, and with his close colleagues providing the manpower. 
There is no doubt that the Congress episode left Billings with a bad taste 
in his mouth. Over the next ten years or so, he almost totally dissociated 
himself from the A.M.A. Even when some of his friends became presidents 
or committee chairmen of the Association, they were unable until soon after 
1900 to persuade him to resume any role in it. Only then did the anti-science 
sentiment in the Association give way to a tolerant attitude with which he 
could be comfortable.12 
10 See summary in Appel, “Biological and Medical Societies,” loc. cit., pp. 
158-162. 
" Stuart Eld ridge to JSB, 10/17/1887, JSB papers NLM, Box 18. 
12 See Burrow, AMA, passim. 222 
Billings in Organized Medicine and Science 
This is not to say that he gave up his objectives on behalf of scientific 
medicine during those late nineteenth century decades. On the contrary, 
his split from the American Medical Association was accompanied almost 
immediately by creation of a set of allegiances with newly established 
professional societies that were explicitly devoted to science in medicine. 
In fact, even before the International Congress took place, he began to 
encourage such societies in both practical and symbolic ways: he became a 
member of several of them, and then invited them to hold their meetings 
in the hall of the Medical Museum and Library. Additionally, as with the 
meetings of The American Surgical Association in 1886 and other societies, 
he served as chairman of arrangements and sometimes delivered a paper. 
Moreover, the Congress of American Physicians and Surgeons, organized as 
an umbrella body for the specialty societies, not only held its initial meetings 
in 1887 at the Army Medical Departments facilities but elected Billings as 
its first president.13 
The Surgeon General s Office had periodically hosted such meetings 
over the years. But the fact that it did so now, in the midst of and shortly 
after the controversies of the mid-1880s, served to demonstrate Billings’s 
and the Office’s unflagging support of scientific medicine. That position 
was particularly underscored by their invitation to the new Association of 
American Physicians to hold its first regular meeting at the Army’s Washington 
facilities. The Association was a limited membership organization, one that 
grew directly from some of the small meetings of science-oriented physicians 
that were held around the United States in 1885 to protest the A.M.A.’s 
rejection of the Billings committee and its choices for the Congress. It was 
thus no matter of chance that a very large proportion of its members and 
participants at this first meeting in 1886 were individuals who only a few 
months earlier had been on Billings’s slate of committee nominees.14 Billings 
himself became one of the Association’s original members. 
The thriving of this society together with the medical specialty 
associations during the 1880s and ’90s of course constituted only a limited 
step toward scientific medicine. The moves of Billings and other advocates to 
13 See Appel, "Biological and Medical Societies,” loc. cit., pp. 158-162. 
14 Prominent among the many individuals who provided such continuity were 
Francis Delafield, S. Weir Mitchell, F. Peyre Porcher, W T. Councilman, 
Reginald Fitz, William Welch, and William Osier. See various lists in Harvey, 
Association of American Physicians, chapters 1 and 2. Billings in Organized Medicine and Science 
223 
extend science throughout mainline medical thinking and practice continued 
to be delayed by the hostility of A.M.A. traditionalists. However, the specialty 
associations rapidly provided themselves with congenial environments for 
the thorough discussion of scientific matters. A prominent reason for this 
was that their members were increasingly well informed and potent in those 
discussions, at least partly because they were among the most regular and 
frequent users of the Surgeon Generals Library and its finding catalogs. 
Moreover, with this access to the literature that was being generated by the 
medical revolution abroad and at home, the society members themselves 
became increasingly able to contribute to the period’s flood of knowledge. 
As such, they became effective participants in the effort to undermine the 
A.M.A. traditionalists and other pockets of medical ‘know-nothingism’. 
Beginning in 1893, Billings and other leaders of scientific medicine 
participated in an ambitious research program sponsored by yet another 
new organization, the ad hoc national Committee of Fifty to Investigate 
the Liquor Problem. Billings himself was one of the organizers of this 
Committee, and, with Seth Low, Charles W. Eliot, Carroll Wright, and 
other educators and scientists, served on its executive committee. At the 
outset, the central body divided into four research units that were to focus 
respectively on the economic, legislative, ethical, and physiological aspects of 
the problem; Billings became chairman of the physiological sub-committee. 
In this capacity, he hand-picked the rest of the sub-committee—Henry P. 
Bowditch, Wilbur O. Atwater, Russell H. Chittenden, William H. Welch, G. 
Alder Blumer, and Francis A. Walker—and with them developed an agenda. 
Over the next ten years, as they could fit them in, the members worked 
on their individual studies. Some of these were laboratory researches on 
the relations of various alcoholic beverages to specific diseases, while the 
others were principally statistical in nature. Billings himself at the beginning 
contributed a bibliography of the pertinent literature and then conducted 
two original statistical investigations. One of these summarized the results of 
a survey on the use of alcoholic drinks among about six hundred educators, 
businessmen, scientists, and other professionals. The other, a study of the 
relations of drinking to insanity, presented the findings of a questionnaire 
that had been sent to 117 mental hospitals through the cooperation of the 
American Medical-Psychological Association.1^ 
15 For details of the sub-committees work, see John Shaw Billings, ed., 
Physiological Aspects of the Liquor Problem, 2 vols (Boston: Houghton, Mifflin, 224 
Billings in Organized Medicine and Science 
When the sometimes lengthy reports of the various experts had been 
finished, Billings pulled them together, added a short history of the 
Sub-Committee’s proceedings, and made arrangements for their publication 
as a book in 1903. Since no provision had been made for vetting the 
individual reports, the book as a whole proved uneven in quality, and parts 
were controversial. The methods and conclusions of Atwater, who insisted on 
viewing alcohol as a food rather than a poison, provoked particular criticism, 
including some by other American Physiological Society members as well 
as by A.M.A. members. Billings, however, seems to have been consistently 
supportive of the Atwater position.16 
A Physician in the Washington Scientific Community 
While Billings’s career-long commitment as a physician to bring about a 
scientifically based medicine sometimes involved him in violent professional 
controversy, his equally long pursuit of interests in science as such and 
involvement with groups of scientists most of whom were not physicians, 
played itself out relatively peaceably. The latter connections often grew 
essentially out of personal intellectual curiosity and usually had little or 
nothing to do with his professional status or future in medicine. At the same 
time, he took them so seriously and brought so many talents to them that 
he achieved respect as a scientist himself along with leadership in a variety 
of science groups both local and national. In large part this standing grew 
out of the major support afforded him by individuals and institutions of 
the Washington scientific community.1 
1903). Billings’s two reports are in Volume 1, pp. 307-335. Much ol his extensive 
correspondence with professionals, hospitals, and others pertaining to those 
reports is included in his letter press notebook on the Committee of Fifty for 
January-June 1895, JSB papers NLM, Box 25. See also JSB, ed., Bibliography 
(Preliminary) of the Literature on the Physiological and Pathological Effects of 
Alcohol and Alcoholic Drinks (Washington: Judd & Detweiler, 1894). 
16 The ramifications of this controversy have been interestingly discussed by 
Jonathan Zimmerman, ‘“When the Doctors Disagree:’ Scientific Temperance 
and Scientific Authority, 1891-1906,”/. Hist. Med. & Allied Scis., Vol. 48 
(April 1993), pp. 171-197. 
1 Various histories examine this community and/or portions of its background. 
For the larger setting, see two now-classic works, Constance McLaughlin Billings in Organized Medicine and Science 
225 
At the time Billings went to live in Washington, the relatively skimpy 
professional medical life of the capital city contrasted conspicuously with 
the richness of the life of learning and science. The three main academic 
institutions in the area, Georgetown University, Columbian (later renamed 
George Washington) University, and the nearby Naval Academy at Annapolis 
all maintained science departments. But many of the most impressive 
scientifically related institutions, activities, and contributors were in the 
federal government. In the mid-1860s, in addition to the Army Surgeon 
General’s Office and Army Engineers, these included the Library of Congress, 
the Coast Survey, the Naval Observatory, the Smithsonian Institution, the 
National Academy of Sciences, a cluster of western exploration projects and 
geological surveys, and other agencies or enterprises.18 
Soon after he joined the Surgeon-General’s Office, Billings’s work 
activities and interests began affording him contacts with individual scientists 
at some of these institutions. Since the older generation of Washington’s 
scientific leaders was dying off by the mid-’60s, many of his initial scientific 
acquaintances in the community proved to be forceful and brilliant 
newcomers like himself. Often these were still youngish veterans of the war 
who were now driven by peacetime ambitions in one or another federal 
agency, men such as the astronomers Simon Newcomb and Edward Holden, 
the mathematician Benjamin Peirce, and the geologist-anthropologist 
John Wesley Powell, and if they met nowhere else regularly, they at least 
Green, Washington: A History of the Capital, 1800-1950, 2 vols. (Princeton: 
Princeton University Press, 1962), Vol. I, pp. 291-400); and A. Hunter 
Dupree, Science in the Federal Government, A History of Policies and Activities 
to 1940 (Cambridge, Mass.: Belknap Press of Harvard University Press, 1957), 
pp. 149-301. Two other interesting and well-written works deal with the 
community in considerable detail, but neither has recognized or discussed in 
any detail the significant roles played by Billings or the Surgeon Generals Office 
in it: James K. Flack, Desideratum in Washington: The Intellectual Community 
in the Capital City, 1870-1900 (Cambridge, Mass.: Schenckman, 1975); and 
Michael J. Lacey, “The World of the Bureaus: Government and the Positivist 
Project in the Late Nineteenth Century,” in Michael J. Lacey and Mary O. 
