key: cord-0026904-mw4yzzlj
authors: McLeod, Robin; Keshavjee, Shaf; Ahmed, Najma; Richards, Robin; Fehlings, Michael G.; Nathens, Avery; Rotstein, Ori D.; Rutka, James T.
title: History of the Department of Surgery at the University of Toronto: celebrating a centennial of progress and innovation
date: 2022-02-03
journal: Can J Surg
DOI: 10.1503/cjs.013621
sha: dcc5a3b8155a7fd51922be60f7671ad0e40cf0f5
doc_id: 26904
cord_uid: mw4yzzlj

Now in its centennial year since inauguration, the Department of Surgery at the University of Toronto lays claim to more than 500 faculty, 270 residents, and 250 clinical fellows. There are 7 direct entry residency training programs, and 4 subspecialty programs accredited by the Royal College of Physicians and Surgeons of Canada. There have been 10 chairs of the department since 1921. This article chronicles the life and times of the previous chairs in sequence; the success of the department originates from its many talented and luminary surgeons who have innovated and shaped their fields of surgery. In recent years, the department’s academic productivity has been characterized by more than 1400 peer-reviewed publications per year, and annual research grant capture in excess of $90 million. Since the time of William Gallie, surgical trainees have been enabled to develop careers in surgery and science through the Gallie Program and, more recently, the Surgeon Scientist Training Program (SSTP) to attain higher graduate degrees. Providing quaternary surgical care at multiple hospital sites in Toronto, the Department of Surgery takes great pride in its robust clinical fellowship programs across all specialties that continue to attract trainees from around the world.

Now in its centennial year since inauguration, the Department of Surgery at the University of Toronto lays claim to more than 500 faculty, 270 residents, and 250 clinical fellows. There are 7 direct entry residency training programs, and 4 subspecialty programs accredited by the Royal College of Physicians and Surgeons of Canada. There have been 10 chairs of the department since 1921. This article chronicles the life and times of the previous chairs in sequence; the success of the department originates from its many talented and luminary surgeons who have innovated and shaped their fields of surgery. In recent years, the department's academic productivity has been characterized by more than 1400 peer-reviewed publications per year, and annual research grant capture in excess of $90 million. Since the time of William Gallie, surgical trainees have been enabled to develop careers in surgery and science through the Gallie Program and, more recently, the Surgeon Scientist Training Program (SSTP) to attain higher graduate degrees. Providing quaternary surgical care at multiple hospital sites in Toronto, the Department of Surgery takes great pride in its robust clinical fellowship programs across all specialties that continue to attract trainees from around the world.

Hospital for Sick Children. After a short sojourn in London, Ontario, as a general practitioner and surgeon, 5 Banting returned to Toronto and convinced John James Rickard Macleod, professor of physiology, that he could perform surgery to ligate the pancreatic ducts in dogs and to isolate the factor from the surviving pancreatic islets that controls diabetes. Upon the purification of "insulin" with the assistance of Dr. James Collip, a biochemist from the University of Alberta, Leonard Thompson, age 14, became the first patient with diabetes to be treated by Banting at the Toronto General Hospital using a purified insulin preparation with encouraging results. 4 Just as the year 1921 is important for the establishment of the first professor and chair of the Department of Surgery at the University of Toronto, Clarence Starr, it also marks the discovery of insulin by Sir Frederick Banting, whose surgical skills were critical in his experimental approach and success.

Starr served as professor of surgery for 8 years. He had served as the president of the American Orthopaedic Association in 1920, and vice-president of the American Surgical Association (ASA) in 1928. He was a skillful adminis-trator, and made lasting contributions to the world literature on the management of hematogenous osteomyelitis. 3 He died in 1928 at age 60 from a myocardial infarction and was succeeded by Dr. William Gallie in 1929.

