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Emil Theodor Kocher (25 August 1841 – 27 July 1917) was a Swiss physician and medical researcher who received the 1909
Nobel Prize in Physiology or Medicine The Nobel Prize in Physiology or Medicine is awarded yearly by the Nobel Assembly at the Karolinska Institute for outstanding discoveries in physiology or medicine. The Nobel Prize is not a single prize, but five separate prizes that, accordin ...
for his work in the physiology, pathology and surgery of the
thyroid The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans it is in the neck and consists of two connected lobes. The lower two thirds of the lobes are connected by a thin band of tissue called the thyroid isthmus. The thyr ...
. Among his many accomplishments are the introduction and promotion of aseptic surgery and scientific methods in surgery, specifically reducing the mortality of thyroidectomies below 1% in his operations. He was the first Swiss citizen and first surgeon to ever receive a Nobel Prize in Medicine. He was considered a pioneer and leader in the field of surgery in his time.


Early life and personal life


Childhood

Kocher's father was Jakob Alexander Kocher (1814–1893), the sixth of seven children to Samuel Kocher (1771–1842), a carpenter, and Barbara Sutter (1772–1849). Jakob Alexander Kocher was a railway engineer and he moved in 1845 to
Burgdorf, Switzerland Burgdorf (french: Berthoud; High Alemannic: ''Bùùrdlef'') is the largest city in the Emmental in the canton of Bern in Switzerland. It was the capital of the district of the same name until 2010, when it became part of the new Emmental dis ...
(near
Bern german: Berner(in)french: Bernois(e) it, bernese , neighboring_municipalities = Bremgarten bei Bern, Frauenkappelen, Ittigen, Kirchlindach, Köniz, Mühleberg, Muri bei Bern, Neuenegg, Ostermundigen, Wohlen bei Bern, Zollikofen , websit ...
), because of his job as regional engineer of
Emmental The Emmental ( en, Emme Valley) is a valley in west-central Switzerland, forming part of the canton of Bern. It is a hilly landscape comprising the basins of the rivers Emme and Ilfis. The region is mostly devoted to farming, particularly dair ...
(''Bezirksingenieur''). He was named chief engineer for street and water in the
canton of Bern The canton of Bern or Berne (german: Kanton Bern; rm, Chantun Berna; french: canton de Berne; it, Canton Berna) is one of the 26 cantons forming the Swiss Confederation. Its capital city, Bern, is also the ''de facto'' capital of Switzerland. ...
at the age of 34 years and he moved with his family to the capital, the city of Bern. In 1858 he left the states service and managed several engineering projects around Bern. Theodor Kocher's mother was Maria Kocher (née Wermuth) living from 1820 to 1900. She was a very religious woman and part of the
Moravian Church , image = AgnusDeiWindow.jpg , imagewidth = 250px , caption = Church emblem featuring the Agnus Dei.Stained glass at the Rights Chapel of Trinity Moravian Church, Winston-Salem, North Carolina, United States , main_classification = Proto-Pro ...
; together with Jakob Alexander, she raised a family of five sons and one daughter (Theodor Kocher was the second son). Theodor Kocher was born on 25 August 1841 in Bern and baptized in the local
Bern Minster Bern Minster (german: Berner Münster) is a Swiss Reformed cathedral (or minster) in the old city of Bern, Switzerland. Built in the Gothic style, its construction started in 1421. Its tower, with a height of , was only completed in 1893. It ...
on 16 September 1841. Together with the family, he moved to Burgdorf in 1845 where he started school. Later his family moved back to Bern where he went to middle and high school (''Realschule'' and ''Literaturgymnasium'') where he was the first of his class. During high school, Theodor was interested in many subjects and was specifically drawn to art and
classical philology Classics or classical studies is the study of classical antiquity. In the Western world, classics traditionally refers to the study of Classical Greek and Roman literature and their related original languages, Ancient Greek and Latin. Classics ...
but finally decided to become a doctor.


