Civil War’s record deaths led to major advances in public health

Pennsylvania is marking the Civil War Sesquicentennial (150th anniversary) with special events at Gettysburg and other locations throughout the state and in Philadelphia. America's bloodiest conflict, of course, led to  more deaths from disease than on the battlefield for both Union and Confederate fighters. These deaths spoke volumes about what public health and medical personnel, as well as ordinary citizens, did not know about the prevention of disease and the treatment of battlefield wounds.  Indeed, the brutality of that war stimulated two advances in public health that remain with us: the United States Sanitary Commission and the National Library of Medicine.

The U. S. Sanitary Commission was a civilian relief organization created by federal legislation to support sick and wounded Union soldiers. Founded by women, who raised money through "Sanitary Fairs" and worked as volunteers and nurses, it was the forerunner of the American Red Cross. The history of the Sanitary Commission is deservedly well chronicled, as are the stories of the luminaries who volunteered with this effort, among them the author Louisa May Alcott.

The second, less well-known but longer-lived public heath legacy of the Civil War was the expansion of the library of the Office of the Surgeon General of the Army -- the forerunner of today's National Library of Medicine.  Under the leadership of Col. John Shaw Billings, an Army surgeon who assumed the post in 1865, the library grew from a small collection of books to an enterprise that today provides materials to researchers and clinicians throughout the world.  Built to ensure that the medical knowledge needed to stem deaths in the military would always be accessible, the library became an institution of international prominence and a vital global resource.

Research gathered from peer-reviewed publications produced by experts from around the globe is the starting point for public health investigations today.  It is where questions are posed and answered and where answers are revisited and questioned again so that new knowledge is created and new clinical applications and preventive measures can be applied.  Today, anyone with a computer and a web connection can find earlier studies and investigations thanks to Billings' development of the Surgeon General's Library.

An organizer and systematizer – in the 21^st century he would probably be a Silicon Valley start up entrepreneur – Billings was a physician, librarian, bibliographer, statistician, educator, hospital planner, and sanitarian. After leaving the Surgeon General's office, he served as professor of hygiene at the University of Pennsylvania, and later as director of the New York Public Library.  He worked on the U.S. Census from 1880 to 1910, helping to develop some of its advanced data collection programs. When we call public health work "data-driven" – based on evidence collected by rigorous study -- we must credit Billings. In 1864, the Library of the Surgeon General of the United States Army held 2,100 books; today the National Library of Medicine is the world's largest medical library, with 2,000 to 4,000 references added daily, Tuesday through Saturday, according to the latest fact sheets.

Billings had medical resources from around the world catalogued and indexed in a publication titled The Index-Catalogue of the Library of the Surgeon-General's Office.   It appeared in five series and sixty-one printed volumes between 1880 and 1961.  Beginning in 1879, the Library published Index Medicus , an index of articles published in scientific medical journals.  In 1996, Pubmed -- the online successor to the indexes created by Billings -- began providing access to MEDLINE®,  the online database of articles published in 5,600 current biomedical journals from the U.S. and 80 foreign countries. (For user-friendly information diseases and conditions, go to Medline PLUS.

The National Library of Medicine is physically located on the campus of the National Institutes of Health, in Bethesda, Md., where it is open to the public. If you want to honor the Civil War's 150th anniversary without visiting a human battlefield, head there -- and see where the battle against disease begins.

Janet Golden, a Rutgers University history professor, specializes in the histories of medicine, childhood and women.

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