Furner, ed., The State and Social Investigation in Britain and the United States 
(Washington: Woodrow Wilson Center Press and Cambridge University Press, 
1993), pp. 127-170. 
18 Dupree, Science in the Federal Government, passim. 226 
Billings in Organized Medicine and Science 
occasionally found themselves together at special scientific or academic 
events. 
Through those early years, however, some of Billings’s most frequent 
scientific contacts were with established scientific leaders at the Smithsonian 
Institution and the United States National Museum. He occasionally 
lectured at those institutions and served on their committees. He had useful 
connections with the Smithsonian’s administrator and future historian 
George Goode. And above all, he and others at the Surgeon-General’s Office 
cultivated the naturalist Spencer Baird, first at the National Museum and 
later as the Smithsonian’s Secretary. In the mid-1860s, for instance, Billings 
sometimes went out of his way to accommodate Baird by finding western 
jobs as contract surgeons for unemployed physicians who were interested 
in natural history collecting. In subsequent years, the two men worked out 
other arrangements that were beneficial to both institutions, among them, 
occasional exchanges of books as well as provisions for distributing the 
Smithsonian’s natural history circulars in the periodic shipments of materials 
that the Surgeon General s Office sent out to army surgeons in the field. Not 
least, after Billings became curator of the medical museum, he continued 
with Baird and his successors the occasional exchanges of skulls and other 
specimens that had been started in earlier decades.19 
During the time that Billings’s own diverse Washington career was 
unfolding, it was Baird more than any of the other leading Washington 
scientists with whom he had consistently close affinity. Baird’s basic work 
activities as a collector and classifier by themselves made him a kindred spirit 
for the newer man. However, as an administrator he became even more of 
a role model, particularly with his superior “capacity for managing men 
and for organization” but also with his unfailing “modesty and usefulness.” 
At other times, in his capacity as a fellow federal science official, Baird 
earned Billings’s special admiration for his ability to defend his programs 
in Congress and win the confidence of Congressional committees. This 
was not only because of his total command of his subject but through his 
“simple manner, evident honesty, . . . and perfect readiness to answer all 
19 See, for example, Baird to JSB, 4/28/1866 and 7/5/1866, both in JSB 
papers NLM, Box 26; also, JSB to J. A. Finley, 1/30/1884; and JSB to Baird, 
1/31/1884, both in JSB papers NLM, Box 14. For a history of the Smithsonian 
during this period, see George B. Goode, ed., The Smithsonian Institution, 
1846-1896(Washington, D.C.: Smithsonian Institution, 1897). Billings in Organized Medicine and Science 
227 
questions.” Finally, as a workaholic who was never known to shirk from 
enormous routine labors, Baird gained not only Billings’s approbation but 
his instinctive understanding.20 
Another important influence at the Smithsonian was that of its first 
Secretary, Joseph Henry. Although Billings served with him between 1876 
and 1878 on the Capitol Ventilation Board, Henry was by then near the 
end of his career and had mainly his personal prestige to contribute to the 
Board’s work. Of far greater significance for Billings was Henry’s initiative 
earlier that same decade in the formation of the Philosophical Society of 
Washington, the capital’s first substantial scientific association. 
In 1870, Henry began working on a project to create a thoroughly 
professional “association of a strictly scientific character,” one whose 
members would be mainly chosen on the basis of their investigative 
experience and “positive contributions to science.” He warned against 
allowing “amateurs and politicians” to control such a society, and he 
insisted that learned papers presented in it should be “subject to free critical 
discussion.”21 The Philosophical Society of Washington was subsequently 
organized in accordance with these principles, held its first meeting in 
March 1871, and chose Henry as its President. The forty-three founding 
members who convened the meeting represented virtually all ofWashington’s 
science-related institutions. For them and their associates there was at last 
a central unifying focus, one that the organization continued to provide 
for the next several decades. At the same time, with a large proportion 
of its membership being drawn from federal departments, bureaus, and 
agencies, the society from its beginning had the authentic outlook of a 
national science society and largely dealt with scientific problems that were 
national in scope. 
The Surgeon General’s Office was involved in the Society from the 
beginning, furnishing five of the founding members, though only two of 
them, Woodward and Billings, went on to perform significant professional 
and scientific services in it on a continuing basis. Woodward became one 
of the most frequent contributors of scientific communications at the early 
20 JSB, “Biographical Memoir of Spencer Fullerton Baird, ' National Academy 
of Sciences, Biographical Memoirs, Vol. 3 (1895), pp. 141-160. 
21 Joseph Henry, “Anniversary Address of the President of the Philosophical 
Society of Washington,” Bulletin of the Philosophical Society of Washington, 
[Vol. I] (1874), pp. v-xiv. 228 
Billings in Organized Medicine and Science 
meetings. He also played important roles on various committees, was one 
of Henry’s eulogists in 1878, and in 1881 became President. 
Billings himself was elected to the Presidency in 1885 even though he 
appeared to have had no committee appointments during the Society’s first 
decade. However, he had more than made up for that lack by the frequence 
of his participation in the discussions of the scholarly papers. Beyond 
that, he frequently took advantage of the society’s scholarly programs to 
try out versions of his own research papers and provide reports on the 
status of his scientific institutions, contributions which usually gave the 
members glimpses of cutting edge developments in some of the period’s 
medical sciences. Among these were papers on the buildup and features 
of the Surgeon General’s Library, on Billings’s researches on ventilation 
and its relation to health and disease, on the mortality statistics of the 
tenth census, the scientific work of the National Board of Health, and his 
modernization plans for the medical museum. One of the most timely was 
his 1877 paper on “Bacteria and Spontaneous Generation,” a report on his 
recent examination, perhaps in Edinburgh, of the unpublished results of a 
number of Joseph Lister’s latest experiments, and including a demonstration 
of the latter’s apparatus for “excluding these organisms from wounds.” These 
innovations and those of other investigators, Billings informed his hearers, 
left no further room to doubt “that the so-called doctrine of spontaneous 
generation is incorrect.”22 
For most of the 1870s and ’80s, the Philosophical Society held its 
biweekly meetings at the Ford’s Theatre facilities of the Medical Museum 
and Surgeon General’s Library. It was an arrangement which helped to keep 
the officers of the Surgeon General’s staff identified with the programs and 
objectives of the Washington’s late nineteenth century scientific community. 
As it happened, there was no dearth of stimulating papers during this time, 
and some were of exceptional interest. Among those was the occasion in 1877 
when wires were strung ahead of time around the museum rooms to allow 
Alexander Graham Bell to demonstrate his telephone to the society members 
22 JSB, “Bacteria and Spontaneous Generation,” (Abstract), Bulletin of the 
Philosophical Society ofWashington, Vol. 2 (1874-1878), pp. 109-110.1 have the 
impression that Billings went out of his way to avoid direct competition with 
Woodward over the governance of this and other professional organizations 
in which both men were active. However, I have found no specific evidence 
to support that supposition. Billings in Organized Medicine and Science 
229 
in one of its earliest public trials.23 But many members considered almost 
every meeting to be a productive learning occasion, particularly since there 
were so many of the nations scientific leaders consistently in attendance to 
hear and learn from. 
To be sure, Ford s Theatre was not an ideal place for these meetings, since 
a certain amount of clutter and crowding had to be put up with. However, 
many of the members developed a certain fondness for it. Billings himself 
could describe the ambiance better than anyone: “ . . . the entrance up the 
narrow stairs, often pervaded with a scientific odor from the laboratory 
on the lower floor—an odor once compared to that of the deluge at low 
tide—the devious and complicated route from the head of the stairs, past 
the General Committee room, to the place of meeting.” And, for him and 
others, a memorable segment of the early meetings was the simple ritual 
that Joseph Henry observed during the 70s when he presided, that is, his 
“custom of taking a five minutes’ dip into one of the volumes ofTransactions 
of the Royal Society, which occupied the shelves behind and on the right of 
his chair, by way of refreshment before calling the Society to order.”2'* 
Virtually from the Society’s beginning, some members, thinking that 
there should also be some less austere type of refreshment, formed the habit, 
following the formal scientific meetings, of adjourning to a saloon around 
the corner on D street for beer, oysters, and relaxed male conversation. 