Studies

He started his studies after obtaining the Swiss
Matura or its translated terms (''Mature'', ''Matur'', , , , , , ) is a Latin name for the secondary school exit exam or "maturity diploma" in various European countries, including Albania, Austria, Bosnia and Herzegovina, Bulgaria, Croatia, ...
in 1858 at the
University of Bern The University of Bern (german: Universität Bern, french: Université de Berne, la, Universitas Bernensis) is a university in the Swiss capital of Bern and was founded in 1834. It is regulated and financed by the Canton of Bern. It is a compreh ...
where Anton Biermer and Hermann Askan Demme were teaching, two professors that impressed him most. He was a studious and dedicated student but still became a member of the Schweizerischer Zofingerverein, a Swiss fraternity. He obtained his doctorate in Bern in 1865 (March 1865) or 1866 While the dissertation was published in 1866 and the HLS refers to 1866 as date of promotion and 1865 as date of completing his studies, all other sources point to 1865 as the date where Kocher obtained his doctorate with his dissertation about ''Behandlung der croupösen Pneumonie mit Veratrum-Präparaten'' (literal English translation: ''The treatment of croupous pneumonia with
Veratrum ''Veratrum'' is a genus of flowering plants in the family Melanthiaceae. It occurs in damp habitats across much of temperate and subarctic Europe, Asia, and North America. ''Veratrum'' species are vigorous herbaceous perennials with highly pois ...
preparations.'') under professor Biermer with the predicate ''summa cum laude unamimiter''. In spring 1865, Kocher followed his teacher Biermer to
Zürich Zürich () is the list of cities in Switzerland, largest city in Switzerland and the capital of the canton of Zürich. It is located in north-central Switzerland, at the northwestern tip of Lake Zürich. As of January 2020, the municipality has 43 ...
, where
Theodor Billroth Christian Albert Theodor Billroth (26 April 18296 February 1894) was a German surgeon and amateur musician. As a surgeon, he is generally regarded as the founding father of modern abdominal surgery. As a musician, he was a close friend and conf ...
was director of the hospital and influenced Kocher significantly. Kocher then proceeded to start a journey through Europe to meet several of the most famous surgeons of the time. It is not clear how Kocher financed his trip but according to Bonjour (1981) he received money from an unknown female
Suisse romande Romandy (french: Romandie or )Before World War I, the term French Switzerland (french: Suisse française) waalso used german: Romandie or , it, Romandia, rm, Romanda) is the French-speaking part of western Switzerland. In 2020, about 2 mill ...
philanthropist who also supported his friend
Marc Dufour Marc Carol Joseph Dufour (September 11, 1941 – January 23, 2015) was a Canadian ice hockey player. He played 14 games in the National Hockey League with the New York Rangers and Los Angeles Kings between 1963 and 1968. The rest of his career, ...
and was probably a member of the
Moravian Church , image = AgnusDeiWindow.jpg , imagewidth = 250px , caption = Church emblem featuring the Agnus Dei.Stained glass at the Rights Chapel of Trinity Moravian Church, Winston-Salem, North Carolina, United States , main_classification = Proto-Pro ...
. In October 1865, he traveled to Berlin, passing through
Leipzig Leipzig ( , ; Upper Saxon: ) is the most populous city in the German state of Saxony. Leipzig's population of 605,407 inhabitants (1.1 million in the larger urban zone) as of 2021 places the city as Germany's eighth most populous, as we ...
and visiting an old friend from high school, Hans Blum. In Berlin, he studied under
Bernhard von Langenbeck Bernhard Rudolf Konrad von Langenbeck (9 November 181029 September 1887) was a German surgeon known as the developer of Langenbeck's amputation and founder of '' Langenbeck's Archives of Surgery''. Life He was born at Padingbüttel, and rec ...
and applied for an assistant position with Langenbeck and
Rudolf Virchow Rudolf Ludwig Carl Virchow (; or ; 13 October 18215 September 1902) was a German physician, anthropologist, pathologist, prehistorian, biologist, writer, editor, and politician. He is known as "the father of modern pathology" and as the founde ...
. Since there was no position available, in April 1867 Kocher moved on to London where he first met
Jonathan Hutchinson Sir Jonathan Hutchinson (23 July 1828 – 23 June 1913), was an English surgeon, ophthalmologist, dermatologist, venereologist, and pathologist. Life He was born in Selby, Yorkshire, of Quaker parents and educated in the local school. Then he ...
and then worked for Henry Thompson and John Erichsen. Furthermore, he was interested in the work of
Isaac Baker Brown Isaac Baker Brown (1811 – 3 February 1873) was a prominent 19th-century English gynaecologist and obstetrics, obstetrical surgeon. He had a reputation as a specialist in the diseases of women and advocated certain surgical procedures, includi ...
and
Thomas Spencer Wells Sir Thomas Spencer Wells, 1st Baronet (3 February 181831 January 1897) was surgeon to Queen Victoria, a medical professor and president of the Royal College of Surgeons of England. Early life He was born at St Albans, Hertfordshire and received ...
, who also invited Kocher to go to the opera with his family. In July 1867, he traveled on to Paris to meet
Auguste Nélaton Auguste Nélaton (17 June 1807 – 21 September 1873) was a French physician and surgeon. Born in Paris, he began studying medicine in 1828 and graduated as an MD in 1836 with a thesis on the effects of tuberculosis on the bones. Three years la ...
,
Auguste Verneuil Auguste Victor Louis Verneuil (; 3 November 1856 – 27 April 1913) was a French chemist best known for inventing the first commercially viable process for the manufacture of synthetic gemstones. In 1902 he discovered the "flame fusion" process, ...
and
Louis Pasteur Louis Pasteur (, ; 27 December 1822 – 28 September 1895) was a French chemist and microbiologist renowned for his discoveries of the principles of vaccination, microbial fermentation and pasteurization, the latter of which was named after ...
. During his travels, he did not only learn novel techniques but also got to know leading surgeons in person and learned to speak English fluently which allowed him later on to follow the scientific progress in the English speaking world with ease. Once returned to Bern, Kocher prepared for his
habilitation Habilitation is the highest university degree, or the procedure by which it is achieved, in many European countries. The candidate fulfills a university's set criteria of excellence in research, teaching and further education, usually including a ...
and on 12 October 1867, he wrote a petition to the ministry of education to award him the ''
venia docendi Doctor of Science ( la, links=no, Scientiae Doctor), usually abbreviated Sc.D., D.Sc., S.D., or D.S., is an academic research degree awarded in a number of countries throughout the world. In some countries, "Doctor of Science" is the degree used f ...
'' (Latin: ''to instruct'') which was granted to him. He became assistant to Georg Lücke who left Bern in 1872 to become professor in
Strasbourg Strasbourg (, , ; german: Straßburg ; gsw, label= Bas Rhin Alsatian, Strossburi , gsw, label=Haut Rhin Alsatian, Strossburig ) is the prefecture and largest city of the Grand Est region of eastern France and the official seat of the Eu ...
.Choong (2009) claims that Kocher became assistant in Bern already in 1866 but according to Bonjour, Kocher was then still in Berlin Kocher was hoping to get his position, but at the time it was customary to appoint German professors to positions at Swiss universities. Accordingly, the faculty suggested
Franz König Franz König (3 August 1905 – 13 March 2004) was an Austrian Cardinal of the Catholic Church. He served as archbishop of Vienna from 1956 to 1985, and was elevated to the cardinalate in 1958. The last surviving cardinal elevated by Pope Joh ...
before Kocher to follow Lücke. However, the students and assistants as well as many doctors preferred Kocher and started a petition to the Bernese government to choose Kocher. Also the press was in favor of Kocher and several famous foreign surgeons, such as Langenbeck from Berlin and Billroth from
Vienna en, Viennese , iso_code = AT-9 , registration_plate = W , postal_code_type = Postal code , postal_code = , timezone = CET , utc_offset = +1 , timezone_DST ...
, wrote letters in support of Kocher. Under this public pressure, the Bernese government (''Regierungsrat'') chose Kocher as the successor of Lücke as Ordinary Professor of Surgery and Director of the
University A university () is an institution of higher (or tertiary) education and research which awards academic degrees in several academic disciplines. Universities typically offer both undergraduate and postgraduate programs. In the United States, th ...
Surgical Clinic at the ''
Inselspital The Inselspital, also named the University Hospital of Bern (German: ''Universitätsspital Bern''), located in Bern, is one of the five university hospitals of Switzerland. It is associated with the University of Bern. The hospital is operated ...
'' on 16 March 1872, despite a different proposal by the faculty.


