A prophet to modern medicine: Ernest Amory CodmanBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f7368 (Published 18 December 2013) Cite this as: BMJ 2013;347:f7368
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We would like to thank Hicks and Makary (1) for highlighting the pioneering work of Ernest Amory Codman. By insisting on measuring patient outcomes and laying down standards for hospitals, often in the face of his colleagues indifference and sometimes downright antipathy, he was truly the originator of surgical audit and medical governance.
May we add a small but important addendum regarding his contribution to improving the safety of anaesthesia practice? Codman’s quest to improve quality of service started as a student with Harvey Cushing at Harvard Medical School. At that time students were expected to administer anaesthesia for surgical procedures. After a number of disasters in 1894 (2), Codman and Cushing determined to become better “etherizers” and to help in this task Codman designed the first anaesthetic chart (Figure 1) which allowed recording of pulse and respiratory rate, thus enabling surgeons and anaesthetists to tell, at a glance, the condition of the patient. Cushing subsequently modified the chart in 1902 to incorporate the newly introduced blood pressure measurement (2). Although more elaborate and sophisticated, the modern day anaesthetic chart has exactly the same purpose as that laid out by Codman 120 years ago.
1 Hicks C, Makary M. A prophet to modern medicine: Ernest Amory Codman. BMJ 2013; 347: f7368.
2 Hirsch N P, Smith G B. Harvey Cushing: His contribution to anaesthesia. Anesth Analg 1986; 1986:65:288-93.
Figure 1: An early ‘ether chart’ dated November 30, 1894
Competing interests: No competing interests