Robert Jones (surgeon)

Robert Jones
Born	28 June 1857 Rhyl, Wales
Died	14 January 1933 Llanfechain, Wales
Nationality	British
Fields	Orthopedic surgery
Known for	Jones fracture

Sir Robert Jones, 1st Baronet, KBE, CB (28 June 1857 – 14 January 1933) was a British orthopaedic surgeon who helped to establish the modern specialty of orthpaedic surgery in Britain.^[1] He was an early proponent of the use of radiography in orthopaedics, and described the eponymous Jones fracture.

Life and work

Robert Jones was born in Rhyl, North Wales, and was brought up in London. His father gave up his career as an architect to take up writing, so his family became quite poor. At the age of 16 he left London to live with his uncle, Hugh Owen Thomas, in Liverpool. He learned about fracture care and the manufacture of braces from his uncle, and attended the Liverpool School of Medicine from 1873 to 1878.^[2] He continued to work with his uncle, and was subsequently appointed Honorary Assistant Surgeon to the Stanley Hospital in Liverpool in 1887.^[3] At this time, Jones and his uncle were among the few surgeons interested in the treatment of fractures, while the majority of orthopaedic surgery was aimed at correcting deformity in children and was carried out by general surgeons.^[1] He received his FRCS in 1889.^[4]

Manchester Ship Canal

In 1888 he was appointed Surgeon-Superintendent for the construction of the Manchester Ship Canal, responsible for the injured among the 20,000 workers during the seven year project. He organised the first comprehensive accident service in the world, dividing the 36 mile site into 3 sections, and establishing a hospital and a string of first aid posts in each section. He staffed the hospitals with medical personnel trained in fracture management. The hospitals were linked by a railway which ran the length of the canal, and Sir Robert could be contacted in Liverpool by telegraphy if his presence was required.^[5] He personally managed 3,000 cases and performed 300 operations in his own hospital. This position enabled him to learn new techniques and improve the standard of fracture management.^[2]

On 3 November 1894, Robert Jones and Alfred Tubby convened a group of surgeons at the Holborn Restaurant in London to Found the British Orthopaedic Society. The society had 31 members, most of whom were still general surgeons with an interest in orthopaedics; this lack of committed orthopaedic surgeons is likely to have been the reason that the society disbanded after 4 years.^[1]

In 1913 Jones served as the President of the orthopaedic section of the International Medical Congress held in London. The subsequent congress was to be held in Munich three years later.^[4]

First World War

At the outbreak of the First World War Jones was mobilised as a Territorial Army surgeon. He observed that treatment of fractures both at the front and in hospitals at home was inadequate, and his efforts led to the introduction of military orthopaedic hospitals. He was appointed Inspector of Military Orthopaedics, with responsibility over 30,000 beds. The hospital in Ducane Road, Hammersmith became the model for both British and American military orthopaedic hospitals. His advocacy of the use of Thomas splint for the initial treatment of femoral fractures resulted in a dramatic reduction in morbidity and mortality from this injury.^[6] Jones was promoted several times for his war service, ending his military career as a major general.^[7]

Radiography

Wilhelm Röntgen announced the discovery of X-rays on 28 December 1895. This discovery was published in the Frankfurter Zeitung newspaper which was translated for Robert Jones by Mrs. Wimpfheimer, a volunteer in his Sunday clinic in Liverpool.

On 7 February 1896, Jones and Oliver Lodge took a radiograph of the wrist of a 12 year old boy to locate a bullet that could not be found by probing. The X-ray required a 2 hour exposure, but successfully demonstrated the bullet lodged in the third carpometacarpal joint. This case was published in The Lancet in February 1896,^[8] the first published clinical radiograph.^[1]

Jones continued to value the use of X-rays in his practice. In a paper published a few months before he died, he remarked:

Radiography here, as in all branches of medicine, is an essential aid to diagnosis. No matter how experienced we may be, we cannot afford to dispense with it, even in the apparently simple and obvious case. Not only should we insist upon procuring a film, but it is equally important that we should welcome the radiologist's reading of it. Some surgeons resent this and say, "Give me the film so that I can read it for myself," but this is an arrogant and stupid attitude, and not to the patient's advantage.^[9]

Jones died, aged 75, in Bodynfoel, nr. Llanfechain.

The Jones fracture

Robert Jones described the fracture of the fifth metatarsal which bears his name in the Annals of Surgery in 1902. In his paper, Jones describes the fracture in a series of 6 patients, the first of which was himself.^[10] He had injured his foot while dancing several months earlier, and had thought the injury to be to a tendon in the foot. He examined himself the day after the injury, and found that the tendon was intact, but he could not find definite evidence of bony injury. He asked a colleague, Dr. David Morgan, to X-ray his foot, and a fracture above the base of the fifth metatarsal was found. The finding of similar fractures in several patients after his own prompted him to write about it. He also noted that the fracture was not caused by direct trauma to the bone, as had always been written before, but by a cross-strain being applied to the bone.^[11]

Honours

Jones was the recipient of many honours from surgical institutions and societies at home and abroad and received honorary degrees from six universities, of which the D.Sc. from the University of Wales (1917) was one. The universal tribute to him as an orthopaedic surgeon was revealed by his election as first president of the International Society of Orthopaedic Surgery. He was made KBE, CB, and a baronet. After his death, his ashes were laid to rest in Liverpool Cathedral.^[7]

Harry Platt was among the orthopaedic surgeons to have been very influenced by the work of Jones.^[12]

References

Further reading

• F. Watson, The Life of Sir Robert Jones, 1934 (London, 1934)
• A. Rocyn Jones in Proceedings of the Royal Society of Medicine, 1907 ff, 1937