Personal life

In 1869, he married Marie Witschi-CourantSeveral alternative spellings to Marie Witschi-Courant exist, for example Maria Witschi (ref hls), Witchi (ref choong2009), Witchi-Cournant (ref tan2008), Maria Witschi but in letters "Marie" (ref
Descriptor
/ref> (1841–1921) or (1850–1925).The Bernese Burgerbibliothek give 1850–1925 as her living years and also Bonjour 1981 writes (pg 86) that she was nineteen in 1869 but does not give a date of death She was the daughter of Johannes Witschi, who was a
merchant A merchant is a person who trades in commodities produced by other people, especially one who trades with foreign countries. Historically, a merchant is anyone who is involved in business or trade. Merchants have operated for as long as industr ...
, and she had three sons together with Kocher. The Kochers first lived at the Marktgasse in Bern and moved in 1875 to a bigger house in the Villette. The house became a place for friends, colleagues and guests to gather and many patients from Kocher's clinic were invited to dine at the Villette. Like his mother, Kocher was a deeply religious man and also part of the
Moravian Church , image = AgnusDeiWindow.jpg , imagewidth = 250px , caption = Church emblem featuring the Agnus Dei.Stained glass at the Rights Chapel of Trinity Moravian Church, Winston-Salem, North Carolina, United States , main_classification = Proto-Pro ...
. This was an uncommon trait that not many colleagues and co-workers shared and until his death, Kocher attributed all his successes and failures to God. He thought that the rise of
materialism Materialism is a form of philosophical monism which holds matter to be the fundamental substance in nature, and all things, including mental states and consciousness, are results of material interactions. According to philosophical materialism ...
(especially in science) was a great evil, and he attributed the outbreak of the
First World War World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, the United States, and the Ottoman Empire, with fighti ...
. Kocher was involved in the education of his three sons and played tennis with them and went horseback riding with them. The eldest son Albert (1872–1941) would follow him to the surgical clinic in Bern and become Assistant Professor of Surgery. On the evening of 23 July 1917, he was called into the Inselspital for an emergency. Kocher executed the surgery but afterwards felt unwell and went to bed, working on scientific notes. He then fell unconscious and died on 27 July 1917.


