John Jones, M.D.: Pioneer, Patriot, and Founder of American Surgery

Abstract

John Jones was a pioneer of American Surgery. Born in Long Island, New York in 1729, he received his medical degree in France from the University of Rheims. He returned to the colonies and helped to establish the medical school that would later become Columbia University’s College of Physicians and Surgeons where he was appointed the first Professor of Surgery in the New World. He used his position to assert that surgeons trained in America should be familiar with all facets of medicine and not be mere technicians. Before the outbreak of the American Revolution, he wrote a surgical field manual, which was the first medical text published in America. A believer in the principles of the American Revolution, he would go on to count Benjamin Franklin and George Washington as his patients. Despite achieving many firsts in American medicine, his influence on surgical training is his most enduring legacy.

Introduction

Because this Festschrift honors Dr. Eric Rose, Valentine Mott, and Johnson and Johnson Professor and Chairman of Surgery at Columbia University College of Physicians and Surgeons, it is appropriate to briefly remember the first Professor and Chairman of Surgery at this institution. Honoring Dr. Rose’s interest in resident education, this tribute is written by two generations of surgeons with the lead author being a new Chief Resident (ADG), and the other authors either former Residency Program Directors (KAF and MAH) or Associate Director (WDW), all very much indebted to Dr. Rose’s educational leadership of the Department.

Master surgeon and patriot, the man with the unassuming name of John Jones will be remembered for his technical prowess, devotion to the cause of American Independence, and many firsts in American surgery. Most importantly, as the first professor of surgery at an American medical school, he was instrumental in shaping the face of surgical training in the young United States of America. Although he was one of the few physicians in the New World who had received formal medical education in Europe, he discarded much of the dogma of the Old World and forged a new vision for the American Surgeon.

Youth and surgical training

For John Jones, medicine was a family affair. His grandfather was a Welsh physician who immigrated to Pennsylvania in 1682 [1]. Jones’ father practiced medicine in New York, where John Jones was born in Long Island in 1729 [2]. He received his early education at a private school in New York. When, at the age of 18 he decided to study medicine [3], formal medical education was unavailable in the Colonies and the training of physicians was accomplished through the apprentice system. Normally, adolescent youngsters entered apprenticeships for a period of 5–7 years, at a cost of approximately $100 per year. The duties included being the master’s house boy, messenger boy, stable boy, and apothecary. In return, the apprentice had the use of the master’s medical library, teaching, and moral guidance. John Jones’ master was his own cousin, Thomas Cadwalader of Philadelphia. Cadwalader, born a Quaker, was himself a former apprentice of John Jones’ father, Evan, and had traveled to Europe after his apprenticeship to complete his formal medical education.

Although apprenticed under Cadwalader for only 3 years, Jones later wrote that, “both in physic and morals [I received] the best and earliest lessons of my life” [4]. Jones then followed in the footsteps of his master by completing his education in Europe. In England, Jones met several famous physicians, including the elderly Cheselden and attended the lectures of William Hunter, the older brother of John. At St. Bartholomew’s hospital, he was befriended by Dr. Percivall Pott, with whom he maintained correspondence for many years [5].

Continuing to follow in his master’s footsteps, Jones went to France where he enrolled in the medical faculty of the University of Rheims and earned the degree of Doctor of Medicine in 1751. His thesis, Observations on Wounds, would later be expanded by him and become the first medical book published in America. After obtaining his M.D. degree, Jones went on a whirlwind medical sightseeing tour. He visited Rouen and met the famous lithotomist Claude Nicholas Le Cat [6] and then went to the Hôtel Dieu in Paris where he met Jean-Louis Petit and Henri Francoise [6]. Of this experience he was to write,

It is impossible for a man of any humanity to walk through the long wards of this crowded hospital, without a mixture of horror and commiseration, at the sad spectacle of misery which presents itself: The beds are placed in triple rows, with four and six patients in each bed; and I have more than once in the morning rounds found the dead lying with the living; for, notwithstanding the great assiduity and tenderness of the nurses, some of whom are women of family, who take the veil and piously devote themselves to that office yet it is almost impossible, from the vast number of patients, to bestow timely assistance upon every individual [5].

The memories of this experience would heavily influence Jones when he later helped to develop the plans for the New York Hospital. The tour continued on to Leyden where he met Boerhaave’s successor, Siegfried Albinus [5], and finally to Edinburgh where he encountered John Gregory, who espoused the traditional division between physicians and surgeons, which Jones was to reject upon returning to the Colonies. Jones’ pupil and future biographer, Dr. James Mease, recorded his impression of Jones’ experience in Europe.

Under masters like these, and enjoying such opportunities, he could not fail, with the assiduity which he employed, of acquiring all the knowledge of that time to be obtained: in consequence of the zeal which he showed in the acquisition of every species of useful knowledge, he attracted the notice of the above celebrated surgeons, which was of essential benefit to him, in the prosecution of his studies; to [Dr.] Pott, in particular he considered himself under peculiar obligations, for the marks of friendship he experienced from him and which could not fail to inspire him with a love of his profession.

