By the early 1890s, it was clear that European and American surgery had been more influenced by advances in medical science than any other field of 19th-century medicine. The discovery of useful anesthetics and the development of methods for preventing wound infections revolutionized surgery and transformed it. Surgery had rapidly transformed from a primitive and dangerous art and craft into a respected and effective specialty in the 19th century. In the final period of the history of surgery in the 19th century, American surgery finally achieved its place as an independent medical specialty separate from other disciplines. With the beginning of William Halsted's work at Johns Hopkins Hospital in Baltimore in May 1889, the last period of surgical evolution also began. Halsted, like many young American specialists, traveled to major cities in Germany after the Civil War to continue and complete his education. By the 1870s, France had lost its pre-eminence in medical education among European centers, and American specialists were returning to their country, learning the German educational tradition. The founding of the Johns Hopkins Hospital and its affiliated medical school (1893) marked the beginning of a new era in American medicine, in which American surgery entered the twentieth century under the guidance and leadership of individuals who would secure its true place in the history of world surgery. John Shaw Billings (1838–1913), who founded the Surgeons' Public Library and compiled its index (1880), was president of the New York Public Library for 17 years. The index became the forerunner of the Index Medicus. Billings summarized the state of American surgery in 1893 as follows. The most important advances in the field of medicine in the United States have occurred primarily in surgery and its many branches. We have made the ligation of some of the great arteries, the removal of intra-abdominal tumors, the treatment of diseases and injuries peculiar to women, the treatment of spinal disorders and various kinds of deformities. Above all, we were the first to demonstrate the use of anesthetics, which was the most important medical advance of the present century. During the last war we showed the Europeans how to build, organize, and manage military field hospitals. We have founded the finest museum in existence on modern military medicine and surgery. We have made a great and valuable contribution to the preparation of written medical sources, and our government possesses the largest and best medical library in the world.