[HF2672, John Shaw Billings: 19th century medical genius: the early years & the National Medical Library]

[1983. Length: 00:24:15, Mix, Sound.]

[This Beta SP was duplicated from a 16mm answer print by Bono FIlm & Video, Inc. for The National Library of Medicine, January 2008]

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[Image of catalog record]

[John Shaw Billings: 19th Century Medical Genius]

[The Early Years & the National Medical Library]

Narrator: The era from the Civil War to World War One was a time of dramatic change, vitality, and productivity. Historians have described these years as the "Age of Energy,” the "Rise of the City," the "Age of Reform," and the "Search for Order.”  [Images of a freight train, city streets, workers in a factory, and a notice reading "Attention Workingmen!"]

It was a period that witnessed the expansion of urban centers, with their unparalleled growth in population, the rise of modern industry, commerce, and banking, the emergence of organized labor, and the crusade for women's rights.

There was also an increase in new colleges and universities, the development of the modern library movement, and numerous efforts to further government participation in public health and welfare.

This was the time when the modern concept of medicine and public health came into being through revolutionary changes in the fields of bacteriology and chemistry, laboratory medicine, medical education, and public health methodology.

One of the remarkable personalities who was instrumental in making these important changes and helped shape the future twentieth century America was John Shaw Billings.

John Shaw Billings was born in Switzerland County, Indiana, on April 12, 1838, one of five children born to James and Abby Shaw Billings. By the age of 14, young Billings was ready for college.

Voiceover: I then went on to fit myself to pass the entrance examination for the sub-freshman class at Miami University in Oxford, Ohio, and passed the examination in the fall of 1852.

Most of my time was spent in reading the books in the college library. I was omnivorous, and read everything. Philosophy, theology, natural science, history, travels, and fiction.

Narrator: Years later, Billings recalled,

Voiceover: When I was in college, the library was not recognized as part of the system of instruction. No professor ever referred the students to it or suggested any use of the books in it.

I always found it easy to get half a dozen or more students to give me permission to borrow for them so that I usually left with as many books as I could carry.

Narrator: Billings ranked second in his graduating class at Miami University and decided to study medicine. He worked for a year to save some money and enter the Medical College of Ohio in the fall of 1858.

While he would have no problems with his studies, his limited funds caused hardship. By becoming custodian of the school's dissecting room, Billings could live in the hospital, and thereby avoided having to pay rent.

Billings' education was very different from the more modern medical education that he helped to promote in the late nineteenth century.

Voiceover:  In those days, they taught us medicine as you teach boys to swim. By throwing them into the water.

I graduated in medicine in a two years' course., with the lecture being precisely the same for each year. I did not attend the systematic lectures very regularly.

I found that, by reading the textbooks, I could get more in the same time, and with very much less trouble. I practically lived in the dissecting room and in the clinics.

Narrator: In 1860, after completing his thesis on the surgical treatment of epilepsy, Billings received his medical degree. He had planned to enter medical practice with one of his former instructors, but on April 12th, 1861, which also happened to be Billings' twenty-third birthday, Fort Sumter was shelled and the Civil War began.

That September, Billings went to Washington and a took three-day examination for admission to the United States Army Medical Corps. He passed with the highest possible grade, ranking first among the candidates, and was immediately appointed a contract surgeon.

Several months later, he was made first lieutenant and assistant surgeon. Thus, Billings began an association with the medical department of the Army which would last for thirty-three years.

Billings' first assignment was to transfer the patients, hospital staff, and equipment from the Union Hotel Hospital in Georgetown to the cavalry barracks at Cliburn in Washington and transform the barracks into a hospital.

Billings found the barracks in an extremely filthy and dilapidated condition with no drainage whatever, no sinks, and no water within half a mile.

Displaying a particular genius for hospital construction, Billings supervised new construction and modification of existing buildings, installed hygienic and sanitary facilities, and produced a one-thousand bed hospital which housed Confederate and Union wounded.

Billings later remembered how the people in the area came to visit the wounded.

Voiceover: The old residents of Georgetown and Washington were mostly in sympathy with the Confederates, and came out bringing good things to eat and drink for the Confederates.

On the other hand, the ladies and families of the members of Congress, and of officers in the department were enthusiastic for the northern side. And they also came with good things, but specified that none should go to the rebels.

We would not receive gifts from either party on these terms. But after a little explanation, they were left to be used for those who needed them most.

Narrator: It was during this Washington period that Billings met his future wife, Catherine Mary Stevens, daughter of former Michigan Congressman, Hestor Lockhart Stevens.

