Surgeons appointed by Spanish royalty contributed to development of oldest U.S. city: St. Augustine, FL

Editor’s note: The American College of Surgeons History and Archives Committee (formerly the Surgical History Group) hosts an annual poster session at Clinical Congress. The following article is based on the second-place winner of the poster competition at Clinical Congress 2019 in San Francisco, CA. An article based on the first-place poster was published in the April issue of the Bulletin.

Surgeons played an active role during 16th century conquistador explorations of Florida and the later development of a Spanish colony at St. Augustine, settled in 1565 and recognized today as the oldest continuously occupied European-established settlement in the continental U.S. However, limited access to health care was a significant barrier to cultivating the colony. Surgeons, both free and imprisoned, faced adversity and treated early settlers and soldiers using scarce supplies. As the colony grew, surgeons became community leaders, often enjoying royally appointed positions and open lines of communication with the Spanish crown.

Surgeons during conquistador expeditions

Juan Ponce de León (see Figure 1) is regarded as the first documented conquistador to explore the Florida coast in anticipation of establishing a Spanish colony. His first Florida voyage landed along the northeast peninsular coast near modern-day St. Augustine in 1513. That expedition explored Florida’s east coast, the Florida Keys, the Dry Tortugas, and parts of southwest Florida until a tropical squall sent their ships back to Puerto Rico.¹ The entourage returned to Florida’s Gulf Coast in 1521, the region where foul weather had abruptly halted their first voyage.² During that mission, Ponce de León unwittingly became the first documented surgical patient in the continental U.S.²

As soldiers unloaded supplies onto a remote island near what is now Fort Myers, they were ambushed by Calusa natives, a then-dominant tribe in Southwest Florida. Ponce de León suffered a penetrating arrow shot in a vulnerable area of the groin caught between two plates of armor. His mariners bolstered a respectable defense against Calusa archers and carried their commander to safety. The ship surgeon removed the arrow and controlled hemorrhage, but Ponce de León soon developed shock. Although unnamed in expedition documents, historians believe Gaspar López de Villalobos, a personal physician to Ponce de León on previous voyages, performed the procedure.³

Ponce de León’s condition worsened, and he ordered the fleet to retreat to Cuba. At the time, Havana was the nearest Spanish settlement where they could access medical supplies and possibly locate another surgeon. Ponce de León ultimately died from shock three days after arriving in Havana. Hemorrhagic shock is a possible cause of death, but he survived the initial procedure and retreat to Cuba.

Some historians have suggested his gradual deterioration may have been caused by a poison Calusa natives routinely applied to their arrow tips.⁴ They derived a toxic substance from the sap of the Manchineel tree, indigenous to the subtropical Everglades and the Caribbean.⁵ Cardiovascular, pulmonary, and neurologic sequelae from the toxin may have influenced his clinical course.⁶ It also is possible that Ponce de León developed bacteremia and died from septic shock, an all-too-common scenario more than 400 years before the discovery of antibiotics.

Ponce de León’s death in 1522 highlighted the challenges of New World conquest. Trauma, infectious disease, and a limited surgical workforce in the New World all plagued missions aimed at establishing a Florida colony. The remote peninsula remained wild, elusive, and unsettled for another 40 years, during which five more Spanish conquistadors attempted to settle in Florida. Hernando de Soto led the largest expedition from 1538 to 1542. The fleet landed near Tampa Bay and explored the Gulf Coast and southeast U.S. Many surgeons who arrived with the fleet likely disbanded along the harsh trek, setting up camp with native tribes, a common practice among those disaffected by conquistador brutality.