Prominent among such members were scientists who had studied in Europe 
and were “fresh from the kellers of Heidelberg or Stuttgart.” I have not 
found any evidence that Billings was a regular member of that group, but he 
may well have joined it occasionally. He did, in any case, agree fully with a 
larger nucleus of the membership that began to complain that “there were 
no collateral attractions” on the society’s programs to which ladies might 
be invited and no facilities of any kind for entertaining guests. It seemed 
anachronistic in Gilded Age Washington that scientists still had no place 
where they could socialize with each other and with their friends in some 
of the ways that businessmen, intellectuals, politicians, and other groups 
were doing in their clubs. Moreover, in the opinion of Billings and other 
23 Richard T. Loomis, “The Telephone Comes to Washington: George C. 
Maynard, 1839-1919,” Washington History, Vol. 12, no. 2 (2000-2001), pp. 
23-25. 
24 JSB, Response to the toast, “Our Four Hundredth Meeting,” Bulletin of the 
Philosophical Society of Washington, Vol. 12 (1892-1894), pp. 549-550. 230 
Billings in Organized Medicine and Science 
Society members who frequently stayed at clubs in other cities during their 
work travels, the Washington scientific community really had an obligation 
to provide comparable lodgings and dining facilities for their out of town 
professional visitors.2' 
In late 1878, such an organization, the Cosmos Club, was formed. 
Deferring the provision of guest facilities for the moment, the Club started 
out in modest temporary quarters. There the founders worked to create a 
body that would be warm in tone, alive, and at all costs avoiding the stuffy 
and decorous solemnity so often encountered in Victorian clubs on both 
sides of the Atlantic. At the same time, literary figures and other intellectuals 
were made eligible for membership alongside the scientists.26 
Billings was not only a founder of the Cosmos Club and one of its 
energetic core of organizers but one who played an active leadership role 
through its early years. The membership made him their first treasurer, put 
him on the Board of Trustees, and in 1885 chose him as Vice President. 
Between 1886 and 1888 he served two terms as President. 
During the latter period, in addition to the usual duties of the Presidency, 
Billings assumed the demanding task of supervising the long delayed 
acquisition of the clubs own building and its alteration to provide for guest 
accommodations. The structure that was selected, the former Dolley Madison 
house on Lafayette Square, was a costly one, but the members considered 
the expenditure well worthwhile. With their support, Billings could move 
aggressively ahead with the project, completing it before the end of 1886.27 
The Cosmos Club now became an attractive and convenient place for 
Billings and the other members to hold their business dinners in, as well as 
The quotations are from C. E. Dutton, “Address,” in William A. DeCaindry, 
et. al., ed., The Twenty-Fifth Anniversary of the Founding of the Cosmos Club of 
Washington, D.C. (Washington, D.C.: The Cosmos Club, 1904), pp. 26-27. 
See also other portions of that volume, especially pp. 1-155. 
26 Among the intellectuals who became founders of the club were the historian 
Henry Adams and the sociologist Lester Ward. However 1 have found no evidence 
that Billings had more than incidental connections with either man. 
These and numerous other details of the club’s history during the Billings years 
are supplied in the 25th anniversary volume, Ibid., especially pp. 89-149. Much 
less valuable for that period is Wilcomb E. Washburn, The Cosmos Club of 
Washington: A Centennial History, 1878-1978 (Washington, D.C.: The Cosmos 
Club, 1978). However, see also the Billings papers at NLM. Billings in Organized Medicine and Science 
231 
for their out-of-town scientific peers and other professionals to stay in while 
they were in the capital. At the same time it became the site for the scientific 
meetings of the Philosophical Society of Washington together with those of 
the Anthropological, Biological, and Chemical societies, as well as those to 
be created later for other individual sciences. With this combination of social 
and scientific functions, the Club thus brought a tangible new dimension to 
the life of science in Washington, both in its local and its national phases. 
Billings in The National Academy of Sciences 
Apart from his active roles in Washington’s scientific life, Billings’s creative 
national decade of the 1870s had given him a far-flung reputation in scientific 
circles. In 1882, that recognition brought him nomination to membership in 
America’s most prestigious scientific body, the National Academy of Sciences, 
and to his election the following year. Chosen at the same meeting were the 
inventor Alexander Graham Bell, the zoologist William K. Brooks, and the 
mathematician Thomas Craig. Billings had six sponsors, individuals who 
were eminent in as many different fields: John Wesley Powell in geology and 
anthropology, William H. Brewer in agricultural science, Benjamin Silliman, 
Jr. in chemistry, John H. Crane in mathematics, Theodore Gill in zoology, 
and Simon Newcomb in astronomy. 
Billings came up for membership at a time when the Academy was 
expanding its membership to better reflect the new fields of scientific interest 
or concentration identified during the nineteenth century. By the 1880s, 
therefore, he could be selected for such things as his promotion of scientific 
thinking in this country, his contributions to the planning and administration 
of science, and his creation of practical systems for the dissemination of 
medical and scientific information. More specifically, his candidacy rested 
heavily on the Academy’s acknowledgment of the unique importance of two 
of his institutions that were still in progress, the Surgeon-General’s Library 
and the Johns Hopkins Hospital. An equally influential factor, moreover, 
was the fact that the members already knew Billings and his merits extremely 
well through their monitoring of the work of the short-lived National Board 
of Health for the United States Congress.28 When they began to consider 
28 The active part of the monitoring process was carried out by a special Academy 
committee chaired by Billings’s close friend, S. Weir Mitchell, but its findings 
were reviewed and voted on by the entire membership. See the “official” history 232 
Billings in Organized Medicine and Science 
him for membership in 1882, of course, they were well aware that the Board 
had by then essentially failed. However, they were in full agreement that 
the failure had been through no fault or deficiency on Billings’s part. On 
the contrary, it was agreed that he had displayed outstanding qualities as an 
organizer and manager of a large science-related enterprise.29 
Once selected, Billings became a productive member of the Academy. He 
accepted more than his share of administrative labors, serving occasionally 
on committees, as the Academy’s treasurer between 1887 and 1898, and 
as one of its Council members between 1896 and 1907. He also, over 
the years, wrote the memoirs of a few of his deceased fellow members. 
Of these, he gave Joseph j. Woodward rather perfunctory treatment and 
Francis Walker only slightly more extended coverage but accorded Spencer 
Baird a highly original and personal scientific appreciation of considerable 
depth. In addition, Billings sometimes presented scientific reports at the 
Academy meetings, particularly papers that summarized the results of recent 
research carried out under his supervision by his associates or students. 
These included studies of the use of composite photography in craniology 
by Washington Matthews; analyses of human bones in one of the medical 
museum’s collections by Matthews and J. L. Wortman; and an investigation 
of the influence of light upon the bacillus of typhoid and the colon bacillus 
by Adelaide W. Peckham.30 Along with those he sometimes sponsored the 
presentations of other junior scientists before the Academy. One of these 
was M.I.T.’s William T. Sedgwick, who demonstrated his Aerobioscope, a 
of the Academy, RexmondC. Cochrane, The National Academy of Sciences: The 
First Hundred Years, 1863-1963 (Washington: National Academy of Sciences, 
1978), pp. 136-137. 
29 For the Academy’s early years, see Ibid, passim. For another commentary on 
Billings’s connections with the Academy, see Chapman, Order Out of Chaos, 
pp. 319-321. For the Academy’s relationships with the National Board of 
Health, see my chapter 4; J. L. Cabell, “Annual Address,’ Public Health Papers 
and Reports of the American Public Health Association, Vol. V (1879), pp. 1-23, 
passim; and JSB, “The National Board of Health and National Quarantine,’ 
Transactions of the American Medical Association, Vol. 31 (1880), pp. 435-455, 
passim. 