They were married in September, 1862, in the St. John’s Church in Georgetown and had a close and affectionate relationship which lasted the rest of their lives.

In the autumn of 1862, Billings was assigned to Philadelphia’s Satterlee General Hospital, which was receiving the casualties from the Battles of Fair Oaks, Malvern Hill, and the second Bull Run.

In March, 1863, he reported to Dr. Jonathan Letterman, medical director of the Potomac in camps near Fredericksburg, not far from where General Joseph Hooker was about to engage General Lee in the battle of Chancellorsville.

After Chancellorsville, Billings saw duty at Gettysburg. Here, he remained on the battlefield for nearly three weeks, caring for over one thousand wounded. About six a.m., July 2, 1863...

Voiceover: I accompanied my regiment until they were under fire and was then ordered to repair to a large stone house and barn near the base of Round Top, and there establish a field hospital.

On entering the house, I found evident traces of hasty desertion. In five minutes, I was joined by the other medical officers. The ambulance train reported to me fifteen minutes later, and by the time the operating tables were up and the materials were dressing arranged, the wounded began to pour in.

I performed a large number of operations of various kinds, received and fed seven hundred and fifty wounded. Most of the wounds were in the lower extremities.

Of three resections of the shoulder joint, all were successful, insofar as that the patients recovered. Five cases of gunshot fracture of the cranium came under my notice. Four of these involved the occipital bone and all were fatal.

Two cases occurred of gunshot fracture of the femur in the upper third. Both were treated by Smith's anterior splint, and one died. In no case of fracture of the long bones, did I attempt any formal resection, but confined myself to removing splinters and foreign bodies, and cutting off very sharp projecting points.

Narrator: On July 6, Billings wrote to his wife.

Voiceover: I am utterly exhausted, mentally and physically. I have been operating night and day. I have been left here, in charge of seven hundred wounded, with no supplies. Our division lost terribly.

Over thirty percent were killed or wounded. I had my left ear just touched with a ball.

Narrator: Three days later, he again wrote to Mrs. Billings.

Voiceover: I am covered with blood and am tired out, almost completely, and can only say that I wish I was with you tonight, and could lie down and sleep for sixteen hours without stopping.

I have been operating all day long and have got the chief part of the butchering done in satisfactory manner.

Narrator: In August, 1864, Billings was relieved from field duty and reported to the Medical Director of the Army of the Potomac in Washington. His assignment was to arrange and analyze the Army's wartime reports.

A project that led to the publication of the six-volume Medical and Surgical History of the War of the Rebellion. Four months later, Billings, age 26 years, was transferred to the Office of the Surgeon and promoted to Lieutenant-Colonel.

He would remain with this office for the next thirty years. Here, he would build a National Medical Library, publish its Index Catalog and Index Medicus, and, using the library as a base of operations, he would make extraordinary contributions in various areas of public health,

to hospital construction, and to the development of modern medical education. The library of the Surgeon General's office had its origin in a small collection of books and journals from the office of the first Surgeon General, Joseph Lovell.

When Lovell died, in 1836, he was succeeded by Thomas Lawson who, in 1840, issued the first catalog of the library, a manuscript listing 134 titles. The collection continued to grow under Lawson's successors, Surgeons General Clement Findley and William Hammond.

And in 1864, when Joseph Barnes assumed the office, the library’s first published catalog contained 485 titles. Surgeon General Barnes felt that the collection should be under the charge of an officer and in 1865, Billings was given the job.

From 1862 through 1866, this modest library in Washington was housed in the Riggs Bank Building at the corner of Fifteenth St. and Pennsylvania Ave. These facilities, however, soon proved inadequate, and Ford's Theatre, purchased by the national government after President Lincoln was assassinated, became the library’s next home.

Its interior was remodeled, and in 1867, the books and journals were transferred from Riggs to the second floor of Ford's Theatre. On the third floor was the department's medical museum. Billings' goal was to make the library, in his words, "as complete as possible.”

He sought all forms of publications pertaining to medicine and public health, monographs, journals, reports of hospitals, institutions, and health agencies, pamphlets, doctoral dissertations, medical works from the sixteenth, seventeenth, and eighteenth centuries, and incunabula, books printed before 1501.

When the library published its third catalogue in 1868, its holdings were three times what they had been in 1865. Purchases by the library depended primarily on the monies appropriated by Congress.