Surgeons are mentioned only a couple of times in more than 1,000 pages of narrative documents from the de Soto expedition;⁷ nonetheless, these few passages are telling. Soldiers disliked one ship surgeon who had falsely advertised his medical and surgical expertise; he later unravelled under pressure as a clinically incompetent imposter. The narrative elaborated: “There was not in the whole army more than one doctor, and he was not so skillful and diligent as was needed; on the contrary, he was stupid and practically useless.”⁸ The clinician described was little more than a Good Samaritan who had an interest in medicine, and may have spent some time lending a hand to an empiric practitioner. Spanish regulations on medical and surgical practice, though part of established law on the Iberian Peninsula, held little weight in the untamed frontier of Florida.⁹

De Soto narratives later described another scene in which a Spanish settler distrusted the expedition surgeon. The patient doubted the surgeon’s ability, noting his lack of dexterity and haphazard treatment for a penetrating knee injury. Displeased by the clinical services rendered, the patient remarked that he would never seek the surgeon’s expertise again, even if on his deathbed. Angry with the accusations, the unnamed surgeon replied that he would refuse treatment if the patient returned, even under life-threatening circumstances.⁸ It remains unclear whether both mentions of surgeons referenced the same person. These isolated journal entries likely were dramatized to some extent but provide insight into daily struggles conquistadors faced on a Florida expedition.

Sixty years after Columbus’s first voyage in 1492, health care delivery in the New World still had its challenges across the Caribbean, especially outside of royal colonies like Santo Domingo, Dominican Republic; San Juan, Puerto Rico; and Havana. Firsthand accounts of mass trauma, endemic disease, starvation, and lackluster medical care trickled back to the Spanish crown. In 1561, King Philip II decided that settling Florida was no longer worthwhile and suspended all plans for future conquistador expeditions.¹⁰

Without Spanish occupation, other European imperials began to express interest in colonizing the Florida peninsula. In June 1564, French fleets made remarkable progress along the unsettled northeastern coast of Florida under the leadership of René Laudonnière. His voyage led a group of French Protestants known as Huguenots to construct and populate a fort near modern-day Jacksonville. They christened the settlement as Fort Caroline, making the first fortified European settlement in the mainland U.S. a French colony.¹¹

French surgeons in Florida

An unnamed surgeon at Fort Caroline contributed to French efforts to settle Florida. He integrated with native Timucua shamans and encouraged the transfer of medical knowledge and technique (see Figure 2). One notable product of this exchange was the European acquisition of the medicinal sassafras plant. After the surgeon at Fort Caroline sent samples back to France, sassafras became popularized across Europe as a wonder drug. Spanish physician Nicolás Monardes’ 1565 monograph Historia Medicinal de las Cosas que se Traen de Nuestras Indias Occidentales (Medical Study of the Products Imported from our West Indian Possessions)—the first comprehensive European book about New World medicine—featured a 20-page discussion on sassafras. One excerpt explained that the French showed the Spanish its medicinal properties and acknowledged the French for treating ill Spanish colonists (see Figure 3).¹² Given the imperial rivalry between the Spanish and French, it was remarkable for a Spanish physician to credit the French with exchanging New World medical wisdom during this period. A separate letter in 1565 from a Fort Caroline settler confirmed that it was the surgeon who facilitated the sassafras exchange.¹³

Spanish forces led by Admiral Menéndez de Avilés massacred the French at Fort Caroline in August 1565. They spared some women, children, and the surgeon, who conveyed local medical knowledge as recognized by Monardes’s 1565 text. French surgeons, in more ways than one, proved their worth over the next 50 years in St. Augustine. Spanish ship surgeons passed through St. Augustine, but their presence was often transient and short-lived. No salary or benefits package was large enough to keep a Spanish physician stationed in the rural, dirt-road, tidal marshland of St. Augustine. Spaniards addressed their physician shortage in part by capturing French ship surgeons and holding them prisoners.

A severe storm in the winter of 1576 blew a French ship, Le Prince, ashore near Santa Elena, a Spanish post in South Carolina. Natives killed most of the crew and enslaved Frenchmen who remained. A total of 40 prisoners from the shipwreck lived and worked for the local tribe. In August 1579, Florida Gov. Pedro Menéndez Marqués issued a command that an army raid their village. Spanish forces kidnapped the native chieftain’s mother, wife, and sister, later releasing them in exchange for 16 French prisoners. Spanish authorities charged the French with piracy in Florida waters and proceeded to execute most of them. Governor Menéndez Marqués commanded they spare only a handful of French prisoners—one surgeon and three boys who could interpret native languages.¹⁴

