Howard W. Jones Jr., a physician who pushed the boundaries of gynecologic surgery, opened the first sex-change clinic in a US hospital and helped achieve the first birth through in vitro fertilization in the United States, died on Friday in Norfolk, Va. He was 104.
His family confirmed his death, of respiratory failure. Dr. Jones, who remained productive into his centenarian years, publishing his final book last fall, died at Sentara Heart Hospital, on the same medical grounds as the hospital in which the historic birth had occurred.
His success in fertilizing a woman’s egg outside the womb, after 41 tries, was achieved alongside his wife, Dr. Georgeanna Jones, one of the nation’s first reproductive endocrinologists. Working together at the Eastern Virginia Medical School in Norfolk, they accomplished the feat when Judith Carr gave birth to Elizabeth Carr, America’s first “test-tube baby,” by cesarean section at 7:46 a.m. on Dec. 28, 1981, at what is now Sentara Norfolk General Hospital.
The birth came two days before Dr. Jones’s 71st birthday and three years after Dr. Robert G. Edwards and a colleague had opened a new era in medicine with the birth, in England, of the world’s first baby conceived through in vitro fertilization, Louise Brown. That achievement, for which Edwards was awarded a Nobel Prize in 2010, enabled millions of infertile couples to bring children into the world and women to have babies even in menopause.
In the United States, baby Elizabeth’s birth helped launch the fertility business. Infertile couples from all over the world flocked to get treatment at a facility the Joneses founded at Eastern Virginia in 1979, the Jones Institute for Reproductive Medicine. Doctors came to train there. The couple had a long professional partnership that was so close, they shared a desk. They were the only US gynecologists invited to the Vatican in 1984 to advise Pope John Paul II about reproductive technology.
Dr. Jones and his wife had joined Eastern Virginia together, accepting positions soon after he retired from Johns Hopkins University in Baltimore at 65, its mandatory retirement age.
Dr. Alan DeCherney, director of reproductive and adult endocrinology at the National Institute of Child Health and Human Development in Bethesda, Md., said that after retiring, Dr. Jones had “reinvented himself” to become “a world leader in in vitro fertilization and fertility problems, almost equivalent to Edwards.”
At Johns Hopkins, Dr. Jones pioneered gynecologic surgery, particularly in operating on babies with ambiguous genitalia — without the typical appearance of either a boy or girl. In 1965, he helped found the Johns Hopkins Gender Identity Clinic, the first sex-change clinic in a US hospital. While at Johns Hopkins, one of his most notable patients was Henrietta Lacks, a black woman whose extracted cancer cells contributed to medical breakthroughs but who contended that they had been removed from her, by other doctors, without her permission.
He continued to write almost until his death. At 102, he self-published the book “Personhood Revisited: Reproductive Technologies, Bioethics, Religion and the Law,” an exploration of the legal and ethical implications of fertility treatments and a critique of legislative efforts to define the union of a sperm and egg as a person — a formulation he did not accept. Dr. Jones would have shopped for a publisher, he said, but he feared that at his age he might have run out of time. He had said the same thing when he was 94, when he self-published “War and Love: A Surgeon’s Memoir of Battlefield Medicine With Letters to and From Home.” The book is a collection of love letters exchanged by him and his wife when he served overseas as chief of an Army mobile surgical team.
His last book, “In Vitro Fertilization Comes to America: Memoir of a Medical Breakthrough,” was published in October by Jamestowne Bookworks.
Dr. Jones met Georgeanna Seegar when they were students. But he had encountered her father, Dr. J. King Seegar, much earlier, on Dec. 30, 1910, at the Jones’s family home in Baltimore. Seegar had been called there to deliver Howard Wilbur Jones into the world.
Howard Sr. was also physician, and as a child Howard Jr. would go on house calls with him in their horse and buggy.
His father died when Howard was 13, and his mother’s identical twin sister moved in to help raise him. (His mother’s name was Ethyl Ruth; her twin, Ruth Ethyl.) Howard Jr. attended the Friends School in Baltimore and Amherst College in Massachusetts, where he took an English course with the poet Robert Frost before graduating cum laude in 1931.
He was a first-year medical student at Johns Hopkins when he connected with his future wife at a lecture in 1932. She was a senior nearby at Goucher College.
After she also went on to Johns Hopkins Medical School, to focus on endocrinology, then a new specialty, Dr. Jones sought her out and began studying with her. They were married on June 22, 1940.