And since there were never enough funds to acquire everything Billings wanted, Billings encouraged gifts, and traded duplicates and unwanted material for items the library needed.

He wrote letters to physicians, publishers, editors, health officials, society officers, librarians, and friends, hoping to receive donations, arrange exchanges, or buy publications at a low price.

Dr. Oliver Wendell Holmes once described how Billings, while visiting his home, entered his library and immediately swooped down on the most valuable things on his bookshelves.

“Doctor Billings,“ said Holmes, "is a bibliophile of such eminence, that I regard him as a positive danger to the owner of a library, if he is ever let loose in it alone.”

When the library published its 1873 catalogue, it consisted of two volumes, plus a supplement, and Billings wrote...

Voiceover: The library now contains about 25,000 volumes and 15,000 single pamphlets, including about seven hundred volumes of theses of the Schools of Paris, Montpelier, and Strasbourg.

As the existence in objects of the collection have become more widely known to the medical profession of the country, a steadily increasing interest in its progress and completeness has been manifested.

Not only did donations to the library increase, its patrons did, also. Many physicians from out of town came to use the library, some from as far away as Chicago. Billings also started to have exhibits displaying some of the library's treasures.

One visitor was so impressed at seeing the display of pamphlets which had belonged to the great French scientist, Claude Bernard, that he wrote an account for the 1870 Boston Surgical and Medical Journal. Billings did not merely want to collect books, he wanted the library's collections used.

The 1873 catalogue allowed readers to find books, theses, and pamphlets by author, but it was not helpful for locating periodical articles by subject.

Billings' next project, therefore, was to produce an Index Catalogue of the library's holdings, listing, in dictionary order, both monographs and periodical articles, the books by author and subject, and the articles by subject only, in a single alphabet.

For Billings, it was a matter of making the resources of the National Medical Library available to all physicians and scholars who wanted to use them.

Helping Billings and his staff in compiling the Index Catalogue was Doctor Robert Fletcher, a scholarly gentleman who had emigrated from Great Britain to the United States in the 1840s and joined the library in 1876.

Fletcher became Billings' chief assistant and the two had a close working relationship for the next twenty years. Billings conceived and planned the work and Fletcher suggested the title, Index Medicus, a Monthly Classified Record of Current Medical Literature of the World.

Billings and Fletcher became co-editors of the new journal, the first issue of which was dated January 31, 1879.  In the introduction, Billings wrote...

Voiceover: The Index Medicus will record the titles of all new publications in Medicine, Surgery, and collateral branches, received during the preceding month. These will be classed under subject headings, and will be followed by the titles of valuable original articles upon the same subject.

At the close of each yearly volume, a double index of authors and subjects will be added, forming a complete bibliography of medicine for the preceding year.

Narrator: The Index Medicus would become the most widely used medical index in the world. Publication of the work was never a financially profitable venture, and, at times, this index to the world's medical literature almost ceased to exist.

However, financial support from the Carnegie Institution of Washington and the interest of the American Medical Association assured its survival until the early 1960s,when the National Library of Medicine resumed publication of the journal.

Billings instituted a forerunner of today’s inter-library loan system. On deposit of $50, physicians outside Washington were allowed to borrow books from the library.

William Osler, Howard Kelly, William Halstead, Reginald Fitz, Walter Reed, Rudolph Mathis, and George Kriel were among those who took advantage of that privilege.

Volume one of Billings' Index Catalogue of the library appeared in 1880. Consisting of 888 pages of text, preceded by a one-hundred-twenty-six page list of the journals indexed, the volume contained only the entries from "A" to "Berlinski.”

Still, it included 9,090 author titles, representing 8,000 volumes and 6,000 pamphlets as well as 9,000 subject titles of books and pamphlets, and 34,000 subject titles of articles in periodicals. By 1880, the collections of the National Medical Library had grown so much, there was neither storage space nor working room in the converted Ford's Theatre Building.

The medical museum on the third floor was filling up with specimens, while the first floor was being used by clerks searching Civil War records for pension applicants.

Furthermore, although the building had brick walls and concrete floors, the structure itself was not fireproof. Billings felt it was essential that the library and museum have a new building.

In order to urge Congress to pass legislation on the construction of a new building, Billings organized a lobbying campaign by the medical profession which lasted more than three years.

Finally, in 1885, Congress approved a bill authorizing a new structure. Designed by Billings, the library museum building was erected on the southeast corner of Seventh and Independence Ave, today, the site of the Hirshhorn Museum.

