Tag: John Shaw Billings

John Shaw Billings: “The Many Lives he Has Led”

See Part I for biographical information about John Shaw Billings, his experience as a Civil War surgeon, and his innovatory Surgeon-General library’s Index Catalogue.

clearing hospital
Ground being cleared for Johns Hopkins Hospital, 1877, photo courtesy of Flickr’s Johns Hopkins Medical Archive’s photostream.

John Shaw Billings’s hospital designs, which limited the spread of disease, and his education of the public about hygiene are more relevant than ever, considering the CDC’s recent struggle to combat the spread of Ebola and Enterovirus D68. Despite modern technology, educating the public about methods of contagion and effectively quarantining the ill remains an issue. We have, in large part, Billings (of Allensville, Indiana) to thank for many of the basic preventive measures in hospitals, particularly with the establishment of the Johns Hopkins Hospital.

The Civil War revolutionized the American medical system, as it required personnel to treat large numbers of severely wounded soldiers in rapid fashion. In addition to treatment problems, such as preventing infection, personnel struggled with administrative issues like locating and communicating with medical staff and procuring supplies. Adapting to these obstacles informed medical treatment in the post-war public health sphere, as Billings confirmed in an address:

The war of 1861-1865, and the great influx of immigrants . . . taught us how to build and manage hospitals, so as to greatly lessen the evils which has previously been connected with them, and it also made the great mass of the people familiar with the appearance of, and work in, hospitals, as they had never been before.

His own experience as a Civil War surgeon and his “novel approach” to hospital administration appealed to the trustees of the Johns Hopkins’ fund, tasked with establishing a hospital for the “indigent sick.” After inviting five medical professionals to submit plans for the hospital, they selected Billings’s design in 1876. In their article, A. McGehee Harvey and Susan L. Abrams noted that it “was Billings the man, rather than his proposal” that convinced the trustees to appoint him to the task, as he was extremely knowledgeable about medical education, hygiene, and the “philosophical underpinnings” of hospital construction.

opening
Johns Hopkins Hospital, 1889, the year of its opening. Photo courtesy of Flickr’s Johns Hopkins Medical Archive’s photostream.
new
Johns Hopkins Hospital, 2013, courtesy of ABC News.

Billings’s essay to the trustees reflected his revolutionary ideas about medical treatment and education, asserting that a hospital should not only treat patients, but educate medical professionals. In that period, requirements to receive one’s medical degree were low and medical education often failed to adequately prepare students to practice medicine. Billings sought to change this by wedding the hospital to the university, providing students with hands-on experience. He also sought to raise standards of medical education, so that a diploma ensured the physician could “learn to think and investigate for himself.”

Under Billings’s design, the Johns Hopkins Hospital opened in 1889 and included a training school for nurses, a pathological laboratory for experimental research, and connected to a building with a teaching amphitheatre. In an address at the opening of the hospital, Billings stated that with the hospital he hoped to produce “investigators as well as practitioners” by having physicians “issue papers and reports giving accounts of advances in, and of new methods of acquiring knowledge, obtained in its wards and laboratories, and that thus all scientific men and all physicians shall share in the benefits of the work actually down within these walls.”

Johns Hopkins Hospital raised the standards of medical education, treatment and sanitation, and was modeled by other hospitals. By 1894, The (Washington D.C.) Evening Star dubbed Billings the “foremost authority in the country in municipal hygiene and medical literature.” In addition to revolutionizing hospital administration and design, Billings was an early advocate of what is referred to today as “bedside manner.” In his 1895 Suggestions to Hospitals and Asylum Visitors, he asked readers to consider

Is a spirit of kindness and gentleness apparent in the place? . . . Is the charitable work of the hospital performed in a charitable way? Do the physicians and nurses display that enthusiasm and esprit due corps which are essential to good hospital work?

NYPL old
New York Public Library Central Building. Image courtesy of “A Digitized History of the New York Public Library,” NYPL.org.

Billings’s accomplishments were not relegated to hospitals. In 1896 Billings served as the first director of the New York Public Library (serving until his death in 1913), expanding its collections “without parallel.” He publicly recognized NYPL female employees and at a Women’s University Club meeting lamented that “most of the library work is done by women, and done splendidly, and it is a shame that they are not better paid.” Industrialist and philanthropist Andrew Carnegie solicited Billings’s help with the establishment of a system of branch libraries in New York City and referred to Billings on various educational matters. Additionally, Billings convinced Carnegie to donate millions of dollars to public libraries throughout the United States.

original sketch
Billings’s original sketch of the NYPL, 1897 (above). Preliminary plan of the NYPL (below). Image courtesy of “A Digitized History of the New York Public Library,” NYPL.org.

Billings also worked with the U.S. Census from 1880 to 1910 to develop vital statistics. He sought to record census data on cards using a hole punch system, which would allow the data to be counted mechanically. Herman Hollerith applied Billings’s concept, devising “‘electrical counting and integrating machines’” employed by the U.S. Census.

Billings passed away March 11, 1913 and was buried in the Arlington National Cemetery. At a meeting to honor Billings’s life at the Stuart Gallery of the New York Public Library, Andrew Carnegie contended of Billings “by his faithful administration of the great tasks committed to him he left the world better than he found it. I never knew a man of whom I could more safely say that.” The Evening Mail summarized the sentiments of many, including the author of this post, stating

“One gasps at the many lives he has led, the many appointments he has filled, and his gigantic work among libraries and hospitals.”

For more about Billings’s pioneering work, as well as his many other accomplishments, see the corresponding Historical Marker Review and the National Medical Library’s extensive John Shaw Billings Bibliography.

