William Edward Gallie (1882–1959): father of the Gallie wiring technique for atlantoaxial arthrodesis

Rimal Hanif DossaniDepartment of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana

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John ShaughnessyDepartment of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana

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Piyush KalakotiDepartment of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana

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Anil NandaDepartment of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana

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William Edward Gallie (1882–1959) was a Canadian general surgeon with special expertise in orthopedic surgery. His experience with surgical management of cervical spine subluxation led him to invent a method of cervical wiring of the atlas to the axis. His method of C1–2 wiring has since been modified, but it still remains one of the three most commonly taught wiring techniques in neurosurgical training programs. Gallie is also hailed for instituting the first surgical training program in Canada, a curriculum his pupils memorialized as the “Gallie course” in surgery. In this historical vignette, the authors describe Gallie’s life and depict his contributions to surgery.

William Edward Gallie (1882–1959) was a Canadian general surgeon with special expertise in orthopedic surgery. His experience with surgical management of cervical spine subluxation led him to invent a method of cervical wiring of the atlas to the axis. His method of C1–2 wiring has since been modified, but it still remains one of the three most commonly taught wiring techniques in neurosurgical training programs. Gallie is also hailed for instituting the first surgical training program in Canada, a curriculum his pupils memorialized as the “Gallie course” in surgery. In this historical vignette, the authors describe Gallie’s life and depict his contributions to surgery.

William Edward Gallie (1882–1959) was a pioneering general surgeon from Canada who invented cervical wiring techniques to achieve fusion of the atlas to the axis.4 Although Gallie is known for his contributions to cervical wiring in the realm of spine surgery, his greatest contribution to surgery was the establishment of a curriculum for postgraduate training of surgeons in Canada, a program his students popularized as the “Gallie course.”12 Prior to this course, there was no system of formal education of surgeons in Canada. Aspiring surgeons left Canada for the United States or the United Kingdom to gain surgical training. Gallie’s influence was not limited to a single surgical discipline. His other novel contributions to surgery include his work on tendon fixation for repair of pediatric foot deformities and use of fascia lata autograft for closure of large ventral abdominal hernias.7,9 Gallie was a prolific leader and educator. He served as the longest acting President of the American College of Surgeons from 1941 to 1947.12 This historical article describes Gallie’s life and details his contributions to surgery.

Biography

William Edward Gallie was born in Barrie, Ontario, Canada, on January 20, 1882. He attended Barrie Collegiate Institute, where he formed strong bonds with his peers playing in amateur hockey clubs.10,11 His father was a successful carpenter. As a young boy, after working a grueling summer as a roofer, Gallie was discouraged from pursuing his father’s profession. During his adolescent years, Gallie was inspired by the successful surgical cure of one his schoolmates suffering from torticollis.10,11 In 1899, at the age of 17, he entered medical school at the University of Toronto. In 1903, at age 21, he graduated as the youngest member of his class.10,11 Gallie then entered a 3-year internship, a commitment to postgraduate surgical training that was unparalleled at the time. He spent 1 year each at the Hospital for Sick Children, Toronto General Hospital, and the Hospital for the Ruptured and Crippled in New York. In 1905, as an intern at Toronto General Hospital, he received the Gold-Headed Cane, an honor awarded to the intern with the best reputation.10,11 In 1906, Gallie became a resident in surgery at the Hospital for Sick Children. The following year, Gallie started as a junior surgeon at the Children’s Hospital, joining Surgeon-in-Chief Clarence Starr as the only other member of the surgical staff. For 3 years, until more surgeons were recruited to bolster the surgical ranks, Gallie and Starr alone shouldered all surgical responsibilities at the Children’s Hospital. In 1914, Gallie married Janet Louise Hart, who remained with him until his passing in 1959. They had 3 children, Alan, Marion, and Hugh; Hugh was the only child to pursue a career in surgery.10,11

In 1919, Gallie passed the examinations required to acquire fellowship in the Royal College of Surgeons, becoming the first Canadian to do so without prior training in England. In 1921, Gallie succeeded Starr as Surgeon-in-Chief of the Children’s Hospital. In 1929, following Starr’s death, he succeeded Starr as Surgeon-in-Chief and Professor of Surgery at Toronto General Hospital.10–12 Prior to his appointment to chair of surgery in 1929, there was no formal training program for surgeons in Canada. Surgeons entered clinical practice following a short 1- or 2-year apprenticeship. Medical colleges in the United States and the United Kingdom attracted Canadian students who wished to pursue a surgical career. Although the Royal College of Physicians and Surgeons of Canada came into existence in 1929 and held its first examinations in 1932, there was no formal surgical residency program to prepare surgeons for these examinations. In 1931, Gallie formulated the first teaching program for surgeons in Canada, a curriculum his pupils nicknamed the “Gallie course” in surgery.10–12