Career

The call for an ordinary professorship at the University of Bern at the age of 30 was the first big career step for Theodor Kocher. In the 45 years he served as professor at the university, he oversaw the re-building of the famous Bernese
Inselspital The Inselspital, also named the University Hospital of Bern (German: ''Universitätsspital Bern''), located in Bern, is one of the five university hospitals of Switzerland. It is associated with the University of Bern. The hospital is operated ...
, published 249 scholarly articles and books, trained numerous medical doctors and treated thousands of patients. He made major contributions to the fields of applied surgery,
neurosurgery Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and pe ...
and, especially,
thyroid The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans it is in the neck and consists of two connected lobes. The lower two thirds of the lobes are connected by a thin band of tissue called the thyroid isthmus. The thyr ...
surgery and
endocrinology Endocrinology (from ''endocrine'' + ''-ology'') is a branch of biology and medicine dealing with the endocrine system, its diseases, and its specific secretions known as hormones. It is also concerned with the integration of developmental events ...
. For his work he received, among other honors, the 1909
Nobel Prize in Physiology or Medicine The Nobel Prize in Physiology or Medicine is awarded yearly by the Nobel Assembly at the Karolinska Institute for outstanding discoveries in physiology or medicine. The Nobel Prize is not a single prize, but five separate prizes that, accordin ...
. According to Asher, the field of surgery has transformed radically during the time of Theodore Kocher and later generations will build on the foundations created by Kocher – if a future historian wanted to describe the state of surgery at the beginning of the 20th century, he only need mention Kocher's ''Text-Book of Operative Surgery''. Three main factors contributed to Kocher's success as a surgeon, according to Bonjour (1981). The first factor was his consequent implementation of antiseptic wound treatment which prevented infection and later death of the patients. The second factor, according to Erich Hintzsche, was his monitoring of the
anesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), a ...
where he used special masks and later used
local anesthesia Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It ...
for
goitre A goitre, or goiter, is a swelling in the neck resulting from an enlarged thyroid gland. A goitre can be associated with a thyroid that is not functioning properly. Worldwide, over 90% of goitre cases are caused by iodine deficiency. The term is ...
surgery which decreased or removed the dangers of anesthesia. As a third factor, Hintzsche mentions the minimal blood loss which Kocher achieved. Even the smallest source of blood during surgery was precisely controlled and inhibited by Kocher, initially because he thought that decomposing blood would constitute an infection risk for the patient.


Early career

Kocher first attained international recognition with his method to reset a dislocated shoulder published in 1870. The new procedure was much less painful and safer than the traditionally used procedure and could be performed by a single physician. Kocher developed the procedure through his knowledge of anatomy. In the same period, Kocher also studied the phenomena of bullet wounds and how they can cause
bone fracture A bone fracture (abbreviated FRX or Fx, Fx, or #) is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a ' ...
s. From these studies resulted one public lecture in 1874 ''Die Verbesserung der Geschosse vom Standpunkt der Humanitaet'' (English: ''The improvement of the bullets from the standpoint of humanity.'') and an 1875 manuscript ''Ueber die Sprengwirkung der modernen Kriegsgewehrgeschosse'' (English: ''Over the explosive effect of modern war rifle bullets.'') He showed that small caliber bullets were less harmful and recommended to use bullets with slower speed.