30 These works are listed with some additional details in Frank Bradway Rogers, 
comp., Selected Papers of John Shaiv Billings (Baltimore: Waverly Press for the 
Medical Library Association, 1965), pp. 291, 295, and 296-297. Billings in Organized Medicine and Science 
233 
new device for “the biological examination of air.” Billings ordered several 
of the devices for the medical museum.31 
In 1884, only a few months after Billings became a member, the 
Academy received a request for professional advice from Congress’s newly 
formed Allison Commission. Specifically, the Commission members desired 
expert opinion that would bear on potential legislation to obtain better 
congressional coordination and control of four of the government’s largest 
scientific bureaus, each of which at the time had considerable autonomy: 
the Signal Service, the Geological Survey, the Coast and Geodetic Survey, 
and the Hydrographic Office of the Navy Department. First of all, an 
Academy committee under General Montgomery Meigs conducted a study 
of the subject and then submitted its report to the entire membership in 
September 1884. The bulk of the committee’s recommendations, including 
those urging some consolidation of the work of the bureaus, seem to have 
elicited little discussion. However, the report’s proposal to place all of the 
bureaus together administratively in the same cabinet department, perhaps 
as a new department of science, brought out considerable difference of 
opinion. Ultimately the Academy accepted the report and sent it on to the 
Allison Commission. However, the issues had been so controversial that for 
the first time in the Academy’s history the vote for acceptance of one of its 
reports was neither unanimous nor harmonious. Billings and several others 
voted against it, while Alexander Agassiz resigned in protest.32 
The Allison Commission continued to discuss these and other issues, but 
it went out of existence before its members could reach a decisive legislative 
solution. However, for the rest of the nineteenth century and beyond, the 
issues that the Commission had raised, particularly that of a federal science 
department, remained of great concern to Congress as well as to America’s 
scientific community. No one in the latter community was more concerned 
or considered the ramifications of the issues more fully than Billings. 
In late 1886, reflecting on his forthcoming presidential address to the 
Philosophical Society of Washington, Billings decided that the occasion 
31 Sedgwick to JSB, 4/4/1888 and 4/25/1888, both in JSB papers NYPL. 
32 I have drawn this paragraph on the Allison Commission largely from two 
excellent sources: Dupree, Science in the Federal Government, pp. 215-231; 
and David H. Guston, “Congressmen and Scientists in the Making of Science 
Policy: The Allison Commission, 1884-1886,” Minerva, Vol. 32, no. 1 (Spring, 
1994), pp. 25-52. 234 
Billings in Organized Medicine and Science 
would be an ideal one for explaining in detail his position on the Allison 
Commission issues. The immediate audience was appropriate since so many 
members of the Society, as administrators or investigators in federal science 
bureaus or departments, had vital stakes in either the immediate or the future 
outcome of the debates. At the same time, he clearly felt that other audiences 
as well—legislators and journalists above all but also the public—needed 
to be educated both in the nature of science and in government-science 
relations if they were to intelligently shape “the present condition and future 
prospects of science in this country.” Accordingly, Billings prefaced his address 
with a discussion of the different kinds of scientists and what each type did, 
especially contrasting the “pure” scientist from those who seek “information 
that may be useful,” but showing how each was valuable in society. Improved 
understanding of such basic details was necessary, he felt, if the national dialog 
over the Allison Commission issues were to gain in force and precision, with all 
discussants using the terms properly and not talking at cross purposes.33 
As the heart of his address, Billings then launched an examination and 
defense of scientists in the late nineteenth century federal government and of 
the ways they were used, especially in the Army and Navy. With the majority 
of the Allison Commission, Billings agreed that government science was “on 
the whole, being well done, and that the people are getting the worth of their 
money.” However, he questioned current proposals to turn the planning work 
of the science bureaus over to “disinterested scientific men—as, for instance 
[to] a committee of the National Academy [on the assumption] that the 
function of the bureau official should be executive only.” And he vigorously 
defended a government practice from which he himself had benefited, 
asserting “that when permanent Government employees have at times not 
enough to do in their own departments, and can be usefully employed in 
scientific work, it is quite legitimate and proper to thus make use of them.” 
Most important, however, he stressed that he was “not inclined at present to 
urge the creation of a department of science as an independent department 
of the Government having at its head a Cabinet officer. Whether such an 
organization may become expedient in the future seems to me doubtful; 
but at all events I think the time has not yet come for it.”34 
33 JSB, “Scientific Men and Their Duties,’ reprinted from Bulletin of the 
Philosophical Society of Washington, Vol. 9 (1886-1887), pp. xxxv-lvi; also in 
Rogers, Selected Papers of JSB, pp. 170-176. 
34 Ibid., pp. 177-185. Billings in Organized Medicine and Science 
235 
Billings closed his address to the Washington science community on a 
cautionary note, rising above any bitterness that he may have harbored from 
setbacks that he had experienced in his pursuit of science, particularly those 
related to the National Board of Health and to the International Medical 
Congress. “We live in a fortunate time and place; in the early manhood 
of a mighty nation, and in its capital city, which every year makes more 
beautiful, and richer in the treasures of science, literature, and art which 
all the keels of the sea and the iron roads of the land are bringing to it . . . 
Yet we may not rest and eat lotus; we may not devote our lives to our own 
pleasure, even though it be pleasure derived from scientific investigation. 
No man lives for himself alone; the scientific man should do so least of all. 
There never was a time when the world had more need of him, and there 
never was a time when more care was needful lest his torch should prove a 
firebrand and destroy more than it illuminates.”33 
Continuities at the End of an Age 
The formal termination of Billings’s mutually advantageous and 
extraordinarily fruitful thirty years of work as a federal scientist in and for 
the Surgeon General’s Office came about in September of 1895, when 
he resigned from the Army. Prominent among the farewells, there was a 
reception for him and his wife at the Sternberg home. And, on October 1st, 
they made their long-planned move from Washington to Philadelphia. 
As things turned out, however, despite the several years of preparing for 
it, Billings never went beyond the beginnings of a new career in Philadelphia. 
In December, 1895, within weeks after his move to the city, he abruptly 
revealed that he had been invited to become director of the recently created 
New York Public Library and wanted to terminate his connections with the 
University of Pennsylvania.36 After much discussion, some of it acrimonious, 
the university trustees and administrative officials reluctantly agreed to his 
release, a process that concluded in June. In turn, Provost William Pepper 
35 Ibid., p. 186. 
36 A comprehensive and otherwise admirable history of the early years of the New 
York Public Library is Phyllis Dain, The New York Public Library: A History of 
its Founding and Early Years (New York: The Library, 1972). For other accounts 
of Billings’s appointment, see Chapman, Order Out of Chaos, pp. 272-274; 
and Garrison, Billings, pp. 281-282. 236 
Billings in Organized Medicine and Science 
and the health professionals at the university were left to try to understand 
Billings’s reasons for withdrawing so unexpectedly from the carefully planned 
arrangements that some of them had a stake in. In addition, they wondered at 
the seeming casualness with which he was terminating his lifetime dedication 
to the advancement of scientific medicine in the United States. 
Billings publicly explained little about his decision beyond the statement 
that he was leaving because he had already accomplished what he had set 
out to do at the University of Pennsylvania. He added, however, that the 
New York position offered a considerably larger opportunity to “contribute 
to the public good” than the one in Philadelphia did. Moreover, it would 
allow him to take advantage of his experience with the Surgeon General’s 
Library and to build upon it in a large way.3 
In addition, certain undoubted factors in Billings’s decision to move do 
not seem to have been made explicit. Among them, during his years with 
the Army, as well as initially with Penn, he had received and thoroughly 
welcomed having one major medical challenge after another to work on. 
But he could not foresee the continuation of many such challenges if he 
remained at Penn. Moreover, the pattern of his professional exchanges during 
the Pennsylvania period suggests that Billings had come to realize that the 
highly successful first stage in America’s medical-scientific revolution—the 
demanding and creative introductory period—was coming to a close, thus 
making a move to a new field more attractive. 
Members of the medical and public health professions who in 1895 
paused to look back at the revolution as it had developed so far were reminded 
how much Billings had influenced it as well as supported them during those 
thirty years. They recalled particularly, in some cases, the incredibly forceful 
personal drive and implacable continuity of purpose that he had been able 
to sustain in his pursuit of their mutual career aims and projects and which 
had rubbed off on many of those who came into contact with him. And, 
looking around the American scene, they appear to have been little surprised 
at the range of major Billings projects that continued as active influences or 
were just coming to fruition even as he withdrew from his medical-public 
health career. I will mention only a few. 
The Surgeon-General’s Library in Washington, of course, was constantly 
growing: becoming more and more the national medical library, expanding 
its collections, and obtaining more and more satisfied users. Meanwhile, the 
37 Quoted in Ibid, p. 281. Billings in Organized Medicine and Science 
237 
volumes of the great subject guide to those collections, the Index Catalogue, 
steadily increased in value as a new volume appeared in print every year. 
Appropriately, the final volume of Series One appeared in 1895. 