Roscoe Reid Graham was a rising star surgeon during Starr's tenure as professor of surgery. He was among the first to successfully enucleate an insulinoma, to treat patients with iodine for chemical thyroidectomy, and to develop a specific surgical procedure for ruptured perforated ulcer disease using an omental patch repair known as the "Graham patch." 6, 7 In 1932, at age 42, Graham became the youngest surgeon ever to be elected as a fellow to the ASA. 7 He served as vice-president of the ASA in 1939, and editor of the Annals of Surgery thereafter.

During Starr's tenure as chair, surgery on the nervous system was initiated in Canada in 1923 by Kenneth George McKenzie, who had spent the prior year training under the tutelage of Harvey Cushing in Boston on a Charles Mickle Fellowship. 8 McKenzie led the Division for almost 30 years, before he was succeeded by Harry Botterell who served in the role from 1952 to 1962. McKenzie worked diligently, almost in isolation, for more than 15 years before the neurosurgery program was given priority status at the Toronto General Hospital. 9,10 He developed pioneering neurosurgical techniques for spasmodic torticollis, and performed the first hemispherectomy in the world on a teenager with epilepsy, who survived without seizures and lived productively for 20 years thereafter. 11 Wise succession planning in the appointment of the subsequent chairs of the Division of Neurosurgery after Botterell has led to this surgical specialty becoming one of the largest and most influential programs of neurosurgery in the world to this day. Global neurosurgical impact has been realized through the clinical and research talents of Ronald Tasker and Andres Lozano in functional neurosurgery; Bruce Hendrick, Harold Hoffman, and Robin Humphreys in pediatric neurosurgery; Charles Tator and Michael Fehlings in spinal cord injury; and William Lougheed in vascular neurosurgery.

A native of Barrie, Ontario, Gallie graduated from the Faculty of Medicine at the University of Toronto in 1903. His training at The Hospital for Sick Children and subsequently the Toronto General Hospital was heavily influenced by Starr and Peters. Gallie devoted his early faculty appointment years to clinical research and published numerous papers on stabilizing paralytic feet, the use of bone grafts in orthopedics, and transplanting fascia and tendons for orthopedic injuries. [12] [13] [14] [15] He was surgeon in chief at The Hospital for Sick Children from 1921 to 1929. Following Starr's passing, Gallie reorganized the university program in surgery and brought much needed uniformity of training to the different hospitals ( Figure 1 ). He was also the first to put specialty care surgical patients on wards to be looked after by specialists. 16 Early in Gallie's tenure as chair, the Department of Surgery moved its offices to the Banting Institute upon its opening on Sept. 16, 1930 , where it remained until 2013 when it moved to its current location on the 5th floor of the Stewart Building.

One of Gallie's lasting contributions was the establishment of the "Gallie Course" in surgery, which provided programmatic training for a select group of surgical trainees. In this 3-year course, the trainees would spend 2 years on surgical services: the first year in general surgery, and the second year divided into 6-month rotations in urology, neurosurgery or pediatric surgery. 17 The course also included 6 months in medicine and 6 months in pathology, with emphasis on surgical research performed during these rotations. The completion of the course would be followed by the certification examinations in surgery administered by the Royal College of Physicians and Surgeons of Canada. The Gallie Course started on July 1, 1931, with 3 residents per year. The "Gallie Club" was formed in 1937 and comprised all past and current trainees of the Gallie Course. The Gallie Club met almost every year thereafter until 1975 ( Figure 2 ). During Gallie's lifetime, 72 trainees completed the Gallie Course. 17 During Gallie's tenure as chair, the Division of Orthopedic Surgery was established in 1939 by Robert Inkerman Harris, with a legitimate training program beginning in 1951 under Frederick Dewar. Luminaries who worked within the division since its founding included Ian MacNab, Walter Bobechko, and John Kostuik in spinal orthopedics; David MacIntosh in orthopedic sports medicine; Robert Jackson in arthroscopy; and Robert Salter and Mercer Rang in pediatric orthopedics. 1 While urological procedures had been performed since 1922 in the first urology service established in Canada under W. Warner Jones, it was not until 1947 that James McLelland, founder of the Canadian Urological Association, became the first professor of urology at the University of Toronto. He was followed in sequence by Carl Aberhardt; Charles Robson, who pioneered radical thoracoabdominal nephrectomy; Andrew Bruce, who was among the first to study the use of Bacillus Calmette-Guérin immunotherapy (BCG) for bladder cancer; and Michael Jewett, who had a specialty focus in uro-oncology. 1 Gallie served as dean of the Faculty of Medicine from 1936 to 1946. During that time, he was also president of the American College of Surgeons for an unprecedented 6-year term during World War II. Gallie stepped down as professor of surgery at the University of Toronto in 1947. He became president of the ASA in 1948. Later in his career, Gallie was able to convince R. Samuel McLaughlin, 

