Because surgery sometimes requires on-the-spot innovation, as well as continual review and improvement of technique, the specialty tends to attract a certain type of tinkerer—one who enjoys taking a hands-on approach to solving a problem.
Ernest Amory Codman, Class of 1895, surgeon and innovator, exhibited this tendency in a big way. An early interest in bones and in the promise of X-rays to treat their diseases led to his forming, with physicians James Ewing and Joseph Bloodgood, a bone sarcoma registry. Codman hoped the registry would provide not only statistical data but also yield insights into tumor behavior and treatment options.
Through a letter mailed to members of the American College of Surgeons in 1920 and published in the Boston Medical and Surgical Journal in 1922, Codman asked readers to send him case summaries of living patients who had undergone surgery for bone sarcoma. Codman eventually received nearly 200 responses to his request.
In that same year, he published an article titled “A New Instrument to be Called the Registry of Bone Sarcoma Scissors,” in which he introduced his newly designed and later patented surgical cutting tool.
Codman’s hope for his tool? To sweeten the pot for surgeons thinking of contributing cases to his registry. As he wrote, “It is my hope … that it will become … socially uncomfortable for any surgeon who is found using this appliance, if he has not recorded his cases of bone sarcoma to the best of his ability.” The record does not show that the imagined social discomfort occurred—nor that Codman ever made any money from the scissors.
Codman’s scissors may not have taken off, but his registry did. It is the first national prospective study of disease and a model for the study of other diseases—an enviable legacy. From this registry arose standardized nomenclature and categories of bone tumors, as well as the concepts of hospital standards and cooperation among radiologists, pathologists, and surgeons in the common goal of treating the patient.
The registry was rooted in Codman’s deep belief in end results—how the patient fared after treatment and what medicine could have done better. This concept, now standard practice, was heretical in 1915, when Codman first proposed it to his colleagues and was nearly expelled from the profession for it.
Image: John Soares