The French surgeon was Jean de Le Compte (identified in Spanish letters as Juan de LeConte). Spanish authorities soon realized Le Compte possessed medical knowledge and sent him to St. Augustine. Upon his arrival in late 1579, Le Compte continued his prison sentence for a grueling seven years, in which he met the medical needs of Spanish and Timucua throughout the community. His good deeds led to a promotion to chief surgeon at the military fort in 1586, a position that came with a modest salary. Because St. Augustine began as a military town, most of his patients were soldiers at the fort. Over the course of his tenure as their surgeon leader, the colony grew and expanded his clinical responsibilities to a larger breadth of patients.¹⁵

Le Compte was the only permanent medical figure in Florida for more than two decades. After 23 years of service, he declared that he was “old and tired and cannot support himself.”¹⁶ He requested a return trip to Europe if the royal authorities were unwilling to negotiate for higher pay. Spanish authorities declined his highball request for a tenfold salary increase. Florida Gov. Gonzalo Méndez de Canço urged him to draft a formal address to the King of Spain regarding his salary and benefits as the only resident physician of the colony. As a testament of his faith and reliance upon his colony’s only permanent surgeon, Governor Méndez de Canço affixed a letter of recommendation to the surgeon’s appeal for a higher salary. The monarch acknowledged the appeal and returned an offer for two-and-a-half times Le Compte’s original salary.¹⁶

Le Compte’s service in St. Augustine was paradoxical. The Spanish were not French allies, but they needed to recruit a physician to their new colony. It speaks volumes that Spanish authorities needed to capture a surgeon and hold him as prisoner to keep a resident physician in St. Augustine. He ran his clinical practice with the support of assistant surgeons and apothecaries who were less skilled.

In an August 1583 letter, Governor Menéndez Marqués wrote to the Spanish crown, mentioning Le Compte as the Frenchman who is “a surgeon” and noting the lack of Spaniards of equal skill.¹⁷ Not only was their medical competence questionable, but they arrived and departed with each new breeze that brought ships through the mouth of the Matanzas River. The king wanted French prisoners like Le Compte sent to Spain, presumably for trial, but Governor Menéndez Marqués refused to relinquish Florida’s only surgeon. He believed that if Le Compte left St. Augustine, “he would be very much missed, and so I determined this time to leave him here.”¹⁷

Three unnamed French surgeons were discussed in letters during the latter half of the 16th century. The St. Augustine community relied on their training to meet the town’s health care needs as well as the demands of Spanish medical regulations, calling for a surgeon to be stationed at each Spanish military fort. On one later occasion in 1668, conflict between Gov. Francisco de la Guerra y de Vega and French surgeon Pedro Pique ultimately led to a pirate raid on St. Augustine. Pique fled on a ship sailing toward Havana that English pirates captured. Florida medical historian William Straight later wrote about the incident,¹⁶ in which the captured surgeon reportedly led the pirates back to St. Augustine and helped them gain entrance to the Matanzas River Inlet with confidential port code signals, thus facilitating a British raid on the Spanish town. Eighty civilians were killed, and the wood-frame hospital was burned to the ground.

Surgeons at the growing Florida colony

Clinical practice represented only one aspect of surgeon life in colonial Florida. Surgeons stationed in St. Augustine served primarily as general practitioners, but there were scattered reports of surgical procedures throughout the first Spanish period (1565–1763). Most surgical procedures on civilians were undocumented or only mentioned briefly on bills and receipts. Le Compte’s service at St. Augustine showed that he often reduced and immobilized fractures of the upper and lower limbs in addition to treating skull fractures. He also handled penetrating trauma from arrows, swords, and musket balls with some regularity.

