William Gissane

Biography

• Born on April 26, 1898 in Redfern, Sydney, Australia. His father was a tea merchant.
• 1917 – Completed his schooling at St Ignatius’ College, Sydney. Captained the cricket XI and school boxing team. Represented the combined Great Public Schools of New South Wales in cricket and rugby.
• 1917–1918 – Enlisted in the Royal Australian Artillery during the First World War and attained the rank of lance-bombardier.
• 1925 – Graduated MB ChM from the University of Sydney. During his medical studies he represented the university in rugby, cricket and boxing and received university Blues in cricket and boxing. He was also an intervarsity boxing champion.
• 1925 – Moved to Britain for postgraduate surgical training, working at St Mark’s Hospital in London, the Royal Devon and Exeter Hospital.
• 1927 – Elected Fellow of the Royal College of Surgeons of Edinburgh.
• 1932 – Obtained the MRCS and Fellowship of the Royal College of Surgeons of England.
• Mid-1930s – Visited Allgemeine Unfallkrankenhaus of Lorenz Böhler in Vienna. The organisation of Böhler’s trauma service and its emphasis on continuity of care strongly influenced Gissane’s later plans for British accident surgery.
• Mid-1930s–1938 – Appointed surgeon in charge of the Accident Unit at St James’s Hospital, Balham, and worked in the fracture service at Lewisham Hospital. He also served as a civilian medical practitioner with the Royal Air Force.
• 1937–1940 – Published across a broad range of emergency and traumatic surgery, including penetrating cardiac injury, intussusception, open fractures, post-traumatic cerebrospinal rhinorrhoea and femoral fractures associated with convulsive therapy.
• 1938 – Appointed surgeon specialist in accident surgery within the London County Council Hospital Service.
• 1941–1964 – Directed the “Birmingham experiment” in accident care.
• 1946 – Described the calcaneal radiographic landmark subsequently known as the critical angle of Gissane during discussion of fractures of the os calcis at the British Orthopaedic Association
• 1952 – Delivered the inaugural Joseph Henry Lecture in Occupational Surgery at the Royal College of Surgeons.
• 1959 – Elected an honorary Fellow of the Royal Australasian College of Surgeons. Spent six months travelling through Australia, and New Zealand as the Sir Arthur Sims Commonwealth Travelling Professor. His only return to Australia after leaving in 1925.
• 1960 – Became honorary director of the Road Injuries Research Group.
• 1961 – Delivered the Robert Jones Lecture and lectured on accident surgery in Canada. Served as vice-president of the British Orthopaedic Association.
• 1964 – Honorary Professorship of Accident Surgery, University of Birmingham. Appointed Commander of the Order of the British Empire for services to accident surgery and injury prevention. Retired as clinical director and surgeon-in-chief after 23 years.
• 1965 – Awarded an honorary Doctor of Science by the University of Wales.
• 1966 – Delivered the Ruscoe Clarke Memorial Lecture and published on the causes and prevention of neck injuries in car occupants and the safety implications of motor-vehicle design.
• 1974 – Received the Viva Shield Gold Medal and Citation for Transport Improvement from the Worshipful Company of Carmen.
• 1978 – A tribute marking his eightieth birthday recognised his influence on hospital organisation, consultant-led trauma care, rehabilitation, injury prevention and road safety.
• Died on April 1, 1981 the fortieth anniversary of the opening of the Birmingham Accident Hospital, aged 82.

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Medical Eponyms

Gissane angle (1946)

The Gissane angle is an obtuse angle on the lateral calcaneal radiograph formed by the downward slope of the posterior facet and the upward slope of the anterior calcaneal process. It lies beneath the lateral process of the talus and represents the junction of strong subchondral cortical struts around the subtalar joint.

Disruption of the angle may indicate an intra-articular calcaneal fracture, but reported normal ranges vary widely and measurement reliability is limited. The angle should be used as a descriptive adjunct rather than a diagnostic threshold or independent guide to treatment. CT is required to define posterior-facet displacement and comminution.

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Gissane spike

The Gissane spike was a calcaneal reduction instrument designed for displaced intra-articular fractures of the os calcis. Inserted from posteriorly into the calcaneal tuberosity or tongue fragment, it acted as a lever to restore alignment and could be retained within a shoe-shaped plaster to support the reduction.

1952 – Peter Essex-Lopresti published the definitive account of the technique in The mechanism, reduction technique, and results in fractures of the os calcis. He credited Gissane with introducing spike-assisted reduction into Britain, proving its value and designing a dedicated spike and handle. The shorter spike was used for closed reduction of tongue-type fractures; a larger version supported elevated articular fragments in joint-depression injuries.

The underlying principle predated Gissane and had been described by Westhues in 1934 and subsequently by Ehalt. Gissane’s contribution was the refinement and dedicated instrumentation rather than invention of the original concept.

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Key medical contributions

The Birmingham experiment and organised trauma care

Gissane believed that injured patients should receive continuous responsibility from a dedicated surgical team rather than pass between a casualty department and disconnected specialties. As clinical director and surgeon-in-chief of the Birmingham Accident Hospital from 1941 to 1964, he organised full-time teams responsible for patients from admission through definitive treatment, rehabilitation and discharge. He preferred the term “team” to the traditional surgical “firm,” bringing together surgeons, anaesthetists, nurses, therapists, laboratory investigators and external specialists around the needs of the injured patient.

