YOUNG AND experienced surgeons returned from World War II in 1945 with enthusiasm and an appetite for addressing new horizons. Anesthesia was coming of age; physicians were beginning to supplant nurse technicians and ether was no longer in vogue. Blood banks were replacing the custom of having an intern type and match relatives on the morning of operation, followed by the withdrawal of 500 mL of blood.
Eugene Bricker, fresh from wartime experience as chief consultant in plastic surgery in the European theater, returned to St Louis, Mo, and a Barnes Hospital surgical staff headed by the towering figure of Evarts Graham. After completing surgical training at Barnes in 1939, Bricker had begun his career in Columbia, Mo, as the first surgeon of the newly opened Ellis Fischel State Cancer Hospital. His partners in this effort were Juan del Regato, radiologist, and Lauren V. Ackerman, pathologist. For 4 years (1939-1942), he had lived in the world of cancer, seeing it in all forms in all body organs. Cancer had become a personal enemy. After returning to St Louis, he attacked the problem of advanced carcinoma of the uterine cervix by teaming up with J. J. Cordonnier, a urologist, to design a surgical approach. It was known that distant spread of carcinoma of the cervix was rare and that most of the affected women died with carcinoma limited to the pelvis. Death usually was due to uremia—later known as renal failure—as a consequence of bilateral lower ureteral obstruction. Management of the end-sigmoid colostomy that followed abdominoperineal resection of the rectum by now was fairly satisfactory when combined with a constipating diet and daily colonic lavage. Simple appliances for colostomy care were not yet developed, and a dry pad under an elastic belt constituted acceptable management.