Much more dramatic, of course, as an example of the ongoing Billings 
program, was the long-awaited completion of the two pioneering institutions 
he was associated with at Johns Hopkins University. The opening of the 
Johns Hopkins Hospital in 1888 in Baltimore, though anticlimactic in some 
respects, was celebrated as the epitome of the up-to-date healing institution. 
At the same time, Billings had been already widely emulated by other builders 
for his meticulous hygienic arrangements in and out of the buildings, 
particularly his elaborate ventilation and heating system. He had been well 
aware that changes in mans knowledge of germs would require modifications 
of those arrangements before too long. That did become necessary in the 
1890s. Meanwhile, the university’s School of Medicine finally opened in 
1893, with Billings’s plans for its staffing, science-based curriculum, and 
functioning already being widely discussed and beginning to serve as the 
American model for other such forward-looking institutions. 
Equally important in other ways for many late nineteenth century 
health officers and physicians in general were Billings’s still-unfinished vital 
statistics publications and other labors for the federal census. But he was, 
in addition, widely thought of for his ongoing encouragement of the use 
of statistical methods in sanitary investigations, medical reports, and other 
tasks, particularly to trace the locality and distribution of disease. Although 
he never mastered higher mathematics to the extent that Britain’s William 
Farr had, he nevertheless enjoyed continuing respect as one of America’s 
most learned and important statists. 
Actually, whatever Americans recalled about or gained from Billings as 
a scholar or investigator, many 1890s sanitarians, physicians, health boards, 
and even certain legislators were still thinking about him primarily as a 
public health administrator. They felt strongly that he had been an ideal 
leader of the National Board of Health and regretted that he had not been 
able to remain longer in that or some other federal agency. However, their 
occasional efforts to revive or replace the Board remained frustrated until 
later in the Progressive era. 
The entire ranks of American health professionals and physicians should 
have expressed gratitude to the departing Billings for a far longer-lasting 
and more successful role that he played throughout his Army medical years. 
This was as the country’s leading intellectual guide through the conflicting 
concepts and procedures that made up the ferments of the bacteriological 238 
Billings in Organized Medicine and Science 
age. He was a tireless sorter and analyst of other peoples’ theories. And 
rather than propose theories of his own, he made himself into a scientist, 
with competence to contribute factual knowledge of his own but especially 
to be able to evaluate the factual knowledge produced by other laboratory 
researchers, statisticians, technologists, and varied investigators. In the 
professional societies and journals, Billings then became the informed 
educator about germs and their behavior as well as about other agencies 
proposed as causes of disease. And as publicist, he passed on reports about 
relevant research in progress and stressed the importance of basic research 
equipment and methods as well as the creation of laboratories themselves. 
Billings remained an enthusiastic advocate of a major role for bacteriology 
in public health work. But he was never blind to the values of certain other 
scientific tools, notably technology and statistics, in helping bring about the 
flourishing of the medical revolution. Historians have not always recognized 
the breadth of this commitment. Epilogue 
Outside the Army; Other Paths to Science 
In accepting his new appointment with the New York Public Library, 
Billings made it clear that he would not cut himself off entirely or 
all at once from his interests and contacts in medicine, public health, and 
science. After going to New York, he thus kept himself available to Sternberg 
and Robert Fletcher, the latter in order to keep abreast of the problems of 
the Army’s medical library, and he rarely missed meetings of the National 
Academy of Sciences. He likewise continued to join and participate in the 
functions of selected new societies or interest groups as diverse as the Charaka 
Club (for medical historians and humanists) and the Nurses Pension Fund 
Movement. Occasionally Billings also took time off to work on designs for 
new hospitals or to attend medical or public health congresses. And, not least, 
during his first years at the new Library he scrupulously worked to honor his 
commitments to finish up certain large medical or scientific projects that had 
been begun in the early 90s in Washington. Chief among those labors were 
his lengthy analyses of vital statistics for the census, some of which extended 
to as late as 1902, while his editorial work for the Committee of Fifty’s reports 
on Physiological Aspects of the Liquor Problem lingered on until 1903. 
Despite such commitments, Billings’s overriding preoccupation now was 
the array of enormous and complex problems associated with developing the 
New York Public Library, an enterprise that everyone who knew him agreed 
was ideally suited to his energies, organizing talents, and intellectual interests. 
Details of the seventeen years that he subsequently spent in shaping and 
building up this great institution cannot be discussed at any length here.1 
However, 1 will comment on one element of that work that led him to a 
final striking reinvolvement in America’s life of science. 
1 See Dain, New York Public Library. 240 
Outside the Army; Other Paths to Science 
Prominent among Billings’s pursuits between 1899 and 1901 were his 
efforts to work out mergers of the city’s small free circulating libraries into 
the central library system as well as to identify sources of financing for new 
branch libraries around the city. Among his many discussions of these and 
other library matters during this time, some of the most challenging and 
ultimately fruitful were with the wealthy industrialist Andrew Carnegie. In 
the course of those meetings, Billings distributed copies of an ambitious 
plan for a large network of branch libraries, including their anticipated 
building costs to the city. Carnegie thanked the other man but gave no 
immediate indication of what he thought of it. However, in early 1901, after 
Carnegie had completed the sale of his steel works to J. Pierpont Morgan, the 
industrialist announced that he was ready to begin practicing his “gospel of 
wealth” in a larger way than before. Specifically, he decided to extend more 
of his new large philanthropies to libraries, including a very large donation 
to the New York Public Library. Writing to Billings, he noted that “our 
conferences upon the needs of Greater New York for Branch Libraries to 
reach the masses of the people in every district have convinced me of the 
wisdom of your plans.” Accordingly he awarded New York City the entire 
amount that the other man had suggested, $5,200,000 to build sixty-five 
branch libraries, a stunning gift at the time.2 
The Carnegie award had varying consequences for the persons involved. 
The press and city politicians alike saw its potential benefits for improving 
the educational opportunities of ordinary citizens. Billings and the Library 
trustees, in turn, were gratified with this substantial advancing of their 
plans for branch libraries, but they also knew that they would now have 
to raise other large amounts in order to properly staff, supply books and 
periodicals, and otherwise equip the new installations, as well as provide 
for continuing upkeep. 
Andrew Carnegie was doubly pleased. For one thing, he had successfully 
reduced his bank account somewhat, even though huge amounts still 
2 For details, see Ibid., pp. 209-247; and Chapman, Order Out of Chaos, pp. 
302-306. Chapman’s quotation from Carnegie’s letter to Billings of March 12, 
1901, is on pages 304-305. Carnegie, in his well-known essays on “Wealth” 
(later changed to “The Gospel ofWealth”), presented his dictum of the moral 
obligation of the rich, before dying, to return their holdings to society through 
philanthropic works. Andrew Carnegie, The Gospel ofWealth and Other Essays 
(New York: Century, 1900). Outside the Army; Other Paths to Science 
241 
remained to give away. Of at least equal consequence, however, was the 
immensely favorable impression that he had gained from his discussions with 
Billings of the latter’s versatility, thoroughness, incisiveness, and rapid grasp of 
detail, among other traits. In fact, from the beginning a favorable chemistry 
seems to have existed between the two men, enhanced undoubtedly by the 
mutually large scale of their vision and their achievements. Relations between 
them seem never to have been complicated by any of the bitterness toward 
Carnegie that still lingered in American society as a result of his and his steel 
firm’s infamous handling of the Homestead Strike of 1892. Like many other 
academics and scientists a decade or so after that event, Billings apparently 
did not consider the other’s large philanthropies as being made with "tainted 
money.” Moreover, the success of their work relations was also aided by the 
refusal of both men to allow their differences in wealth to stand between 
their respect for and appreciation of the other as an individual. 
Carnegie thus had no hesitation about moving on from the branch library 
discussions to utilize Billings as advisor on other proposed philanthropies, 
while Billings in turn readily took the necessary time off from library matters 
to help out in what he regarded as an important undertaking on Carnegie’s 
part. It is not clear how many different proposals Billings became involved in 
or how much of his time was involved. However, it is evident that his work as 
one of the principal Carnegie advisors did expand steadily after 1901. As one 
indicator of this, by the end of that year, to facilitate their communications, 
Carnegie had made available all three of his telephone numbers to Billings, 
one of them a private line.3 Moreover, the two began meeting more often 
for dinners, concerts, the theater or other social events. 