Dr. Jones started his career at Johns Hopkins, initially working part time while also working in the private clinic of the gynecologist Dr. Howard Kelly, who had pioneered radium therapy for cancer patients. Kelly was one of the so-called Big Four who had founded Johns Hopkins Hospital. In the 1950s, Dr. Jones collaborated on landmark studies with Dr. Richard Wesley TeLinde, proving that cervical cancer in situ — in which tumors have not invaded the cervix’s surface — was more dangerous than previously thought. They found that the tumors become deadly invasive cancers if left untreated.
Dr. Jones encountered Henrietta Lacks in 1951. The 30-year-old wife of a Baltimore steelworker, she showed up at Johns Hopkins Hospital — the only one near her that would treat blacks — complaining of a “knot” in her abdomen. Dr. Jones discovered a lump in her cervix and performed a biopsy, which led to a cancer diagnosis. Cancerous cervix cells that were subsequently removed from Lacks were the first to grow in culture.
The continued use of Lacks’s “immortal” cancer cell line, as biologists call it, led to breakthroughs in research on the polio vaccine, chemotherapy, cloning, gene mapping, and in vitro fertilization. She died later, in 1951.
In her best-selling 2010 book, “The Immortal Life of Henrietta Lacks,” Rebecca Skloot contended that the cancerous cells had been removed from Lacks without the patient’s knowledge. (Oprah Winfrey’s production company has said it is adapting the book for an HBO film.) Dr. Jones, who did not perform the biopsy that yielded the immortal cells, maintained that Lacks had signed the permit “that all patients signed that was inclusive of doing everything we did.”
“There was no controversy,” he said. “That was something that was created later on.”
Dr. Jones began studying genital anomalies in the 1950s and became an authority in the field, collaborating with Dr. William Wallace Scott in writing the textbook “Hermaphroditism, Genital Anomalies and Related Endocrine Disorders,” published in 1958. He then began focusing on intersex teenagers, whose sexual anatomy does not fit typical definitions of female or male.
He began studying the chromosomes involved in the phenomenon at a lab he had started at Johns Hopkins. His clinical team of surgeons, endocrinologists and psychologists began treating patients with genital abnormalities from around the world.
The thinking at the time was that before the age of 18 months, children who underwent sex-change surgery would adapt psychologically to the sex in which they were reared. In other words, a baby could be switched from a boy to a girl or vice versa as long as the surgery was done early enough and the parents raised the child with, for example, gender-appropriate clothes and toys.
Among Dr. Jones’s patients was David Reimer, a newborn who was badly maimed during a botched circumcision. Following the parents’ wishes, Dr. Jones removed the remnants of the boy’s genitals and created a vagina. David was later given estrogen during puberty to promote secondary female sex changes. (David’s story was told in John Colapinto’s best-selling book “As Nature Made Him: The Boy Who Was Raised as a Girl,” which portrayed the child as always feeling like a boy despite having a girl’s name, clothes, and toys.)
Today, some doctors in the field — now called disorders of sex development, or DSD — and many advocates for intersexual individuals oppose sex-change surgery on infants as well as surgery to correct ambiguous genitalia, in which the parents choose one sex or the other. The opponents believe that the patient should be given the choice at a later age.
Dr. Jones bridled at being criticized, long after the fact, for performing such surgery. “You are doing what the conventional wisdom around that time said to do,” he said. “Which doesn’t mean if the situation arose today you would necessarily do the same thing.”
After learning about Christine Jorgensen, an American who became widely known for having a male-to-female sex change operation in Denmark in 1951, Dr. Jones said that if the Europeans can do it, he could, too. He helped found the Johns Hopkins Gender Identity Clinic in 1965.
“There was a lot of discussion of the appropriateness of doing it — if it would really solve the problem” of a person’s feeling uncomfortable as a man or woman and wanting to change, he said. But the questions about sex-change surgery were not moral or psychological ones, he said — “not what reaction it would have with the general public but, from a medical point of view, if it would really be helpful.”
“We said we had to find out,” he said.
Dr. Jones, who lived in Portsmouth, Va., across the Elizabeth River from Norfolk, is survived by his two sons, Howard III, who is chairman of obstetrics and gynecology at Vanderbilt University in Nashville, and Lawrence, a Denver financial adviser; a daughter, Georgeanna Jones Klingensmith, a professor of pediatrics and a former director of the Barbara Davis Diabetes Center for Childhood Diabetes at the University of Colorado, Denver; seven grandchildren, and 14 great-grandchildren.
Georgeanna Jones died in 2005.
Well into his last years Dr. Jones continued to go to his office at the Jones Institute to read and write and to attend lectures, though he stopped working with patients in the early 1990s, when his wife contracted Alzheimer’s disease.
“When she stopped seeing patients, I decided to stop, too,” he said. “Without her, it wasn’t fun anymore.”