1947 – As the workload increased, the surgical service was reorganised into three teams, each comprising a senior surgeon, assistant surgeon, anaesthetist, registrar and two house surgeons. By 1954 the hospital recorded approximately 54,000 new registrations annually. Gissane recognised the limitations of an isolated trauma hospital and increasingly advocated locating accident services beside a general hospital with immediate access to specialist support.

1963 – Gissane published The stages of development and the organization of the Birmingham Accident Hospital. The paper summarised the hospital’s evolution as a coordinated service combining acute treatment, reconstructive surgery, rehabilitation, education and research.

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Rehabilitation, occupational medicine and return to work

Gissane treated rehabilitation as a continuation of acute care rather than an activity beginning after the surgeon had finished. Physiotherapy commenced as early as possible, therapists attended outpatient clinics and recovery was assessed partly by whether patients could resume their previous employment or be retrained for suitable alternative work.

1942 – The rehabilitation service, initially led by Rhaiadr Jones, expanded from temporary accommodation into a dedicated hospital floor containing a gymnasium and physiotherapy department.

1943 – A rehabilitation workshop was established at the Austin Motor Company’s Longbridge factory. Patients trained on familiar industrial equipment such as lathes and drills, so that exercise reproduced the movements and resistance required at work. Joint hospital–factory clinics allowed staff to follow patients back into employment or identify alternative duties when return to the original occupation was unsuitable.

Gissane also strengthened links with industrial medical officers, promoted training for industrial nurses, doctors, students and ambulance personnel and supported the appointment of staff able to understand the physical demands of individual occupations. His approach required clinicians to know not only the anatomical injury but what the patient’s work involved and whether recovery was sufficient to perform it safely.

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Road injury epidemiology and prevention

Gissane regarded increasing road trauma as a modern epidemic that could be studied systematically by relating collision circumstances and vehicle structures to the anatomical injuries observed in hospital and at post-mortem examination.

1960 – Became honorary director of the Road Injuries Research Group, established with John Bull and supported by the Automobile Association. The group combined information from police reports, coroners, hospitals and survivors to reconstruct serious collisions and determine how their frequency and severity might be reduced.

1961 – The first progress report illustrated proposed safety modifications for cars and lorries, several of which later entered wider use. Gissane and Bull also published a study of 183 road deaths occurring in and around Birmingham during 1960.

1962–1964 – Published on the nature and causes of major road injuries, injuries from road accidents and fatalities on the M1 motorway.

1966–1973 – Extended the programme to neck injuries in vehicle occupants, motor-car design, long-term disability after road trauma and fatal car–lorry collisions. His work assessed not only drivers and passengers but also pedestrians, cyclists and motorcyclists .

The work created a direct chain between crash investigation, vehicle vulnerability, injury pattern and preventive engineering.

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Major Publications

• Gissane W. Discussion on “Fractures of the os calcis” (Proceedings of the British Orthopaedic Association, 1946). J Bone Joint Surg Am 1947; 29: 254–255
• Gissane W. The work of the Birmingham Accident Hospital and Rehabilitation Centre. J R Sanit Inst. 1949 Sep;69(5):638-42.
• Gissane W. Thoughts on the clinical organization of a regional accident service. Br J Plast Surg. 1950 Jan;2(4):224-32.
• Gissane W. A dangerous type of fracture of the foot. J Bone Joint Surg Br. 1951 Nov;33-B(4):535-8.
• Logan WP, Gissane W. Discussion on the epidemiology of accidents. Proc R Soc Med. 1953 Jun;46(6):449-56.
• Gissane W. Advances in the treatment of injuries from accidents. Practitioner. 1955 Oct;175(1048):450-70. 
• Gissane W. The history and purpose of the Birmingham Accident Hospital. Br J Clin Pract. 1956 Nov;10(11):739-42
• Gissane W, Bull J, Jackson D. Current therapeutics. CXXXI. Wound dressings. Practitioner. 1958 Nov;181(1085):640-9.
• Gissane W. Internal fixation of fractures. Proc R Soc Med. 1959 Apr;52(4):291-2.
• Gissane W. The nature and causes of major road injuries in and around a provincial city. Ann Occup Hyg. 1962 Apr-Jun;5:85-93.
• Gissane W. The stages of development and the organization of the Birmingham Accident Hospital. Postgrad Med J. 1963 Dec;39:683-7.
• Gissane W. The causes and the prevention of neck injuries to car occupants. Ann R Coll Surg Engl. 1966 Sep;39(3):161-3.
• Gissane W, Bull J. Fatal car occupant injuries after car lorry collisions. Br Med J. 1973 Jan 13;1(5845):67-71. doi: 10.1136/bmj.1.5845.67.
• Gissane W. A summing up. Injury. 1978 Aug;10(1):54-5.

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References

Biography

• London PS. Inaugural William Gissane Lecture: man and memorial. Injury. 1982; 14(3): 211-34
• Harrison SH. Accident surgery—the life and times of William Gissane. Injury. 1984; 16(3): 145-54
• Jackson DM. A birthday tribute to Professor William Gissane. The Journal of bone and joint surgery. British volume. 60-B (2): 149
• Biography: Gissane, William (1898 – 1981). Plarr’s Lives of the Fellows Online. Royal College of Surgeons of England
• Bibliography. Gissane, William. WorldCat Identities

Eponymous terms

• Essex-Lopresti P. The mechanism, reduction technique, and results in fractures of the os calcis. Br J Surg. 1952 Mar;39(157):395-419. 
• Cadogan M. Eponymythology of foot injuries. LITFL