Can J Surg/J can chir 2022;65(1)

president of General Motors Canada, to donate substantial funds to establish a foundation to support advanced postgraduate studies for trainees in surgery. 18 Since the establishment of this fund in 1951, more than 300 surgeons have taken advantage of these "McLaughlin scholar ships." Productive and active in life almost to the end, Gallie died in 1959 from disseminated squamous cell carcinoma from a tooth socket. In Gallie's name and honour, the Department of Surgery celebrates "Gallie Day," established in 1974 as an annual event to celebrate and highlight the accomplishments of surgical residents in the Surgeon Scientist Training Program (SSTP) pursuing graduate degrees. Upon Gallie's passing, McLaughlin endowed the "Gallie Lecture" with the Royal College of Physicians and Surgeons of Canada, which is now presented at the Canadian Surgery Forum. 18 Gallie was named to the Canadian Medical Hall of Fame in 2001.

During Gallie's tenure as professor of surgery, Donald Walter "Gordon" Murray, a surgeon appointed to the Toronto General Hospital became known as one of Canada's greatest surgical pioneers. 19 Murray was among the first to perform internal stenting of obstructing esophageal cancer 20 and bone autotransplantation for malunion of the scaphoid, 21 and to study the use of heparin in vascular surgery in humans to prevent thrombosis after arterial embolectomy and cardiac valve surgery. 22 Murray also invented a renal dialysis machine and purified anticancer sera to treat patients with cancer, foreshadowing the field of immunotherapy. 19, 23 In Murray's name and honour, the Gordon Murray lectureship was established in the Department of Surgery in 2004 to honour an international luminary in surgery ( Figure 3 and Table 1 ).

Gallie was succeeded by Robert Meredith Janes, who served as professor of surgery from 1947 to 1957 (Figure 1) . Janes was considered an outstanding thoracic surgeon and surgeon educator. He was a founding member of the American Board of Thoracic Surgery in 1948, and became president of the American Association for Thoracic Surgery (AATS) in 1953. Born on a small farm in Lambton County, Ontario, Janes did his early surgical training at The Hospital for Sick Children and at St Bartholomew's Hospital in the United Kingdom. Together with his close surgical colleague and friend at the Toronto General Hospital, Norman Shenstone, he invented the lung tourniquet used to help facilitate lobar resections. 24 After World War II, Janes encouraged new faculty members in surgery to pursue research activities and further supported the surgeon-scientist paradigm at the University of Toronto. Janes also coordinated the rotations of surgical trainees at the 4 main teaching hospitals. 25 Just as there was a "Gallie Club" of former trainees of William Gallie, so there was the "Janes Society" formed in 1955, comprising a group of Janes' trainees from 1943 to 1953, totaling some 114 members (Figure 4) . The tenth anniversary meeting of the Janes Society took place on the occasion of Dr. Janes' 70th birthday in 1964, in Glasgow, Edinburgh, and London, with dinner at the Royal College of Surgeons in London. Janes retired from surgical practice in 1964 at age 70, but was still active in steering surgical services at the Humber Memor ial Hospital and at the newly formed North York General Hospital. Janes was notable for being kind, gentle, unselfish, loyal to ideals, a revered teacher, brilliant surgeon, and a fine gentleman. 24 During Janes' tenure as professor and chair of surgery, notable leaders in cardiac surgery included William Gordon Bigelow, who was instrumental in developing the first artificial heart pacemaker and pioneered the use of hypothermia in heart surgery; 26 and William T. Mustard, who developed a congenital heart operation to repair transposition of the great vessels to salvage children with "blue baby syndrome. 

