W. James Gardner

1967, San Francisco

Two unforeseen events helped to shape and direct the career of W. James Gardner, M.D., the honored guest of the Seventeenth Annual Meeting of the Congress of Neurological Surgeons. Suffice it to say, however, that Dr. Gardner is a man who would have had an illustrious career in any field of endeavor, regardless of circumstances.

The first and perhaps more important of these two events was the one that led to his decision to become a neurosurgeon rather than follow in the footsteps of his father who was a general surgeon in McKeesport, Pennsylvania. After receiving his M.D. degree in 1924, Dr. Gardner remained at the University of Pennsylvania School of Medicine for training which was to include 2 years of internship and 3 years of general surgery. Each intern was required to spend 3 months on the service of Charles H. Frazier, M.D., professor of surgery and head of the division of surgery. Dr. Frazier limited his surgery mainly to neurological and thyroid problems. An autocrat both in and out of the surgical amphitheatre, he was a perfectionist who operated meticulously and would not tolerate the slightest blood loss. The Frazier service was not well liked by the house staff because of the long, arduous hours and the stern demeanor of its chief. Just as Dr. Gardner began his tour of duty with Dr. Frazier, the resident resigned and full responsibility for running the service fell on Dr. Gardner, the intern. At the end of 3 months, since no resident had been found, Dr. Gardner stayed on for a second period out of sympathy for Dr. Frazier's predicament. Somewhere during this period a spark was struck that ignited his interest in neurosurgery, because plans for training in general surgery were discarded in favor of neurosurgery. Our honored guest remained with Dr. Frazier for a further 3 years, thus formalizing his training in neurosurgery, a field that he probably would not have entered if he had not been exposed to such an unexpectedly intensive beginning. One of the highlights of these formative years, according to Dr. Gardner's recollection, was the frequent consultations between Dr. Frazier and the noted Philadelphia neurologist Dr. W. G. Spiller.

The second happenstance to alter Dr. Gardner's life was the Cleveland Clinic disaster in May 1929, which took the lives of 126 persons, including that of its neurosurgeon, Charles E. Locke, M.D. Instead of returning to the Pittsburgh area as he had contemplated, Dr. Gardner, on the recommendation of Dr. Frazier, joined the staff of the Cleveland Clinic to fill the unexpected opening. Thus began a most fruitful and rewarding association which was to last for 35 years.

Dr. Gardner wrote more than 200 scientific papers. For the most part his contributions were clinically oriented, since he was not one to pursue a laboratory project for the sake of pure science. There must be some clinical application to each bit of experimental work, or he paid it scant attention. He always maintained that there was nothing more stimulating to a curious mind than the problems encountered in the care of sick patients. A constant source of amazement to his resident staffwas his ability to recall and apply effectively experimental evidence in order to explain clinical phenomena and solve clinical problems.

Despite an extremely active surgical and outpatient practice, Dr. Gardner was never without some project to further occupy his time. Each problem was followed through with dogged determination even though the initial results may have been enough to discourage the most enthusiastic participant. Inventiveness and serendipity, combined with hard work and determination, were among his greatest attributes. Although the work for the resident staff seemed endless, not one on his service could say that he worked harder than "the boss."

Because his interests were so numerous and varied, it was difficult to select the outstanding contribution that Dr. Gardner made to the specialty of neurosurgery. A large surgical practice made it imperative for him to develop surgical techniques that were quick, effective, without frills, and advantageous for patient and surgeon. He was one of the early proponents of the sitting position for both cranial and spinal surgery. From this developed the use of the "G suit" to control venous pressure and prevent air embolism. In addition, he developed a surgical chair with such versatility that it could be utilized with the patient in any position and a head clamp for positive fixation of the skull during surgery. He was the first to advocate and use induced arterial hypotension for intracranial surgery.

Neurological and roentgenographic diagnosis occupied much of Dr. Gardner's attention over the years. An excellent neurologist, he always found that neurological problems present a challenge, even though not of a surgical nature. He was among the first to advocate the use of pneumoencephalography for the diagnosis of suspected intracranial surgical problems, even when these were associated with increased intracranial pressure. The procedure of lumbar discography was quickly adopted and he used it successfully for more than 15 years.