At some time during the spring or summer of 1901 Carnegie asked 
Billings to participate in some early discussions concerning possible support 
of large ventures in education, the sciences, or both. Two prominent 
university educators, President Andrew D. White of Cornell and former 
President Daniel C. Gilman of Johns Hopkins, were already trying to interest 
Carnegie in supporting some form of national university. At the same time, 
various individuals in Washington, including the Director of the United 
States Geological Survey, Charles D. Walcott, were promoting a broad 
type of educational institution that could serve as a suitable memorial to 
George Washington. During the summer, Carnegie invited White, Gilman 
' See Billings’s manuscript Diary for 1901, unnumbered page at the end, in JSB 
papers NYPL, copied on NLM MS film 25, Reel 61. 242 
Outside the Army; Other Paths to Science 
and Billings to continue the discussions with him at his so-called “castle” in 
Scotland. Afterward, Billings briefly wrote a friend about his “interesting” 
several days there, which seem to have been launched “every morning at 
seven thirty by the bagpipes played under my window, and [being] marched 
solemnly into dinner every evening to the strains of the same ferocious 
instrument.”4 Subsequently, he resisted other such invitations because of 
Carnegie’s stringent limitations on smoking in the castle. 
During the discussions in Scotland, Billings let it be known that he 
did not favor much of what was in the various proposals. He did agree that 
the city of Washington would be the appropriate site for whatever type of 
instituation was settled on. Before the meetings broke up, however, he began 
suggesting that Carnegie consider creating an institution that would focus on 
supporting urgently-needed original scholarly research in America, research 
in science First and foremost to be sure, but also in other areas of learning. 
By mid-November, back in New York, when Carnegie asked Billings and 
Gilman to argue the various proposals with him one more time, Billings 
submitted a rough outline of his thinking. In it he “advised instead of a 
university [that] the institution be founded for the promotion of original 
research, advanced teaching, etc., to be located in Washington, to be so 
original as not to interfere with the work of any existing university, but 
on the contrary to assist them, and to grant scholarships, etc., for work in 
laboratories and institutions outside of Washington as well as in it.”’ 
Impressed by Billings’s presentation, Carnegie enthusiastically accepted 
the basics of the plan and then sat down with Billings and Gilman to work 
up a more polished and detailed version. That done, he almost immediately 
established the Carnegie Institution of Washington as one of America’s 
4 Billings’s letter is quoted in Garrison, Billings, p. 306. For further details on 
these discussions, see Howard S. Miller, Dollars for Research: Science and its 
Patrons in Nineteenth-Century America (Seattle: University of Washington Press, 
1970), pp. 166-173. There is, up to the present, no full-scale scholarly history 
of the Carnegie Institution of Washington. 
5 For a selective but perceptive study of the origins and internal politics of the 
Carnegie Institution, see Nathan Reingold, “National Science Policy in a 
Private Foundation: The Carnegie Institution of Washington,” in Alexandra 
Oleson and John Voss, ed., The Organization of Knowledge in Modern America, 
1860-1920 (Baltimore: The Johns Hopkins University Press, 1979), pp. 
313-318. The quotation is on p. 317. Outside the Army; Other Paths to Science 
243 
earliest research foundations, one that was made public at virtually the same 
time as the launching of the Rockefeller Institute for Medical Research. In 
December 1901 he bestowed an initial grant of $10,000,000 upon the new 
institution and went on to name its initial trustees. 
As these developments unfolded, Billings made himself available, 
with little or no hesitation, to do whatever else he could to make the new 
foundation a success. For his part, Carnegie tried to make sure that Billings, 
together with Gilman and Walcott, would continue to bring their wisdom, 
energy, and leadership to the enterprise, at least through the early formative 
years, and thus provide continuity to the planning, organizing, and setting 
in motion of the institution’s research support structures and programs. 
Possibly after consulting with Billings and others, he thus installed Gilman 
as President and obtained Walcott to be Secretary, and then ensured that 
Billings would remain at the center of things by placing him simultaneously 
as a trustee, as one of the seven-man Executive Committee, and from 1903 
onward as Chairman of the Board of Trustees. 
Serving in these capacities for the rest of his life, Billings thus remained 
as one of a troika of eminent leaders in this elite body of savants, nearly 
all of whom were brilliant in one field of learning or another. Walcott 
apparently got along well with the other two leaders as well as with the other 
trustees, and he stayed as Secretary through the period. Gilman, however, 
who was not always on good terms with Billings and was frustrated at 
not having as much power as he wanted, resigned the presidency in 1904. 
After a search for a replacement, Billings ultimately got his associates to 
settle upon a geophysicist, Robert S. Woodward, for the job.6 Years earlier 
in Washington, he had known and was comfortable with the capable 
Woodward. And the two now seemed to have found that they could 
work reasonably well with each other in this new situation even though 
6 In connection with the subsequent search for a replacement, there appears 
to have been a distinct possibility, though apparently not documented, that 
Carnegie or someone else attempted to interest Billings in becoming a candidate 
for the presidency. If the latter had been at all interested, he would have had 
to notify the New York Public Library trustees at an early date, since election 
to the presidency would have required him to leave the library position. At 
any event, it is known that the trustees during this period, justifiably alarmed 
at the possibility of losing him, voted the first of several sizeable bonuses for 
Billings. Dain, New York Public Library, pp. 90-91, describes the bonuses. 244 
Outside the Army; Other Paths to Science 
both were strong-minded individuals.7 They agreed that the health of 
the Institution demanded an assurance of there being a variety of honest 
opinions freely given. 
Since the Carnegie Institution had been chartered in Washington, D.C., 
these and its other officials conducted most of their business in that city, for 
the first several years in rented quarters and hotels. For Billings, of course, 
the satisfying of that requirement meant his being ready and willing to take 
whatever train trips between New York and the Capital were necessary. 
Actually, meetings of the executive committee alone were scheduled for 
almost every month, and Woodward and others were impressed that Billings, 
despite occasional illness, missed so few of them.8 
Central among the items of housekeeping business that the executive 
committee discussed from time to time during the Institutions early years 
was the question of a permanent administration building. At some point, 
Billings gave specificity to those discussions by circulating his views of 
what kind of building was desired, the number and kinds of rooms, the 
dimensions, the functions to be served, and so on. And in general, he 
concluded, “The building should be severely plain, but dignified and as 
nearly fireproof as practicable. Special pains should be taken to secure good 
ventilation in ail parts of the building, so that life in it may be tolerable 
during a tropical summer.”9 Subsequently, Billings seems to have been the 
official who enlisted the architectural services of Carrere and Hastings, the 
same firm he was working with on the New York Public Library building. 
Reingold believes, probably correctly, that Woodward bested Billings in some 
of the Institution’s policy power struggles. Nathan Reingold, “National Science 
Policy," loc.cit., pp. 315-317. However, I disagree with his conclusion that this 
struggle resulted in permanent “bitter enmity” between the two men. For a 
contrasting picture of what seems to have been a generally cordial relationship, 
see Woodward’s extended “Reminiscences of Dr. Billings,” quoted in Garrison, 
Billings, pp. 348-356. 
h Robert S. Woodward, “Report of the President of the Carnegie Institution of 
Washington, for the year ending October 31, 1913,” Yearbook of the Carnegie 
Institution for 1913 (Washington: The Institution, 1913), pp. 8-9. 
9 [J.S.B.], “General Requirements of Proposed Building,” undated MS in JSB 
papers NYPL, Box 58 (Carnegie Institution of Washington). See also “Report 
of the President, 1908,” Yearbook of the Carnegie Institution of Washington, No. 
7 (Washington: The Institution, 1908), pp. 24-25. Outside the Army; Other Paths to Science 
245 
Fie also provided general oversight of the builder and other contractors. In 
the process, he gained the admiration of Woodward and other engineers 
among the trustees for his proficiency in reading blueprints.10 
A contract for construction of the new building was awarded in 
January 1908 for an estimated $221,000. It became ready for occupancy 
late the next year, some eighteen months before the formal opening of 
Billings’s other current major building project, the New York Public 
library’s central building. In December 1909, a two-day program was 
organized to mark the opening of Washington’s new science facility. On 
Monday, the 13th, the executive committee met in the afternoon, while 
in the evening, Billings as Chairman of the Board of Trustees, presided 
over the dedication program, which featured remarks by Elihu Root and 
Andrew Carnegie, and a scientific lecture by George Flail on the new 
solar laboratory, followed by a reception. The second day was taken up 
by a trustees’ luncheon followed by the annual trustees meeting, another 
meeting of the executive committee, and the trustees’ dinner at the New 
Willard Hotel. On the next two days the public was invited to see the new 
building and its special exhibits.11 
During the Institution’s early years, the officers, trustees, and advisors 
spent much time in identifying the areas of science and learning that most 
needed research stimulation. They organized themselves into research 
departments for the main areas of interest and recruited able scientists to head 
them; by 1908 there were ten such departments. The officers and members 
also gave much attention to one of the Institution’s stated objectives, “to 
discover the exceptional man in every department of study whenever and 
wherever found,” though in practice the identifying of significant needed 
research was often easier than finding outstanding individuals to do it. 
