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But First There Was Billings

The intellectual architect of Hopkins Hospital was John Shaw Billings, battlefield surgeon in the Civil War, creator of a monumental bibliography of the world's medical literature, a pioneer in public hygiene and sanitation, an expert in hospital construction and management, and first director of the New York Public Library. It was this multi talented man who, virtually alone, designed the entire Hopkins Hospital and figured out how a medical school could operate within it. According to Frank Bradway Rogers, former director of the National Library of Medicine, which Billings transformed into the world's best medical library, "He had organizing genius and a passion for doing. Vision he had, managerial adroitness and a dogged and relentless power of will."

But if Billings was a man of prodigious achievements, he is, enigmatically, unknown and unsung. Billings (1838-1913) himself was an enigma, considered by some to be arrogant and abrasive, an obsessive, rather tactless man with a high-pitched, irritating voice and very few close friends. Others described him as simple, modest and unassuming, someone who never vaunted himself - a characterization probably too generous for a man who once tried, unsuccessfully, to persuade a British acquaintance to submit his name for membership in the Royal Society.

Whatever the case, few at Hopkins today even recognize Billings' name; he has never made his way into the popular Hospital folklore that keeps the memories of founding physicians Welch, Osler, Halsted and Kelly alive. In fact, in the early 1970s the centerpiece Administration Building was renamed after Billings, but the change has never stuck in everyday parlance. Nevertheless, it was a fitting memorial, for he laboriously laid out plans for the building in his Georgetown study in the late 1870s, after spending months in Europe studying hospital design.

As a battleground surgeon during the Civil War, Billings earned his reputation as an organizer by moving whole field hospitals, revising the Union Army's ambulance corps and keeping statistics on battle injury. He was appalled by the way wounded soldiers were typically treated.

"He decried the standard notion that if there was any injury to an extremity, you lopped it off," says his biographer, Carleton Chapman.

"There was complete ignorance that was responsible for much higher mortality than if the limb was left alone, and a startling lack of knowledge that, no matter how good your treatment, if you don't bother to feed the patient or give him enough milk to drink, he will probably die from other causes. Billings also maintained that fishing for a bullet in a battle wound might better not be done, that the surgeon introduced infection more often than not. He was a sensible man."

It was Billings the Hopkins Hospital trustees eventually turned to when considering ideas for construction, heating, ventilation and administration of the proposed Hospital. He came up with a plan, with which he admitted he wasn't really happy, and they sent him to Europe to get advice to improve it from administrators of the more respected European hospitals. Travel was the only pastime Billings ever indulged in as he was unhappily married and had no hobbies; he made 16 trips abroad in his lifetime. On this trip, Billings visited art galleries in his spare hours, after sounding out university professors and hospital experts, and his letters home were characteristically caustic, if witty. He found the Venuses dreadfully overfed and disdained the collected paintings of the martyrdom of St. Sebastian, which he said were the sort one finds in the bar rooms of country hotels in Indiana.

Billings not only roughed out a revised layout for the Hospital, including making sure it was prewired for electricity even before Hopkins generated its own electricity and long before power had been extended to the Hospital site, but he was the first to suggest a four-year medical school program, with no more than 25 students to a class. He favored stringent entrance requirements, tough tests that would eliminate wasting "time and labor on men not fitted to receive the kind of instruction which we propose to give."

He also advocated practical work in the Hospital. Billings was the man who pressed University President Daniel Coit Gilman to hire William Henry Welch, betting that the young pathologist would mature into a natural leader (see "Founding Four.") In fact, after Johns Hopkins himself, Billings is probably the single most critical player in giving shape to a novel idea for revolutionizing American medicine.

In a 10-page letter to the Hospital trustees, he urged this role for Hopkins:

"This hospital should advance our knowledge of the causes, symptoms and pathology of disease, and methods of treatment, so that its good work shall not be confined to the city of Baltimore or the state of Maryland, but shall in part consist in furnishing more knowledge of disease and more power to control it, for the benefit of the sick and afflicted of all countries of all future time."

The Hospital trustees asked Billings to take on the job of first Hospital superintendent, but having shepherded the Hospital from the drawing board to its opening 12 years later, Billings declined the offer, and his official connection with the Hospital ended in 1889.

Billings returned to the Surgeon General's office, from which he retired as lieutenant colonel in 1895. Then he oversaw the combination of the Tilden Trust and the Astor and Lenox Libraries into the New York Public Library, and served as its first director until he died in 1913.

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