The 16th Historical Clinicopathological Conference

John Paul Jones 

This patient is credited with having given the U.S. Navy “its earliest traditions of heroism and victory.” He was born in Kirkbean, Scotland, in July 1747, went to sea as an apprentice at the age of 13, and spent the next three decades “riding the whirlwind and directing the storm” of a life aboard sailing ships. As far as we know, he was in good health until age 26, when a severe fever sent him to bed for 16 days and left him “much reduced.” He recovered, and except for psychological highs and lows bordering on manic-depressive disorder, which troubled him throughout his life, seems to again have been well for seven years.

At age 33, after many months at sea, the patient complained of eyes so sore he was almost blind and for a time so incapacitated he was unable to visit friends on shore. His behavior then was “Qweeg-like, suspicious and slightly dotty,” and though only in his 30s, he felt like an old man. Three years later, during service in the West Indies, a severe attack of “tropical fever” caused him to travel to a Moravian sanatorium in Bethlehem, Pennsylvania, for “cold bath” treatments, which seem to have cured him. He had had similar illnesses previously. However, nothing more is known of their character or treatment or at what ages they occurred.

At age 41, the patient developed “bronchial problems” during a grueling overland trip from Hamburg to Copenhagen under extremely cold conditions in an open carriage. From Copenhagen, he traveled to St.

Petersburg through ice floes in a small open boat to take command of a Russian fleet, arriving exhausted, sick, and depressed. The illness lingered on for months. Although its specific characteristics are unknown, it is believed to have involved the lungs, in that afterwards, the patient had a persistent “hacking cough” and “gray visage.”

Not much is known of the patient’s family history. His father worked as a landscaper, his mother as a housekeeper. He had an older brother (a tailor) who died at age 36 of unknown cause. Two sisters survived him. Nothing is known of their medical histories.

At the height of his career, the patient was one of America’s most celebrated naval commanders. Although an aggressive captain of military vessels, he was never wounded in battle. He was well-proportioned, though small of stature (5’5″), with a handsome face, soft voice, easy, polite manner and a fertile mind. He never married and had no known offspring. His social life consisted of a tangle of love affairs involving myriad women ranging from prostitutes to grand dames. He avoided hard spirits but “in good weather” would drink three glasses of wine after dinner.

Shortly before his 45th birthday the patient’s physical decline accelerated with mounting anorexia, yellowing of his skin, and swelling of his legs and abdomen. He coughed constantly, producing much mucus and complaining of difficulty breathing. He died alone in his room two weeks after his 45th birthday, face down on his bed with feet on the floor. The cause of death listed on his burial certificate was “dropsy of the chest.”

His body was pickled in alcohol, placed in a lead-lined coffin and interred in a Protestant cemetery at the outskirts of Paris. An autopsy performed 113 years later showed only a “spot” in the left lung consistent with healed bronchopneumonia (devoid of tubercle bacilli) and shrunken kidneys, which on microscopic examination contained numerous fibrotic glomeruli and thickened arterioles. The heart, liver, spleen and gall bladder were normal.

Matthew R. Weir, MD

Lori Lyn Bogle, PhD