In 1947, Gallie retired as chair of surgery at Toronto General Hospital (Fig. 1). In 1951, he molded his longstanding friendship with Robert S. McLaughlin, a wealthy tycoon and owner of General Motors in Canada, to benefit Canadian surgical education.15 McLaughlin generously endowed the R. S. McLaughlin Foundation, a trust that provided funding for surgical postgraduate education and for research in the surgical sciences. Not surprisingly, the Chair of Surgery at the University of Toronto is named after R. S. McLaughlin. Gallie was awarded numerous honors throughout his lifetime. In 1947, the Royal College of Surgeons awarded Gallie the Gold Medal, an honor bestowed to only 20 individuals in its 150-year history.10,11 Gallie served as President of the American Orthopedic Association in 1932, Vice President of the Royal College of Physicians and Surgeons of Canada from 1937 to 1939, President of the American College of Surgeons from 1941 to 1947, and President of the American Surgical Association in 1948.3,11,12 At the age of 77, Dr. Gallie died at the Princess Margaret Hospital in Toronto on September 25, 1959.11 In 2001, Gallie was inducted into the Canadian Medical Hall of Fame (http://cdnmedhall.org/inductees/dr-william-gallie).

Fig. 1.
Fig. 1.

Photograph of Dr. William Edward Gallie on the occasion of his retirement from Chair of Surgery at the University of Toronto in 1947. Obtained from Essays in Surgery. Presented to Dr. W. E. Gallie on the Occasions of His Retirement from the Chair of Surgery in the University of Toronto.12

Gallie’s Contributions to Surgery

Cervical Wiring

In 1939, Gallie wrote about articular facet fractures of the cervical spine resulting in anterior subluxation.4 In cases in which heavy cervical traction up to 35 pounds did not reduce the deformity, Gallie performed an open operation through a midline posterior cervical incision to manually reduce the subluxation under direct vision.4,6 Over time, Gallie encountered a high rate of recurrence of anterior subluxation despite cervical traction and open surgical reduction. To reduce the risk of recurrence, Gallie strengthened manual reduction by placing bone grafts and fastening “the two vertebra together by fine steel wire passed around the laminae or spines.”4 Although rudimentary, this was Gallie’s first—and only—description of his wiring method, a technique that he applied to atlantoaxial and subaxial cervical vertebrae. Yet it was the specific technique of C1–2 wiring to secure an H-shaped iliac crest autograft that became eponymous with Gallie. Understanding how the above C1–2 wiring technique was attributed to Gallie requires a brief overview of the history of cervical wiring.

Cervical wiring dates back to 1910, when Mixter and Osgood first described their technique in a young boy with rotatory atlantoaxial subluxation.14 The rotatory subluxation recurred despite successful manual reduction. “Braided silk soaked in tincture of benzoin” was passed beneath the posterior arch of C-1 and hooked beneath the spinous process of C-2 to attach the vertebrae together.14 In 1941, Willard and Nicholson described a case of a 3-year-old girl with anterior atlantoaxial subluxation that recurred following reduction with a cervical collar.17 When open reduction with Mixter and Osgood’s method using silk suture failed, Willard and Nicholson passed 2 wire sutures around “the posterior arches of the first and second cervical vertebrae,” and at the 21-month follow-up, lateral radiographs showed no movement at C1–2 on flexion and extension.17

In the 1940s, Gallie modified Willard and Nicholson’s wiring technique with the addition of an H-shaped iliac crest autograft placed dorsal to the posterior C-1 arch and indented to seat securely over the C-2 spinous process.2 The graft was cinched to the C1–2 vertebrae with steel wires passed beneath the arch at C-1 but underneath the spinal process at C-2 so that the wires enter the spinal canal only at C-1 (Fig. 2). Although never described directly in Gallie’s own words, the above technique was attributed to Gallie by subsequent surgeons who performed C1–2 wiring.

Fig. 2.
Fig. 2.

