Powell's Pearls: Eugene Myron Bricker M.D. (1908-2000)

Eugene Myron Bricker was born August l, 1908 in Carbondale, Illinois. He graduated from Carbondale High School in 1927. He received a bachelor’s degree in 1930 from Southern Illinois Teachers College, where he later was inducted into the Hall of Fame for his accomplishments in football and track. He graduated from Washington University School of Medicine in St. Louis, Missouri with his M.D. degree in 1934. His internship and residency in surgery were at Barnes Hospital in St. Louis from 1934-1938. At Washington University he was Instructor in Surgery from 1938-1944, Assistant Professor 1944-1946, Associate Professor 1946-1947, Associate Professor of Clinical Surgery 1947-1966, and Professor from 1966 until becoming Emeritus Professor in 1975. He served as Visiting Professor at the University of South Florida in Tampa 1978-1979. Between 1938 and 1975, he also worked at St. Louis Children's Hospital, St. Louis Maternity Hospital, St. Louis City Hospital, Barnes Hospital, and St. Luke's Hospital.

In 1939 he became Chief Surgeon at Ellis Fischel State Cancer Hospital in Columbia, Missouri. From 1942-1946 Bricker served in the United States Army Medical Corps as a Colonel and was a senior consultant for plastic surgery in the European Theater of Operations. During World War II Bricker was instrumental in developing standard procedures for wound closure and treatment of hand injuries. He was the first one to place a pedicle flap on a gunshot wound of the hand within 24 hours of the injury. This did a great deal toward establishment of the policy, in effect before the end of the war, that all hand injuries be closed by qualified surgeons as soon after wounding as possible. Dr. Bricker's work during the war also included major contributions to the treatment of bums.

Dr. Bricker, a pioneer in pelvic exenteration, performed his first total exenteration for rectal cancer on August 8, 1940, at Ellis Fischel State Cancer Hospital [2]. This was six years before Alexander Brunschwig (1901-1969) performed his first total pelvic exenteration on December 12, 1946 in Chicago for cancer of the vagina. By 1967 Brunschwig had performed 925 exenterations at Memorial Hospital for Cancer and Allied Diseases in New York City, so that exenteration became known as the "Brunschwig Procedure" [4]. Brunschwig's technique for replacing bladder function was to implant the ureters into a functional sigmoid colon, creating a "wet colostomy", which exposed the ureters and kidneys to the fecal stream and often led to hyperchloremic acidosis, ascending infection, and renal failure.

After Bricker returned from military service, he began to perform pelvic exenterations in which he constructed bladders from cecum and ascending colon [5]. Apparently the first attempt to divert the urinary stream into an isolated segment of ileum and ascending colon was done by Verhoogan and DeGraeuwein in 1908, which they accomplished by using an appendicostomy as a urethra. The first patient in whom Bricker constructed a uretero-ileal conduit was also the woman who was his first operative patient with advanced post-irradiation carcinoma of the cervix [7, 8]. The uretero-ileal conduit became known as the "Bricker ileal loop conduit" and provided the means for continuous unobstructed drainage of urine through an abdominal stoma into an external appliance.

In 1950, a device invented by an ileostomy patient, referred to in the literature only as "Rutzen" altered the direction of efforts aimed at solving the problem of bladder substitution. Working in his basement in Chicago, Rutzen constructed the prototype of a rubber bag that could be applied to an abdominal stoma with a water-tight seal being formed with a cement attachment to the skin. Brunschwig credited this invention as an important step in keeping the skin and the patient dry postoperatively. To Eugene Bricker, who first tried the appliance on two patients at the Veterans Administration Hospital in St. Louis, the results were so promising that he suspended his efforts to create a continent stoma [7].

Dr. Bricker wrote ten book chapters, and 46 journal articles. In 1952 he was President of the Society of University Surgeons, in 1962 President of the Missouri State Surgical Society, in 1963. President of the St. Louis Surgical Society, in 1966 First Vice President of the American Surgical Association, in 1968 Second Vice President American College of Surgeons, in 1968 Vice President Southern Surgical Association, and in 1973 President Society of Pelvic Surgeons. He was certified by the American Board of Surgery in 1941 and the American Board of Plastic Surgery in 1942. He won eight awards for his meritorious service and achievements as an outstanding teacher. His surgery residents all referred to him as "Daddy Big Scissors." "Big Scissors" referred to Dr. Bricker's deft use of long pelvic instruments; "daddy" expressed their enormous respect for this giant of a man. Dr. Bricker died January 1, 2000 at age 91, at his residence in Olivette. He was survived by his wife, Margaret Bricker, one daughter, and two sons.

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John Powell

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References

1. Curriculum Vitae: Eugene Myron Bricker, M.D.
2. Lopez MI, Standiford SB, Skibba JL (1994) Total pelvic exenteration. A 50-year experience at the Ellis Fischel Cancer Center. Arch Surg 129: 390-396. [Crossref]
3. BRUNSCHWIG A (1948) Complete excision of pelvic viscera for advanced carcinoma: A one-stage abdominoperineal operation with end colostomy and bilateral ureteral implantation into the colon above the colostomy. Cancer 1: 177-183. [Crossref]
4. Brunschwig A, Barber HR (1969) Pelvic exenteration combined with resection of segments of bony pelvis. Surgery 65: 417-420. [Crossref]
5. Eugene M. Bricker, Ben Eiseman (1950) Bladder Reconstruction from Cecum and Ascending Colon Following Resection of Pelvic Viscera. Ann Surg 132: 77-84. [Crossref]
6. Verhoogen J, DeGraeuwe A (1909) La cystectomie totale. Folia Urol 3: 629-634.
7. Bricker EM (1994) Evolution of radical pelvic surgery. Surg Oncol Clin North Am 3: 197-203.
8. BRICKER EM (1950) Bladder substitution after pelvic evisceration. Surg Clin N.Am 30: 1511-1521. [Crossref]