Physicians pondering second careers are sometimes chided for over-reaching ambition, as is the point of this variation on a common anecdote, meant to be both humorous and instructive: “‘When I retire’, a surgeon told an historian, ‘I plan to be a medical historian.’ The historian replied that when he retired he planned to practice surgery.” While some might find the implied absurdity amusing, those who know of John Shaw Billings won’t get the joke.
sic parvis magna
‘Great things from small beginnings’ describes precisely the remarkable career of a boy from rural Indiana, Billings supported himself through college and afforded medical school by managing the dissecting room. When he passed away in 1913 at seventy four years of age, people gathered at the New York Public Library to hear eulogies from the preeminent physicians William Welch and William Osler (co-founders of Hopkins Medical School), the philanthropist Andrew Carnegie, the President of The American Library Association (Billing’s old job) and the reading of a letter from Senator Elihu Root.
The fact that he founded the New York Public Library as we now know it was but one of his many accomplishments. By all contemporary accounts, he was a man of such character and intellect that he could without presumption set lofty goals and accomplish them one by one. We here recount but some of his achievements.
Billings was tall, handsome and competent. At Cincinnati’s Medical College of Ohio his thesis on “The Surgical Treatment of Epilepsy” earned him faculty attention and a comfortable career was in arm’s reach. Instead he joined the Union Army in 1862. As a battlefield surgeon in the Civil War he came close to being blown up. Surviving the Was, his Army career lasted over thirty years. His industriousness came to the attention of President Cleveland and Billings was assignment to diverse projects, including the US Census and a foreign expedition. As a self-tutored expert in building design, he helped shape the Johns Hopkins Hospital, Brigham and Women’s Hospital and the Army Medical Museum.
His engagement with the Army Medical Museum brings us round to an achievement for which every physician is grateful. It was there that he crafted an instrument of scientific discovery and patient care that won him membership in the prestigious National Academy of Science.
Medical Historian de facto
But first a brief digression on the “history of medical history”, for which see the essay on the relationship between physicians and historians in this pursuit.
To be historically accurate, Billings became the preeminent bibliographer of medicine, not a medical historian per se. But his knowledge of medical history did win invitations to teach at non other then Hopkins, (the oldest such academic program in Britain or America), and at the Lowell Institute. He wrote medical history of the Civil War, the Medical College of Ohio, of America, of “The King and Scrofula” and so on. The biographical memoir published four years after his death, in the National Academy of Sciences, says of him: “Through his lectures and writings on the history of medicine, Billings was one of the original prime movers in the development of its study and investigation in the United States.”—This from one of the eminent medical historians of his time, Fielding Garrison.
It goes on: “…what he read he seemed never to forget. His memory was like a good index of a vast mental library.” One can readily imaging a Billings of today scanning the cereal box at breakfast or eyes glued to an ebook reader while standing in line. Oliver Wendell Holmes recalled Billings' visit to him in his library. Unguided and and instinctively Billings selected two books from Holme’s shelves—the very two most prized by Holmes. He knew the medical literature better than no other of his time. And he had a passion for sharing.
The US Army’s Gift of Knowledge
His knowledge began with his ensconcement at the Army Medical Museum, first as librarian, then, in 1864, as curator. At the time the Surgeon General’s Library, founded in 1836, had about one thousand books. His latent talent for organizing knowledge was at the ready when the Army directed that $85,000 dollars left over from the Civil War hospital budget should be assigned to the Surgeon General’s office. By the time Billings left, the library had grown to over 300,000 books. The Armed Forces Institute of Pathology, which preceded the Army Museum, was the seed; the financial wind fall was the nourishment; and Billings the cultivator that gave rise to the National Library of Medicine (NLM). With over seven million items, it is the largest medical library in the world. (sic parvis magna redux)
This brings us to the Index Medicus. Billings devised a scientific classification of the libraries holdings and, along with his assistant Dr. Robert Fletcher, began, in 1880, a monthly supplement to this index—the Index Medicus. As he put it, he wanted “…to establish for the use of American physicians a fairly complete library, and … a comprehensive index which should spare medical teachers and writers the drudgery of consulting thousands or more indexes or the turning over the leaves of many volumes to find the dozen or more references of which they might be in search." As mundane as this may seem to the modern physician, it was the essential substrate for knowledge-building by physicians ever since, and remains so, albeit transformed and recognized now by a different name.
Index Medicus ‘on steroids’
I recall taking my turn to peruse our department’s monthly copy of Index Medicus. We would pocket it for the day and urgently scan the contents at lunch (or during journal club if you could get away with it). The printed versions from Billings' era were subsidized by the Carnegie Foundation. The American Medical Association, AMA, took over from 1927 to 1956 before the NLM got involved. In 1963, at the cost of $3M, General Electric produced a computerized version, the only large scale database of its time. It was called MEDLARS (Medical Literature Analysis and Retrieval system). When remote access was given to medical libraries it became MEDLINE (MEDLARS Online). I still remember watching my librarian firing up a modem to submit my pre-formatted query, and then waiting for the dot matrix printer to hammer out a list of references. Now of course, I, and every other physician on the planet, can query this database for free and ad libitum by logging onto PubMed.
Before we conclude our introduction to John Shaw Billings, let’s enumerate some of his titles and achievements.
MD Medical College of Ohio
Head, Vital Statistics division of US Census
(developed numeric encoding of medical data for punch cards)
Curator, Army Medical Museum
Founder (w/ Dr. Fletcher) of Index Medicus
Colonel, United States Army
(Civil War combat surgeon—Gettysburg)
Advisor, Johns Hopkins Hospital
(design of hospital and curricula)
Lecturer, Hopkins and Lowell Institute
(medical history) [continues...]
Director University Hospital, University of Pennsylvania
Chairman, Carnegie Institute
President American Library Association
Founder New York Public Library
(amalgamated the Astor-Linox Libraries and Tilden Fund)
Honorary Fellow, Royal College of Physicians
Associate Fellow, American Academy of Arts and Sciences
Treasurer, National Academy of Science
(enlarged the membership to anthropologist, philologists, etc)
Dr. Billings was a family man with five children. With horizons yet to explore, he died at 74, of pneumonia following surgery for a kidney stone. He is buried in Arlington National Cemetery.
We end on a note about the character of the man, as a physician and human being. John Cadwalader, was a partner in what became the oldest law firm in New York. As a Trustee of the New York Public Library, he chaired the memorial service for John Shaw Billings. He tells of the time he kidded Billings about his lengthy list of honorary degrees. Billings replied “There is one thing I value far more than these … the friendships which I have been so happy as to gather on the way.”
And the esteemed physician S. Weir Mitchell in the memoirs of the National Academy of Sciences, praised Billings for two things: his promethean career, and the compassionate care Billings gave to Mitchell’s brother, who died in hospital during the Civil War.
"James H. Cassedy spent more than 35 years as Historian in the History of Medicine Division of the National Library of Medicine ... where he was editor of the annual Bibliography of the History of Medicine. Among his many publications are ... Medicine & American Growth 1800-1860..."
"This account of his life and labors has been prepared as a memorial at the instance of his family and friends. While the records of his early life are meagre, the account given in his letters and notebooks of his experiences as a medical officer during the Civil War is, in some sort, a contribution to history. For, as the late Dr. Weir Mitchell once observed, no adequate record of the actual details of an army surgeons daily life during that period has been published to date."
"Reprint of the first edition, one of the Rosenbach lectures in Bibliography. Three talks; The Beginnings, the 17th and 18th Centuries and Medical Subject Indices...reproducing title pages of important medical bibliographies. With the bookplate and pencil signature of Gavin Bridson. "