Schematic of the Gallie (A), Brooks-Jenkins (B), and Sonntag (C) wiring techniques. Modified with permission from Dickman et al: J Neurosurg 74:190–198, 1991.2

Gallie’s technique was improved over the ensuing decades. In 1978, Brooks and Jenkins at Vanderbilt University described atlantoaxial wiring by the wedge compression method.1 The technique involved wedging 2 rectangular iliac crest grafts on both sides of midline. The bone grafts were each secured with 2 wires passing beneath the C-1 arch and the C-2 lamina so that the wires were in the spinal canal through the entire C1–2 junction (Fig. 2). Brooks and Jenkins reported a 93% rate of success with this technique and did not encounter neurological deficits arising from the wires’ presence in the spinal canal.

In 1991, Dickman and Sonntag described yet another method of posterior cervical wiring. In contrast to the Brooks-Jenkins method, a single iliac crest graft, 4 cm long and 1 cm wide, was placed between the arch of C-1 and the C-2 spinous process and molded so that the concave aspect of the graft was flush with the dura.2 Similar to the Gallie technique, the Sonntag method required passing the wires beneath the C-1 posterior arch but beneath the C-2 spinous process to secure the bone graft (Fig. 2). The authors reported a success rate of 99% with the Sonntag technique.2 The Gallie, Brook-Jenkins, and Sonntag methods are the 3 most commonly taught posterior C1–2 wiring techniques in neurosurgical programs.

General Surgery Contributions

Gallie made numerous technical contributions to other areas of surgery, including tendon fixation (1913–1916)7,8 and transplantation of fascia as “living sutures” for repair of large hernia openings (1921–1924).9 In 1915, Gallie described his experience in his first 100 cases utilizing tendon fixation for correction of different types of pediatric foot deformities.8 In patients with varus deformity, Gallie cut the peroneal tendons from their normal attachments, manipulated the peroneal tendons to correct the deformity, and finally sutured the tendons to a new location on the fibula such that the deformity would remain corrected. Following a brief period when the foot remained plastered to allow the sutures to heal, Gallie described the results of this operation as “most gratifying” allowing the patient to walk “without limp” and “without any splints of any kind.”8 In 1922, Gallie described the closure of large ventral hernia openings with fascia lata autograft. Using fascia lata as “living suture,” Gallie first sutured fascia lata “quarter-inch” sized strips to the edges of the hernia opening and then approximated fascia lata strips from each end of the hernia to achieve a durable defect closure. Gallie described over 10 years of experience with this method and stated that this “greatly reduced the incidence of [hernia] recurrence.”9

The Gallie Course

Gallie’s contributions to cervical wiring and other areas of surgical knowledge are eclipsed by his commitment to Canadian postgraduate surgical education. There is no doubt that the training of surgeons “is his greatest achievement.”12 When he became Professor of Surgery at the University of Toronto in 1929, Gallie marshaled the Departments of Pathology, Anatomy, and Physiology to coalesce into a teaching program for postgraduate surgeons.12 He rallied his surgical colleagues to form a teaching group that has the honor of being the first organized plan for teaching of surgeons in Canada. Gallie’s students immortalized his program by calling it the “Gallie course” in surgery. The course comprised 3 years of training in all the major divisions of surgery, followed by a year of specialization at another center. The systematic organization of Gallie’s course consistently produced competent surgeons who provided care for the Canadian armed services during World War II. Pupils of the Gallie course were awarded membership in the “Gallie Club,” a group that met once a year on his birthday “for intellectual stimulus and good fellowship.” In 1947, when Gallie retired from the position of Chair at University of Toronto, his colleagues and students presented him with a volume of 52 surgical essays. Published by the University of Toronto Press, the essays were a reflection of “the practice of surgery in the Toronto school and the influence which Dr. Gallie has wielded upon Canadian surgery.”12

In Dr. Gallie’s words, the establishment of a surgical training program was not simple, as “it involved a complete change of the attitude of the staff towards surgical education.”5 In his Listerian address to the 79th Annual Meeting of the Canadian Medical Association, Gallie urged his fellows surgeons to “no longer look on [residents] as servants but as graduate students, and that they should be prepared to teach them to do the operations that they could much more quickly and skillfully themselves.”5 Gallie proudly remarked that the “change has been accomplished…and now if any of you have occasion to visit these various hospitals you will find most of the operations being done by resident staff under the guidance and supervision of their teachers.” In the 26 years following inception of the Gallie course, a total of 60 surgeons graduated from the course and started practice in different corners of Canada. Two graduates achieved the rank of Professor of Surgery, 9 of Assistant Professors, and 5 of Surgeon-in-Chief at various hospitals in Toronto. Despite the productivity of the Gallie course in training surgeons, Gallie considered the training of 60 surgeons “a mere drop in the bucket” and recommended that the program be extended to all medical schools in Canada.5