Relocation of Inselspital and call to Prague

As soon as Kocher became professor, he wanted to modernize the practices at the Bernese
Inselspital The Inselspital, also named the University Hospital of Bern (German: ''Universitätsspital Bern''), located in Bern, is one of the five university hospitals of Switzerland. It is associated with the University of Bern. The hospital is operated ...
. He noticed that the old building did not suffice the modern standards and was too small – half of the patients seeking medical attention had to be turned away. In spring 1878, he visited several institutions around Europe to evaluate novel innovations for hospitals and implement them if possible in Bern. He wrote down his observations in a lengthy report for the Bernese government, giving instructions even for architectonic details. In a speech on 15 November 1878, he informed the general public about the pressing needs of a new hospital building. Finally, he used his call to
Prague Prague ( ; cs, Praha ; german: Prag, ; la, Praga) is the capital and largest city in the Czech Republic, and the historical capital of Bohemia. On the Vltava river, Prague is home to about 1.3 million people. The city has a tempera ...
to pressure the government: He would only stay in Bern if he was either granted 75 beds in the new building or would get money to increase his facilities in the old building. Finally, in the winter of 1884/1885 the new building was finished and the
Inselspital The Inselspital, also named the University Hospital of Bern (German: ''Universitätsspital Bern''), located in Bern, is one of the five university hospitals of Switzerland. It is associated with the University of Bern. The hospital is operated ...
could be moved. At the time,
Prague Prague ( ; cs, Praha ; german: Prag, ; la, Praga) is the capital and largest city in the Czech Republic, and the historical capital of Bohemia. On the Vltava river, Prague is home to about 1.3 million people. The city has a tempera ...
had the third largest university clinic in the German speaking world and it was a great honor for Kocher when he received a call as a professor to Prague in spring 1880. Many colleagues, especially international ones, urged Kocher to accept while Bernese doctors and colleagues begged him to stay. Kocher used this call, to demand certain improvements for the university clinic from the Bernese government. They accepted all his demands, the government promised him to begin building the new
Inselspital The Inselspital, also named the University Hospital of Bern (German: ''Universitätsspital Bern''), located in Bern, is one of the five university hospitals of Switzerland. It is associated with the University of Bern. The hospital is operated ...
building the next year, increased his credit for surgical equipment and books to 1000 franks and increased the number of beds for Kocher in the new Inselspital. Thus, Kocher decided to stay and many Bernese and Swiss students and professionals thanked him for it. He cited the affection of his students as one of his main reasons for staying. The university students organized a torchlight procession on 8 June 1880 in his honor.


Aseptic surgery

It is unclear whether Kocher directly knew
Joseph Lister Joseph Lister, 1st Baron Lister, (5 April 182710 February 1912) was a British surgeon, medical scientist, experimental pathologist and a pioneer of antiseptic surgery and preventative medicine. Joseph Lister revolutionised the craft of s ...
, who pioneered the antiseptic (using chemical means to kill bacteria) method, but Kocher was in correspondence with him. Kocher had recognized the importance of aseptic techniques early on, introducing them to his peers at a time when this was considered revolutionary. In a hospital report from 1868, he attributed the lower mortality directly to the "antiseptic Lister's wound bandaging method" and he could later as director of the clinic order strict adherence to the antiseptic method. Bonjour (1981) describes how his assistants were worried about wound infection for fear of having to explain their failure to Kocher himself. Kocher made it a matter of principle to investigate the cause of every wound infection and remove every potential source of infection, he also banned visitors from his surgeries for this reason. He published multiple works on aseptic treatment and surgery.


Contributions to Neurosurgery

Kocher also contributed significantly to the field of neurology and
neurosurgery Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and pe ...
. In this area, his research was pioneering and covered the areas of
concussion A concussion, also known as a mild traumatic brain injury (mTBI), is a head injury that temporarily affects brain functioning. Symptoms may include loss of consciousness (LOC); memory loss; headaches; difficulty with thinking, concentration, ...
, neurosurgery and
intracranial pressure Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. ICP is measured in millimeters of mercury ( mmHg) and at rest, is normally 7–15 mmHg for a supine adult. ...
(ICP). Furthermore, he investigated the surgical treatment of
epilepsy Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical ...
and spinal and cranial trauma. He found that in some cases, the epilepsy patients had a brain tumor which could be surgically removed. He hypothesized that epilepsy was caused by an increase in ICP and believed that drainage of cerebrospinal fluid could cure epilepsy. The Japanese surgeon Hayazo Ito came to Bern in 1896 in order to perform experimental research on epilepsy. Kocher was especially interested in the ICP during experimentally induced epilepsy and after Ito returned to Japan, he performed over 100 surgeries in epilepsy patients. The American surgeon
Harvey Cushing Harvey Williams Cushing (April 8, 1869 – October 7, 1939) was an American neurosurgeon, pathologist, writer, and draftsman. A pioneer of brain surgery, he was the first exclusive neurosurgeon and the first person to describe Cushing's disease. ...
spent several months in the lab of Kocher in 1900, performing cerebral surgery and first encountering the
Cushing reflex Cushing reflex (also referred to as the vasopressor response, the Cushing effect, the Cushing reaction, the Cushing phenomenon, the Cushing response, or Cushing's Law) is a physiological nervous system response to increased intracranial pressure (IC ...
which describes the relationship between blood pressure and
intracranial pressure Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. ICP is measured in millimeters of mercury ( mmHg) and at rest, is normally 7–15 mmHg for a supine adult. ...
. Kocher later also found that
decompressive craniectomy Decompressive craniectomy ('' crani-'' + '' -ectomy'') is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, str ...
was an effective method to lower ICP. In his surgery textbook ''Chirurgische Operationslehre'', Kocher dedicated 141 pages of 1060 pages to surgery of the nervous system. It included methods of exploration and decompression of the brain.


