existence couldn’t be more precarious (with the inference of a hellish
collusion), their earthly subsistence increasingly deteriorated with
headaches, bodily injuries, tongue bites, confusion, and psychosis.
The rare early philosopher had insight that seizures were not
underworldly, but instead were physical disease states. Only in the last
century have seizure disorders become treatable, roughly in the same time
frame that shoulder instability has become manageable. All medical
pioneers shared a certain exasperation, an odium, for the way things were.
Even today, when speaking with patients who are burdened with unjust
conditions, I have a bitter sadness and vexation for their “dis-ease” that I
know my medical forbears had in great measure, as well as a disgust for
their poor understanding of what causes disease and how to treat it.
Dr. Charles Neer glanced at the X-rays of Mrs. Harrison’s shoulder,
recognizing in a moment that the elderly New Yorker’s arm would be
useless for the rest of her life. Frustration growing, Dr. Neer reckoned that
this was the third severe shoulder fracture of the month, and he had
nothing to offer the patient—at least nothing that would help—and his
sense of impotence roiled beneath his tranquil exterior. He had been
summoned to the emergency room to evaluate the seventy-year-old
Manhattanite who had fallen in her apartment earlier in the day and had
been conveyed to the Columbia Presbyterian Medical Center. Although his
hospital was one of the first in the world to have a “fracture service,” Dr.
Neer knew that in 1951, he was powerless to help Mrs. Harrison, not with
surgery, not with a plaster cast, not with a prayer.
With the discovery of X-rays in 1895, Wilhelm Röntgen had
revolutionized fracture care—instead of doctors blindly treating crooked
and shattered limbs, X-rays divulged detailed information about the
location and “personality” of the broken bones. Soon, fracture taxonomy
reports appeared in medical journals, and these would eventually guide
treatment. Each bone in the body, in time, would have its own
classification scheme, usually referred to by its primary author. In the first
half of the 20th century, little appreciable progress in patient care had been
achieved, but physicians had started to notice the predictable patterns by
which bones break.
The “father of shoulder surgery” is Ernest Amory Codman, a firebrand
who published The Shoulder in 1934, the first textbook solely dedicated to