Billings himself particularly pushed his associates to support Robert Fletcher’s 
application for funds to revive publication of the Index Medicus as well as the 
project of Charles Davenport for a Station for Experimental Evolution.12 
10 Woodward, "Reminiscences,” in Garrison, Billings, p. 353. 
11 "Dedication of Administration Building,” document dated 1909, in JSB papers 
NYPL, Box 58 (Carnegie Institution). 
12 For a summary of this stage of the Index Medicus, see Miles, National Library 
of Medicine, pp.211-212. For the early history of the Station for Experimental 
Evolution, see report of the Department of Experimental Biology, in Carnegie 
Institution of Washington, Year Book, No. 3, 1904 (Washington: The 246 
Outside the Army; Other Paths to Science 
However, he also gave his support to such diverse proposals as those for 
laboratories of geophysics and nutrition, a project in marine biology, and a 
department of historical research.13 
As Chairman of the Board of Trustees, Billings was occasionally 
called on from time to time to represent the Institution at special events. 
However, the core of his service to the Institution, and the source of his 
greatest satisfactions in it, lay in the regular meetings of the executive 
committee with their meticulous ongoing evaluation routine of planning, 
discussion, contention, and compromise of program proposals. Other 
committee members occasionally complained that, in participating in 
these functions, Billings was abrupt, domineering, or otherwise too much 
the former army officer. But nearly all of them seemed to feel that he 
was nevertheless an outstanding committee man, one who, more often 
than anyone else, recognized the strengths and weaknesses of proposals 
or policy arguments. 
A particularly perceptive assessment of Billings’s work for the Institution 
and appreciation of his importance as a man of science was made by one 
of the non-scientists on the executive committee. This was the brilliant 
public servant and jurist, Elihu Root, who admiringly observed Billings’s 
performance throughout all of the other man’s eleven years of service. 
As one result, he came to consider Billings as a role model for the other 
trustees, and doubtless for scientists everywhere, because of the traits that 
he brought to the executive committee’s demanding scientific procedures. 
Root summarized them at the memorial services for Billings in 1913: “The 
breadth and variety of his learning, the definite certainty of his knowledge, 
the catholicity of his interest in all matters coming within the field of science, 
made his opinion of the greatest value. His service was devoted and untiring. 
He had intellectual as well as moral integrity, and a rugged independence 
of character which commanded recognition and respect. He came as near 
as any man I ever knew to absolute independence of judgment, and he was 
so simple and natural and unhesitating in his expression that his positive 
differences of opinion created no irritation. No project or expenditure could 
pass his scrutiny by easy or indolent acquiescence but only as it approved 
Institution, 1905), pp. 22-49. Billings’s brief remarks at the opening of the 
Station are on pp. 37-38. 
13 Summarized in Garrison, Billings, pp. 354-355. Outside the Army; Other Paths to Science 
247 
itself to his experience and reason. Yet he was essentially constructive and 
progressive in his views and wishes, and he was simple, modest, unassuming, 
without pride of opinion or personal bias. He never advertised himself or 
vaunted himself. ’14 
14 Elihu Root to John D. Cadwalader, 4/23/1913, in The New York Public 
Library, Memorial Meeting in Honor of the Late Dr. John Shaw Billings, April 
25, 1913(New York: The Library, 1913), p. 1 5. Other original and valuable 
appreciations of Billings in this same volume include those by William H. 
Welch on Billings in public health and medicine (pp. 10-13); by William 
Osier on Billings as medical bibliographer (pp. 8-10); and by Andrew 
Carnegie (pp. 13-14). INDEX 
Omitted from the index are such obvious topics as Public health, 
Hygiene, Sanitation, Statistics, and Science. These subjects pervade all 
aspects of Billings’s career and are, in one way or another, the subject 
of every chapter. Only a few headings are given under Billi ngs’s name, 
and those are ones that refer to him personally rather than his career. 
Obviously, every index heading has a relation to Billings. 
Abbe, Cleveland: 65 
Abbott, A. C.: Ill, 119 
Abbott, Samuel W.: 208 
Adams, Henry: 111 
African-Americans: 205 
Alcohol: 223-24, 239 
Allison Commission: 233-35 
American Institute of Architects: 118 
American Medical Association: 28, 85, 
216-24 
American Public Health Association: 
85, 120-21, 132-46, 151-54, 
163-66, 176-77, 184-85, 217 
American Society of Heating and 
Ventilating Engineers: 118 
American Surgical Association: 222 
Army Medical Museum, 23, 92-99, 
104-5, 112-13, 220, 222 
Association of American Physicians: 222 
Atwater, Wilbur O.: 223-24 
Bacteriology: 97-99 
Bailhaiche, Preston H.: 145 
Baird, Spencer F.: 107, 226, 231 
Baker, Henry B.: 164 
Baltimore: 86-87, 202-203, 205 
Banyuard, W. H. H.: 155 
Barker, Benjamin Fordyce: 89 
Barnard, Frederick A. P.: 126 
Barnes Hospital: 59-62, 102 
Barnes, Joseph K.: 14, 17-23, 59, 
79-80, 102, 140-41, 173 
Bell, Alexander Graham: 197-98, 228, 231 
Bell, A. N.: 141 
Bemiss, Samuel M.: 145, 153 
Bergey, David H.: 119 
Bertillon, Jacques: 210 
Billings, John Shaw: Civil War army 
medical officer, 13-18; education 
of, 14-15; home life. 31-34; 
resignation from Army, 235 
Birthrate: 207 
Blumer, G. Alder: 223 
Bodio, Luigi: 210 
Boston: 85-86, 202-203 
Boutwell, George S.: 57 
Bowditch, Henry I.: 85, 141, 146 
Bowditch, Henry P.: 71, 223 
Brackett, C. N.: 167 
Brewer, William H.: 231 
Brooks, William K.: 231 
249 Buck, Albert H.: 122-24 
Cabell, James L.: 145-49, 169 
Capitol Ventilation Board: 102 
Carnegie, Andrew: 240-45 
Carnegie Institution: 242-46 
Cartwright lectures: 210 
Casey, Thomas: 102, 107 
Catell, James McKeen: 97 
Cattle diseases: 25-27 
Census: 172-215, 237-39 
Chadwick, Edwin: 137 
Chadwick, James Read: 85-86 
Chaille, Stanford: 151 
Chandler, Charles: 133 
Chapin, Charles V.: 208 
Charaka Club: 239 
Chittenden, Russell H.: 223 
Cholera: 136 
Cincinnati: 14-15 
Civil War: 13-18 
Clark, Edward: 59, 102, 107 
Cleemann, R. A.: 169 
Cluss, Adolph: 113 
Columbia University: 126-27 
Commission on Uniform Military 
Health Statistics: 211-12 
Committee ol Fifty to Investigate the 
Liquor Problem: 223, 239 
Committee on Registration and Vital 
Statistics: 163-71 
Committee on Uniform Military 
Health Statistics: 211-12 
Conference on Vital Statistics: 168-71 
Cosmos Club: 230-31 
Cowdrey, S. G.: 94 
Cox, Christopher, 76, 141 
Craig, Thomas: 231 
Crane, Charles IT: 18 
Crane, John: 231 
Curtis, Edward: 19 
Davenport, Charles: 245 
Davis, Nathan S.: 217 
District of Columbia: 31-34, 76-77, 
108-109, 202-206, 224-31,244-45 
Durgin, Samuel H.: 169 
Eaton, Dorman: 141, 144 
Eliot, Charles W: 223 
Exhaust Ventilator Company: 107 
Farquhar, F. W.: Ill 
Farr, William: 161 
Fletcher, Robert: 59, 79, 239, 245 
Flint, Austin, Sr.: 90, 218 
Folsom, Charles F.: 155 