The next chair of the Department of Surgery was William Richard Drucker, who served from 1966 to 1972 (Figure 1 ). Unlike all other chairs in surgery, Drucker was an American who hailed from Case Western Reserve University and was passionate about surgical metabolism and hemorrhagic shock. Under his leader-ship, the undergraduate medical education curriculum was enhanced, and the concept of surgical practice plans was introduced. He also helped to establish Divisions of General Surgery and Thoracic Surgery. The Toronto East General (now Michael Garron Hospital) and St. Joseph's Hospitals became affiliated with the University of Toronto for surgical procedures. 1 Upon completion of his term as chair, Drucker returned to the United States to become dean of medicine at the University of Virginia in Charlottesville.

While there had been a long history of thoracic surgery procedures being performed in Toronto with the likes of Norman Shenstone, Robert Janes, Harold Wookey, Norman Delarue, Stuart Vandewater and Fred Kergin, it was during Drucker's tenure that the Division of Thoracic Surgery was formally established. In 1967, the Division of Thoracic Surgery formally separated from the Division of Cardiovascular Surgery and formed its own division. 32 Other notable thoracic surgeons to follow included Griff Pearson, Robert Ginsberg, and Joel Cooper, who were instrumental in performing the first lung transplant in the world in 1983 in a patient who survived long term. 32 Griff Pearson was a charismatic and innovative thoracic surgeon who attracted many surgeons to come and train in the "Toronto School of Thoracic Surgery." Pearson and his disciples pioneered many surgical techniques in tracheal surgery, esophageal surgery, lung cancer and lung transplantation that have continued to transform the field. This program has trained numerous leaders in thoracic surgery worldwide. 

Bernard "Bernie" Langer followed Wilson in the role of RS McLaughlin chair ( Figure 5 ). Langer graduated from medical school at the University of Toronto, and entered the surgical training program in general surgery, although he professes that his first surgical area of interest was neurosurgery. Langer did postgraduate surgical training in surgical oncology at MD Anderson Cancer Center in Houston, followed by additional fellowship training at the Brigham in Boston in 1962-63. Upon his return to Toronto, there were strong waves of anti-Semitism preventing many Jewish trainees from receiving positions. Langer was a superb technical surgeon. He completed the first liver transplant in Toronto in 1985 together with gastroenterologist Gary Levy. Together with Steve Strasberg, Charles Tator and Rudolph Falk, Langer established the SSTP, a program in the Department of Surgery that enables surgical trainees to spend focused research time to complete a masters or PhD. 1 Funding for the program was derived from the surgical practice plans, and from a variety of postgraduate awards. Langer wanted all trainees to be able to stay in Toronto for their research training, as they would also contribute to the advancement of research in the department. Since its inception, the SSTP has trained more than 450 surgical residents, and the current complement of trainees is 45 residents. 34 Another one of Langer's major accomplishments was to strengthen and expand the departmental practice plans in order to share and transfer income to support academic activities. It was also Langer's idea to establish different university chairs in the specialties of surgery to serve 5-year terms, renewable once for a total of 10 years. Upon completion of his term as chair, 