In 1929, as Surgeon-in-Chief at the Hospital for Sick Children, Gallie obtained a fellowship for Dr. William Keith, who graduated from medical school at the University of Toronto in 1927, to pursue neurosurgical studies at the University of Chicago under Dr. Percival Bailey.13 In 1933, Keith joined the staff at the Hospital for Sick Children and served as Chief of Neurosurgery until his retirement in 1964. Over the course of his career, Keith became one of the leading figures of pediatric neurosurgery in Canada and beyond and trained many pediatric neurosurgeons. By virtue of his longstanding friendship with Dr. Frank Mayfield, Keith was among the founding figures of the American Academy of Neurological Surgeons.16 By way of facilitating Keith’s training in neurosurgery, Gallie indirectly contributed to the blossoming of the subspecialty of neurosurgery in Toronto.

In 1948, in his presidential address to the American Surgical Association, Gallie expanded his vision to suggest improvements to undergraduate medical education.3 During Gallie’s training, 2 clinical years during undergraduate medical education provided sufficient exposure to the surgical disciplines. As his career progressed, the clinical undergraduate medical curriculum was expanded to 3 years to accommodate students’ exposure to the rapidly advancing and specialized field of surgery. At the time, the licensing boards were giving license to medical practitioners without postgraduate surgical training. Despite the increased exposure to surgery during the undergraduate years, Gallie cautioned that this “half-baked” training could give rise to “unscrupulous” surgical practice.3 Instead of such disorganized exposure to the surgical sciences, Gallie advocated that medical students learn the fundamentals of anatomy, pathology, and physiology pertaining to the various surgical disciplines and that those interested in pursuing surgery must enter a postgraduate surgical program.3

Conclusions

Gallie’s influence on surgical knowledge and education are often likened to that of Sir William Osler on the medical disciplines. His towering legacy of creating a system of surgical training lives on to this day. Dr. William Spence, one of the surviving members of the Gallie Club, entered the training program the same year as Dr. Gallie’s son, Hugh, and remembered Gallie as one to be “judged not to have an enemy in the world” (personal communication, 2015). When remembering her grandfather, Dr. Brenda Gallie, one of the leading figures in pediatric ophthalmology, said that only thoughts of warmth and love fill her memories. She recalls Gallie’s hobby of fishing and his trips with R. S. McLaughlin to the Maritimes, a friendship that undoubtedly led to the formation of the McLaughlin Foundation for surgical education (personal communication, 2015). She also recalls her grandfather’s reply when she wrote him for advice in selecting a career. Gallie wrote, “Follow your heart, and whatever you do, it will be right.”

Disclosures

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Author Contributions

Conception and design: Dossani. Acquisition of data: Dossani, Shaughnessy, Kalakoti. Analysis and interpretation of data: Dossani, Shaughnessy, Kalakoti. Drafting the article: Dossani, Shaughnessy, Kalakoti. Critically revising the article: Dossani. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: Nanda. Administrative/technical/material support: Nanda, Dossani. Study supervision: Nanda, Dossani.

Supplemental Information

Previous Presentations

A portion of this paper entailing Dr. Gallie’s legacy was given as an oral presentation at the History Section of the 84th AANS annual meeting in Chicago, Illinois, on May 4, 2016.

References

  • 1

    Brooks AL, Jenkins EB: Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg Am 60:279284, 1978

  • 2

    Dickman CA, Sonntag VK, Papadopoulos SM, Hadley MN: The interspinous method of posterior atlantoaxial arthrodesis. J Neurosurg 74:190198, 1991

  • 3

    Gallie WE: Address of the President: He Shall Have a Noble Memory. Ann Surg 128:321331, 1948

  • 4

    Gallie WE: Fractures and dislocations of the cervical spine. Am J Surg 46:495499, 1939

  • 5

    Gallie WE: The practice of surgery in Canada. Can Med Assoc J 59:201206, 1948

  • 6

    Gallie WE: Skeletal traction in the treatment of fractures and dislocations of the cervical spine. Ann Surg 106:770776, 1937

  • 7

    Gallie WE: Tendon fixation for deformity resulting from partial paralysis. Ann Surg 61:9495, 1915

  • 8

    Gallie WE: Tendon fixation in infantile paralysis: observations based on one hundred operations. Ann Surg 62:481487, 1915

  • 9

    Gallie WE, Lemesurier AB: Living sutures in the treatment of hernia. Can Med Assoc J 13:469480, 1923

  • 10

    Harris RI: As I remember him: William Edward Gallie, surgeon, seeker, teacher, friend. Can J Surg 10:135150, 1967