Most detailed evidence for the scope of clinical surgery came through letters with Spanish authorities, in which surgeons at the royal hospital in St. Augustine reported their expert opinion to the crown on conditions of Spanish statesmen. Natives shot military leader Don Francisco Ponce de León during an uprising in 1705. Musket balls shattered his humerus and the standard of care warranted an amputation for the comminuted fracture. He died of hemorrhagic shock during the procedure, making it unclear whether traumatic axillobrachial arterial injury or uncontrolled surgical bleeding led to his death. In 1727, chief surgeon Juan Frisonou documented that his patient, Gov. Antonio de Benavides, developed an abscess that required an operation. Frisonou located the painful pocket of pus between his buttocks, near the lower level of the coccyx, and commented that it impaired the governor’s ability to urinate and empty his bowels. Frustrated by the lack of surgical instrumentation in St. Augustine, Frisonou recommended transporting the governor to Cuba. In Havana, chief physician and surgeon Carlos Del Ray drained the governor’s 7 cm perirectal abscess.¹⁶

On rare occasions, surgeons attracted negative attention to St. Augustine. As the colony grew, the problem became not the supply of surgeons but the need for well-trained surgeons who practiced responsibly. One chief garrison surgeon, Carlos Robson, was embroiled in a scandal during the 1680s. In a letter to royal authorities, colonial Gov. Juan Márquez Cabrera wrote, “Not only is he not a physician or a qualified surgeon, but also he is deprived of consciousness most of the time by being drunk.”¹⁸ Years later, concerns arose about another surgeon, and the governor wrote, “Although we have a great need for a physician, if there is not a competent one to be found, we will manage with the surgeon of the garrison who, were he not so taken by rum, is not bad, but everybody refrains from calling him.”¹⁶ Royal officials responded to the negligence by calling on the Hospitalliers de San Juan de Dios, a Catholic fraternal order devoted to providing health care in underserved areas that still exists today.¹⁹ Florida officials requested that three men come from Havana to staff the St. Augustine hospital, creating tension among local priests in St. Augustine who held privileges at the hospital as medico-friars. They protested the arrival of medical support from Cuba, but the crown ultimately overrode their petition and wrote an order for new hospital administrators.

The surgeon’s role in colonial Florida society has been best captured by the East Florida Papers,²⁰ a vast repository of colonial documents from the Second Spanish Period (1784–1821) compiled by the U.S. Library of Congress. Surgeons exchanged more than 100 letters with other surgeons, colonial Florida governors, and the Spanish crown. This correspondence speaks volumes, especially when considering the position of surgeons in Europe, who had less social status than physicians, training as apprentices and practicing their craft without a formal medical education.²¹ Another noteworthy characteristic was communication between French, Spanish, British, and American surgeons, many of whom practiced at the same St. Augustine Royal Hospital at one time or another. As a dominant Spanish colony, they communicated almost uniformly in Español Castellano—the King’s Spanish—despite their multinational heritage as a collective group.

The East Florida Papers, portions of which are still undergoing English translation and transcription, add clarity to Florida medical history and paint surgeons’ lives on a more personal level (see Figure 4). These documents show surgeons appointed and vetted by the Spanish monarchy, demonstrating the formality and permanence intended by granting privileges to practice at the Royal Hospital. Even into the early 19th century, royally appointed surgeons were required to petition the crown if they intended to resign from their position.²² They most commonly requested transfer to Havana, at that time a bustling port with more resources than St. Augustine. As government employees, they periodically wrote local governors to ask for house repairs.

Surgeons testified in court for their clinical expertise and as respected leaders in the community. One documented hearing in 1791 focused on banishing a patient with leprosy from St. Augustine.²³ Other ill patients periodically were sent to Havana, in anticipation that the sea breezes and higher elevation in Cuba would offer cleaner air, believed to be more suitable for recovery. Other letters described surgeons who were called on horseback to remote parts of Florida and coastal Georgia where they operated in the field.²⁴ Although surgeons were respected as a whole, some documents commented on the arrest and imprisonment of individual surgeons, one of whom needed to be extradited from “America” in 1818,²⁵ likely because he fled across the border to Georgia, then part of the newly formed U.S.

Altogether, the history of surgery in St. Augustine is rich and contrasts with existing papers that focus on medical developments in the British colonies, including Jamestown and Plymouth in 1607 and 1620, respectively. The royally appointed surgeons of St. Augustine made significant contributions to the establishment of clinical practice in the New World, and their impact is more than a footnote in this nation’s medical history.

References

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