During the prosecution of his studies in Europe, Dr. Jones was industrious in collection of all the useful information in his power, especially upon those branches of science more immediately connected with his profession. To anatomy, as the hand-maid of surgery, and the basis of medical science, he paid the greatest attention, but he did not suffer this to engross the whole of his time: convinced of the intimate connection between the different branches of the profession, he considered the separation of them, not only as contrary to nature, but as highly detrimental to the progress of the science; and therefore believed that a knowledge of one part was indispensably requisite to a right understanding of the other [2].

Laying the foundation for American surgery: the first American professor of surgery and the New York Hospital

Jones returned to the colonies and set up a practice in New York City. He was an associate of John Bard, M.D., and, applying what he learned from Europe’s famous lithotomists, he was the first person to perform lithotomy in America [5]. He could perform the operation in slightly more than a minute, a testament to his technical prowess [6]. In 1755, his surgical practice was interrupted by the French and Indian War. Jones volunteered for the New York Militia, which was sent north to protect Fort Edward from invasion by the French forces. During the fighting, the French commander, Baron d’Escoux was wounded four times. As a result of Jones’ burgeoning reputation, the Baron requested to be placed under Jones’ care. Three of the wounds healed well, and the fourth, a wound to the bladder, resulted in a vesicular fistula [5, 6]. The successful management of this prominent patient helped to cement Jones’ place as one of the preeminent surgeons of his day.

Returning to New York, Jones rejoined the prominent New York physician John Bard and later his son, Samuel [7]. After Samuel completed his medical education in England, facilitated by letters of introduction from Jones, the two physicians combined to initiate the formation of the medical school that would later become Columbia University’s College of Physicians and Surgeons. On August 4, 1767, Jones, Samuel Bard, Samuel Clossy, Peter Middleton, and James Smith petitioned the Board of Governors of King’s College (renamed Columbia College after the Revolutionary War) to establish a medical school in New York. The Board responded promptly and favorably, King George III agreed to grant the charter, and in November 1767, the school first opened its doors. Jones was named Professor and Chair of Surgery—the first man to hold that title in the American Colonies.

He gave his inaugural lecture on November 4th, in which he outlined his vision for the American Surgeon. Fortunately, a copy of this lecture has been preserved in the Library of the College of Physicians of Philadelphia: “Hence it will be very evident, how necessary it is for the student in surgery to make himself thoroughly acquainted with all those branches of medicine, which are requisite to form, the most accomplished Physician; to which must be superadded some peculiar qualifications, to constitute the surgeon, of real merit and abilities.” These qualifications included: “He ought to have steady hands, and be able to use both alike…strong clear sight…and above all, a mind calm and intrepid, yet humane, and compassionate, avoiding every appearance of terror and cruelty to his patients, amidst the most severe operations” [5].

He concluded his remarks by assailing the prevailing sentiment in Europe that surgeons were, and should be, mere technicians.

To conclude, Gentlemen, if the science of surgery, then, requires genius, knowledge and indefatigable application to render its Professors truly respectable, what must we think of the insolence and malevolence of those who represent it as a low mechanical art, which may be taught a butchers boy in a fortnight—yet such false and absurd representations have been made of it, by some who have enjoy’d no small share of medical reputation in this country, and what is equally reproachful, there have been men who stil’d themselves gentlemen, ignorant and weak enough to credit such absurdities [2].

Jones continued to give a series of lectures at the new medical school until the outbreak of the American Revolution. During this time, he and Samuel Bard petitioned the King for a charter to form what would become the New York Hospital. The charter was granted in June 1771 [5], and Dr. Jones was appointed to the staff in 1774 [2]. Jones returned to Europe to raise funds and obtain supplies for the new hospital and to renew his friendship with Dr. Pott [7, 8]. His experience in Europe’s crowded hospitals still fresh in his mind, Dr. Jones was able to influence the design of the hospital to limit the number of beds in each ward to eight and to ensure proper ventilation of the building [2]. Unfortunately, the first structure burned down in 1775 and was not rebuilt until 1791, just before Jones’ death, so his practice did not benefit from the inauguration or design of the hospital [2].

First American surgical text

The other highly significant achievement that Jones accomplished before the outbreak of hostilities with England was to publish a book that would be of great importance to Colonial Revolutionary field surgeons. Dedicated to his former teacher Thomas Cadwalader, Jones’ Plain Concise Practical Remarks on the Treatment of Wounds and Fractures is considered to be the first medical book, the first surgical text, and the first American army manual published in the New World [5]. Jones stated in its dedication that, “If I cannot cure the fatal diseases of my unfortunate country, I can at least pour a little balm into her bleeding wounds”; we can surmise that Jones meant for his work to be used in the looming struggle for independence. Thus, the book was not an exhaustive surgical text but contained essays outlining the management of trauma and its complications and also contained an appendix on camp and military hospitals that drew extensively from the works of Sir John Pringle [7]. The text was reprinted in 1776, emphasizing the importance of the work, and was used extensively during the Revolutionary War [9]. “At the commencement of the Revolutionary War, we had one medical book by an American author, three reprints, and about twenty pamphlets,” Dr. John Shaw Billings wrote in 1876 [10]. John Jones was the American author, and the only medical book the fledgling American army used was written by him.

