Three surgeons who were contemporaries and gained fame for their contributions to pelvic surgery were John Cedric Goligher (1912–), Mark M. Ravitch (1910–1989), and Norman D. Nigro (1912–).
Goligher was an innovative surgeon who was one of the first to recognize the value of intestinal stapling. He also provided the statistical design for randomized, controlled studies in surgical research. Ravitch, a pediatric surgeon, described the nonoperative treatment for intussusception in infants and children by using hydrostatic pressure reduction through barium enema. He was also a pioneer in using mechanical stapling for surgery. Nigro made important contributions to the concept of combined therapy for cancer of the anal canal. In addition, he was an early advocate of the value of nutrition in the etiology of cancer of the large bowel.
John Cedric Goligher was born on March 13, 1912, in Londonderry, Northern Ireland. He received his medical degree in 1934 from the University of Edinburgh (Scotland) and then served as a house officer at the Royal Infirmary of Edinburgh. After this, he became a resident surgical officer at St. Mark’s Hospital (London) and senior registrar at St. Mary’s Hospital (London). In 1947, he was appointed consultant surgeon at both hospitals.
In 1955, Goligher accepted the Chair at the University of Leeds (England) Department of Surgery and at the Leeds General Infirmary. In 1978, he retired from active practice to Wetherby, England (approximately 10 miles northeast of Leeds). His range of accomplishments in contemporary surgery was unparalleled, and he was one of the preeminent clinical investigative surgeons in the world.
The most important of his writings is probably his textbook Surgery of the Anus, Rectum, and Colon. This was a popular textbook that went through five editions. His work at Leeds attracted many surgeons from around the world who were interested in gastrointestinal disease. One of his important contributions was in intestinal stapling, and his experience with stapling was described in “Experience With the Russian Model 249 Suture Gun for Anastomosis of the Rectum.”
Goligher has received international recognition and been awarded many honors, including honorary degrees (both in medicine and science) and numerous fellowships from international societies.
Mark M. Ravitch was a leading pediatric surgeon and a pioneer in the United States in the use of mechanical stapling devices for surgery. He was an authority on congenital hernia of the diaphragm, deformities of the chest wall, and intussusception. His analysis of intussusception in infants and children, a condition in which the intestines do not connect, led to a treatment that avoided surgery.
Ravitch was born in New York City on September 12, 1910, of Russian immigrant parents. He graduated from the University of Oklahoma in Norman in 1930 with a bachelor’s degree in zoology. He earned his M.D. degree from the Johns Hopkins University School of Medicine in 1934. After a surgical internship at Johns Hopkins, he became a house officer in pediatrics there. He spent 1942 to 1943 as a surgical resident with the famous surgeon Alfred Blalock (1899–1964) at the Johns Hopkins Hospital.
During World War II (1939–1945), Ravitch was a major in the U.S. Army Medical Corps in Europe from 1943 to 1946. After the war, he returned to the Johns Hopkins Medical School and was director of its blood bank.
In 1952, Ravitch left Baltimore to become clinical professor of surgery at Columbia University and director of the Department of Surgery at Mount Sinai Hospital, both in New York City. After 4 years in New York City, he returned to Baltimore in 1956, where for 10 years he was surgeon-in-chief of the Baltimore City Hospitals.
In the early 1960s, he was one of the first American surgeons to introduce mechanical stapling devices, first developed in Europe. From 1969 to 1986, Ravitch was professor of surgery at the University of Pittsburgh (Pennsylvania) and surgeon-in-chief at Montefiore Hospital in Pittsburgh.
Ravitch’s main contribution to colorectal surgery was his development of the nonoperative treatment of intussusception in infants and children by the use of hydrostatic pressure reduction through barium enema. He also was a nationally recognized authority on the correction of chest-wall deformities. He made original contributions to the management of congenital diaphragmatic hernias. Also, he is considered the innovator of the sphincter-saving alternative in the management of inflammatory bowel disease and familial polyposis.
Ravitch introduced the concept of mucosal stripping to limit the chance of recurrent disease while maintaining continence. The principles of Ravitch’s procedure were later modified by the English surgeon Alan Parks (1920–1982), who produced the pouch-ileoanal procedure. Ravitch is also known for his two-volume A Century of Surgery, which documented the history of American surgery from 1880 to 1980.
Mark M. Ravitch, surgeon, teacher, author, and editor, died of carcinoma of the colon and prostate on March 1, 1989, at the age of 78 years. He was a member of numerous medical and surgical societies in the United States and abroad. He had honorary memberships and fellowships in more than 20 national and international surgical organizations.
Norman D. Nigro was born in Syracuse, New York, in 1912, but early on, his family moved to Detroit (Michigan), where he received his early education. However, he returned to Syracuse to attend the University of Syracuse and received a liberal arts degree in 1934. In 1937, he received his M.D. degree from the Medical School of the University of Syracuse. He interned at St. Joseph’s Hospital in Syracuse in 1937 to 1938.
After his internship, Nigro went to Wayne State University in Detroit to work with the surgeon Louis Jacob Hirschman (born in 1878). During World War II (1939–1945), Nigro was a captain in the 17th Army General Hospital with the 5th Army in Italy (1942–1945). After the war, he returned to Wayne State University, where he remained for the rest of his life.
Nigro developed an interest in colorectal surgery when he worked with Hirschman and later became secretary of the American Proctologic Society. In 1965, he was elected president of the organization now known as the American Society of Colon and Rectal Surgeons. For 14 years, from 1972 to 1986, he served as secretary to the American Board of Colon and Rectal Surgery.
Nigro is especially well known for emphasizing combined therapy for the treatment of anal cancer. He suggested that irradiation and chemotherapy be given preoperatively, approximately 6 weeks before abdominoperineal excision. Before he retired to St. Clair Shores (southeastern Michigan, approximately 10 miles northeast of Detroit) in 1989, he made notable contributions to the understanding of the role of nutrition in the etiology of cancer of the large bowel. Nigro has received many national and international honors.
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Goligher JC, Lee PW, Macfie J, et al. Experience with the Russian model 249 suture gun for anastomosis of the rectum. Surg Gynecol Obstet 148: 517, 1979(Original Article).
Goligher JC, Lee PWR, Macfie J, et al. Experience with the Russian model 249 suture gun for anastomosis of the rectum. Dis Colon Rectum 36: 873, 1993(Classic Article).
Nigro ND, Vaitkevicius VK, Considine B Jr. Combined therapy for cancer of the anal canal: a preliminary report. Dis Colon Rectum 17: 354, 1974(Original Article).
Nigro ND, Vaitkevicius VK, Considine B Jr. Combined therapy for cancer of the anal canal: a preliminary report. Dis Colon Rectum 36: 709, 1993(Classic Article).
Obituary. Ravitch, Mark M. MD. JAMA 261:2971, 1989.
Obituary (Ravitch). New York Times 34 Section I:1, March 4, 1989.
Ravitch MM. Anal ileostomy with sphincter preservation in patients requiring total colectomy for benign conditions. Surgery 24: 170, 1948(Original Article).
Ravitch MM. Anal ileostomy with sphincter preservation in patients requiring total colectomy for benign conditions. Dis Colon Rectum 33: 529, 1990(Classic Article).