The Classic

Abstract

E. A. Codman (1869–1940) was Boston born and bred: Harvard College, Harvard Medical School, and the Massachusetts General Hospital. This is hardly the background one would expect of a medical Don Quixote who spent his life tilting at professional windmills and fighting to advance his ideas, most of which were ahead of his time. Graduating in the same year that Rontgen discovered roentgenograms (1895), he was caught up in the enthusiasm surrounding their introduction into medical practice. As early as 1896, he was making routine and contrast roentgenographic studies of bones and joints. In 1905 he submitted an essay, “The Use of the X-ray in the Diagnosis of Bone Diseases,” for the Gross Prize. It was passed over, the prize being awarded to a paper on the value of carotid artery ligation in the treatment of malignant tumors of the face. From this seminal work came the early roentgenographic characterization of malignant bone tumors (Codman's triangle), his involvement with the Bone Tumor Registry of the American College of Surgeons, and his description of what is now called chondroblastoma of the proximal humerus (Codman's tumor). As a third-year medical student, he traveled abroad, visiting medical clinics. In Vienna he learned for the first time about the subacromial bursa and its bursitis. His interest piqued, he pursued the subject exhaustively, attracting attention to this condition and eventually publishing a book about the shoulder (Codman's exercises). It is this privately printed book, distributed to his friends, that contains the autobiographical preface revealing the nature and charm of this unusual man. It was his effort to evaluate the long-term results of surgical treatment, his “End Result Idea,” that engendered the greatest opposition from his colleagues and led to his resignation from the staff of the Massachusetts General Hospital in 1914. His idea was taken up by the Committee on Hospital Standardization and the Society of Clinical Surgery and involved im as a founding member of the American College of Surgeons. Perhaps I have sacrificed my success as a distinguished surgeon to these pursuits [hunting and fishing]. I have loved them better than teaching dozing medical students, the pride of amphitheater dexterity, or the hushed dignity of the consultant at the bedside of important persons. On many a bright October day I have been glad that my talents as a teacher were not in demand. In the spring when I dig up the first worm in my garden, I say with Hambone: ‘That old red worm he look up in my face and say, Whar yo’ fishing pole?‘ Then I get my reward for not being an overworked Chief of the Surgical Service. In summer as I drift about on some out-of-way pond in my portable boat, watching the cotton wool in the clouds, and momentarily expecting a strike from a ’big one,‘ I am grateful I am not in demand at the bankers' bedsides.’ (From Codman, E. A.: The Shoulder. Boston, Thomas Todd, 1934.)