Service in the Revolutionary War and physician to the founders

The separation from England was a difficult time for the colonies, which had extensive ties with the mother country; this was true for Dr. Jones as well. He condemned the extreme radicals, who attempted to boycott citizens who did not sign a general association to execute the actions of the Continental Congress. However, Jones was a Whig and seemed to wish actively for independence. In a letter of June 20, 1775, he expressed this sentiment, “I hear Coll Washington is appointed Commander of the American Army, and I sincerely wish he was already set out to direct their operations in Boston” [9]. However, like many colonists, Jones did not rule out reconciliation with England if proper concessions could be made. Regarding the anticipated arrival of a Royal commission to the Continental Congress, he wrote,

[I]f they come quickly, to offer you something like a chart blanche, perhaps we may have peace upon the footing of reconciliation, otherwise, from the rising spirit and temper of the people, I presume you will have under necessity of declaring yourselves the High and Mighty States of the Thirteen United colonies and hast to your arms for the support of your titles [9].

After the capture of New York City by English troops in 1776, Jones was forced to actively take a side in the growing conflict. Despite the fact that, with only one other exception, the rest of King’s College medical faculty were Tories and remained in New York, Jones left for Albany [8]. There, he enlisted in the Continental Army as an Assistant Surgeon for the Tenth Massachusetts Regiment and was promoted to Surgeon of that Regiment in 1777 [2]. Jones also was active in Revolutionary politics and was a member of the First Session of the New York Senate. Due to poor health and worsening asthma, Jones was forced to leave Albany for the recently liberated city of Philadelphia. He continued in the service of the Continental Army there until 1781, when he resigned his commission [2] and started to practice medicine in Philadelphia. He also achieved great success in this city, being appointed at the Pennsylvania Hospital and elected Vice President of the College of Physicians of Philadelphia.

Due to his fame and service to his country, Dr. Jones acquired some famous patients at this time, notably Benjamin Franklin and George Washington. Jones was the physician who was called to attend Mr. Franklin during his final days. Jones’ account of these events was published in the Pennsylvania Gazette:

About sixteen days before his death, he was seized with a feverish indisposition, without any particular symptoms attending it til the third or fourth day, when he complained of a pain in his left breast….he continued till five days before his death, when his pain and difficulty of breathing entirely left him….- when an imposthumation, which had formed itself in his lungs, suddenly burst, and discharged a great quantity of matter, which he continued to throw up while he had sufficient strength to do it, but as that failed, the organs of respiration became gradually oppressed—a calm lethargic state succeeded—and on the 17th instant, about eleven o’clock at night, he quietly expired, closing a long and useful life of eighty-four years and three months [3].

As a sign of appreciation for his medical services, John Jones was mentioned in Franklin’s will: “I give twenty guineas to my good friend and physician, Dr. John Jones” [11].

In 1790, President George Washington contracted pneumonia. The disease grew so severe that Thomas Jefferson wrote, “We have been very near losing the President” [12]. Jones’ former colleague, Dr. Samuel Bard was attending to the President at that time. Due to the seriousness of the situation, Dr. Bard asked his old friend to assist in the treatment of the illness. Thus, Jones came to be involved in the medical care of another of our country’s Founding Fathers. Somewhat ironically, it was during a professional visit to George Washington, on the evening of June 17, 1791 that John Jones contracted his own fatal illness. That night, the temperature rapidly cooled during Jones’ trip home and the next day he awoke with fever, diarrhea, and fatigue [2]. The illness compounded his long struggle with asthma, and Dr. John Jones passed away in his sleep on June 23, 1791 [2]. He was buried in the Arch Street burial ground, but all traces of the site were erased during the yellow fever epidemic in 1795 because the cemetery was used for mass burials. Dr. Benjamin Rush marked the passing of the father of American surgery by writing in his diary, “This day died Dr. John Jones…aged 57…He was much lamented by his friends and patients, as well as by his brother physicians. His manners were gentle and amiable, and his conduct truly liberal in his profession. He was without a rival in surgery in the United States. His education was extensive, and he spoke agreeably upon all subjects. He lived and died a batchelor” [9].

Significance

John Jones rose to prominence at a turning point in the history of the United States. It also was a critical period for the history of American surgery, because training was becoming formalized through the founding of the first medical schools in the colonies. Due to his independent spirit, Jones established the model for the American surgeon that was vastly different from the model set forth by the leading lights of European medicine. His inaugural lecture to the medical school class established that surgical training in America would not create mere technicians, but instead knowledgeable physicians with the additional ability to perform complex operations. This philosophy put into practice, more than Jones’ other major contributions, the creation of a medical school, the first publication of a medical text in the colonies, or the ministering to our Founding Fathers, is his legacy.