When Reznick left for Queen's University to become dean of health sciences in 2010, David Latter, cardiac surgery, became interim chair until James Rutka was appointed as RS McLaughlin chair in 2011 ( Figure 5 ). Rutka had completed a 10-year term as the Dan Family chair in neurosurgery and served as president of the American Association of Neurological Surgeons, and American Academy of Neurological Surgery before accepting the position. During his tenure as chair, Rutka established programs in best practices in surgery; global surgery; equity, diversity and inclusion; wellness; and late career transitioning. 35 The offices of the Department of Surgery moved from the Banting Institute, where they had remained for 83 years, to the Stewart Building. Rutka became editor-in-chief of the Journal of Neurosurgery in 2013, 36 a Member of the Order of Ontario in 2015, and Officer of the Order of Canada in 2017. During his tenure, Rutka and his executive team ( Figure 6 ) bolstered electronic communications; hired a medical illustrator; doubled annual research and advancement funding from $50 million to $100 million (Figure 7 and Figure 8) , and from $4 million to $8 million, respectively; and helped to establish 12 new university/hospital chairs to a total of 71 endowed chairs in the Department of Surgery. New academic job descriptions were developed for surgeons with interests in ethics, global health, and entrepreneurship. Rutka also led the department through the years of the COVID-19 pandemic (2020-2021). As in years past when the department hosted national surgical groups to hold their annual meetings in Toronto, the Department of Surgery played host to the United Kingdom Traveling Society in 2016 (Figure 9 ). In each of the past 2 years, the Department of Surgery has ranked fourth in the world by the US News and World Report. 

Partnership for Excellence: Medicine at the University of Toronto and Academic Hospitals

George Armstrong Peters (as I remember him)

Acute hematogenous osteomyelitis: Clarence L. Starr (1868-1928): orthopedic infections

Getting out of town

Graham: an enduring legacy in the 21st century

An enduring legacy in the 21st century

Biographical sketch of Kenneth G. McKenzie (1892-1964)

And the Founding of Neurosurgery in Canada

Harvey Cushing, and the early neurosurgical treatment of spasmodic torticollis

Tendon fixation in infantile paralysis: observations based on one hundred operations

Bone wedging -a method of eliminating the introduction of foreign materials in open operations on fractures

The late results of the living suture operation in ventral and inguinal hernia

father of the Gallie wiring technique for atlantoaxial arthrodesis

an appreciation

Driving Force: The McLaughlin Family and the Age of the Car

Surgical Limits: The life of Gordon Murray

A method of palliative treatment of carcinoma of the oesophagus

Bone graft for non-union of the carpal scaphoid

The use of heparin in thrombosis

Experiments in immunity in cancer

Robert Meredith Janes (1894-1966): professor of surgery

The Janes Surgical Society

Cold hearts. The story of hypothermia and the pacemaker in heart surgery

The surgical management of transposition of the great vessels

Surgical treatment of aortic valve disease

A quarter of a century of experience with aortic valve-sparing operations

Late outcomes of mitral valve repair for floppy valves: implications for asymptomatic patients

Evolution of thoracic surgery in Canada

CD44 expression and hyaluronic acid binding of malignant glioma cells

Navigating the postgraduate research fellowship: a roadmap for surgical residents

Toward late career transitioning: a proposal for academic surgeons

Leading transition while maintaining tradition

Content licence: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons. org/licenses/by-nc-nd/4.0/

The Department of Surgery at the University of Toronto has enjoyed a rich history with contributions to virtually all surgical specialties through its talented faculty and highly structured and successful training programs. Each of the 10 chairs has led change and encouraged excellence in academic surgery. The research enterprise has expanded beyond basic and medical science to now include clinical epidemiology, surgical education, quality improvement, and health services. Pioneers in surgery, including Sir Frederick Banting, Gordon Murray, Kenneth McKenzie, William Mustard, William Bigelow, Griff Pearson and others too numerous to mention here within the pages of this discussion, have helped shape their respective specialties at the University of Toronto and worldwide. The research enterprise has expanded beyond basic and medical science to now include clinical epidemiology, surgical education, quality improvement, and health services research. With expanding programs in global outreach, best practices, surgeon wellness, and diversity, the future of the Department of Surgery continues to be bright.Affiliations: From the Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.

Contributors: All authors contributed substantially to the conception, writing and revision of this article and approved the final version for publication.