Ford, William F.: 124 
Ford’s Theatre: 228-29 
Forum: 203-206 
Fungus: 27-28 
Gannett, Henry: 193 
Garrison, Fielding H.: 69 
Gill, Theodore: 231 
Gilman, Daniel Coit: 64-66, 70-71, 
241-43 
Goode, George: 226 
Guiteras, Juan: 151,208 
Hall, George: 245 
Halsted, William S.: 66-67 
Hamilton, John B.:l49, 157-59, 221 
Hammond, William A.: 37-38, 127 
Harris, Elisha: 133, 138, 164-65, 
167-71 
Havana Yellow Fever Commission: 
151 
Hayden, Horace: 65 
Henry, Joseph: 102, 227, 229 
Hering, Rudolph: 133, 151 
Hilgard, Julius: 65 
History of medicine: 68-73, 239 
250 Holden, Edward: 225 
Hollerith, Herman: 182-91, 200 
Holmes, Oliver Wendell: 85 
Hospitals: Army, 20, 45-48, 50, 56, 
63; Barnes Hospital, 59-62, 102; 
Childrens Hospital, 62; Garfield 
Memorial Hospital, 62; marine 
hospital, 57-58; Johns Hopkins 
Hospital, 60-68, 104, 115-16, 231, 
237; U. S. Soldiers Home, 58-59; 
University ol Pennsylvania, 87 
Hough, John Stockton: 81 
House Committee on Ventilation: 106 
Hunt, Ezra xM: 169 
Hunt, William C.: 193 
Huntington, David L.: 59 
Hurd, Henry: 87 
Huxley, Thomas: 112 
Immigration: 206-207 
International Congress of Hygiene and 
Demography: 211 
International Medical Congresses: 91, 
211, 218-21 
International Statistical Institute: 211 
Jacobi, Abraham: 89-90, 124 
Jane way, Edward G.: 169 
Jarvis, Edward: 132, 162, 164, 173 
Jews: 196 
Johns Hopkins University: Hospital: 
60-68, 104, 115-16, 231, 237; 
history of medicine at, 69-73; 
Medical School: 64-68, 124-26, 237; 
Johnson, Hosmer A..: 146, 154, 166 
Jones, Joseph: 153 
Journals: 116-17 
Keen, William W.: 87 
Kelly, Howard A.: 66, 81 
King, Francis T.: 73 
King, William A.: 181, 194-97, 
213-14 
Kinyoun, Joseph J.: Ill 
Koch, Robert: 98-99 
Korosi, Josef: 210 
Laboratories: 99-100, 115-16 
Lamb, Daniel S.: 94 
Legislation: 123-24, 142-45, 148 
Leidy, Joseph: 87 
Leland, John D.: 194 
Libraries: 113-14, 240; Boston 
Medical, 85; New York Public, 
235, 239 (see also Surgeon 
Generals Library) 
Low, Seth: 223 
Marine Hospital Service: 133, 149, 
157-58, 166 
Martin H. Newell: 66 
Matthews, Washington: 96, 232 
McClellan, Ely: 136 
Medical School of Ohio: 15 
Medical Society of the District of 
Columbia: 77 
Meech, Levi: 208 
Meigs, Montgomery: 233 
Memphis: 109, 154-55 
Merriam, William R.: 214 
Microscopy: 23-28, 97-98 
Military medicine: 13-55, 211-12 
Mitchell, S. Weir: 81, 87, 119 
Mitchell, Robert W: 146, 154, 166 
Murray, Robert: 92 
Museums: 113-14 (see also Army 
Medical Museum, Smithsonian 
Institution) 
Myrdacz, Paul: 211 
National Academy oi Sciences: 231-35 
National Board of Health: 131-60, 
165-72, 176-77, 231,237 
New Orleans: 152-53, 1 56 New York Academy of Medicine: 89, 90 
New York City: 89-91, 102-103 
New York Public Library: 235, 239 
Newcomb, Simon: 65, 225, 231 
Newsholme, Arthur: 210 
Nichols, William R.: 124 
Nurses Pension Fund Movement: 
239 
Olcott, W H.: 194 
Olmsted, Frederick Law: 103, 106 
Osier, William: 66-68, 81 
Otis, George A.: 18 
Palmer, George T: 119 
Parvin, Theophilus: 217 
Peckham, Adelaide W.: 232 
Peirce, Benjamin: 225 
Pepper, William: 87-88, 128 
Pfeiffer, Carl: 105 
Philadelphia: 56, 87-89, 202 
Phillips, Samuel F.: 145 
Philosophical Society of Washington: 
227-29, 233 
Porter, Robert P.: 187-88, 190-92 
Powell, John Wesley: 225, 231 
Principles of Ventilation and Heating 
and Their Practical Application: 
117 
Public schools: 114 
Quarantine: 138, 141 -42, 150 
Railroads: 52-53, 84 
Rauch, John H.: 165, 169 
Remsen, Ira: 66, 150 
Republican Party: 103 
Riis, Jacob: 208 
Root, Elihu: 245-46 
Sanitary Engineer: 116-17 
Schumann, Franz: 103 
Schoolhouses: 114-115 
Sedgwick, William T: 232 
Shattuck, Lemuel: 162 
Shrady, George F.: 90 
Silliman, Benjamin, Jr.: 231 
Smart, Charles: 155, 157 
Smith, Stephen: 133, 141, 145, 166, 
169 
Smithmeyer, J. L.: 107 
Smithsonian Institution: 225-27 
Snow, Edwin M. : 132, 162, 165, 167, 
177 
Solomons, A. S.: 196 
Sternberg, George: 94-95, 127, 
151-59,219,239 
Stevens, Katherine: 31-35 
Stiles, Charles Wardell: 127 
Surgeon Generals Library : 28-30, 
68-69, 77-82, 84,91-92, 104, 
112-13, 140-41, 164, 220, 
222-23, 231, 236-37, 239, 245 
Surveys: public health, 39-41, 137-40, 
154-55; army sanitation, 39-51, 
54-55; Jewish population, 196 
Tabulating machine: 182-91, 200 
Tiffany, Harry: 194 
Toner, Joseph M.: 76, 144 
Treatise on Hygiene and Public Health: 
122-24 
Tuberculin: 98-99 
Turner, Thomas J.: 145, 152, 169 
United States Army: Medical School, 
127-28; post-Civil War, 17-22, 
36-55; hospitals, 45-48, 50; 
sanitation, 37-55; Soldiers Home, 
58-60; Surgeon General’s Office, 
13-30,77,135,140, 158,222, 
227-28; Western posts, 43-55 
(see also Surgeon General’s 
Library, Army Medical Museum) 
252 United States Congress: 102-111, 140, 
142, 226, 233-35 
United States Census: 138, 172-215, 
237, 239 
United States Sanitary Commission: 37 
United States Soldiers Home: 58-60 
United States Capitol: 102-11 
University curricula: 124-30 
University of Pennsylvania: 235-36; 
hospital, 87; Institute of Hygiene, 
128-30; 
laboratories, 115-16 
Urban population: 198-202 
Ventilation and Heating. 117 
Ventilation: 101-14 
Verdi, Tulio S.: 145 
Vital statistics: 161-215 
Walcott, Charles D.: 241,243 
Walker, Francis A.: 173-78, 180-81, 
187, 192-93, 206-207, 223, 232 
Wardell, James H.: 178, 193 
Waring, George E.: 109-10, 133, 150, 
155 
Washington, D. C., see District of 
Columbia 
Welch, William H.: 66-67, 72-73, 81, 
90, 223 
White, Andrew D.: 241 
Whitney, William: 150 
Wilbur, Cressy L.: 208 
Willcox, Walter F.: 208, 213-14 
Winsor, Justin: 85 
Wood, Horatio C.: 87, 150 
Woodhull, Alfred A.: 19 
Woodward, Robert S.: 243-45 
Woodward, Joseph J.: 18, 133, 227, 231 
Woodworth, John M.: 133, 141-43 
Wortman, J. L.: 232 
Wright, Carroll D.: 193, 223 
Yellow fever: 136, 142, 150-53, 156 
253 LaVergne, TN USA 
12 April 2010 
179058LV00001B/5/P Much has been written about John Shaw Billings’s (1838-1913) role in the founding 
and development of two great American libraries, the Army Medical Library and the 
New York Public Library, to the neglect of other aspects of his career. Billings’s role 
as a physician was many-faceted. Beginning his medical career as an Army surgeon 
during the Civil War, during the next 30 years he added to his medical skills those of 
scientist, administrator, and planner, builder, and organizer of several important medical 
and public health activities and institutions. 
This book explores Billings as a leader of the “medical revolution” and the public health 
movement of the late 19th century. It emphasizes the part he played as a link between the 
growing federal government’s presence in health policy and scientific activity and the world 
of private medicine and local public health. 
James H. Cassedy spent more than 35 years 
as Historian in the History of Medicine 
Division of the National Library of Medicine 
in Bethesda, Maryland, where he was editor 
of the annual Bibliography of the History of 
Medicine. Among his many publications are 
American Medicine and Statistical Thinking, 
1800-1860, Medicine & American Growth 
1800-1860, Medicine in America: A Short 
History, and Demography in Early America: 
Beginnings of the Statistical Mind, 1600-1800. 
Xlibris