Interested in historic hospitals and medical advancements? Stay tuned for our forthcoming marker about Central State Hospital, an Indianapolis mental health facility that opened in 1848 and built a groundbreaking pathology lab in 1896.

John Shaw Billings: “I Could Lie Down and Sleep for Sixteen Hours without Stopping”

John Shaw Billings portrait, n.d. Photo courtesy of the National Library of Medicine.

We all know those people, who accomplish more in one hour than we do all week, who redefine “industrious” and excel at everything they try. Indiana native John Shaw Billings was the archetype, a visionary with seemingly infinite energy who revolutionized medical and bibliographical practices that endure into the 21st century. Billings stands among several Hoosiers who are profoundly influential, yet under recognized, including the inventor of the television Philo T. Farnsworth and creator of one of America’s first automobiles Elwood Haynes.

Billings was born April 12, 1838 in Allensville, Indiana; his family moved to the East Coast briefly in 1841 and returned in 1848. Ambitious from a young age, Billings made a deal with his father that, in exchange for forfeiting inherited property, his father would fund his college education. At the age of 14 and after intensive study, he passed the entrance exam for  Miami University at Oxford, Ohio, where he incessantly studied philosophy and theology at the college library. After earning his B.A., he entered the Medical College of Ohio at Cincinnati in 1858, where he undertook his thesis “The Surgical Treatment of Epilepsy” that would later inform his monumental bibliographical endeavors.

John Shaw Billings : an autobiographical fragment 1905 (facsimile copy of the original manuscript), courtesy of Archive.org.

Shortly after graduation, Billings’s training coincided with the start of the American Civil War, providing him with opportunities to apply his medical knowledge. In 1861, Billings traveled to Washington, D.C. and became a contract-surgeon with the military. Soon thereafter he was appointed assistant surgeon in the U.S. Army, working at the Union Hospital in Georgetown. While there, his “extraordinary manual skill and boldness in dealing with difficult cases attracted the attention of the surgeon-general,” and he was put in charge of Cliffburne Hospital near Georgetown.

As a Civil War surgeon at several prominent battles–including the Battles of Chancellorsville, Gettysburg, Cold Harbor, and Petersburg–Billings was tasked with establishing field hospitals, operating and treating wounded soldiers for hours while under fire, and transporting waves of injured soldiers from battle sites with limited equipment. Billings lamented the trials of his work, writing to his wife about the Battle of Gettysburg:

“I am utterly exhausted, mentally and physically. I have been operating night and day, and am still hard at work. I have been left in charge of 700 wounded, and have got my hands full. Our division lost terribly, over 30 per cent were killed and wounded. I had my left ear just touched with a ball . . . I am covered with blood, and am tired out almost completely, and can only say that I 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 work done in a satisfactory manner.”

After the battle, Billings understandably left field work for a brief period due to “nervous tension and physical exhaustion.” In August 1864, Billings helped edit field reports that became the monumental The Medical and Surgical History of the War and eventually transferred to the Surgeon-General’s Office, where he remained until retirement in 1895.

billings in army
Albumen silver print, ca.1862, courtesy of Smithsonian Libraries blog.

As the war concluded, hospitals submitted surplus operating funds to the Surgeon-General’s Office; these funds were given to Billings to build up the Surgeon-General’s library, which later became the National Library of Medicine. Billings expanded the collection by writing to editors, librarians, physicians, and State Department officials requesting book donations, eventually increasing its holdings from 600 entries in 1865 to 50,000 by 1873. The scope of the collection soon required a guide to help researchers locate desired publications. Billings understood firsthand the difficulty of locating such sources, as his thesis research required intensive time, labor, and travel to libraries in Cincinnati and Philadelphia.

With the assistance of Dr. Robert Fletcher, Billings devised a catalogue for the Surgeon-General library’s holdings, publishing the first volume of the Surgeon General’s Medical Index Catalogue in 1880. He hoped it “would spare medical teachers and writers the drudgery of consulting ten thousand or more different indexes or of turning over the leaves of as many volumes to find the dozen or so references of which they might be in search.” As new medical materials were published, Billings struggled to keep the Catalogue current, so he devised the Index Medicus, a monthly supplement that focused on new and select publications. The Index Medicus was the forerunner to the medical databases MEDLINE and PubMed.

library
Surgeon General’s Library, ca. 1890. Billings sits at center table, courtesy of New York Public Library Digital Gallery.

Prior to Billings’s systematic efforts to compile and organize medical literature, researchers and physicians had few methods to effectively locate sources, including medical studies and reports on operations. The Index Catalogue and Medicus served as a nearly comprehensive clearinghouse of medical literature, both current and historical, whose contents could aid in medical education and diagnoses. Dr. Stephen J. Greenberg and Patricia E. Gallagher summarize the magnitude of Billings’s efforts in “The Great Contribution,” contending that “with only ink and index cards, they [Billings and Fletcher] tamed an enormous and complex technical literature in virtually every written language on the planet” and that the indices “paved the way for the great databases that now are the primary underpinnings for the medical research of the future.”

Billings’s efforts at the Surgeon-General’s library served as the beginning of his library work, which would one day lead him to industrialist and philanthropist Andrew Carnegie. For more information on Billings’s Civil War activities and establishment of the Surgeon-General’s library and corresponding Index Catalogue, see the Historical Marker Review.

Check back for Part II: “A New Era of Hospital Construction” about Billings’s involvement in the establishment of Johns Hopkins Hospital and how it revolutionized medical treatment and education.