Contributions to Thyroid surgery

Thyroid surgery, which was mostly performed as treatment of
goitre A goitre, or goiter, is a swelling in the neck resulting from an enlarged thyroid gland. A goitre can be associated with a thyroid that is not functioning properly. Worldwide, over 90% of goitre cases are caused by iodine deficiency. The term is ...
with a complete
thyroidectomy A thyroidectomy is an operation that involves the surgical removal of all or part of the thyroid gland. In general surgery, endocrine or head and neck surgeons often perform a thyroidectomy when a patient has thyroid cancer or some other conditio ...
when possible, was considered a risky procedure when Kocher started his work. Some estimates put the mortality of thyroidectomy as high as 75% in 1872. Indeed, the operation was believed to be one of the most dangerous operations and in France it was prohibited by the Academy of Medicine at the time. Through application of modern surgical methods, such as antiseptic wound treatment and minimizing blood loss, and the famous slow and precise style of Kocher, he managed to reduce the mortality of this operation from an already low 18% (compared to contemporary standards) to less than 0.5% by 1912. By then, Kocher had performed over 5000 thyroid excisions. The success of Kocher's methods, especially when compared to operations performed by
Theodor Billroth Christian Albert Theodor Billroth (26 April 18296 February 1894) was a German surgeon and amateur musician. As a surgeon, he is generally regarded as the founding father of modern abdominal surgery. As a musician, he was a close friend and conf ...
who was also performing thyroidectomies at that time, was described by
William Stewart Halsted William Stewart Halsted, M.D. (September 23, 1852 – September 7, 1922) was an American surgeon who emphasized strict aseptic technique during surgical procedures, was an early champion of newly discovered anesthetics, and introduced several ...
as follows: Kocher and others later discovered that the complete removal of the
thyroid The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans it is in the neck and consists of two connected lobes. The lower two thirds of the lobes are connected by a thin band of tissue called the thyroid isthmus. The thyr ...
could lead to
cretinism Congenital iodine deficiency syndrome is a medical condition present at birth marked by impaired physical and mental development, due to insufficient thyroid hormone (hypothyroidism) often caused by insufficient dietary iodine during pregnancy. It ...
(termed ''cachexia strumipriva'' by Kocher) caused by a deficiency of thyroid hormones. The phenomena was reported to Kocher first in 1874 by the general practitioner August Fetscherin and later in 1882 by Jacques-Louis Reverdin together with his assistant Auguste Reverdin (1848–1908). Reverdin met Kocher on 7 September in
Geneva , neighboring_municipalities= Carouge, Chêne-Bougeries, Cologny, Lancy, Grand-Saconnex, Pregny-Chambésy, Vernier, Veyrier , website = https://www.geneve.ch/ Geneva ( ; french: Genève ) frp, Genèva ; german: link=no, Genf ; it, Ginevra ...
at the international hygienic congress (''internationaler Hygienekongress'') and expressed his concerns about complete removal of the thyroid to Kocher. Kocher then tried to contact 77 of his 102 former patients and found signs of a physical and mental decay in those cases where he had removed the thyroid gland completely. Ironically, it was his precise surgery that allowed Kocher to remove the thyroid gland almost completely and led to the severe side effects of
cretinism Congenital iodine deficiency syndrome is a medical condition present at birth marked by impaired physical and mental development, due to insufficient thyroid hormone (hypothyroidism) often caused by insufficient dietary iodine during pregnancy. It ...
. Kocher came to the conclusion that a complete removal of the thyroid (as it was common to perform at the time because the function of the thyroid was not yet clear) was not advisable, a finding that he made public on 4 April 1883 in a lecture to the German Society of Surgery and also published in 1883 under the title ''Ueber Kropfexstirpation und ihre Folgen'' (English: ''About Thyroidectomies and their consequences''). Reverdin had already made his findings public on 13 September 1882 and published further articles on this topic in 1883; yet still Kocher never acknowledged Reverdin's priority in this discovery. At the time, the reactions to Kocher's lecture were mixed, some people asserted that
goitre A goitre, or goiter, is a swelling in the neck resulting from an enlarged thyroid gland. A goitre can be associated with a thyroid that is not functioning properly. Worldwide, over 90% of goitre cases are caused by iodine deficiency. The term is ...
and
cretinism Congenital iodine deficiency syndrome is a medical condition present at birth marked by impaired physical and mental development, due to insufficient thyroid hormone (hypothyroidism) often caused by insufficient dietary iodine during pregnancy. It ...
were different stages of same disease and that cretinism would have occurred independently of the removal of the thyroid in the cases which Kocher described. In the long run however, these observations contributed to a more complete understanding of thyroid function and were one of the early hints of a connection between the thyroid and congenital cretinism. These findings finally enabled thyroid hormone replacement therapies for a variety of thyroid related diseases.