The six papers that he wrote on chronic subdural hematoma, which include the first satisfactory explanation ofthe so-called latent interval and an effective method of reexpanding the cerebral hemisphere after drainage of a chronic subdural hematoma, were evidence of Dr. Gardner's interest in this subject. His vast experience in the management of tic douloureux, a major interest throughout his career, was concerned not only with treatment but also with the development of a theory of the pathophysiology of this condition.

Since 1950, when our honored guest first wrote about the surgical treatment of Arnold-Chiari malformation, he devoted considerable time and effort to the study of this and related problems. Gradually there evolved a theory of the common origin of such conditions as Arnold-Chiari malformation, Dandy-Walker syndrome, syringomyelia, meningomyelocele, and certain forms of congenital hydrocephalus. While this idea was by no means universally accepted, the concept was exciting and it challenged the somewhat rigid theories of the time.

Wartime service in the Navy introduced him to the use of Tantalum for cranioplasty. He continued to use it since that time and advocated immediate repair of cranial defects with Tantalum, even in the presence of compound wounds.

Total care of the patient was always Dr. Gardner's goal and custom. He maintained that the patient suffers when the responsibility for management is divided among two services or more. This concern in his inventive mind led to the development of a number of interesting devices to ensure proper patient care. Perhaps the best known of these is the alternating pressure pad which applies a pneumatic principle in the prevention and treatment of bedsores.

His pioneering work was manifested in several other areas, namely, cerebral hemispherectomy in the treatment of glioma, the treatment of carotid cavernous fistula by muscle embolization, the application of sympathectomy in the treatment of various ailments, the surgical treatment of hemifacial spasm, and the use of intraspinal steroid injections in the treatment of sciatica.

The ability and willingness to teach were always among Dr. Gardner's greatest attributes. He liked nothing better than to show an exhibit at a medical meeting, where he could be found from opening to closing time hard at work explaining his theories and observations to an interested audience. Over the years there was a steady procession of residents passing through his service. By 1967, Dr. Gardner had given full training to 28 neurosurgeons and partial training to 14 others, not to mention the innumerable general surgical residents who spent a few months in neurosurgery. Each man was always given the opportunity to work, study, and participate to the best of his ability. He could feel secure in the knowledge that the Chief would give him full backing and support both during his training and thereafter.

Dr. Gardner was born in McKeesport, Pennsylvania, on June 12, 1898. He attended Washington and Jefferson College (A.B. 1920). He received his M.D. from the University of Pennsylvania Medical School in 1924, as did his father, William James, 30 years before, and his son, William James III, 30 years later. He had a fond attachment to western Pennsylvania where he spent many of his boyhood summers hunting and fishing in the Allegheny forests and streams.

Dr. Gardner maintained his interest in outdoor activities throughout his life. He had a particular fondness for hunting, and managed to indulge in this hobby despite his active schedule. He participated in sports with the same zeal and energy that was given to scientific pursuits, and remained a prime protagonist of all physical culture. He took up ice skating and tennis at the age of 50 and did well with both sports. His skiing career, however, ended with a broken tibia. An excellent dancer, he thoroughly enjoyed a party, where he probably was found sometime during the occasion busily organizing and participating in a bit of "close barbershop harmony."

Dr. Gardner was married to Ann Ray Kieffer of San Angelo, Texas, and had three children, including W. James III, a general surgeon in Utah. During World War I, he served in the United States Army Infantry as a private, and was a lieutenant commander in the Navy during World War II.

Dr. Gardner was active in many of the national and sectional organizations. He was president of the Society of Neurological Surgeons, vice president of the Cushing Society, and on the Board of Governors of the American College of Surgeons. He was on the Board of Neurological Surgery for 6 years. During his 35 years at the Cleveland Clinic, he served actively in many important capacities. He thoroughly believed in and enjoyed this type of group practice. Upon reaching the compulsory retirement age of 65, he entered private practice. Dr. W. James Gardner died in January 1986.