And in August, 1887, Billings and his staff moved in. This would be the home of the National Medical Library for the next 75 years, until 1962, when it moved into its new quarters in Bethesda, Maryland.

A few years after the new library was opened in 1891,Billings hired a young man who would soon make his own contributions to medical bibliography and the history of medicine.

This was Fielding H. Garrison, who became co-editor of the Index Medicus, editor of the Index Catalogue, and who published over 200 papers, including the well-known monograph, An Introduction to the History of Medicine.

Billings had called the Index Catalogue project his labor of love and in 1895, the final volume of the first series was published. William Osler considered the catalogue Billings [?] down to posterity.

By this time, the library had more than 308,000 books and pamphlets and a survey revealed that the library's holdings had surpassed those of all other medical repositories in the country.

The Index Catalogue, therefore, provided access to a truly great body of medical literature. William Osler declared that, "While the catalogue only represents the contents of the library, it really is an exhaustive index of medical literature.

So general were Dr. Billings' interests, that all departments of medicine are represented, and there is not a subject, as there is scarcely an author of note, ancient or modern, not in the catalogue.”

In 1914, William H. Welch wrote, in the Johns Hopkins Hospital Bulletin, "I questioned whether America has made any larger contribution to medicine than that made by Billings in building up and developing the library and in the publication of the Index Catalogue and the Index Medicus. That, in my judgment, is our greatest contribution to medicine. And we owe it to this extraordinary man."

Billings' work established his reputation internationally and brought him numerous honors.

In 1895, Colonel Billings retired from the army and left the library. In Philadelphia, some two hundred fifty physicians gathered to honor this remarkable individual with a testimonial.

And, in a final tribute, they presented him with a silver container, on which was engraved, “To John S. Billings, from 259 physicians of the United States and Great Britain in grateful recognition of his services to medical scholars.”

Inside, was a check for ten thousand dollars. The three decades Billings spent building the National Medical Library were not devoted only to the library and medical bibliography.

Billings also had other official assignments and was engaged in many other projects advancing American medicine and public health.

He was a member and Vice President of the1879 National Board of Health. He helped to reorganize the Marine Hospital Service, the forerunner of the U.S. Public Health Service.

From 1880 to 1912, he was consultant for the10th, 11th, and 12th U.S. Census. It was at the time of the 10th census in 1880, that Billings proposed to Herman Hollerith, a special agent of the census office, the idea that led to the development of punch card tabulation.

Some years later, Hollerith formed the Tabulating Machine Company, which eventually became the IBM Corporation.

In 1883, the Army Medical Museum came under Billings' charge. And among his contributions here was the creation of the largest historical collection of microscopes in the world.

Billings contributed significantly to the field of medical education. He was Chief Medical Advisor to the President of The Johns Hopkins University, and was instrumental in bringing Doctors William Welch and William Osler to Johns Hopkins.

He designed the Johns Hopkins Hospital and Peter Bent Brigham Hospital in Boston, and he taught courses in the history of medicine.

He planned the Laboratory of Hygiene at the University of Pennsylvania and, for a short period in 1895, he was Professor of Hygiene at that institution. Billings was also an influential member of the Carnegie Institution of Washington for many years.

Finally, after Billings left Washington, he helped organize the New York Public Library. He designed its central building, became its first director, and induced Andrew Carnegie to support the institution which Billings then developed into the most prestigious public library system in the country.

Endowed with uncommon qualities of leadership, Billings' achievements had a major impact on the development of American medicine and public health. Billings had ideas, and he was a mover.

In 1913, John Shaw Billings died and his friend of many years, S. Weir Mitchell, recalled, "What was most exceptional in this man was the unfailing fund of energy on which he drew for every novel duty and an industry which never seemed to need the refreshment of idleness. He had that rare gift: the industry of the minute."

[Produced By The Lister Hill National Center for Biomedical Communications]

[National Library of Medicine, Bethesda MD, 1983]

[National Institutes of Health, Public Health Service, U.S. Department of Health and Human Services]

[Script and Consultation by Manfred Waserman Ph.D,, History of Medicine Division, National Library of Medicine]

[In addition to the National Library of Medicine, we wish to acknowledge the following sources of prints and photos]

[Bettman Archives]  [Library of Congress] [New York Public Library] [Alan Mason Chesney Medical Archives, The Johns Hopkins Medical Institutions] [Miami University at Oxford Ohio, Special Collections Library]  [Martin Luther King Library, Washingtoniana Collection, Washington DC] [Armed Forces Institute of Pathology, Prints and Photos Archives]