Further contributions to science

Kocher published works on a number of subjects other than the thyroid gland, including
hemostasis In biology, hemostasis or haemostasis is a process to prevent and stop bleeding, meaning to keep blood within a damaged blood vessel (the opposite of hemostasis is hemorrhage). It is the first stage of wound healing. This involves coagulation, ...
, antiseptic treatments, surgical infectious diseases, on gunshot wounds, acute
osteomyelitis Osteomyelitis (OM) is an infection of bone. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. The long bones of the arms and legs are most commonly involved in children e.g. the femur and humerus, while the ...
, the theory of strangulated
hernia A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Various types of hernias can occur, most commonly involving the abdomen, and specifically the groin. Groin hern ...
, and abdominal surgery. The Nobel Prize money he received helped him establish the Kocher Institute in Bern. A number of instruments (for example the craniometer) and surgical techniques (for example, the Kocher manoeuvre, and kocher incision) are named after him, as well as the Kocher-Debre-Semelaigne syndrome. The Kocher manoeuvre is still a standard practice in orthopaedics. Kocher is also credited for the invention in 1882 of the Kocher's Surgical Clamp, which he used to prevent blood loss during surgery. One of his main works, ''Chirurgische Operationslehre'' (Text-Book of Operative Surgery ), was published through six editions and translated into many languages. During his life, Kocher published 249 articles and books and supervised more than 130 doctoral candidates. He was
rector Rector (Latin for the member of a vessel's crew who steers) may refer to: Style or title *Rector (ecclesiastical), a cleric who functions as an administrative leader in some Christian denominations *Rector (academia), a senior official in an edu ...
of the university in 1878 and 1903. He was president of the Bernese and the Swiss physicians association and co-founded the Swiss society for surgery in 1913 and became its first president. In 1904 or 1905 he built a private clinic called "Ulmenhof" which had space for 25 patients. Here Kocher catered to the wealthier patients, which in many cases were international. He also treated the wife of
Lenin Vladimir Ilyich Ulyanov. ( 1870 – 21 January 1924), better known as Vladimir Lenin,. was a Russian revolutionary, politician, and political theorist. He served as the first and founding head of government of Soviet Russia from 1917 to 19 ...
,
Nadezhda Krupskaya Nadezhda Konstantinovna Krupskaya ( rus, links=no, Надежда Константиновна Крупская, p=nɐˈdʲeʐdə kənstɐnˈtʲinəvnə ˈkrupskəjə; 27 February 1939) was a Russian revolutionary and the wife of Vladimir Lenin ...
and operated on her in Bern (in 1913).


Legacy

Kocher was also a famous and loved teacher. During nearly 100 semesters he taught his knowledge to about 10 000 students of the University of Bern. He was able to inspire students and taught them to think clearly and logically. Specifically, Kocher also taught a generation of Jewish-Russian students who could not study in Russia. This association with Russia has also led the
Russian Geographical Society The Russian Geographical Society (russian: Ру́сское географи́ческое о́бщество «РГО»), or RGO, is a learned society based in Saint Petersburg, Russia. It promotes geography, exploration and nature protection w ...
to name a volcano after him (in the area of Ujun-Choldongi in
Manchuria Manchuria is an exonym (derived from the endodemonym "Manchu") for a historical and geographic region in Northeast Asia encompassing the entirety of present-day Northeast China (Inner Manchuria) and parts of the Russian Far East (Outer Manchu ...
). Among his many local and international students were Carl Arend (Bern), Oscar Bernhard (St. Moritz), Andrea Crotti (Ohio), Gustave Dardel (Bern), Carl Garré (Bonn), Gottlieb and Max Feurer (St. Gallen), Anton Fonio (Langnau), Walter Gröbly (Arbon), Carl Kaufmann (Zürich), Albert Kocher (Bern), Joseph Kopp (Luzern), Ernst Kummer (Geneva), Otto Lanz (Amsterdam), Edmond Lardy (Geneva) Jakob Lauper (Interlaken), Albert Lüthi (Thun), Hermann Matti (Bern), Charles Pettavel (Neuenburg), Paul Pfähler (Olten), Fritz de Quervain (La Chaux de Fonds / Basel / Bern), August Rickli (Langenthal), Ernst Rieben (Interlaken), August Rollier (Leysin),
César Roux César Roux (23 March 1857, in Mont-la-Ville – 21 December 1934, in Lausanne) was a Swiss surgeon, who described the Roux-en-Y procedure. He studied medicine at the University of Bern, where his influences included Christoph Theodor Aeby ...
(Lausanne), Karl Schuler (Rorschach), Fritz Steinmann (Bern), Albert Vogel (Luzern), Hans Wildbolz (Bern) as well as the American neurosurgeon
Harvey Cushing Harvey Williams Cushing (April 8, 1869 – October 7, 1939) was an American neurosurgeon, pathologist, writer, and draftsman. A pioneer of brain surgery, he was the first exclusive neurosurgeon and the first person to describe Cushing's disease. ...
. Other notable students of his include Hayazo Ito (1865–1929) and S. Berezowsky which also spread his techniques in their respective home-countries (Japan and Russia). Kocher's name is living on with the Theodor Kocher Institute, the Kochergasse and the Kocher Park in Bern. In the
Inselspital The Inselspital, also named the University Hospital of Bern (German: ''Universitätsspital Bern''), located in Bern, is one of the five university hospitals of Switzerland. It is associated with the University of Bern. The hospital is operated ...
, there is a bust of Kocher, created by Karl Hänny in 1927. In the Kocher Park there is another bust, created by Max Fueter. In 1950, the Swiss historian
Edgar Bonjour Edgar is a commonly used English given name, from an Anglo-Saxon name ''Eadgar'' (composed of '' ead'' "rich, prosperous" and ''gar'' "spear"). Like most Anglo-Saxon names, it fell out of use by the later medieval period; it was, however, rev ...
(1898–1991) who was married to Dora Kocher wrote a 136-page monograph on Kocher's life that was extended again in 1981.