  • 11

    Harris RI: William Edward Gallie, 1882–1959: an appreciation. Can Med Assoc J 81:766770, 1959

  • 12

    Harris RI, Janes RM (eds): Essays in Surgery: Presented to Dr. W. E. Gallie on the Occasions of His Retirement from the Chair of Surgery in the University of Toronto. Toronto: University of Toronto Press, 1951

    • Search Google Scholar
    • Export Citation
  • 13

    Jea A, Al-Otibi M, Rutka JT, Drake JM, Dirks PB, Kulkarni AV, et al.: The history of neurosurgery at the Hospital for Sick Children in Toronto. Neurosurgery 61:612625, 2007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Mixter SJ, Osgood RB: IV. Traumatic lesions of the atlas and axis. Ann Surg 51:193207, 1910

  • 15

    Rutka JT: A brief history of the Department of Surgery at the University of Toronto. University of Toronto. (http://surgery.utoronto.ca/about/history.htm) [Accessed February 15, 2017]

    • Search Google Scholar
    • Export Citation
  • 16

    Rutka JT, Wallace C: Excellence in neurosurgery program building: enhancing the academic mission. Clin Neurosurg 57:100111, 2010

  • 17

    Willard DP, Nicholson JT: Dislocation of the first cervical vertebra. Ann Surg 113:464475, 1941

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  • Expand
  • View in gallery

    Photograph of Dr. William Edward Gallie on the occasion of his retirement from Chair of Surgery at the University of Toronto in 1947. Obtained from Essays in Surgery. Presented to Dr. W. E. Gallie on the Occasions of His Retirement from the Chair of Surgery in the University of Toronto.12

  • View in gallery

    Schematic of the Gallie (A), Brooks-Jenkins (B), and Sonntag (C) wiring techniques. Modified with permission from Dickman et al: J Neurosurg 74:190–198, 1991.2

  • 1

    Brooks AL, Jenkins EB: Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg Am 60:279284, 1978

  • 2

    Dickman CA, Sonntag VK, Papadopoulos SM, Hadley MN: The interspinous method of posterior atlantoaxial arthrodesis. J Neurosurg 74:190198, 1991

  • 3

    Gallie WE: Address of the President: He Shall Have a Noble Memory. Ann Surg 128:321331, 1948

  • 4

    Gallie WE: Fractures and dislocations of the cervical spine. Am J Surg 46:495499, 1939

  • 5

    Gallie WE: The practice of surgery in Canada. Can Med Assoc J 59:201206, 1948

  • 6

    Gallie WE: Skeletal traction in the treatment of fractures and dislocations of the cervical spine. Ann Surg 106:770776, 1937

  • 7

    Gallie WE: Tendon fixation for deformity resulting from partial paralysis. Ann Surg 61:9495, 1915

  • 8

    Gallie WE: Tendon fixation in infantile paralysis: observations based on one hundred operations. Ann Surg 62:481487, 1915

  • 9

    Gallie WE, Lemesurier AB: Living sutures in the treatment of hernia. Can Med Assoc J 13:469480, 1923

  • 10

    Harris RI: As I remember him: William Edward Gallie, surgeon, seeker, teacher, friend. Can J Surg 10:135150, 1967

  • 11

    Harris RI: William Edward Gallie, 1882–1959: an appreciation. Can Med Assoc J 81:766770, 1959

  • 12

    Harris RI, Janes RM (eds): Essays in Surgery: Presented to Dr. W. E. Gallie on the Occasions of His Retirement from the Chair of Surgery in the University of Toronto. Toronto: University of Toronto Press, 1951

    • Search Google Scholar
    • Export Citation
  • 13

    Jea A, Al-Otibi M, Rutka JT, Drake JM, Dirks PB, Kulkarni AV, et al.: The history of neurosurgery at the Hospital for Sick Children in Toronto. Neurosurgery 61:612625, 2007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Mixter SJ, Osgood RB: IV. Traumatic lesions of the atlas and axis. Ann Surg 51:193207, 1910

  • 15

    Rutka JT: A brief history of the Department of Surgery at the University of Toronto. University of Toronto. (http://surgery.utoronto.ca/about/history.htm) [Accessed February 15, 2017]

    • Search Google Scholar
    • Export Citation
  • 16

    Rutka JT, Wallace C: Excellence in neurosurgery program building: enhancing the academic mission. Clin Neurosurg 57:100111, 2010

  • 17

    Willard DP, Nicholson JT: Dislocation of the first cervical vertebra. Ann Surg 113:464475, 1941

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