Named in his honor

*The Kocher lunar crater named in his memory. *An asteroid (2087) Kocher also commemorates his name. *The prize for outstanding young researchers in any field at the University of Berne is named Theodor Kocher Prize. It is awarded yearly since 1915.


Eponyms

* Kocher's forceps – a surgical instrument with serrated blades and interlocking teeth at the tips used to control bleeding *
Kocher's point Kocher's point is a common entry point through the frontal bone for an intraventricular catheter to drain cerebrospinal fluid from the anterior horn of the lateral ventricle. It is located 2–3 centimeters lateral to the midline (at approximately t ...
– common entry point for an intraventricular catheter to drain cerebral spinal fluid from the cerebral ventricles * Kocher manoeuvre – a surgical manoeuvre to expose structures in the retroperitoneum * Kocher–Debre–Semelaigne syndrome – hypothyroidism in infancy or childhood characterised by lower extremity or generalized muscular hypertrophy, myxoedema, short stature and cretinism * Kocher's incision – used in
cholecystectomy Cholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. In 2011, cholecystectomy was the eighth most common operating room procedure performed i ...
* Kocher's incision II – is used in thyroid surgery *
Kocher's sign Kocher's sign is a medical sign that denotes an eyelid phenomenon in hyperthyroidism Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormones by the thyroid gland. Thyrotoxicosis is the condition that occurs ...
– eyelid phenomenon in hyperthyroidism and Basedow's disease


Honors

*
Nobel Prize in Physiology or Medicine The Nobel Prize in Physiology or Medicine is awarded yearly by the Nobel Assembly at the Karolinska Institute for outstanding discoveries in physiology or medicine. The Nobel Prize is not a single prize, but five separate prizes that, accordin ...
(1909) * Hon
FRCS Fellowship of the Royal Colleges of Surgeons (FRCS) is a professional qualification to practise as a senior surgeon in Ireland or the United Kingdom. It is bestowed on an intercollegiate basis by the four Royal Colleges of Surgeons (the Royal C ...
(Fellow of the Royal College of Surgeons, 25 July 1900) * President of the Bernese and Swiss physician societies * President of the Swiss society for surgery * President of the German society for surgery (1902) * Honorary member of the German society for surgery (1902) * Chairman of the first international surgery conference in Brussels 1905 * several honorary memberships and honorary doctorates


Works

During his life, Kocher published 249 articles and books and supervised more than 130 doctoral candidates. The following is an incomplete list of his most important works: * ''Die antiseptische Wundbehandlung'' (Antiseptic wound treatment; 1881) * ''Vorlesungen über chirurgische Infektionskrankheiten'' (Lectures on surgical infections; 1895)
''Chiruigische Operationslehre''
(1894; Eng. trans. a
''Textbook of Operative Surgery''
2 vols., 1911)


Notes


References


Further reading

* * including the Nobel Lecture on 11 December 1909 ''Concerning Pathological Manifestations in Low-Grade Thyroid Diseases'' * * *


External links

*



* * {{DEFAULTSORT:Kocher, Emil Theodor 19th-century Swiss physicians Nobel laureates in Physiology or Medicine Swiss Nobel laureates Swiss people of the Moravian Church Scientists from Bern 1841 births 1917 deaths